Jeni Vaitsman

Apoio social e redes: conectando solidariedade e saúde

Este artigo discute alguns aspectos da participacao de usuarios de um servico publico de saude, o Instituto de Pesquisa Clinica Evandro Chagas (IPCEC/Fiocruz), em uma associacao de pacientes, a Associacao Lutando para Viver (ALpViver). Baseado em pesquisa qualitativa, com entrevistas semi-estruturadas e observacao participante, o trabalho analisa o papel dessa associacao, na visao de profissionais do hospital e pacientes, a partir dos conceitos de rede social, apoio social e empowerment. A relevância deste estudo se da a partir da nocao de que a valorizacao de uma cultura participativa dentro das instituicoes de saude contribui para aumentar a autonomia e elevar a auto-estima dos usuarios, melhorando a qualidade de vida e de saude dos mesmos.

Proteção social no Brasil: o que mudou na assistência social após a Constituição de 1988

O trabalho discute as mudancas do componente assistencial da protecao social nas duas decadas que se seguiram a Constituicao de 1988. Discute as transformacoes da protecao e assistencia social nas ultimas decadas e os processos que, na decada de 1990, fizeram avancar os processos de reforma da politica assistencial social no Brasil, sem no entanto produzir grandes mudancas no modelo de oferta de servicos. A partir dos anos 2000, ha uma significativa expansao de recursos e de cobertura de beneficios e servicos na area assistencial. Argumenta que os programas de transferencia de renda, embora surgidos e difundidos em um contexto internacional de politicas restritivas, no Brasil, ao se integrarem a um sistema publico e universal de assistencia social, alargaram substantivamente o escopo da protecao social. Alguns efeitos da expansao do sistema de protecao social no Brasil sao apontados: diminuicao da desigualdade de renda; construcao da capacidade institucional na area da assistencia social; o significado social, politico e simbolico da inclusao de um amplo segmento populacional a um sistema publico de assistencia social por meio de uma estrutura de provisao fora dos tradicionais mecanismos de filantropia e clientelismo.

Interação e conflito entre categorias profissionais em organizações hospitalares públicas

The article discusses some data from a study on the opinions and perceptions of the labor situation and environment among health professionals and administrative workers at the Research Center of the Evandro Chagas Hospital (CPqHEC/FIOCRUZ) in Rio de Janeiro. Certain patterns of conflict observed in the study express the distribution of power and prestige which is typical of hospitals. Many of the meanings people ascribe to their experiences within the organization are mediated by social representations originating in the broader social context to which the organization belongs.

Metodologia de elaboração do Índice de Percepções Organizacionais

This article presents the methodological basis for elaborating an Organizational Perceptions Index. The tool allows one to grasp the perceptions of organization members and solve some problems identified in the process. It is assumed that perceptions are the result of individual and collective subjectivities, the latter referring to culturally-bounded, socially-constructed representations. The Organizational Perceptions Index expresses the positive or negative perceptions of organization members and integrates data related to four organizational dimensions: infra-structure, management, environment, and culture. The methodology integrates research data in an evaluation tool, with the aim of orienting interventions and monitoring changes over time.

Satisfação e responsividade em serviços de atenção à saúde da Fundação Oswaldo Cruz

The paper discusses the results of research into user satisfaction in three healthcare facilities at Oswaldo Cruz Foundation in Rio de Janeiro. The analysis is based on the concepts of user satisfaction and responsiveness. Perceptions and opinions of outpatients from Instituto de Pesquisa Evandro Chagas, Instituto Fernandes Figueira and Centro de Saude Escola Germano Sinval Faria were investigated. Intention samples were drawn for each institution and a total of 1.339 valid questionnaires were obtained. The study found that patients are satisfied with healthcare at Fiocruz, especially with health professionals. Nevertheless, restroom hygiene and privacy during consultations were less well evaluated. The improvement of these aspects depends not only on financial and technological investments but on changes in organizational culture. The first part of the paper discusses the literature on user satisfaction and responsiveness, with the definition of the categories that guided the study. The methodology is then presented as well as the four health services dimensions assessed - dignity, agility, facilities and communication - and the results are analyzed.

The Zero Hunger and Brazil without Extreme Poverty programs: a step forward in Brazilian social protection policy

Brazilian social protection programs have had consistent effects in reducing poverty and inequality among their respective target-groups: children, adolescents and pregnant and breastfeeding women. In 2011, the Brazil without Extreme Poverty program was launched as a strategy to eradicate extreme poverty by 2014. It makes the promotion of rights the core concept of the official political narrative. This study seeks to provide a systematic description of the Brazil without Extreme Poverty program and its initial results. A review of official documents and academic studies on the social protection programs was conducted. The Brazil without Extreme Poverty program represents an incremental approach to the social protection policies enacted by the previous administration. It advocates a multidimensional and focused approach, funded primarily by the federal government. The strategy subscribes to the international trend of associating social protection with employment and income generation policies.

Procedimentos e percepções de profissionais e grupos atuantes em mercados de planos de saúde no Brasil

This study analyzes the mechanisms used in Brazil by health plan and insurance operators, hospitals and physicians for organizing the access to health care services and their strategies towards cost reduction and decision-making. The study is based on the literature about regulation of the health services, with special focus on micro-management and managed care. From an intentional sample of health care organizations selected according to the number of beneficiaries, organizational modality and geographic criteria we selected probabilistic samples of doctors and hospital services. Data were collected through questionnaires applied to key informants from health care operators and affiliated doctors and hospitals. Results suggest that the relationships between health care organizations, physicians and hospitals follow basically patterns inherited from the former social security system, mainly with fixed pricing and open account payments. More complex financing mechanisms, risk sharing and efficiency strategies are of minor interest. Mechanisms for risk reduction and encouragement of adequate use of technologies are weak. Cost control is mainly based on co-payment and barriers to access to the services. We conclude that in Brazil managed care is still in its beginning.

Universalization and Privatization: How Policy Analysis can Help Understand the Development of Brazil’s Health System

Abstract The article addresses the present configuration of Brazil’s health system. Although it is defined as comprising universal access, hegemonic public funding and direct provision of care, today it is fragmented and under private sector hegemony, with strong inequity in health care provision. Comparison between health expenditure indicators in 26 emerging countries shows that state expenditures have been of lesser magnitude, even as compared with other emerging countries. Out-of-pocket expenditures are high and that compromises equity. The failures of Brazil´s health reform are seen as an outcome of the pattern of organization of domestic collective interests. It is argued that, as the Constitution proposed no veto against the market operating in the health sector, interests with greater voice have succeeded in imposing their preferences in decision-making arenas for private health care. The discussion is based on policy analysis literature and health system typologies. The data are analysed by descriptive statistics.

Entrevista com Jairnilson da Silva Paim: "um balanço dos 20 anos do Sistema Único de Saúde (SUS)"

This study is the result of an expanded research-action project aimed at presenting and discussing the main thematic units that emerged from discussions cond...

Análise de políticas, políticas de saúde e a Saúde Coletiva

O artigo analisa o desenvolvimento da Saude Coletiva no Brasil como um campo que se estruturou com base em ao menos tres principios similares aos das policy sciences definidas nos Estados Unidos por H. Laswell na decada de 1950: multidisciplinaridade, resolucao de problemas e normatividade. A partir dai, a ideia de uma ciencia aplicada a tomada de decisao para as politicas publicas difundiu-se sob o nome de analise de politicas. Enquanto nos Estados Unidos a normatividade foi vista pelos cientistas politicos como incompativel com a ciencia, no Brasil esta convergencia esteve na base da institucionalizacao da Saude Coletiva como um campo academico interdisciplinar e de intervencao nas politicas de saude a partir dos anos 70, quando o movimento pela reforma na saude avancou sustentado em varias frentes, como academia, governo, sindicatos e outros movimentos sociais. Com a consolidacao democratica e as mudancas de porte empreendidas no setor saude, a incorporacao de conhecimento cientifico as decisoes em politicas de saude tambem ocorreu no Brasil, destacando-se a producao da Saude Coletiva reunindo acao politica e conhecimento. Aborda-se, no desenvolvimento do campo da Saude Coletiva: por um lado, o apoio do Ministerio da Saude a estudos orientados a politica e o da Abrasco, no reconhecimento do carater multidisciplinar e normativo da Saude Coletiva. Por outro, na esfera da acreditacao academica, as disputas epistemicas e a competicao por recursos financeiros com o predominio das formas de legitimacao baseados nos criterios da biomedicina que vem colocando em xeque os principios normativos, multidisciplinares e orientados as politicas que haviam originado o campo.