Mário Scheffer

A feminização da medicina no Brasil

The feminization of Medicine in Brazil Aiming to settle the historical evolution of physicians’ distribution in Brazil by gender, an ecological study was conducted by secondary database cross-checking (linkage). For a general characterization of the physicians were considered the 27 Regional Medicine Council, complemented by the National Medical Residency and the Brazilian Medical Association databases. The results show that since 2009, among new registered doctors there are more women than men. Although men still prevail (60.1%) in the active physicians population, in the group aged less than 29 years old, women have become majority. The consistent trend of increased participation of women in the medical profession in Brazil, observed over the past decades and intensified over the past few years, indicates the need to reassess and readjust the proposals for implementation of public policies in the area.

The privatization of medical education in Brazil: trends and challenges

BackgroundLike other countries, Brazil is struggling with issues related to public policies designed to influence the distribution, establishment, supply and education of doctors.While the number of undergraduate medical schools and places available on medical schools has risen, the increase in the number of doctors in Brazil in recent decades has not benefitted the population homogeneously.The government has expanded the medical schools at the country’s federal universities, while providing incentives for the creation of new undergraduate courses at private establishments. This article examines the trends and challenges of the privatization of medical education in Brazil.MethodsThis is a descriptive, cross-sectional study based on secondary data from official government databases on medical schools and courses and institutions offering such courses in Brazil. It takes into account the year when the medical schools received authorization to initiatte the activities, where they are situated, whether they are run by a public or private entity, how many places they offer, how many students they have enrolled, and their performance according to Ministry ofEducation evaluations.ResultsBrazil had 241 medical schools in 2014, offering a total of 20,340 places. The private higher education institutions are responsible for most of the enrolment of medical students nationally (54 %), especially in the southeast. However, enrolment in public institutions predominate more in the capitals than in other cities. Overal, the public medical schools performed better than the private schools in the last two National Exam of Students’ (ENADE) .ConclusionThe privatization of the teaching of medicine at undergraduate level in Brazil represents a great challenge: how to expand the number of places while assuring quality and democratic access to this form of education.Upon seeking to understand the configuration and trends in medical education in Brazil, it is hoped that this analysis may contribute to a broader research agenda in the future.

Programa Mais Médicos: em busca de respostas satisfatórias

O artigo em debate, ao apresentar os sistemas de saude australiano e norte-americano, em contraste com o Brasil, traz um panorama sobre o dificil desafio, compartilhado por diversos paises, de enfrentar a ma distribuicao ou a falta localizada de medicos.No sentido de ampliar o debate e evidenciar sua complexidade, tomam-se por base duas extensas revisoes publicadas

Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study

Background Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analysed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed a collection of 6 standardised indicators: 2-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR) and protection against impoverishing and catastrophic expenditure. This study aims to characterise the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves. Methods Using Brazils national healthcare database, commonly reported healthcare variables were used to calculate or simulate the 6 surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anaesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of surgical inpatient hospitalisations and a γ distribution of incomes based on Gini and gross domestic product/capita. Findings In 2014, SAO density was 34.7/100 000 population, surgical volume was 4433 procedures/100 000 people and POMR was 1.71%. 79.4% of surgical patients were protected against impoverishing expenditure and 84.6% were protected against catastrophic expenditure due to surgery each year. 2-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97.2% of the population has 2-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators. Interpretation Brazils public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce and better distribution of surgical volume. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation should be encouraged for all nations seeking to better understand their surgical systems.

O capital estrangeiro e a privatização do sistema de saúde brasileiro

, que permite a participacao de empresas e do capital estrangeiro, direta ou indiretamente, nas acoes e cuidados a saude.Ao impor a Uniao o financiamento de emen-das parlamentares individuais e ao vincular a despesa federal da saude a receita corrente liqui -da, a EC 86 levara a diminuicao de recursos em relacao aos valores garantidos pela legislacao vi-gente, que ja eram por demais restritivos.Assim, a norma legal potencializa restricoes ao financiamento do SUS, que vem desde o des-cumprimento da, that allows participation, directly or indirectly, of foreign capital, in health-related actions and care.By imposing on the Federal Government the financing of individual parliamentary amend-ments, and by binding federal expenditures on health to the net current revenues, EC 86 will de-crease the amount allocated by the current legis-lation, which is already too restricted.Thus, the legal regulation enhances the fi-nancial constraints of the SUS, which include lack of compliance with the

Formação e experiência profissional dos médicos prescritores de antirretrovirais no Estado de São Paulo

OBJECTIVE: Analysis of the professional profile of physicians who prescribe antiretroviral drugs (ARV) to HIV infected persons in the State of Sao Paulo. METHODS: Databases from different sources, namely Ministry of Health, Sao Paulo State Regional Medical Council, National Commission on Medical Residency and the Lattes platform, were consulted. Data concerning socio-demographic characteristics, academic and professional background and experience for the period from October 2007 to May 2009 were analyzed. RESULTS: The regular ARV prescription for 74 thousand patients was issued by 1,609 physicians whose characteristics are: evenly distributed according to gender, aged between 30 to 49 years, live in the metropolitan area of Greater Sao Paulo, graduated 16.1 years ago on the average, come from 93 different Brazilian medical schools, hold a specialty diploma in 67.5% of cases, most of them in the field of Infectious Diseases (38.9%). The mean number of patients per physician was 10, though 51.6% of physicians prescribed for 20 or more patients. Of these physicians 62% reported specific knowledge or experience with HIV care , although 2.7% of all prescriptions were issued by physicians without this specific qualification. Regions of high AIDS incidence showed a smaller number of prescribing physicians. The cities of Registro and Ribeirao Preto showed the highest concentration of physicians lacking proper credentials. CONCLUSION: The absolute majority of HIV patients receives their prescriptions from duly trained and experienced physicians. Nevertheless, the large number of non-qualified physicians together with the reduced number of physicians in HIV high incidence regions make up the major challenge for comprehensive and adequate care of HIV patients.

The state of the surgical workforce in Brazil

BACKGROUND A critical insufficiency of surgeons, anesthesiologists, and obstetricians exists around the world, leaving billions of people without access to safe operative care. The distribution of the surgical workforce in Brazil, however, is poorly described and rarely assessed. Though the surgical workforce is only one element in the surgical system, this study aimed to map and characterize the distribution of the surgical workforce in Brazil in order to stimulate discussion on future surgical policy reforms. METHODS The distribution of the surgical workforce was extracted from the Brazilian Federal Medical Board registry as of July 2014. Included in the surgical workforce were surgeons, anesthesiologists, and obstetricians. RESULTS There are 95,169 surgeons, anesthesiologists, and obstetricians in the surgical workforce of Brazil, creating a surgical workforce density of 46.55/100,000 population. This varies from 20.21/100,000 population in the North Region up to 60.32/100,000 population in the South Region. A total of 75.2% of the surgical workforce is located in the 100 biggest cities in Brazil, where only 40.4% of the population lives. The average age of a physician in the surgical workforce is 46.6 years. Women make up 30.0% of the surgical workforce, 15.8% of surgeons, 36.6% of anesthesiologists, and 53.8% of obstetricians and gynecologists. CONCLUSION Brazil has a substantial surgical workforce, but inequalities in its distribution are concerning. There is an urgent need for increased surgeons, anesthesiologists, and obstetricians in states like Pará, Amapá, and Maranhão. Female surgeons and anesthesiologists are particularly lacking in the surgical workforce, and incentives to recruit these physicians are necessary. Government policies and leadership from health organizations are required to ensure that the surgical workforce will be more evenly distributed in the future.

O financiamento de campanhas pelos planos e seguros de saúde nas eleições de 2010

Nas eleicoes de 2010, as empresas de planos de saude destinaram R

The feminization of Medicine in Brazil

11,8 milhoes em doacoes oficiais para as campanhas de 153 candidatos a cargos eletivos, o que contribuiu para a eleicao de 38 deputados federais, 26 deputados estaduais, 5 senadores, alem de 5 governadores e da presidente da Republica. Outros 82 candidatos receberam apoio, mas nao foram eleitos. Faz-se necessario tornar mais transparente o financiamento e o lobby dos planos de saude, para que prevalecam interesses publicos e coletivos na definicao de politicas, na regulacao e no funcionamento do sistema de saude brasileiro.

Representação política e interesses particulares na saúde: o caso do financiamento de campanhas eleitorais pelas empresas de planos de saúde privados no Brasil

The feminization of Medicine in Brazil Aiming to settle the historical evolution of physicians’ distribution in Brazil by gender, an ecological study was conducted by secondary database cross-checking (linkage). For a general characterization of the physicians were considered the 27 Regional Medicine Council, complemented by the National Medical Residency and the Brazilian Medical Association databases. The results show that since 2009, among new registered doctors there are more women than men. Although men still prevail (60.1%) in the active physicians population, in the group aged less than 29 years old, women have become majority. The consistent trend of increased participation of women in the medical profession in Brazil, observed over the past decades and intensified over the past few years, indicates the need to reassess and readjust the proposals for implementation of public policies in the area.