RESUMEN
COVID-19-related controversies concerning the allocation of scarce resources, travel restrictions, and physical distancing norms each raise a foundational question: How should authority, and thus responsibility, over healthcare and public health law and policy be allocated? Each controversy raises principles that support claims by traditional wielders of authority in "federal" countries, like federal and state governments, and less traditional entities, like cities and sub-state nations. No existing principle divides "healthcare and public law and policy" into units that can be allocated in intuitively compelling ways. This leads to puzzles concerning (a) the principles for justifiably allocating "powers" in these domains and (b) whether and how they change during "emergencies." This work motivates the puzzles, explains why resolving them should be part of long-term responses to COVID-19, and outlines some initial COVID-19-related findings that shed light on justifiable authority allocation, emergencies, emergency powers, and the relationships between them.
Asunto(s)
COVID-19 , Asignación de Recursos , Atención a la Salud , Servicios Médicos de Urgencia , Política de Salud , Humanos , Asignación de Recursos/legislación & jurisprudencia , SARS-CoV-2RESUMEN
La pandemia por COVID-19 ha suscitado problemas éticos y médico-legales, entre los que destaca la asignación equitativa de recursos sanitarios, sobre todo en relación a la priorización de pacientes y el racionamiento de recursos. El establecimiento de prioridades está siempre presente en los sistemas sanitarios y depende de la teoría de justicia aplicable en cada sociedad. El racionamiento de recursos ha sido necesario en la pandemia por COVID-19, por lo que se han publicado documentos de consenso para la toma de decisiones sustentadas en cuatro valores éticos fundamentales: maximización de los beneficios, tratar a las personas igualmente, contribuir en la creación de valor social y dar prioridad a la situación más grave. De ellos derivan recomendaciones específicas: maximizar beneficios; priorizar a los trabajadores de la salud; no priorizar la asistencia por orden de llegada; ser sensible a la evidencia científica; reconocer la participación en la investigación y aplicar los mismos principios a los pacientes COVID-19 que a los no-COVID-19
The COVID-19 pandemic has raised ethical and medico-legal problems, which include the equitable allocation of health resources, especially in relation to the prioritization of patients and the rationing of resources. Priority setting is always present in healthcare systems and depends on the theory of justice applicable in each society. Resource rationing has been necessary in the COVID-19 pandemic, and therefore consensus documents have been published for decision-making based on four fundamental ethical values: maximization of benefits, treating people equally, contributing to creating social value and giving priority to the worst off, from which specific recommendations derive: maximize benefits; prioritize health workers; do not prioritize attendance on a first-come, first-served basis; be sensitive to scientific evidence; recognize participation in research and apply the same principles to COVID-19 patients as to non-COVID-19 patients
Asunto(s)
Humanos , Valor de la Vida , Manejo de Atención al Paciente/legislación & jurisprudencia , Selección de Paciente/ética , Infecciones por Coronavirus , Cuidados Paliativos al Final de la Vida/ética , Cuidados para Prolongación de la Vida/ética , Pandemias/legislación & jurisprudencia , Toma de Decisiones/ética , Discusiones Bioéticas , Revisión de Utilización de Recursos/legislación & jurisprudencia , Asignación de Recursos/legislación & jurisprudencia , Negativa al Tratamiento/ética , Negativa al Tratamiento/legislación & jurisprudenciaRESUMEN
The article deals with the analysis of the criteria for the allocation of scarce health resources during the pandemic produced by the COVID 19 virus in Spain. It critically analyses the absence of a legal-constitutional perspective in the elaboration of such criteria and suggests the incorporation of the criterion of equity as a guarantee of the effective exercise of the constitutional right to health protection by vulnerable persons.
Asunto(s)
Betacoronavirus , Recursos en Salud/ética , Pandemias/ética , Asignación de Recursos/ética , COVID-19 , Constitución y Estatutos , Infecciones por Coronavirus/prevención & control , Teoría Ética , Agencias Gubernamentales , Prioridades en Salud , Recursos en Salud/legislación & jurisprudencia , Recursos en Salud/provisión & distribución , Accesibilidad a los Servicios de Salud/ética , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Derechos Humanos/legislación & jurisprudencia , Humanos , Grupos Minoritarios , Pandemias/legislación & jurisprudencia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Publicaciones , Asignación de Recursos/legislación & jurisprudencia , Rol , SARS-CoV-2 , Justicia Social , Sociedades Médicas , España/epidemiología , Triaje/ética , Poblaciones VulnerablesRESUMEN
The COVID-19 pandemic has brought discussions around the appropriate and fair rationing of scare resources to the forefront. This is of special importance in a country such as South Africa (SA), where scarce resources interface with high levels of need. A large proportion of the SA population has risk factors associated with worse COVID-19 outcomes. Many people are also potentially medically and socially vulnerable secondary to the high levels of infection with HIV and tuberculosis (TB) in the country. This is the second of two articles. The first examined the clinical evidence regarding the inclusion of HIV and TB as comorbidities relevant to intensive care unit (ICU) admission triage criteria. Given the fact that patients with HIV or TB may potentially be excluded from admission to an ICU on the basis of an assumption of lack of clinical suitability for critical care, in this article we explore the ethicolegal implications of limiting ICU access of persons living with HIV or TB. We argue that all allocation and rationing decisions must be in terms of SA law, which prohibits unfair discrimination. In addition, ethical decision-making demands accurate and evidence-based strategies for the fair distribution of limited resources. Rationing decisions and processes should be fair and based on visible and consistent criteria that can be subjected to objective scrutiny, with the ultimate aim of ensuring accountability, equity and fairness.
Asunto(s)
Infecciones por Coronavirus , Infecciones por VIH/epidemiología , Asignación de Recursos para la Atención de Salud/métodos , Unidades de Cuidados Intensivos , Pandemias , Selección de Paciente/ética , Neumonía Viral , Asignación de Recursos , Triaje , Tuberculosis/epidemiología , Betacoronavirus/aislamiento & purificación , COVID-19 , Coinfección , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Necesidades y Demandas de Servicios de Salud/organización & administración , Humanos , Unidades de Cuidados Intensivos/economía , Unidades de Cuidados Intensivos/normas , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Asignación de Recursos/ética , Asignación de Recursos/legislación & jurisprudencia , SARS-CoV-2 , Sudáfrica/epidemiología , Triaje/economía , Triaje/ética , Triaje/legislación & jurisprudenciaRESUMEN
El artículo aborda el análisis de los criterios de asignación de recursos sanitarios escasos durante la pandemia producida por el virus covid 19 en España. Se analiza críticamente la ausencia de una perspectiva jurídico-constitucional en la elaboración de tales criterios y se sugiere la incorporación del criterio de equidad como garantía del efectivo disfrute del derecho constitucional a la protección de la salud por parte de las personas vulnerables
The article deals with the analysis of the criteria for the allocation of scarce health resources during the pandemic produced by the covid 19 virus in Spain. It critically analyses the absence of a legal-constitutional perspective in the elaboration of such criteria and suggests the incorporation of the criterion of equity as a guarantee of the effective exercise of the constitutional right to health protection by vulnerable persons
Asunto(s)
Humanos , Infecciones por Coronavirus/epidemiología , Vulnerabilidad ante Desastres , Protocolos Clínicos/clasificación , 17627/legislación & jurisprudencia , Pandemias/ética , Prevención de Enfermedades , Capacidad de Reacción/legislación & jurisprudencia , Asignación de Recursos/legislación & jurisprudencia , Prioridades en Salud/éticaRESUMEN
In this article, I review the ethical issues that arise in the allocation of deceased-donor organs to children and young adults. By analyzing the public media cases of Sarah Murnaghan, Amelia Rivera, and Riley Hancey, I assess whether public appeals to challenge inclusion and exclusion criteria for organ transplantation are ethical and under which circumstances. The issues of pediatric allocation with limited evidence and candidacy affected by factors such as intellectual disability and marijuana use are specifically discussed. Finally, I suggest that ethical public advocacy can coexist with well-evidenced transplant allocation if and when certain conditions (morally defensible criteria, expert evidence, nonprioritization of the poster child, and greater advocacy for organ transplantation in general) are met.
Asunto(s)
Donación Directa de Tejido/ética , Asignación de Recursos para la Atención de Salud/ética , Defensa del Paciente/ética , Asignación de Recursos/ética , Factores de Edad , Niño , Preescolar , Fibrosis Quística/cirugía , Donación Directa de Tejido/legislación & jurisprudencia , Femenino , Asignación de Recursos para la Atención de Salud/legislación & jurisprudencia , Asignación de Recursos para la Atención de Salud/organización & administración , Historia del Siglo XXI , Humanos , Discapacidad Intelectual , Trasplante de Riñón , Trasplante de Pulmón/ética , Trasplante de Pulmón/legislación & jurisprudencia , Masculino , Redes Sociales en Línea , Padres , Defensa del Paciente/legislación & jurisprudencia , Neumonía/cirugía , Prejuicio , Opinión Pública , Asignación de Recursos/legislación & jurisprudencia , Asignación de Recursos/organización & administración , Trastornos Relacionados con Sustancias , Obtención de Tejidos y Órganos/ética , Obtención de Tejidos y Órganos/organización & administración , Listas de Espera , Síndrome de Wolf-Hirschhorn/cirugía , Adulto JovenAsunto(s)
Infecciones por Coronavirus , Teoría Ética , Recursos en Salud/organización & administración , Pandemias , Neumonía Viral , Asignación de Recursos/economía , Ventiladores Mecánicos/provisión & distribución , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Análisis Costo-Beneficio , Instituciones de Salud , Humanos , Neumonía Viral/epidemiología , Asignación de Recursos/ética , Asignación de Recursos/legislación & jurisprudencia , SARS-CoV-2Asunto(s)
Infecciones por Coronavirus/epidemiología , Recursos en Salud/legislación & jurisprudencia , Disparidades en Atención de Salud , Neumonía Viral/epidemiología , Asignación de Recursos/ética , Asignación de Recursos/legislación & jurisprudencia , Comités Consultivos , Betacoronavirus , COVID-19 , Recursos en Salud/provisión & distribución , Humanos , Cooperación Internacional , Liderazgo , Pandemias , SARS-CoV-2 , Organización Mundial de la SaludRESUMEN
The COVID-19 pandemic poses unprecedented challenges for the German health care system. What is already the case in some other countries, may occur in Germany in the near future also: Faced with limited ICU resources, doctors will be forced to decide which patients to treat and which to let die. This paper examines the legal implications of such decisions. It takes up arguments from the general discussion on prioritization in medicine. A constitutional hurdle for the application of utilitarian criteria (in particular patients' age or social role) comes from the principle that every human life is of equal value and must not be traded off against others ("life value indifference"). However, the limits that the Grundgesetz (German Basic Law) sets for state actions do not apply directly to doctors. According to the Musterberufsordnung (professional code of conduct), doctors act based on their conscience and the requirements of medical ethics and humanity. The implications of this normative standard for the prioritizing in an exceptional situation as the COVID 19 pandemic have not been sufficiently clarified. This uncertainty leads to emotional and moral burdens for doctors. The authors conclude that the German law grants a limited freedom of choice that allows physicians to apply utilitarian criteria in addition to purely medical decision algorithms.
Asunto(s)
Infecciones por Coronavirus/mortalidad , Toma de Decisiones/ética , Ética Médica , Neumonía Viral/mortalidad , Asignación de Recursos/ética , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/terapia , Costo de Enfermedad , Atención a la Salud/legislación & jurisprudencia , Alemania , Humanos , Legislación Médica , Pandemias , Médicos/ética , Médicos/normas , Neumonía Viral/terapia , Asignación de Recursos/legislación & jurisprudencia , SARS-CoV-2 , Valor de la VidaRESUMEN
The Nagoya Protocol on Access and Benefit Sharing is a transparent legal framework, which governs the access to genetic resources and the fair and equitable sharing of benefits arising from their utilization. Complying with the Nagoya regulations ensures legal use and re-use of data from genetic resources. Providing detailed provenance information and clear re-usage conditions plays a key role in ensuring the re-usability of research data according to the FAIR (findable, accessible, interoperable and re-usable) Guiding Principles for scientific data management and stewardship. Even with the framework provided by the ABS (access and benefit sharing) Clearing House and the support of the National Focal Points, establishing a direct link between the research data from genetic resources and the relevant Nagoya information remains a challenge. This is particularly true for re-using publicly available data. The Nagoya Lookup Service was developed for stakeholders in biological sciences with the aim at facilitating the legal and FAIR data management, specifically for data publication and re-use. The service provides up-to-date information on the Nagoya party status for a geolocation provided by GPS coordinates, directing the user to the relevant local authorities for further information. It integrates open data from the ABS Clearing House, Marine Regions, GeoNames and Wikidata. The service is accessible through a REST API and a user-friendly web form. Stakeholders include data librarians, data brokers, scientists and data archivists who may use this service before, during and after data acquisition or publication to check whether legal documents need to be prepared, considered or verified. The service allows researchers to estimate whether genetic data they plan to produce or re-use might fall under Nagoya regulations or not, within the limits of the technology and without constituting legal advice. It is implemented using portable Docker containers and can easily be deployed locally or on a cloud infrastructure. The source code for building the service is available under an open-source license on GitHub, with a functional image on Docker Hub and can be used by anyone free of charge.
Asunto(s)
Biotecnología/métodos , Curaduría de Datos/métodos , Minería de Datos/métodos , Bases de Datos Genéticas , Biotecnología/legislación & jurisprudencia , Minería de Datos/legislación & jurisprudencia , Intercambio de Información en Salud/legislación & jurisprudencia , Humanos , Cooperación Internacional , Asignación de Recursos/legislación & jurisprudencia , Asignación de Recursos/métodosRESUMEN
On 6 March 2020, the Italian Society of Anaesthesia Analgesia Resuscitation and Intensive care (SIAARTI) published the document "Clinical Ethics Recommendations for Admission to and Suspension of Intensive Care in Exceptional Conditions of Imbalance between Needs and Available Resources". The document, which aims to propose treatment decision-making criteria in the face of exceptional imbalances between health needs and available resources, has produced strong reactions, within the medical-scientific community, in the academic world, and in the media. In the current context of international public health emergency caused by the CoViD-19 epidemic, this work aims to explain the ethical, deontological and legal bases of the SIAARTI Document and to propose methodologic and argumentative integrations that are useful for understanding and placing in context the decision-making criteria proposed. The working group that contributed to the drafting of this paper agrees that it is appropriate that healthcare personnel, who is particularly committed to taking care of those who are currently in need of intensive or sub-intensive care, should benefit from clear operational indications that are useful to orient care and, at the same time, that the population should know in advance which criteria will guide the tragic choices that may fall on each one of us. This contribution therefore firstly reflects on the appropriateness of the SIAARTI standpoint and the objectives of the SIAARTI Document. It then turns to demonstrate how the recommendations it proposes can be framed within a shared interdisciplinary, ethical, deontological and legal perspective.
Asunto(s)
Infecciones por Coronavirus , Cuidados Críticos , Pandemias , Neumonía Viral , Asignación de Recursos/ética , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Cuidados Críticos/ética , Cuidados Críticos/legislación & jurisprudencia , Recursos en Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Unidades de Cuidados Intensivos , Comunicación Interdisciplinaria , Italia , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Guías de Práctica Clínica como Asunto , Asignación de Recursos/legislación & jurisprudencia , SARS-CoV-2Asunto(s)
Política de Salud , Trasplante de Pulmón/normas , Asignación de Recursos/legislación & jurisprudencia , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/organización & administración , Femenino , Geografía , Humanos , Estados Unidos , Listas de Espera/mortalidad , Adulto JovenRESUMEN
OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.
Asunto(s)
Recesión Económica , Política de Salud , Accesibilidad a los Servicios de Salud/economía , Asignación de Recursos/legislación & jurisprudencia , Derecho a la Salud/legislación & jurisprudencia , Migrantes/psicología , Adulto , Bolivia/etnología , Femenino , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Entrevistas como Asunto , Masculino , Marruecos/etnología , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/legislación & jurisprudencia , Investigación Cualitativa , Rumanía/etnología , Determinantes Sociales de la Salud , España , Migrantes/legislación & jurisprudencia , Migrantes/estadística & datos numéricosRESUMEN
Resumo Este artigo objetiva identificar novas fontes de receitas para a alocação adicional de recursos para o atendimento das necessidades de saúde da população fixadas nas despesas do orçamento federal, no contexto do processo de subfinanciamento do Sistema Único de Saúde e dos efeitos negativos da Emenda Constitucional 95/2016 para esse processo - queda verificada na proporção da receita corrente líquida federal destinada para o SUS. Nessa perspectiva, é preciso enfrentar o problema do subfinanciamento vinculando à busca por recursos adicionais junto a novas fontes de financiamento com as ações e serviços públicos de saúde que serão aprimoradas, ampliadas e criadas, cujos critérios são: quanto às fontes, exclusividade para o SUS, não regressividade tributária e revisão da renúncia de receita; e, quanto aos usos, priorização da atenção básica como ordenadora da rede de atenção à saúde e valorização dos servidores. O resultado calculado para as fontes variou entre R$ 92 bilhões e R$ 100 bilhões, superior aos R$ 30,5 bilhões apurados para os usos nos termos descritos. Foi realizada pesquisa documental para o levantamento de dados junto a fontes secundárias, especialmente nos relatórios encaminhados ao Conselho Nacional de Saúde pelo Ministério da Saúde.
Abstract This paper aims to identify new sources of revenue for the additional allocation of resources to meet the population's health needs fixed in the federal budget expenses, in the context of the Unified Health System (SUS) underfunding process and the negative effects of Constitutional Amendment 95/2016 for this process - verified decrease in the proportion of federal net current revenue destined to SUS. From this perspective, it is necessary to address the problem of underfunding by linking the search for additional resources with new sources of funding with actions and public health services that will be improved, expanded and created, of which criteria are: regarding sources, exclusivity for SUS, non regressive taxing and review of revenue waiver; and, regarding uses, prioritization of primary care as reference of the health care network and appreciation of civil servants in the health area. The result calculated for the sources ranged from R$ 92 billion to R$ 100 billion, higher than the R$ 30.5 billion calculated for uses under the described terms. A documentary research was conducted to collect data from secondary sources, especially in the reports sent to the National Health Council by the Ministry of Health.
Asunto(s)
Presupuestos/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Asignación de Recursos/legislación & jurisprudencia , Financiación de la Atención de la Salud , Financiación Gubernamental/legislación & jurisprudencia , Programas Nacionales de Salud/legislación & jurisprudencia , Impuestos/economía , Brasil , Salud Pública/economía , Asignación de Recursos/economía , Financiación Gubernamental/economía , Programas Nacionales de Salud/economíaRESUMEN
Resumo A "crise" é um fenômeno que corresponde a políticas globais e locais com repercussões sociais, políticas e econômicas e é o contexto para este artigo, que visa refletir sobre a resposta brasileira à epidemia de HIV/AIDS. Examinamos dimensões deste fenômeno, como a revisão de consensos das políticas de austeridade, seus impactos e a construção de "antiagendas" que dificultam a narrativa dos direitos humanos, gênero, sexualidade e saúde e obstaculizam o trabalho de prevenção e o cuidado na área de HIV/AIDS. Tal guinada conservadora pode ser associada à censura a materiais especializados e à mudança recente na estrutura de gestão do Ministério da Saúde, à extinção de centenas de conselhos participativos no âmbito do executivo federal e à nova Política Nacional sobre Drogas que substitui a orientação de "redução de danos" para a de "abstinência". Todos esses fenômenos reaquecem uma antiga preocupação: que o "vírus ideológico" venha a suplantar o vírus biológico, acentuando o quadro de estigma e de discriminação. Somados à agressiva orientação socioeconômica neoliberal que ameaça o Estado brasileiro, tais fatos afetariam a continuidade das respostas institucionais ao HIV/AIDS.
Abstract "Crisis" is a phenomenon that is part of global and local policies with social, political, and economic repercussions. It is the context of this paper that aims to reflect on the Brazilian response to the HIV/AIDS epidemic. We examined the realms of this phenomenon, such as the review of the consensus on austerity policies, their impact and the construction of "anti-agendas" that hinder the narrative of human rights, gender, sexuality, and health and hamper HIV/AIDS prevention and care. Such a conservative move can be associated with censorship of specialized materials and the recent change of management in the structure of the Ministry of Health, the extinction of hundreds of participatory councils within the Executive Branch and the new National Policy on Drugs that replaces the guidance "harm reduction" with one of "abstinence". All these phenomena revive an old concern, that is, that the "ideological virus" will outweigh the biological virus, exacerbating the situation of stigma and discrimination. Besides the neoliberal socioeconomic orientation that threatens the Brazilian state, such facts would affect the continuity of institutional responses to HIV/AIDS.
Asunto(s)
Humanos , Infecciones por VIH/prevención & control , Asignación de Recursos/economía , Recesión Económica , Programas Nacionales de Salud/economía , Prevención Primaria/métodos , Brasil/epidemiología , Infecciones por VIH/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Atención a la Salud/economía , Asignación de Recursos/legislación & jurisprudencia , Derecho a la Salud , Programas Nacionales de Salud/legislación & jurisprudenciaRESUMEN
This paper aims to identify new sources of revenue for the additional allocation of resources to meet the population's health needs fixed in the federal budget expenses, in the context of the Unified Health System (SUS) underfunding process and the negative effects of Constitutional Amendment 95/2016 for this process - verified decrease in the proportion of federal net current revenue destined to SUS. From this perspective, it is necessary to address the problem of underfunding by linking the search for additional resources with new sources of funding with actions and public health services that will be improved, expanded and created, of which criteria are: regarding sources, exclusivity for SUS, non regressive taxing and review of revenue waiver; and, regarding uses, prioritization of primary care as reference of the health care network and appreciation of civil servants in the health area. The result calculated for the sources ranged from R$ 92 billion to R$ 100 billion, higher than the R$ 30.5 billion calculated for uses under the described terms. A documentary research was conducted to collect data from secondary sources, especially in the reports sent to the National Health Council by the Ministry of Health.
Este artigo objetiva identificar novas fontes de receitas para a alocação adicional de recursos para o atendimento das necessidades de saúde da população fixadas nas despesas do orçamento federal, no contexto do processo de subfinanciamento do Sistema Único de Saúde e dos efeitos negativos da Emenda Constitucional 95/2016 para esse processo queda verificada na proporção da receita corrente líquida federal destinada para o SUS. Nessa perspectiva, é preciso enfrentar o problema do subfinanciamento vinculando à busca por recursos adicionais junto a novas fontes de financiamento com as ações e serviços públicos de saúde que serão aprimoradas, ampliadas e criadas, cujos critérios são: quanto às fontes, exclusividade para o SUS, não regressividade tributária e revisão da renúncia de receita; e, quanto aos usos, priorização da atenção básica como ordenadora da rede de atenção à saúde e valorização dos servidores. O resultado calculado para as fontes variou entre R$ 92 bilhões e R$ 100 bilhões, superior aos R$ 30,5 bilhões apurados para os usos nos termos descritos. Foi realizada pesquisa documental para o levantamento de dados junto a fontes secundárias, especialmente nos relatórios encaminhados ao Conselho Nacional de Saúde pelo Ministério da Saúde.
Asunto(s)
Presupuestos/legislación & jurisprudencia , Financiación Gubernamental/legislación & jurisprudencia , Financiación de la Atención de la Salud , Programas Nacionales de Salud/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Asignación de Recursos/legislación & jurisprudencia , Brasil , Financiación Gubernamental/economía , Humanos , Programas Nacionales de Salud/economía , Salud Pública/economía , Asignación de Recursos/economía , Impuestos/economíaRESUMEN
"Crisis" is a phenomenon that is part of global and local policies with social, political, and economic repercussions. It is the context of this paper that aims to reflect on the Brazilian response to the HIV/AIDS epidemic. We examined the realms of this phenomenon, such as the review of the consensus on austerity policies, their impact and the construction of "anti-agendas" that hinder the narrative of human rights, gender, sexuality, and health and hamper HIV/AIDS prevention and care. Such a conservative move can be associated with censorship of specialized materials and the recent change of management in the structure of the Ministry of Health, the extinction of hundreds of participatory councils within the Executive Branch and the new National Policy on Drugs that replaces the guidance "harm reduction" with one of "abstinence". All these phenomena revive an old concern, that is, that the "ideological virus" will outweigh the biological virus, exacerbating the situation of stigma and discrimination. Besides the neoliberal socioeconomic orientation that threatens the Brazilian state, such facts would affect the continuity of institutional responses to HIV/AIDS.
A "crise" é um fenômeno que corresponde a políticas globais e locais com repercussões sociais, políticas e econômicas e é o contexto para este artigo, que visa refletir sobre a resposta brasileira à epidemia de HIV/AIDS. Examinamos dimensões deste fenômeno, como a revisão de consensos das políticas de austeridade, seus impactos e a construção de "antiagendas" que dificultam a narrativa dos direitos humanos, gênero, sexualidade e saúde e obstaculizam o trabalho de prevenção e o cuidado na área de HIV/AIDS. Tal guinada conservadora pode ser associada à censura a materiais especializados e à mudança recente na estrutura de gestão do Ministério da Saúde, à extinção de centenas de conselhos participativos no âmbito do executivo federal e à nova Política Nacional sobre Drogas que substitui a orientação de "redução de danos" para a de "abstinência". Todos esses fenômenos reaquecem uma antiga preocupação: que o "vírus ideológico" venha a suplantar o vírus biológico, acentuando o quadro de estigma e de discriminação. Somados à agressiva orientação socioeconômica neoliberal que ameaça o Estado brasileiro, tais fatos afetariam a continuidade das respostas institucionais ao HIV/AIDS.
Asunto(s)
Recesión Económica , Infecciones por VIH/prevención & control , Programas Nacionales de Salud/economía , Asignación de Recursos/economía , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Brasil/epidemiología , Atención a la Salud/economía , Infecciones por VIH/epidemiología , Humanos , Programas Nacionales de Salud/legislación & jurisprudencia , Prevención Primaria/métodos , Asignación de Recursos/legislación & jurisprudencia , Derecho a la SaludRESUMEN
Water resources allocation is an urgent problem for basin authorities. In order to obtain greater economic benefits from limited water supplies, sub-regions must cooperate with each other. To study the influence of cooperation among sub-regions and the symmetry of cooperation information on the interests of the basin authority and each sub-region, this study proposes a regional water allocation model in three different situations: (1) non-cooperation; (2) cooperation and information symmetry; (3) cooperation and information asymmetry. The proposed model clearly reflects the Stackelberg game relationship between the basin authority and sub-regions. Finally, the model is applied to the Qujiang River Basin in China, and the decisions of the basin authority and sub-regional managers of the Qujiang River Basin under three different situations are discussed. The results show that regional cooperation benefits both the cooperative regions and the social welfare value of the entire river basin, when compared with non-cooperation.
Asunto(s)
Difusión de la Información , Asignación de Recursos/estadística & datos numéricos , Recursos Hídricos/provisión & distribución , China , Asignación de Recursos/legislación & jurisprudencia , Gobierno EstatalRESUMEN
US Pediatric Heart Allocation Policy was recently revised, deprioritizing candidates with cardiomyopathy while maintaining status 1A eligibility for congenital heart disease (CHD) candidates on "high-dose" inotropes. We compared waitlist characteristics and mortality around this change. Status 1A listings decreased (70% to 56%, P < .001) and CHD representation increased among status 1A listings (48% vs 64%, P < .001). Waitlist mortality overall (subdistribution hazard ratio [SHR] 0.96, P = .63) and among status 1A candidates (SHR 1.16, P = .14) were unchanged. CHD waitlist mortality trended better (SHR 0.82, P = .06) but was unchanged for CHD candidates listed status 1A (SHR 0.92, P = .47). Status 1A listing exceptions increased 2- to 3-fold among hypertrophic and restrictive cardiomyopathy candidates and 13.5-fold among dilated cardiomyopathy (DCM) candidates. Hypertrophic (SHR 6.25, P = .004) and restrictive (SHR 3.87, P = .03) cardiomyopathy candidates without status 1A exception had increased waitlist mortality, but those with DCM did not (SHR 1.26, P = .32). Ventricular assist device (VAD) use increased only among DCM candidates ≥1 years old (26% vs 38%, P < .001). Current allocation policy has increased CHD status 1A representation but has not improved their waitlist mortality. Excessive DCM status 1A listing exceptions and continued status 1A prioritization of children on stable VADs potentially diminish the intended benefits of policy revision.
Asunto(s)
Cardiopatías Congénitas/mortalidad , Trasplante de Corazón/mortalidad , Asignación de Recursos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/estadística & datos numéricos , Listas de Espera/mortalidad , Niño , Preescolar , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Masculino , Pronóstico , Asignación de Recursos/estadística & datos numéricos , Tasa de SupervivenciaRESUMEN
The federal system for allocating donated livers in the United States is often criticized for allowing geographic disparities in access to livers. Critics argue that such disparities are unfair on the grounds that where one lives is morally arbitrary and so should not influence one's access to donated livers. They argue instead that livers should be allocated in accordance with the equal opportunity principle, according to which US residents who are equally sick should have the same opportunity to receive a liver, regardless of where they live. In this paper, we examine a central premise of the argument for the equal opportunity principle, namely, that geographic location is a morally arbitrary basis for allocating livers. We raise some serious doubts regarding the truth of this premise, arguing that under certain conditions, factors closely associated with geographic location are relevant to the allocation of livers, and so that candidates' geographic location is sometimes a morally non-arbitrary basis for allocating livers. Geographic location is morally non-arbitrary, we suggest, since by taking it into account, the UNOS may better fulfill its central goals of facilitating the effective and efficient placement of organs for transplantation and increasing organ donation.