Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Assistência Ambulatorial/economia , California , Controle de Custos , Cuba , Acessibilidade aos Serviços de Saúde , Humanos , Medicaid , Atenção Primária à Saúde/economia , Estados UnidosRESUMO
A brief account of the main events in the history of National Health Insurance systems is presented, from its beginnings in the late 18th and early 19th centuries, with the creation of "sickness insurance" funds, to the patterns of its development in today's world.
Assuntos
Previdência Social/história , Saúde Global , História do Século XVIII , História do Século XIX , História do Século XX , Saúde Pública , Previdência Social/legislação & jurisprudência , Previdência Social/organização & administração , GuerraRESUMO
National health care systems of Latin America have long consisted of a mixture of several subsystems, principally traditional healing; religious charity; Ministries of Health; social security organizations; other government agencies; voluntary agencies; enterprises; and a modern private market. Observations in Brazil and Peru in 1984, compared with 1962, show great changes in the proportions and character of all of these subsystems, particularly an expanding impact of the social security programs, in terms of people covered and the financial support of health services.
Assuntos
Atenção à Saúde/tendências , Países em Desenvolvimento , Brasil , Serviços de Saúde do Indígena/tendências , América Latina , Assistência Médica/tendências , Programas Nacionais de Saúde , Peru , Prática Privada/tendências , Previdência SocialRESUMO
The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of medical students by a factor of five. Formal residency training (never before available within the country) in primary care specialties has been established. Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.
PIP: This article explores the policies and early experiences of the extensive changes in the preparation of health personnel in Nicaragua; massive changes in the health care system were launched after the victory of the Sandinista Revolution in 1979. It reviews the status of health personnel training in the country today, the integration of these programs into planning for the health system, and problems arising their rapid appearance. The Unified National Health System was established in 1979 in an attempt to transform some of Latin America's worst health indices. This system is based on the stated principles of planning, regionalization, public participation, and primary care. To implement these policies, high priority has been given to the development of health professions training programs appropriate to the system's special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of meidcal students by a factor of 5. Formal residency training in primary care specialties has been established. Training for allied health professions has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a trmendous need for educational resources, both human and material. The greatest constraint in expanding medical education was the lack of qualified teachers. As a solution, the new health system has made public sector employment much more available and attractive; most Nicaraguan physicians today divide their time between public and private practice, and the pressures on voluntary teaching time are heavy. The Health Ministry has developed strategies for making clinical teaching more attractive and prestigious in compensation. Medical curriculum reform since 1979 is designed to turn out doctors capable along 4 lines: clinical service, teaching, administration and research. Special importance is placed on integrated teaching and service. These multiple objectives are built into the teaching program from the very beginning. To date there are 6 schools of nursing in the country (4 before 1979), with 5 times the pre-1979 enrollment. Nicaragua has made a deliberate decision not to train mid-level medical workers. However, volunteer health personnel, the Brigadistas, have played a definite role in Nicaraguan communities. They concentrate on public education and mobilize the people for immunization and sanitation campaigns. Additionally, traditional birth attendants in rural areas have been recognised by the Health Ministry and been given training to upgrade their performance. Much in the new System has emulated policies of Cuba, especially the emphasis on public education, models for personnel training and community-oriented primary care.
Assuntos
Ocupações em Saúde/educação , Programas Nacionais de Saúde , Pessoal Técnico de Saúde/educação , Currículo , Educação Médica/história , Educação Médica/tendências , Educação em Enfermagem , Docentes de Medicina/provisão & distribuição , Política de Saúde , História do Século XX , Humanos , Programas Nacionais de Saúde/história , Programas Nacionais de Saúde/organização & administração , NicaráguaRESUMO
In comparison to other Latin American countries at a similar or more advanced stage of economic development, Cuba has a relatively high ranking on major health status indicators. This paper examines the reasons for this contrast and concludes that they are largely political. This suggests that the severe health deficiencies of most developing countries are not inevitable consequences of poverty.