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Introduction. Las compras estratégicas son un componente importante del financiamiento del sistema de salud. Puede mejorar la productividad, la justicia y la responsabilidad en la prestación de atención médica en caso de considerar la calidad. Este estudio, que se realizó como una revisión sistemática, tuvo como objetivo investigar el estado de la calidad en cinco dominios de compras estratégicas en el sistema de salud para responder qué, para quién, de quién, cómo comprar y cuánto comprar. Material y Métodos: Este estudio revisó sistemáticamente los artículos publicados en las bases de datos de Web of Sciences (WOS), Scopus, PubMed, Medline vía Ovid, Embase desde 2000 hasta octubre de 2019. Las palabras clave utilizadas para la búsqueda en las bases de datos incluyeron las siguientes: Sector Salud, Entrega de atención médica, garantía de calidad, mejora de la calidad y compras estratégicas. Un total de 182 artículos fueron seleccionados y revisados ​​por cuatro investigadores. Se excluyeron los artículos con contenido irrelevante. Los datos de los artículos seleccionados se analizaron mediante el método de análisis de contenido. Resultados: De los 182 artículos recopilados mediante la búsqueda en las bases de datos seleccionadas, se analizaron 16 artículos. Con base en los resultados de este estudio, las compras estratégicas en el sistema de salud resultan en la entrega de servicios con mayor calidad. Conclusión: Las compras estratégicas pueden mejorar el desempeño del sistema de salud al elegir el proveedor más apropiado y el método de pago más apropiado, junto con la equidad en la prestación de servicios de atención médica de calidad

Introducction. Strategic purchasing is an important component of financing in the health system. It can enhance productivity, justice, and accountability in the health care delivery in case of considering the quality. This study, which was conducted as a systematic review, was aimed at investigating the status of quality in five domains of strategic purchasing in the health system to answer what, for whom, from whom, how to buy, and how much to buy. Material and Methods: This study systematically reviewed the articles published in the databases of Web of Sciences (WOS), Scopus, PubMed, Medline via Ovid, Embase from 2000 to October 2019. The keywords used to search the databases included the following: Health Care Sector, Delivery of Health Care, Quality Assurance, Quality Improvement, and Strategic Purchasing. A total of 182 articles were selected and reviewed by four researchers. Articles with irrelevant content were excluded. Data of the selected articles were analyzed using the content analysis method. Results: Of the 182 articles collected through searching the selected databases, 16 articles were analyzed. Based on the results of this study, strategic purchasing in the health system results in the delivery of services with higher quality. Conclusion: Strategic purchasing can enhance the performance of the health system through choosing the most appropriate provider and the most appropriate payment method, along with equity in providing quality health care services

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Central nervous system diseases include brain or spinal cord impairments and may result in movement disorders almost always manifested by paralyzed muscles with preserved innervations and therefore susceptible to be activated by electrical stimulation. Functional electrical stimulation (FES)-assisted cycling is an approach mainly used for rehabilitation purposes contributing, among other effects, to restore muscle trophism. FES-assisted cycling has also been adapted for mobile devices adding a leisure and recreational benefit to the physical training. In October 2016, our teams (Freewheels and EMA-trike) took part in FES-bike discipline at the Cybathlon competition, presenting technologies that allow pilots with spinal cord injury to use their paralyzed lower limb muscles to propel a tricycle. Among the many benefits observed and reported in our study cases for the pilots during preparation period, we achieved a muscle remodeling in response to FES-assisted cycling that is discussed in this chapter. Then, we have organized some sections to explore how FES-assisted cycling could contribute to functional rehabilitation by means of changes in the skeletal muscle disuse atrophy.

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Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.

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There are few comprehensive studies available on barriers encountered from the initial seeking of healthcare through to the resolution of the health problem; in other words, on access in its broad domain. For Colombia and Brazil, countries with different healthcare systems but common stated principles, there have been no such analyses to date. This paper compares factors that influence access in its broad domain in two municipalities of each country, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had had at least one health problem within the last three months (2163 in Colombia and 2155 in Brazil). The results reveal important barriers to healthcare access in both samples, with notable differences between and within countries, once differences in sociodemographic characteristics and health needs are accounted for. In the Colombian study areas, the greatest barriers were encountered in initial access to healthcare and in resolving the problem, and similarly when entering the health service in the Brazilian study areas. Differences can also be detected in the use of services: in Colombia greater geographical and economic barriers and the need for authorization from insurers are more relevant, whereas in Brazil, it is the limited availability of health centres, doctors and drugs that leads to longer waiting times. There are also differences according to enrolment status and insurance scheme in Colombia, and between areas in Brazil. The barriers appear to be related to the Colombian system's segmented, non-universal nature, and to the involvement of insurance companies, and to chronic underfunding of the public system in Brazil. Further research is required, but the results obtained reveal critical points to be tackled by health policies in both countries.

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