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September 30, 2013

Essay on Management of Public Health Care Systems

Management of Public Health Care Systems
            In this paper we will discuss, compare, and contrast the management of public health care systems in America and Brazil.  The health system of the United States actually consists of a set of health systems which is more or less complex. The federal government, state governments and local governments have developed, often in concert, their role in protecting public health. The rule is that the services of direct health care services are provided by the private sector. Many of these government departments and non-government share of public funds, have the same technical advice, meet the same regulatory standards and have the same research in health that are provided by the federal government, state governments and local governments.(Mcormick, 2000)

            The government provides health insurance to eligible people who live in need (primarily through Medicaid), people 65 and older (primarily through Medicare) and the military. In 2004, approximately 88% of people covered by private health insurance benefits from any plan offered by their employer. The proportion of the population covered by public health insurance increased from 24.7% in 2000 to 27.3% in 2005. This increase is primarily due to an increase in the number of people who have Medicaid insurance, the percentage rose from 10.6% in 2000 to 13%, or 38.1 million people in 2005. The number of elderly Medicare beneficiaries has remained relatively stable during the study period, they accounted for 42.5 million policyholders in 2005. Approximately nine million American soldiers receive health care benefits under the program of health care for military TRICARE. (Broyles, 2002)
            Overall spending on health care accounted for approximately 15.2% of GDP in 2004. Public expenditure corresponded to 44.7% of total health expenditure and private, to 55.3%.
The responsibility of individual health care is decentralized. The government provides health insurance to vulnerable groups such as families in need, people with disabilities and seniors. Most people, however, get health insurance through their employer or take out themselves. That said there were still 46.6 million U.S. citizens without insurance 20054. Services of direct health care, including primary care, secondary and tertiary, are provided mostly by thousands of hospitals and private clinics in the country. The federal government directly funds other hospitals and clinics that treat military personnel and veterans as well as Alaska Natives and Native Americans.
In 2000, there were 2.56 doctors and 9.37 nurses per 1 000 inhabitants in the United States. The number of hospital beds per 10 000 inhabitants was 33 in 2003.
               No reform of the health system has occurred in the late 1990s, however, has made some major restructuring and new commitments to meet changing needs. In 2006, Medicare beneficiaries were offered coverage for prescription drugs, and in May 2006, 90% of program participants had Medicare coverage. Most people pay a monthly premium for benefit, which reduces the costs of prescription drugs and avoid future increases.
            According to the National Cooperative Business Association (National Association of Cooperatives), health cooperatives in the United States contribute significantly to the costs of health care and insurance premiums remain affordable for consumers and small businesses and they can exercise some control over the price of prescription drugs. They also allow the community hospitals and nonprofit hospitals to remain independent and have improved the quality of home care and assistance for independent living. Finally, they have helped small independent pharmacists to compete with supermarkets and offer prescription drugs at the local level.(Anderson, 2004)
            In the health sector, it is possible to find all types of cooperatives: consumer cooperatives, worker cooperatives as well as purchasing and shared services. As part of this study, consumer cooperatives and workers are of particular interest.
Many health care organizations integrate (HMOs) in the U.S. are originally owned cooperatives to consumers. Because of competition and the high cost of health care, many of them merged or were sold to health care companies. Moreover, the cooperatives that have survived provide members with competitive services and quality.
            It is mainly in the field of home care workers' cooperatives that have developed. Poor working conditions of employees in this area explain the high turnover, which decreases the quality of service. Cooperatives in the field of home care workers belonging to the advantage of offering higher wages because they belong to the people they employ.(Bradbury, 2005)
            The United States does not have a universal health care system and the only developed country that has not put in place the system. According to rough estimates, two thirds of urban hospitals in the US are non-profit hospitals and the balance between for-profit hospitals and public hospitals is evenly divided and maintained.
            On the other hand in Brazil, The programs supported by the World Bank helped control the spread of serious tropical diseases, ease access to health services in poor areas and contributed the establishment of an epidemiological surveillance system. But although the projects on the fight against disease and basic health services respond to concerns important and legitimate, it remains to address critical issues such as inequality and inefficiency persistent characterize the financing of health services. In Brazil, the health care system and its management require more reforms than America.
            Brazil, is one the middle-income countries characterized by a relatively high degree of poverty, a system health care known for inefficiency and inequity, and a population exposed to various endemic diseases.(World Bank, 2001)
The health status of Brazilian children is significantly better than the last two decades. Mortality rates child ratios and height for age, being good indicators of the state of general health of children, have markedly improved in recent years. These changes are due to the complex interplay of progress at the purchasing power of maternal education, access to health care, including therapy oral rehydration salts, utilities and water supply, and behaviors individual such as the more common practice of breastfeeding and a greater spacing of births.
                        But despite recent progress, serious inequalities persist. Thus, in the North East region poorest and most rural of the country and one where the weight traditions is the largest, state of health children is much less satisfactory and is improving more slowly than in other regions. While across the country, over 10% of children still suffer from serious stunting in Northeast, they are nearly 18% or even 25% rural areas of this region.
                 Although the Brazilian government and donors international funds, including the World Bank, gave it much attention since the North-East cannot achieve the same progress as other areas in the health. This is due not to differences in income, but the fact that more urbanized areas have made more progress in terms of access to child and maternal health care, education maternal and reproductive practices. In Brazil, the fertility rate has declined
            The number of births per woman fell from 5.8 in 1970 to 2.3 in 1996, despite the absence
almost total official population policy. Recently, there has been a dramatic decline in the total fertility in the Northeast. Although recent years, governments are much more interested
family planning and reproductive health, the indifference with which they showed before was
limited the role of the Bank.
Declining fertility rates has contributed to the recent improvement in the health status of
children, reducing the risks associated with low spacing and the high number of
pregnancies per woman, and has reduced demand immunizations, prenatal care and services
birth attendants, which ultimately reduced the pressure to bear on the health systems and made
care more accessible.
Sociologists see the high rate abortion and contraceptive use the main determinant of fertility decline. The most common methods to limit fertility are female sterilization and the pill. The Bank has financed two projects in health services based in the North-East from the mid-80s,
under the development plan established 15 years by the Brazilian government for the Northeast Region.
Under these projects were constructed centers health care, encouraged better management at the federal and various states, and provided technical training for the establishment develop new modules of basic health care and of comprehensive care programs for women and children.
Partly because of political and difficult macroeconomics, these projects have transformed into programs designed to build facilities and providing medical equipment. They have succeeded in expanding access to basic health services, but without transforming the mode of care delivery basic health within that system.
The Bank's strategy has, however, several shortcomings. First, much of health posts built to improve access to health care to poor is underused, devoid of personnel and equipment necessary to meet the needs of an increasingly demanding and urbanized country. But as the projects did not include a system monitoring and appropriate evaluation, it is difficult to determine what their real influence was.(Baer, 2001)
            Available data indicate that the contribution of these projects was probably limited because disbursements were slow until 1994, when which the most progress in child health
had already been registered. (Maria, 2000)
The clinics are often underutilized and it appears from group sessions discussion that consumers are dissatisfied quality services and they prefer more consultant doctors rather than nurses in clinics. Procedures for the registration, control, and labeling of foods are established under federal legislation, which assigns specific responsibilities to the health and agriculture sectors. In the health sector, health inspection activities have been decentralized to the state and municipal governments. The environmental policy derives from specific legislation and from the Constitution of 1998.

McCormick MC, Weinick RM, Elixhauser A, (2000) “Annual report on access to and utilization of health care for children and youth in the United States” Cengage Learning

Broyles RW, Narine L, Brandt EN Jr.(2002) “The temporarily and chronically uninsured: Does their use of primary care differ? J Health Care

Bradbury RC, Golec JH, Steen PM(2005) “Comparing uninsured and privately insured hospital patients”  Cengage Learning

Baer, Werner (2001) “The Brazilian economy: growth and development” Greenwood Publishing

Andersen R, Aday LA. (2000)  “Access to medical care in the U.S.: Realized and potential” Med Care

Andersen R. (2004) “Revisiting the behavioral model and access to medical care: Does it matter?”  J Health
Maria, Sonia,(2000) “Reshaping health care in Latin America: a comparative analysis of health care reform in Argentina, Brazil, and Mexico” IDRC
World Bank, (2001) “Investment in health: social and economic returns” Pan American Health Org


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