Rozprawy doktorskie na temat „Healthcare reforms”
Utwórz poprawne odniesienie w stylach APA, MLA, Chicago, Harvard i wielu innych
Sprawdź 50 najlepszych rozpraw doktorskich naukowych na temat „Healthcare reforms”.
Przycisk „Dodaj do bibliografii” jest dostępny obok każdej pracy w bibliografii. Użyj go – a my automatycznie utworzymy odniesienie bibliograficzne do wybranej pracy w stylu cytowania, którego potrzebujesz: APA, MLA, Harvard, Chicago, Vancouver itp.
Możesz również pobrać pełny tekst publikacji naukowej w formacie „.pdf” i przeczytać adnotację do pracy online, jeśli odpowiednie parametry są dostępne w metadanych.
Przeglądaj rozprawy doktorskie z różnych dziedzin i twórz odpowiednie bibliografie.
Kabajulizi, Judith. "Macroeconomic implications of healthcare financing reforms : a computable general equilibrium analysis of Uganda". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2016. http://researchonline.lshtm.ac.uk/2545198/.
Pełny tekst źródłaSHAHINI, VIOLA. "WELFARE STATE CHANGE IN ALBANIA: COMPARING THE POLITICS OF PENSION AND HEALTHCARE REFORMS". Doctoral thesis, Università degli Studi di Milano, 2022. http://hdl.handle.net/2434/919925.
Pełny tekst źródłaKornreich, Yoel. "Unorthodox approaches to participation in authoritarian regimes : the making of China's recent healthcare reforms". Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/38163.
Pełny tekst źródłaAhmad, Farooq. "Healthcare reforms in the state teaching hospitals of Peshawar, Pakistan : a multi-stakeholder perspective". Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/422208/.
Pełny tekst źródłaLiang, Zhanming, i N/A. "Characteristics, Competencies and Challenges: A Quantitative and Qualitative Study of the Senior Health Executive Workforce in New South Wales, 1990-1999". Griffith University. School of Public Health, 2007. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20070914.091446.
Pełny tekst źródłaLiang, Zhanming. "Characteristics, Competencies and Challenges: A Quantitative and Qualitative Study of the Senior Health Executive Workforce in New South Wales, 1990-1999". Thesis, Griffith University, 2007. http://hdl.handle.net/10072/366277.
Pełny tekst źródłaThesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Public Health
Faculty of Health
Full Text
Ferreira, Mariana Ribeiro Jansen. "Tendências e contratendências de mercantilização: as reformas dos sistemas de saúde alemão, francês e britânico". Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-06042016-142523/.
Pełny tekst źródłaOver the last thirty years, between mid-1980 and 2010 decades, Germany, France and the United Kingdom healthcare systems have been renovated, creating a growing marketisation in the financing and provision of services. This Thesis analyzes the roots of these changes, and identifies that marketisation did not take place or by the same mechanisms nor with the same depth, with important institutional inertia. The observed differences attest to the specificities of each country in terms of its economic context, their political arrangements, the institutional characteristics of each system and the different social conflicts (intra and extra healthcare system). The German, French and British health systems, while public systems of broad coverage and completeness, are the result of the period after the II World War. A number of factors have contributed to that historic moment: the very impact of the conflict, which forged the expansion on national solidarity and greater pressure from workers; the rise of socialism in the Soviet Union; a bigger support for action and state planning; strong economic growth, thanks to the emergence of a Fordist accumulation regime, based on the productivity expansion. The accommodation of the capital-labor conflict in this context occurred through the real wages expansion and the development of the Welfare State, ie public policies for the creation and / or expansion of a social safety net. However, the 1970s economic crisis eroded the funding base and raised questions about its effectiveness amid the transformation of Fordist accumulation regime in a finance-led one, leading to adoption of constant reforms over the next several decades. In addition, specific health sector transformation complicate the situation, given the growing population aging, the demand for broader and more complex care, and especially the costs derived from technological resources. This scenario boosted the implementation of a number of changes in the three systems, with emphasis on the incorporation of market mechanisms (such as the pricing of services, the induction of competition between service providers), the growth of the responsibility of users for funding the system (such as the increase in co-payments and the reduction in public coverage) and the expansion of the direct participation of the private sector in the provision of health services (performing ancillary services, public hospitals management, purchasing state institutions). However, simultaneously, the reforms expanded access and state regulation in addition to the change in funding base, mainly in France. This means that marketisation was not the only direction of the reforms, due to two main reasons: the very economic crisis drove portion of the population of postwar health protection mechanisms, requiring state reaction, and different actors influenced the changes, blocking or at least limiting a single market direction.
Conteh, Abdulai Abubakarr. "A critical evaluation of the effects of neo-liberal (market-driven) reforms in achieving the goal of human security in Sierra Leone". Thesis, Brunel University, 2014. http://bura.brunel.ac.uk/handle/2438/13236.
Pełny tekst źródłaGuimarães, Cristian Fabiano. "A variação do coletivo na saúde". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/130525.
Pełny tekst źródłaThis study discusses the notion of the collective in healthcare through the analysis of the games and disputes that take place over this expression in the field of Italian and Brazilian healthcare reforms, with the objective of understanding the uniqueness of collective healthcare. Taking as its starting point the fact that collective healthcare marks a difference in the health area, it is impotant to understand the notion of "collective", taking it as an analyzer, with the objective of monitoring how it is expressed in healthcare and which concepts it updates. To make this discussion, we situate our research in a genealogical perspective, analyzing the composition and the loss of sense in reformist territories in the Italian and Brazilian scenarios. We discuss the images constructed to express the collective in healthcare – the people, the group and the civil society – in order to propose a different way to think this expression, that is procedural and intensive in character, comming to understand the collective as power. It is not the establishment of that notion to the forms assigned to it that asserts the public healthcare, but the strength that characterizes the collective as something unspecific, condition for the change in power. Following the reformist experiments, it became clear that the imagination and the composition of common notions are trigger mechanisms for variation, enabling desire and resistance. By analyzing the collective in collective healthcare in coordination with the Italian and Brazilian reform movements, we stress the uniqueness of this expression in the healthcare area. To consider this uniqueness prevents, paradoxically, the reproduction of a policy that affirms the precepts of social medicine or public healthcare in the field of collective healthcare, opening the possibility for new productions of meaning.
Kubacki, David. "News Reporting During the Healthcare Reform Debate". University of Toledo / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1333319763.
Pełny tekst źródłaPiedra, Peña Juan Andrés. "Efficiency and Spatial Structure of the Public Healthcare System: The Ecuadorian Case". Doctoral thesis, Universitat Autònoma de Barcelona, 2021. http://hdl.handle.net/10803/673975.
Pełny tekst źródłaDurante la última década, Ecuador ha pasado por muchas reformas enfocadas en promover objetivos de salud basados en equidad y cobertura de salud universal. Sin embargo, las decisiones basadas en la equidad pueden afectar la eficiencia del sistema de salud, ya que una mayor demanda de atención médica requerirá un mayor uso de los recursos de salud. Esto despierta interés en considerar el estudio de la eficiencia del sistema sanitario. Esta tesis propone evaluar el desempeño de eficiencia de los hospitales públicos ecuatorianos; dada la marcada heterogeneidad regional que caracteriza la realidad ecuatoriana, se propone un marco de análisis donde la estructura espacial juega un papel clave para comprender y dar forma a la distribución heterogénea de los recursos y sus determinantes. En primer lugar, esta tesis se enfoca en la medición de la eficiencia de los hospitales públicos, desarrollando una nueva metodología empírica que toma en cuenta la heterogeneidad del sistema. Luego, responde si la variación de la eficiencia en un hospital afecta la eficiencia de los hospitales vecinos y si las variaciones de la demanda afectan la eficiencia hospitalaria. Finalmente, evidencia hasta qué punto la eficiencia de los hospitales públicos está determinando la movilidad interregional de los pacientes y su efecto indirecto en otros hospitales (espacialmente correlacionados). En conclusión, se evidencia que el aumento en la demanda de tratamiento médico tuvo un efecto positivo general sobre el desempeño hospitalario, tanto a través de efectos directos como indirectos. Los impulsores potenciales de este efecto se refieren al uso ineficiente de los recursos excedentes y la capacidad de los hospitales públicos. El tiempo que tuvieron los hospitales para adaptarse a la afluencia de pacientes antes de las reformas y la inversión pública desplegada también puede tener una participación significativa en este efecto. Los resultados también proporcionan evidencia de que una mayor eficiencia de los hospitales especializados tiene un fuerte efecto de atracción sobre los pacientes de las regiones menos desarrolladas. Esta afluencia de pacientes está siendo captada por hospitales vecinos, quienes incrementan su eficiencia para atraer dicha demanda, mostrando evidencia de un efecto de competencia. Las implicaciones políticas dirigen la atención al diseño de estrategias de salud bien planificadas, considerando las externalidades territoriales, la dotación tecnológica y el nivel de especialización como características clave. Se puede orientar una mayor inversión pública para aumentar la oferta de tratamiento especializado en las regiones menos desarrolladas. En las regiones desarrolladas, los tomadores de decisiones pueden aprovechar los efectos indirectos para promover la eficiencia, fortalecer las reformas hospitalarias e inversión pública (estratégicamente asignada) para mejorar el desempeño del sistema regional de salud.
During the past decade, Ecuador has been going through many reforms focused on promoting equity-based and universal healthcare coverage goals. However, equity-based decisions can affect the efficient performance of the healthcare system, as more demand for medical care will require higher use of healthcare resources. The importance to care for the efficient performance then is drawn to attention. In this thesis, we propose to assess the efficiency performance of Ecuadorian public hospitals; given the marked regional heterogeneity that characterizes the Ecuadorian reality, we propose a framework of analysis where the spatial structure plays a key role to understand and shape the heterogeneous distribution of resources and its determinants. First, we focus on the efficiency measurement of public hospitals, developing a new empirical methodology that takes into account the heterogeneity of the system. Then, we answer whether efficiency variation in a hospital affects the efficiency of neighboring hospitals and whether demand variations affect hospital efficiency. Finally, we will disentangle to what extent the efficient performance of public hospitals is determining interregional patient mobility, and whether it has an indirect effect on other (spatially correlated) hospitals. We conclude that the increase in the demand for medical treatment had an overall positive effect on hospital performance, both through direct and spillover effects. Potential drivers of this effect refer to the inefficient use of the spare resources and capacity of public hospitals. The time that hospitals had to adapt to the forthcoming inflow of patients before the reforms and the public investment deployed may also have significant participation in the effect. The results also provide evidence that the efficiency performance of specialized hospitals has a strong pulling effect on patients from less-developed regions. This inflow of patients is being captured by neighboring hospitals who are increasing their efficiency to attract this demand, showing evidence of competition. Policy implications drive the attention to the design of well planned healthcare strategies considering territorial externalities, technological endowment and specialization level as key features. Higher public investment can be targeted to increase the supply of specialized treatment in less-developed regions. In developed ones, decision-makers can take advantage of spillover effects to promote efficiency strengthening hospital reforms and well allocated public investment to enhance the regional healthcare system’s performance.
Universitat Autònoma de Barcelona. Programa de Doctorat en Economia Aplicada
Richardson, Timothy R. "Military healthcare reform and legislative changes for FY01". Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2000. http://handle.dtic.mil/100.2/ADA387369.
Pełny tekst źródła"December 2000." Thesis advisor(s): Doyle, Richard B. ; Barrett, Frank J. Includes bibliographical references (p. 75-81). Also available online.
Jarfors, Anna-Lena, i Kristin Svensson. "Verksamhetsstyrning i primärvården : Stödjer ersättningsmodellerna verksamhetens mål för primärvården, en studie av Region Region Jönköpings län och Landstinget Blekinge". Thesis, Linnéuniversitetet, Institutionen för ekonomistyrning och logistik (ELO), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-71543.
Pełny tekst źródłaThe health care system has undergone major changes over the years and is today a central part of our welfare society. The trend is to direct citizens towards the Primary Health Care sector, making the health care system face new challenges. The primary challenges are related to the allocation of resources and guiding priorities for this. Today, health care is increasingly controlled by economic incentives, where the link to compensation is based on, compensation models. How the compensation model is designed varies between different principal stakeholders whom are designing their care choice model after its own priorities of primary health care objectives. The aim of the current study is to analyse whether the different compensation models in primary care supports the goal to work towards and what experience the different operators, politicians, administrative management and profession, have of compensation models ' effects. To study how the compensation model supports business goals in primary care two organizations has been selected, County Council of Jönköping and Blekinge on which a comparative research design has been applied. Data for the theoretical frame of reference is based on published articles, books and other information material from the authorities. Primary data has been gathered from six qualitative, semi-structured interviews. Secondary data for the study consists of data collected from each region/County Councils. To use a compensation model for the allocation of resources in primary health care is considered to be a good instrument in which monetary remuneration justifies. Objectives as availability, equal treatment, high quality care, person-centred care, patient safety, along with cost-effective care can sometimes counteract with each other. Good cost control is often a priority when governing health care operations, monitoring and control the business needs much administration, thus undermining the objective of cost effective care. Compensation model is effective way to control primary health care since monetary compensation is involved but the model is not used primarily to steer towards the target but for cost control. The experience of the effects of the compensation model is that they sometimes act counterproductive towards goal for the health care system and you might receiving unwanted effects as manipulation of data and focus what you can do to generate more compensation. A vast amount of administration is needed to follow up compensation models.
Ferrante, Livio. "Decentralization and health performance in Italy: theoretical and empirical issues". Doctoral thesis, Università di Catania, 2017. http://hdl.handle.net/10761/3630.
Pełny tekst źródłaYan, Qing. "Inequity of Chinese healthcare system". Thesis, University of Macau, 2015. http://umaclib3.umac.mo/record=b3258539.
Pełny tekst źródłaChan, Yee-ying Michelle, i 陳意映. "The formulation and implementation of healthcare reform in Hong Kong". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31966469.
Pełny tekst źródłaWang, Guang-Xu. "Network analysis of the universal healthcare financial reform in Taiwan". Thesis, University of Nottingham, 2015. http://eprints.nottingham.ac.uk/29827/.
Pełny tekst źródłaChan, Yee-ying Michelle. "The formulation and implementation of healthcare reform in Hong Kong". Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B2329470x.
Pełny tekst źródłaBlackadar, Kerry Jean. "A content analysis of US newspaper coverage of Canada and the UK’s healthcare systems during America’s healthcare reform". Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/27836.
Pełny tekst źródłaKooverjee, Mukesh Manilal. "A perspective on healthcare delivery systems with the emphasis on South African healthcare and the need for reform". Thesis, Stellenbosch : Stellenbosch University, 2002. http://hdl.handle.net/10019.1/52687.
Pełny tekst źródłaENGLISH ABSTRACT: The need for efficient and equitable health provision remains a challenge for all countries and economies of the world. Defining health, healthcare and health provision are contentious issues, and public debate rages on as governments throughout the world attempt to quell public demands and expectations. Healthcare scenarios differ vastly from country to country, each attempting to accommodate its own needs, given the limitations placed on the systems in terms of human and financial resources. These differences are large as will be seen when countries with developed market economies are compared to those in the less fortunate Third World. The financing of healthcare systems is a complex and challenging task. Affordability of healthcare is an issue for all nations of the world. Most countries enjoy a mix of private and public funding to ensure that some degree of good health is attained by the nation as a whole. South Africa has a unique health system in that it has two distinct and separate health systems. This is not by chance. South Africa is a country that boasts enormous diversity but huge inequalities in terms of race, culture, class and income. Systems had therefore developed along very defined lines where the privileged have had access to expensive, modern and private healthcare while the poor and indigent have had to use a poorly structured public service. The purpose of this literature review is to research and to define those issues and concepts which require clearer perspective. It will also look at healthcare.
AFRIKAANSE OPSOMMING: Die noodsaaklikheid vir effektiewe, billike en regverdige gesondheidsvoorsiening bly 'n uitdaging vir alle ekonomieë van die wêreld. Om gesondheid, gesondheidsorg- en gesondheidsvoorsiening te definieër, is 'n kontensieuse aangeleentheid en die openbare debat duur voort, soos regerings in die wêreld poog om te voldoen aan oorweldigende openbare eise en verwagtinge in hierdie verband. Gesondheidsorg-opsies verskil drasties van land tot land, wat elk poog om sy eie behoeftes te akkommodeer, gegewe die beperkings wat die sisteem belas in terme van menslike en finansiële hulpbronne. Hierdie verskille is beduidend, soos wat gesien kan word wanneer lande met ontwikkelde mark-ekonomieë vergelyk word met die lande in die minder bevoorregte derde-wêreld. Die finansiering van gesondheidsorg-sisteme is 'n komplekse en uitdagende taak. Die bekostigbaarheid van gesondheidsorg is 'n aangeleentheid wat al die lande van die wêreld raak. Die meeste lande van die wêreld het 'n gemengde gesondheidsorg-sisteem wat bestaan uit gedeeltelik privaat en gedeeltelik openbare fondse, sodat toegesien word dat 'n mate van goeie gesondheid bereik word deur die land as geheel. Suid-Afrika het 'n unieke gesondheidsorg-sisteem deurdat twee besondere en aparte gesondheidsisteme bestaan, wat beslis nie toevallig is nie. Suid-Afrika is 'n land wat spog met enorme verskeidenheid, maar beduidende ongelykhede in terme van ras, kultuur, klas en inkomste. Gesondheidsorg-sisteme het dus ontwikkel langs baie beslisde lyne waar die bevoorregtes toegang gehad het tot duur, moderne en privaat vesekerings-gebaseerde gesondheidsorg, terwyl die arm en armlastiges gebruik moes maak van 'n swakker gestruktureerde openbare diens. Die doel van hierde nagevorsde oorsig is om navorsing te doen om sisteme uit 'n globale perspektief te identifiseer en daardie beginsels toe te pas, wat voordelig kan wees in 'n plaaslike konteks. Daar word aanvaar dat die Suid-Afrikaanse gesondheidsorg-sisteem baie het om te leer van ervarings in beide die ontwikkelde en ontwikkelende lande. 'n Besondere begrip hiervoor, is die basis waarop 'n suksesvolle gesondheidsorg-sisteem in hierdie land gevestig kan word. Daar word gehoop dat deur die besondere perspektief te hê, sekere werkbare oplossings gevind en bereik kan word.
Lindsay, Gail Margaret. "Nothing personal?, narrative reconstruction of Registered Nurses' experience in healthcare reform". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ63623.pdf.
Pełny tekst źródłaNoir, Charles Randall. "Information systems strategy and organizational reform in the Indian healthcare sector". Thesis, University of Cambridge, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.611794.
Pełny tekst źródłaLynch, Carmela Josephine. "The Effect of Healthcare Reform on the Sustainability of Nonprofit Hospitals". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2130.
Pełny tekst źródłaMiles, James Leon. "The Center for Total Health: Healthcare Reform in Cook County, Illinois". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1856.
Pełny tekst źródłaClark, Spencer R. "Health Care Reform's Effect on Private Medical Practices". Scholarship @ Claremont, 2011. http://scholarship.claremont.edu/cmc_theses/209.
Pełny tekst źródłaLoriston, Izienne P. "Informing BPM practice in Emergency Units of South African hospitals for improved patient flow". Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28442.
Pełny tekst źródłaLoomis, Jennifer Cullen. "Activist Doctors: Explaining Physician Activism in the Oregon Movement for Single-Payer Healthcare". PDXScholar, 2015. https://pdxscholar.library.pdx.edu/open_access_etds/2214.
Pełny tekst źródłaMcKnight, Jacob. "Constructing reform in the Ethiopian healthcare system : unintended consequences for hospitals and patients". Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:e844b6c5-2830-49ad-a411-2b3c0cb849ad.
Pełny tekst źródłaKabir, Shahnaz. "Reform strategies for management of vascular patients to reduce readmission and healthcare costs". Thesis, Utica College, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10250824.
Pełny tekst źródłaThe capstone project reports the risk factors causing unplanned hospital readmission of vascular patients as well as the effects on healthcare cost. The methods for determining the risk factors include clinical indicators for risk prediction process, and the STAAR (State Action on Avoidable Rehospitalization) initiatives, which can be used as healthcare improvement projects to facilitate the cross-continuum team. The findings indicate a relationship between the patient’s engagement in the lower extremity vascular procedure, and effectiveness of follow-up after surgery in the reduction of hospital readmission and healthcare cost. Potential strategies to prevent the risk factors for readmission of vascular patients and to reduce the healthcare cost are discussed. Presenting unplanned readmission for vascular patients and reducing the cost associated with readmission is important for senior leaders and policy makers to improve health care outcome.
Tetteh, Dinah A. "U.S. Newspapers Coverage of The 2009/10 Healthcare Reform Debate: A Content Analysis". Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etd/1256.
Pełny tekst źródłaZhao, Hongwen, i zhaohongwen@nhei cn. "Governing the healthcare market: Regulatory challenges and options in the transitional China". La Trobe University. Public Health, 2005. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20080131.100619.
Pełny tekst źródłaGarcia, Tanisha. "Associations Between Leadership Style and Employee Resistance to Change in a Healthcare Setting". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2536.
Pełny tekst źródłaHenawi, Mohammed Khaled. "Healthcare financing reform in the Kingdom of Saudi Arabia : an assessment of willingness to pay". Thesis, Aston University, 2017. http://publications.aston.ac.uk/33345/.
Pełny tekst źródłaLundberg, Maya. "Location choice of private primary healthcare providers in Sweden : After the Primary Care Choice Reform". Thesis, Umeå universitet, Nationalekonomi, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-174828.
Pełny tekst źródłaMakgatho, Adolf Tapelo. "Making sense of stakeholder responses to impending major policy reform in the private healthcare sector". Diss., University of Pretoria, 2015. http://hdl.handle.net/2263/52436.
Pełny tekst źródłaMini-disseration (MBA)--University of Pretoria, 2015.
nk2016
Gordon Institute of Business Science (GIBS)
MBA
Unrestricted
Jammoul, Nada Youssef. "Health system reform and organisational culture : an exploratory study in Abu Dhabi public healthcare sector". Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/health-system-reform-and-organisational-culture-an-exploratory-study-in-abu-dhabi-public-healthcare-sector(a0e332d3-dc09-4839-be99-698d0c0f2690).html.
Pełny tekst źródłaHon, Wai-ping Tiki. "An analysis of policy options to tackle the problem of expanding expenditure in public healthcare in Hong Kong". Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B21036640.
Pełny tekst źródłaChen, Yan, i 陈龑. "Health care financing in China : what lessons China can learn from other countries on healthcare reform?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193770.
Pełny tekst źródłapublished_or_final_version
Public Health
Master
Master of Public Health
Chen, Dongjin. "Legacies and Incentives:Explaining Variation in Local Healthcare Expenditure Variation in Post-Mao China". Kent State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=kent1343052167.
Pełny tekst źródłaArjoon, Cindy. "A Comparative Study: How Educational and Healthcare Preparedness Affected Marketization of the Chinese and Indian Economies". Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4432.
Pełny tekst źródłaFisher, Ronald L. "What Cost Hospital Quality: Performance Uncertainty Under Market Reform". VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/705.
Pełny tekst źródłaHon, Wai-ping Tiki, i 韓慧萍. "An analysis of policy options to tackle the problem of expanding expenditure in public healthcare in Hong Kong". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31965842.
Pełny tekst źródłaNew, Elizabeth. "RACISM, RESISTANCE, RESILIENCE: CHRONICALLY ILL AFRICAN AMERICAN WOMEN’S EXPERIENCES NAVIGATING A CHANGING HEALTHCARE SYSTEM". UKnowledge, 2018. https://uknowledge.uky.edu/anthro_etds/28.
Pełny tekst źródłaMelo, Daniela Tranches de. "A influência dos movimentos sociais na normatização e efetivação das políticas públicas : a experiência do Movimento Sanitário e do Sistema Único de Saúde". Universidade do Estado do Rio de Janeiro, 2013. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=7033.
Pełny tekst źródłaO trabalho parte da hipótese de que os movimentos sociais potencializam sua capacidade de pautar agendas e normatizar suas demandas quando conseguem convergir para uma agenda única. Busca-se exemplificar essa tese por meio de uma análise do Movimento Sanitário e a subsequente Reforma Sanitária. A partir da atuação deste movimento foi possível incluir uma nova forma de entender a saúde na Constituição de 1988 e sua regulamentação via Lei Orgânica da Saúde LOS , responsável pela criação do Sistema Único de Saúde SUS. O objetivo norteador do trabalho é a compreensão do motivo pelo qual algumas políticas públicas de saúde foram implementadas com sucesso enquanto outras permaneceram no papel. Argumenta-se que o fato de muitas das premissas instituídas na Lei Orgânica ainda não terem sido efetivadas tem relação, entre outros fatores, com a crescente fragmentação e institucionalização dos movimentos pela saúde, ocorrida ao longo da década de 1990. Hoje o que se observa é uma grande heterogeneidade dos atores ligados ao setor, com os novos movimentos sociais pela saúde apresentando-se de forma cada vez mais difusa. No ano em que o Sistema Único completa 25 anos, é necessário repensar suas estratégias, falhas e sucessos. Destarte, o trabalho leva à reflexão de que ao se buscar a efetivação do SUS legal é premente que doravante se retomem os princípios fundantes da Reforma Sanitária.
The study departs from the hypothesis that social movements improve their ability to bring specific themes to the forefront and to introduce new regulations when they converge around a single agenda. It illustrates this thesis through an analysis of the Sanitary Movement and the subsequent Health Reform. Their actions allowed for a new way of understanding health in the 1988 Constitution and its regulation via Health Law - LOS - , responsible for the creation of the Unified Health System - SUS. The guiding purpose of this thesis is to explain why some public policies related to healthcare were successfully implemented while others were not. In other words, the study examines the factors behind the non-effectiveness of the premises established by the LOS, indicating that this occurred in part due to the increasing fragmentation and institutionalization of the healthcare movement throughout the 1990s. Today one can observe an expressive heterogeneity in the healthcare movement with new actors presenting themselves in an ever more diffuse way. In the year that SUS turns 25, we need to rethink its strategies, successes and failures. This thesis leads to the final reflection that in order for SUS to actually work it is pressing that all actors involved in the healthcare movements return to and reclaim the Sanitary Reform founding principles.
Toffoli, Luisa Patrizia. "'Nursing Hours' or 'nursing' hours - a discourse analysis". Thesis, The University of Sydney, 2011. http://hdl.handle.net/2123/8367.
Pełny tekst źródłaWang, Mengyuan. "The way of chinese medical reform : new trends in the era of the “internet+” and big data". Master's thesis, Instituto Superior de Economia e Gestão, 2019. http://hdl.handle.net/10400.5/18585.
Pełny tekst źródłaA China é um país com uma população imensa, com recursos médicos insuficientes e distribuição desigual. Portanto, existem muitos problemas no serviço de saúde. Devido ao desenvolvimento atrasado do sistema médico, a qualidade dos recursos médicos é baixa, o custo é alto e a eficiência dos serviços médicos é baixa. Um dos principais fatores explicativos dessa situação é a falta de apoio do governo e seguro médico imperfeito. Para resolver esse problema, o governo começou a reformar o sistema de segurança médica. Desde a reforma do seguro médico de 1988, após várias mudanças, o sistema de seguro médico da China amadureceu gradualmente. A tese descreve brevemente a estrutura básica, o conteúdo e o caminho da mudança nos cuidados de saúde. E as deficiências do atual sistema de seguro médico. A análise introduz o papel da "Internet+" e da "big data" na reforma do sistema de seguro médico e avalia as potencialidades da sua introdução e operacionalização para a gestão e governança do sistema de saúde.
China is a population republic country has insufficient medical resources and uneven distribution. Therefore, there are many medical problems. Due to the backward development of the medical system, the quality of medical resources is poor, the efficiency of medical services is low, and the cost is high, which brings many difficulties for the Chinese people to seek medical treatment. However, one of the main factors of these problems is the lack of government support and imperfect medical insurance. To solve this problem, the government began to reform the medical security system. Since the 1988 medical insurance reform, after several changes, China's medical insurance system has gradually matured. The thesis will briefly describe the basic framework, content and path of change in health care. And the shortcomings of the current medical insurance system. According to the characteristics of the times, talk about the impact of "Internet +" and "Big Data" on the current Chinese industry, including people's lives. Therefore, the analysis introduces the positive role of big data Internet for the reform of medical insurance system, and provides convenience for the management and governance of medical insurance system. Analyze whether "Internet +" and "Big Data" can lead to new trends in the reform of the health care system.
info:eu-repo/semantics/publishedVersion
Yamada, Go. "Input-output analysis on the economic impact of medical care in Japan". 京都大学 (Kyoto University), 2016. http://hdl.handle.net/2433/215218.
Pełny tekst źródłaSchimmel, Noam. "Presidential rhetoric justifying healthcare reform : continuity, change & the contested American moral order and social imaginary from Truman to Obama". Thesis, London School of Economics and Political Science (University of London), 2013. http://etheses.lse.ac.uk/779/.
Pełny tekst źródłaLENAKAKI, Angeliki. "Why do Traditional Performance Management Systems in Healthcare not always lead to Improved Performance? Outlining the Unintended Consequences of the Greek Healthcare Reform in a Public Hospital through a Dynamic Performance Management Approach". Doctoral thesis, Università degli Studi di Palermo, 2021. http://hdl.handle.net/10447/514805.
Pełny tekst źródłaResearchers all around the globe have not yet come to an end as regards the supposed positive impact of traditional performance management systems in healthcare, and some research has shown that, paradoxically, performance management policies do not always lead to improved hospital performance. Despite the extensive research identifying the “pitfalls” of the NPM reforms around Europe and the unintended consequences for hospital staff and patients, little is known about the mechanisms that caused those negative effects, which essentially creates a research gap worth investigating. This PhD study tries to address this gap and show why do traditional PM Systems in healthcare not always lead to improved performance, by outlining the unintended consequences of the Greek healthcare reform in a public hospital. By conducting empirical research using a case-study, and by adopting a systemic perspective, this research addresses this gap and sheds light on how hospital performance is perceived by stakeholders of a Greek public hospital and what mechanisms drive its dynamic behaviour. Following a systemic approach, the selected case study - which is a real hospital in the Greek Healthcare system - allowed us to investigate the causing mechanisms of the negative consequences of the Greek healthcare reform on the performance of the case hospital. In doing so, we framed our analysis using the Dynamic Performance Management methodology. Recently, researchers have started to see those negative outcomes as “system pitfalls”, occurring from the non-linear interconnection and the dynamic interaction of the different elements and factors that comprise the health system and the healthcare institutions, i.e., their structure, the policies implemented, the behaviour and the decisions of healthcare workers and patients inside this system. The implementation of a systemic performance assessment methodology in Healthcare is sponsored by many recent scholarly contributions in the field (Arnaboldi et al., 2015; Costanza et al., 2014; Bivona, 2010, 2015; Bivona & Cosenz, 2017a, 2017b; Bivona & Noto, 2020; Davahli et al., 2020; Franco-Santos & Otley, 2018; Fryer et al., 2009; Helal, 2016; Renmans et al., 2017; Mwita, 2000; Noto et al., 2020; Vainieri, Ferrè, et al., 2019; Vainieri, Noto, et al., 2020; Wang et al., 2020). Adopting a systemic perspective means taking as a unit of analysis the organisation as a whole, and not one unit or department; acknowledging its internal and external environment and culture in which health care is performed; and considering the concurrent existence of the pitfalls documented as inherent to the structure of the system and the policies implemented. Studies using such a methodology would be necessary in order to address the gap in existing knowledge, as well as to support policy-makers in designing better, more quality-oriented healthcare policies, interventions and reforms in the future. The purpose of this study was to empirically conceptualise a qualitative model of hospital performance as perceived by stakeholders of a Greek public hospital and use the DPM analysis in order to help policymakers in Greece re-design performance management policies and foster hospital performance. We adopted a systemic, participatory, inductive and dynamic approach by combining the Group Model Building and System Dynamics methodologies into the Dynamic Performance Management approach (Bianchi, 2016). Other research traditions identified in our study are the Stakeholders Theory and Participation. All those approaches stand in the constructivist side of the continuum as research approaches, because they all consider realities as subjective, complex and multi-layered, actively shaped by perceptions and opinions of stakeholders (De Gooyert, 2019; Lane & Schwaninger, 2008). Mixed methods were used to facilitate our approach, combining primary qualitative data from two Group Model Building sessions; four open, unstructured preliminary interviews; and seven semi-structured, disconfirmatory interviews; with secondary, qualitative and quantitative data from a scoping literature review and from a critical literature review; as well as from official, open-access, online text-documents and closed-access, internal text-documents of the hospital’s interdepartmental communication. An open call for participation in the research was sent by email to around 70 different hospitals in the cities of Athens and Thessaloniki in Greece, and the gatekeeper was identified. Starting from the gatekeeper, snowball sampling was used to select 10 participants in the case hospital for the Group Model Building (GMB) sessions, including at least one person from each main key-stakeholder category that our extensive stakeholder analysis identified (i.e., managers, doctors, nurses, paramedics and patients), with the purpose of “eliciting” their mental models and “capturing” them in a qualitative system dynamics model (causal loop diagram). Four of the participants were also interviewed before the GMB sessions (face-to-face, one-to-one preliminary interviews). Convenient sampling was used in order to identify seven more public hospital stakeholders from other public hospitals in Greece for the disconfirmatory interviews. The data analysis included a Scoping Review of the International Literature of Performance Management in the Health Sector; a Critical Review of the Literature on the Greek Healthcare Reform; a Stakeholder Analysis; a Narrative Analysis of Preliminary Interviews and Documents; a Qualitative System Dynamics Analysis (Causal Loop Diagram) of the Simplified version of the Conceptual Model of Hospital Performance created during the GMB sessions; and, finally, the Dynamic Performance Management (DPM) analysis. The GMB sessions helped hospital stakeholders gain a better understanding of what hospital performance is in a more systematic way; define it; show its trend (dynamic behaviour) in the hospital during the last decade in a diagram; and conceptualise it as a system, depicted as a qualitative system dynamics model of hospital performance (CLD - Causal Loop Diagram). The two final versions of this CLD Model (i.e., the Conceptual and the Policy Models of Hospital Performance, available in Appendixes 21 and 22 respectively and thoroughly described in terms of the variables and links they contain in Appendix 24) are the main outputs of the GMB sessions, and formed the basis of our analysis and research findings. The Conceptual Model of Hospital Performance is a CLD model that depicts the actual structure of hospital performance and can be used to explain its currently low levels, whereas the Policy Model of Hospital Performance is extended to incorporate the policy structure, i.e., the changes in the system structure which are necessary, according to our participant stakeholders, in order to improve hospital performance. Hospital performance was defined by the participant stakeholders as the provision of patient-centred care to the patient, with safety (for the patients and the staff); responsibility (adherence to protocols, proportions and procedures) and dignity (nice and clean facilities, reduced waiting times and no informal payments). The historical trend of the Hospital performance in the case hospital was also depicted in a diagram over time called Reference Mode (available in Appendix 19). The Reference Mode created and agreed upon by the participants showed that, despite the counterintuitive negative outcomes documented, the level of the overall performance in the case hospital has been slightly increasing after the healthcare reform and is now stabilizing. Our research showed that the Performance Management policies introduced during the Greek healthcare reform had a negative impact on many aspects of hospital performance in general, and in our case hospital in particular. The new policies undeniably contributed to the reduction of hospital spending, but they simultaneously contributed to the deterioration of hospital service quality. Goal-setting, the main PM strategy followed by Greek public hospitals according to Law N4369/16, is until today not properly implemented in the case hospital and managers seem to treat performance objectives as completely separated from performance and quality, and to consider them totally outside of their everyday tasks. Those findings of the preliminary interviews and documents analysis were validated from the findings of the pretests, conducted before the GMB sessions. Four of the goals that were set by the division managers of the case hospital came up during the GMB sessions and were integrated in the CLD model that the participants built: Standardization of the nursing forms of the nursing departments and units; Standardization of clinical procedures; Use of an Information System in the Interdepartmental Communication; and Application of digital signature and electronic document management. We combined our findings from the documents’ analysis with the descriptions of those goals, as set by the division managers, and we informed them with the findings from our DPM instrumental and objective analysis, which allowed us identify the activities and the resources that are needed for the achievement of each of those four goals. In that respect, we found that apart from the “tangible” strategic resources identified by the managers of the case hospital (e.g., financial and human resources) as essential in the achievement of each of those four goals, Management Capacity - which is an intermediate, administrative product of the hospital, built by the public workers - was equally necessary. Out of all the unintended negative outcomes of the Greek healthcare reform documented in the literature, we found the following seven negative outcomes to be present at the case hospital: (1) Low Quality and Safety of Services perceived by health workers and patients; (2) Low Patient Satisfaction; (3) Informal Payments; (4) High Mortality Rates; (5) Numerous Medical Errors; (6) High Nosocomial & Multidrug-Resistant Bacteria Infections Rates; (7) Low adherence to Clinical Guidelines and Treatment Protocols. Regarding those seven negative outcomes, the analysis of the simplified version of the Conceptual Model of Hospital Quality which the participant stakeholders created during the GMB sessions at the case hospital, showed that: (1) Low Quality and Safety are mostly associated with the variables Survival Rate / Patients' Health Status & Quality of Life and Complications of our model, and can be explained by the dominance of the balancing loops B3 - Actual Time Available & Errors, and B4 - Actual Time Available and Adherence to Guidelines & Protocols, both of which cause those two variables to decrease as in the Limits to Success archetype, resulting at less Proper Communication & Attendance to Patients’ Needs, more Errors and Complications, longer Length of Stay, higher Nosocomial Infections Rate, and, finally, to lower Survival Rate and Patients’ Health Status & Quality of Life after treatment (Dynamic Hypothesis 1). (2) Low Patient Satisfaction can be explained by the dominance of the loops B1 – Word of Mouth & Waiting Times, B2 – Patient Satisfaction & Attendance to Patients’ Needs, B3 - Actual Time Available & Errors, and B4 - Actual Time Available and Adherence to Guidelines & Protocols, all of which lead to a gradual decrease and stabilisation of Patient Satisfaction and of Hospital Reputation in the long run as in the Limits to Success archetype, resulting at less Proper Communication & Attendance to Patients’ Needs, more Informal Payments for early Surgery/Admission longer Waiting List for Surgery or Admission, longer Waiting Time in ER & Outpatient Services and, finally, to lower Survival Rate and Patients’ Health Status & Quality of Life after treatment. (Dynamic Hypothesis 2). (3) The existence of Informal Payments can be explained by the Loop R2 – Informal Payments & Corruption, which leads to a perpetual increase of private spending and to the outspread of corruption between the case hospital doctors, given the good reputation of the case hospital and the long waiting lists that are already in place. This phenomenon is sustained by the current policies in place, which favour the creation of long waiting lists. However, this phenomenon is also sustained by factors external to the case hospital and to our model, such the relative tolerance of the Ministry of Health and of the authorities, and the widespread idea between patients in Greece that informal payments are necessary for a timely and proper treatment. (Dynamic Hypothesis 3). (4) High Mortality Rates can be explained by the Loops B3 - Actual Time Available & Errors, and B4 - Actual Time Available and Adherence to Guidelines & Protocols, both of which lead to a gradual decrease and stabilisation at a low level of the Actual Time Available per Patient and of the Adherence to Guidelines & Protocols in the long run as in the Limits to Success archetype, resulting at less Proper Communication & Attendance to Patients’ Needs, more Errors and Complications, longer Length of Stay, higher Nosocomial Infections Rate, and, finally, to higher Failure & Mortality Rates. (Dynamic Hypothesis 4). (5) Numerous Medical Errors can be explained by the Loop B3 - Actual Time Available & Errors, which leads to a gradual decrease and stabilisation at a low level of the Actual Time Available per Patient and of the Adherence to Guidelines & Protocols in the long run as in the Limits to Success archetype, resulting at higher Difficulty of Shift Schedule for nurses and doctors, less Proper Communication & Attendance to Patients’ Needs and, finally, to more medical, nursing and patients’ Errors (Dynamic Hypothesis 5). (6) High Nosocomial & Multidrug-resistant bacteria Infections Rates can be explained by the loops R5 – Multidrug Resistance in the General Population and B4 - Actual Time Available and Adherence to Guidelines & Protocols, both of which cause Nosocomial Infections to increase in the long run, resulting at more Complications and higher Multidrug Resistance in the General Population (Dynamic Hypothesis 6). (7) Low Adheremce to Clinical Guidelines and Treatment Protocols can be explained by the loop B4 - Actual Time Available and Adherence to Guidelines & Protocols, which leads to a gradual decrease and stabilisation at a low level of the Actual Time Available per Patient in the long run, as in the Limits to Success archetype, resulting at increased Difficulty of Shift Schedule for nurses and doctors, low Availability of Equipment, ICT, Standard Procedures & Digital Forms and, finally, to low Adherence to Guidelines & Protocols. In order to test those seven hypotheses, a quantified SD model (a stock-flow diagram) would be needed, as that would enable us to run simulations and test our hypothesis in different scenarios to analyse the loop dominance. Such a model is out of the scope and purposes of the present, qualitative study and is not included, but is recommended for future research. However, we used the Dynamic Performance Management analysis as an alternative method, in order to: (1) identify Strategic Resources, Performance Drivers and End Results of hospital performance and show their role in the hospital performance management and measurement; (2) show how the time factor influences the overall hospital performance; (3) understand the contribution of each one of the four hospital divisions (the Medical, the Nursing, the Administrative & Financial and the Technical division) on the End Results (i.e., the final hospital services produced); (4) allow the division managers to start concentrating on the core intermediate, administrative products that divisions are required to deliver on the process that leads to the final end-results; (5) map the ultimate and intermediate services value chain provided to both external and internal users of the case hospital; (6) make performance measures (i.e., the drivers and end-results associated with the delivery of products) explicit and then link them to the goals and objectives of the division managers of the case hospital; (7) discuss the insights that the DPM analysis offers us for a sustainable Performance Management in Greek public hospitals in general, and in the case hospital in particular. The identification of Strategic Resources, Performance Drivers and intermediate End Results, as well as the different views that our DPM analysis offered (i.e., instrumental, dynamic, subjective, objective) provided the hospital decision-makers with signs of potential future shift in End Results, and can help public hospital managers in Greece interpret and calculate the consequences of an incident or the implications of a policy; show possible discrepancies on performance; and try to mitigate it. The performance measures we identified could be helpful to foresee possible changes in the financial and clinical results of public hospitals in Greece. When framed in a wider sense than budgetary control, transaction cost drivers can provide hospital managers and policy makers in Greece with valuable information for strategic planning, such as the opportunity to identify trade-offs in space and in time (e.g., higher costs for investments and for managerial capacity building in the short-run, versus investments in equipment, ICT, and facilities that would increase performance in the long run). Thus, the performance management policies adopted at the case hospital during the healthcare reform ( i.e., structure and process reforms undertaken) and their overall impact for Greek public hospitals’ outputs and outcomes, can now be examined through a different “lenses” by the hospital managers; lenses that will allow them overcome the seven counterintuitive, negative outcomes documented, and align the hospital’s and the different division’s and departments’ goals and actions to achieve improved efficiency and effectiveness, along with better hospital service quality for patients.
Guimar?es, Shyrley Bispo. "A atua??o do psic?logo no contexto das refer?ncias ambulatoriais em sa?de mental de Aracaju - SE". Universidade Federal do Rio Grande do Norte, 2011. http://repositorio.ufrn.br:8080/jspui/handle/123456789/17475.
Pełny tekst źródłaConselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico
Psychologists‟ insertion in mental healthcare ambulatory clinics occurred during the decade of 1980, in the context of the claims disseminated by sanitary and psychiatric reforms, of the formation of minimum mental healthcare teams and of the retraction of the private clinic. Historically, this migration had been accompanied by the importation of practices traditionally applied at the clinics. Furthermore, the lack of clear guidelines from the Health Ministery occasioned the opening of ambulatory clinics with diversified structures at each city. The objective of this dissertation was to study the practices of psychologists at mental healthcare ambulatory references at Aracaju-SE. Were interviewed psychologists of these services and managers of the municipal health secretary using a semi-structured interview guideline, in addition to the analysis of management reports. It was observed that the mental healthcare references had experienced substantial changes referred to its structures and operation, leading to a present framework of expansion and readjustment. It was realized that there is an effort by the psychologists to maintain individual and group assistance, using adjustments in the frequency of the sessions and in the focus of the activities. Besides the progresses, the relation with the psychiatrist still works basically through the medical record, blocking advances on joint discussions of the cases. Some advances toward the amplified clinic are notable, like the overcoming of the isolated usage of psychiatric diagnostic and the replacement of the line‟ criterion by the urgency one. Sheltering had become an interesting strategy on flux ordination, however the mismatch between offer and demand seems to be a matter which extrapolates the psychologists‟ sphere at the references. For this reason the narrow of the relation with family healthcare centers seems to be the major challenge to be faced by psychologists at mental healthcare ambulatory references
A inser??o do psic?logo nos ambulat?rios de sa?de mental ocorreu na d?cada de 1980, no contexto das reivindica??es propagadas pela reforma sanit?ria e psiqui?trica, da forma??o de equipes m?nimas de sa?de mental e da retra??o da cl?nica privada. Historicamente, essa migra??o foi acompanhada da importa??o de pr?ticas tradicionalmente aplicadas no consult?rio. Ademais, a falta de diretrizes claras por parte do Minist?rio da Sa?de ocasionou a abertura de ambulat?rios com estruturas diversificadas em cada munic?pio. O objetivo desta disserta??o foi estudar a atua??o do psic?logo nas Refer?ncias Ambulatoriais em Sa?de Mental de Aracaju-SE. Foram entrevistados psic?logos desses servi?os e gestores da secretaria municipal de sa?de a partir de roteiro semiestruturado, al?m da an?lise de relat?rios de gest?o. Observou-se que as Refer?ncias em Sa?de Mental sofreram transforma??es substanciais quanto ? sua estrutura e funcionamento, levando a um quadro atual de expans?o e de readequa??o. Percebeu-se um esfor?o por parte dos psic?logos em manter os atendimentos individuais e de grupo, a partir de ajustes na frequ?ncia nas sess?es e no foco das atividades. N?o obstante os progressos, a rela??o com o psiquiatra ainda se processa basicamente pelo prontu?rio, impedindo de avan?ar na discuss?o conjunta dos casos. S?o not?veis alguns avan?os em dire??o ? cl?nica ampliada, como a supera??o do uso do diagn?stico psiqui?trico de forma isolada e da substitui??o do crit?rio fila pelo de urg?ncia. O acolhimento tornou-se uma estrat?gia interessante de ordena??o do fluxo, por?m o descompasso entre oferta e demanda parece ser uma quest?o que extrapola o ?mbito dos psic?logos das refer?ncias. Por essa raz?o, o estreitamento da rela??o com as unidades de sa?de da fam?lia parece ser o maior desafio a ser enfrentado pelos psic?logos das Refer?ncias Ambulatoriais em Sa?de Mental