RESUMO
Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.
Assuntos
Reforma dos Serviços de Saúde/normas , Patient Protection and Affordable Care Act/normas , Cobertura Universal do Seguro de Saúde/normas , Chile , Humanos , Medicaid/normas , Estados UnidosRESUMO
Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.
Assuntos
Humanos , Reforma dos Serviços de Saúde/normas , Cobertura Universal do Seguro de Saúde/normas , Patient Protection and Affordable Care Act/normas , Estados Unidos , Chile , Medicaid/normasAssuntos
Tempestades Ciclônicas/economia , Atenção à Saúde/economia , Desastres/economia , Guias como Assunto , Serviços de Saúde/economia , Medicaid/economia , Medicaid/normas , Tempestades Ciclônicas/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Desastres/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Humanos , Porto Rico , Estados UnidosRESUMO
BACKGROUND: Understanding immigrants' interactions with the United States (US) healthcare system will likely make it possible to meet their healthcare needs and improve their quality of life in the US. Although challenges to accessing and utilizing healthcare in the US have been identified, there is little information specific to Brazilian-born immigrants' experiences. Brazilians comprise a fast-growing immigrant population group in the US. The purpose of this study was to explore Brazilian immigrant women's perspectives and experiences with healthcare services in the US to gain insights into factors amenable to interventions that may contribute to disparities in access to and utilization of services. METHODS: Five focus groups were conducted from April to May in 2015 using a purposeful sampling of Brazilian-born immigrant women living in Massachusetts, US. RESULTS: Thirty-five women participated in this study. Although participants expressed their overall satisfaction with the US healthcare system, they noted several barriers to care, including sociocultural differences in delivery of care and communication barriers, including inconsistent quality of interpreting services. CONCLUSIONS: This study provides new information on the experiences and challenges faced by Brazilian immigrant women in accessing and utilizing healthcare services in the US and points out opportunities for improving services and the overall health of this immigrant population. Addressing noted sociocultural differences and communication barriers including inconsistent quality of hospital's interpreting services might enhance Brazilian-born immigrants' experiences with the healthcare system.
Assuntos
Emigrantes e Imigrantes/psicologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Adulto , Brasil/etnologia , Barreiras de Comunicação , Feminino , Grupos Focais , Disparidades em Assistência à Saúde , Humanos , Massachusetts , Serviços de Saúde Materna/estatística & dados numéricos , Medicaid/normas , Pessoa de Meia-Idade , Parto , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Gravidez , Pesquisa Qualitativa , Qualidade de Vida , Estados UnidosRESUMO
Gubernatorial administrations in New Mexico have initiated four overhauls of the publicly funded behavioral health care system over the past two decades. The most recent effort, Centennial Care, was implemented under a Section 1115 Medicaid waiver in January 2014. The authors describe Centennial Care, which closely resembles the now defunct restructuring of the public system that introduced Medicaid managed behavioral health care to the state in 1997. They also note disruptions in services to clients and hardships for providers, described locally as a "behavioral health crisis," that resulted from actions taken in 2013 by the current gubernatorial administration to force the takeover of 15 nonprofit service delivery agencies by five Arizona companies. These actions led to an onsite investigation by the Centers for Medicare and Medicaid Services.