Les systèmes de soins de santé au Canada et aux États-Unis : convergence impossible?

Le Canada et les États-Unis doivent faire face à d’importantes remises en question de l’orientation de leurs systèmes de santé. Les débats dans les deux pays sont marqués par les mêmes préoccupations, notamment l’augmentation rapide des coûts, l’écart croissant entre l’étendue des services assurés, leur accessibilité et l’efficacité de leur gestion. Cet article examine l’évolution des réformes de l’assurance santé au Canada et aux États-Unis et se penche sur deux questions. En quoi les réformes de l’assurance santé entreprises dans les deux pays divergent-elles ou convergent-elles? Comment l’institutionnalisation d’un certain type de système d’assurance santé conditionne-t-il les réformes subséquentes? Il semble improbable que les systèmes de santé du Canada et des États-Unis évoluent dans le sens de la convergence. L’obstacle principal à une telle évolution réside dans la nature de leurs institutions politiques, qui conditionnent le débat politique et l’orientation de leurs politiques dans le domaine de la santé.Both Canada and the United States are facing important choices about the future direction of their health care Systems, choices that are influenced by the same basic concerns about rapid increases in health expenditures, gaps in coverage and access to health care, and problems of efficiency and effective administration. This article examines the evolution of health insurance reform in Canada and the United States and addresses two main questions. To what extent have the two countries experienced paths of divergence or convergence in their approach to health insurance reform? How has the institutionalization of a certain type of health insurance System conditioned future reform? The article concludes that, while the two Systems are experiencing similar pressures for change, it is unlikely that Canada and the United States will converge in their approach to health reform due to the configuration of political institutions and the different policy legacies in health insurance development

The Last Line of Defence for Citizens : Litigating Private Health Insurance in Chaoulli v. Quebec

Litigating health care policy under the Canadian Charter of Rights and Freedoms has become an increasingly common phenomenon. The judicialization of health policy in this form raises important questions about the general phenomenon of legal mobilization. This article examines these questions in the context of Chaoulli v. Quebec (2005), in which the Supreme Court invalidated Quebec\u27s prohibition against private insurance for medical services provided through the public health care system. Among the questions this article explores are: How do such cases get into the judicial system? Under what conditions are such claims likely to be successful? What is the impact of such litigation on the broader policy environment

The Last Line of Defence for Citizens : Litigating Private Health Insurance in Chaoulli v. Quebec

Litigating health care policy under the Canadian Charter of Rights and Freedoms has become an increasingly common phenomenon. The judicialization of health policy in this form raises important questions about the general phenomenon of legal mobilization. This article examines these questions in the context of Chaoulli v. Quebec (2005), in which the Supreme Court invalidated Quebec\u27s prohibition against private insurance for medical services provided through the public health care system. Among the questions this article explores are: How do such cases get into the judicial system? Under what conditions are such claims likely to be successful? What is the impact of such litigation on the broader policy environment

Reversal of Fortune: Litigating Health Care Reform in Auton v. British Columbia

In June 2004 the Supreme Court heard oral arguments in Chaoulli v.Quebec (Attorney General) and Auton (Guardian ad litem of) v. British Columbia (Attorney General). at issue in Chaoulli was the constitutionality of legal restrictions on the private provision of health care; at issue in Auton was the constitutionality of British Columbia’s decision not to fund a specific treatment for autism within its public health care system. Chaoulli and Auton are the most visible manifestations of an increasingly common phenomenon: The use of rights-based litigation as an instrument of health care policy reform. This paper focuses on Auton as an example of legal mobilization. It explores three key questions about the phenomenon of planned, strategic litigation: How these cases enter the judicial system? Under what conditions are they likely to be successful? What is the impact of winning — or losing — on the broader policy environment? the paper concludes with some general comments on the use of litigation for health care policy reform

Intese: il caso dei Testimoni di Geova

SOMMARIO: 1. Premessa – 2. Le due mancate intese e la discussione parlamentare – 3. L’art. 8 cpv. Cost. e il limite del non contrasto con l’ordinamento giuridico – 4. Alcune riflessioni conclusive

Foot length measurements of newborns of high and low risk pregnancies

OBJETIVO Comparar las mediciones de la longitud hallux-calcáneo de los recién nacidos en embarazos de alto y bajo riesgo en un hospital público de Goiânia, GO.MÉTODOSEstudio transversal realizado de abril 2013 a mayo 2015, cuya muestra estuvo constituida por 180 recién nacidos, 106 de mujeres con embarazos de alto riesgo y 74 de mujeres con embarazos de bajo riesgo. Los datos se analizaron de manera descriptiva. La medida de la longitud hallux-calcáneo se realizó mediante regla de plástico rígido transparente, graduada en milímetros. Se midieron en ambos pies, las longitudes de la punta del hallux hasta el final del calcáneo. RESULTADOS Se encontró una relación estadísticamente significativa entre la longitud hallux-calcáneo y el peso del recién nacido, entre las circunferencias cefálica y torácica en el grupo de alto riesgo y entre la circunferencia cefálica en el grupo control. CONCLUSIÓN Existe la necesidad de crear puntos de corte para identificar los recién nacidos con desviaciones de crecimiento intrauterino utilizando la longitud desde el hallux hasta el calcáneo.OBJECTIVE Comparing foot length measurements of newborns in high and low risk pregnancies at a public hospital in Goiânia, GO, Brazil. METHOD A cross-sectional study carried out between April, 2013 and May, 2015, with a sample consisting of 180 newborns; 106 infants of women from high-risk pregnancies and 74 of women from low-risk pregnancies. Data were descriptively analyzed. Foot length measurement was performed using a stiff transparent plastic ruler, graduated in millimeters. The length of both feet was measured from the tip of the hallux (big toe) to the end of the heel. RESULTS A statistically significant relationship was found between the foot length and newborn’s weight, between the cephalic and thoracic perimeters in the high-risk group and between the cephalic perimeter in the control group. CONCLUSION There is a need for creating cut-off points to identify newborns with intrauterine growth disorders using foot length.OBJETIVO Comparar as medidas do comprimento hálux-calcâneo de recém-nascidos em gestações de alto e baixo risco em um hospital público de Goiânia, GO. MÉTODO Estudo transversal, realizado no período de abril de 2013 a maio de 2015, cuja amostra constituiu-se de 180 recém-nascidos, 106 filhos de mulheres com gestação de alto risco e 74 de mulheres com gestação de baixo risco. Os dados foram analisados descritivamente. A medida do comprimento hálux-calcâneo foi realizada utilizando-se de régua plástica transparente rígida, graduada em milímetros. Foram medidos ambos os pés, aferindo-se o comprimento da ponta do hálux até a extremidade do calcâneo. RESULTADOS Foi encontrada relação estatisticamente significante entre o comprimento hálux-calcâneo e o peso do recém-nascido, entre os perímetros cefálico e torácico no grupo de alto risco e entre o perímetro cefálico no grupo controle. CONCLUSÃO Existe necessidade da criação de pontos de corte para identificar recém-nascidos com desvios de crescimento intrauterino utilizando-se do comprimento hálux-calcâneo

PIODERMA GANGRENOSO – RELATO DE CASO GANGRENOSUM PYODERMA – CASE REPORT

Objetivos: Relatar um caso de pioderma gangrenoso é o objetivo deste artigo, que utilizou como metodologia o levantamento de informações do prontuário médico de um Hospital Público de Goiânia, com concomitante revisão bibliográfica nos principais sites de pesquisa na área da saúde. Relato do caso: Paciente NPSC, 37 anos, feminina, branca, refere que há um ano e seis meses iniciou dor tipo queimação no dorso do pé esquerdo, seguindo-se o aparecimento de lesão ulcerada neste local. Duas semanas após, surgiu úlcera semelhante no antebraço esquerdo, ambas sem trauma prévio, com pródromos de dor local intensa, nódulos subcutâneos e evolução aguda para ulceração central de bordas delimitadas eritêmato-violáceas, com fundo necrótico e purulento. Exames de anticorpos para doenças autoimunes e para diagnóstico diferencial com tuberculose, sífilis e hepatites B e C negativos. No histopatológico da lesão: derme com infiltrado inflamatório misto (neutrófilos, eosinófilos e linfócitos); achados compatíveis com a hipótese clínica de pioderma gangrenoso. Consideracoes finais: O pioderma gangrenoso é uma dermatose autoimune crônica rara caracterizada por neutrofilia dérmica de caráter não infeccioso e não neoplásico e sem vasculite primária, com associação ou não a doenças sistêmicas de origem reumatológica, inflamatória, hematológica ou malignas. Teorias sugerem uma disfunção neutrofílica (defeitos na quimiotaxia ou hiper-reatividade). Acomete preferencialmente mulheres jovens, com pico de incidência entre vinte e cinquenta anos e tem curso frequente de exacerbações e remissões. Em 50 a 70% dos pacientes, associa-se a uma doença sistêmica de base, o que foi identificado nesta paciente, que tinha um diagnóstico prévio de lúpus eritematoso sistêmico