MARIO CESAR SCHEFFER
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- Financialization in healthcare(2022) BAHIA, Ligia; SCHEFFER, Mario
- O capital estrangeiro e a privatização do sistema de saúde brasileiro(2015) SCHEFFER, Mario
- Beyond the Mais Medicos (More Doctors) Program(2016) SCHEFFER, Mario
- The multiple uses of telemedicine during the pandemic: the evidence from a cross-sectional survey of medical doctors in Brazil(2022) SCHEFFER, Mario; CASSENOTE, Alex; ALVES, Maria Teresa Seabra Soares de Britto E; RUSSO, GiulianoBackground The use of telemedicine, or the provision of healthcare and communication services through distance-based technologies, has increased substantially since the 2019 novel coronavirus (COVID-19) pandemic. However, it is still unclear what are the innovative features of the widespread use of such modality, its forms of employment and the context in which it is used across pluralist health systems, particularly in low- and middle-income settings. We have sought to provide empirical evidence on the above issues by analysing the responses of medical doctors in a representative cross-sectional survey in two states in Brazil: Sao Paulo and Maranhao. Methods We analysed the responses of 1,183 physicians to a survey on the impact of COVID-19 on their livelihood and working practice. Two independent samples per state were calculated based on a total of 152,511 active medical registries in Sao Paulo and Maranhao. Proportional stratified sampling was performed and the distributions for gender, age, state and location of address (capital or countryside) were preserved. The survey contained questions on the frequency of physicians' employment of telemedicine services; the specific activities where these were employed, and; the forms in which the pandemic had influenced the adoption or consolidation of this technology. We performed descriptive and univariate analysis based on the chi-square test or Fisher's exact test for the qualitative data, and the Mann-Whitney test in the quantitative cases. Data were shown as absolute frequency and proportion with a 95% confidence interval. Results In our sample of physicians, telemedicine was employed as a form of clinical collaboration by most doctors (76.0%, 95 CI 73.6-78.5), but only less than a third of them (30.6%, 95 CI 28.0-33.3) used it as a modality to provide healthcare services. During the pandemic, telemedicine was used predominantly in COVID-19-related areas, particularly for hospital-based in-patient services, and in private clinics and ambulatory settings. Male, younger doctors used it the most. Doctors in Sao Paulo employed telemedicine more frequently than in Maranhao (p < 0.001), in urban settings more than in rural areas (p < 0.001). Approximately three-quarters of doctors in large hospitals reported using telemedicine services (78.3%, 95 CI 75.9-80.6), followed by doctors working for smaller private clinics (66.4%, 95 CI 63.7-69.1), and by a smaller proportion of primary care doctors (58.4%, 95 CI 55.6-61.2). Conclusions Our study suggests that telemedicine may have helped ensure and expand the range of communication and healthcare services in low- and middle-income settings during the COVID-19 pandemic. However, the modality appears to lend itself to be disproportionally used by doctors working in specific, priviledged sections of pluralistic health systems, and presumably by patients seeking care there. Regulation and incentives will be required to support the use of the technology across health systems in low- and middle-income countries in order to increase access to services for less disadvantaged populations.
- Assessing burn care in Brazil: An epidemiologic, cross-sectional, nationwide study(2018) CITRON, Isabelle; AMUNDSON, Julia; SALUJA, Saurabh; GUILLOUX, Aline; JENNY, Hillary; SCHEFFER, Mario; SHRIME, Mark; ALONSO, NivaldoBackground: The aim of this study was to describe the national epidemiology of burns in Brazil and evaluate regional access to care by defining the contribution of out-of-hospital mortality to total burn deaths. Methods: We reviewed admissions data for Brazil's single-payer, free-at-point-of-care, public-sector provider and national death registry data abstracted from DATASUS for 2008-2014. Admissions, in hospital mortality, hospital reimbursement, and total deaths from the death registry were assessed for records coded under ICD-10 codes corresponding to flame, scald, contact, and electrical burns. Results: A total of 17,264 burn deaths occurred between 2008-2014 (mean annual 2,466 [SD 202]). Of all burns deaths 79.1% occurred out of hospital, with marked regional differences in the proportion of out-of-hospital deaths (P < 0.001), the greatest being in the North region. The mean annual number of admissions >24 hours was 18,551 (SD 1,504) with the greatest prevalence of flame burns overall (43.98%) and scalds prevailing in < 5 years (57.8%). Regional differences were found in per-capita admissions (P < 0.001) with the greatest number in the Central-West region. A mean of $1,022 (SD $94) US dollars was reimbursed per burn admission. Conclusion: Given that nearly 80% of burns mortalities occurred out of hospital, prevention of burns along-side interventions improving prehospital and access to care have potential for the greatest impact.
- Planos privados de saúde com coberturas restritas: atualização da agenda privatizante no contexto de crise política e econômica no Brasil(2016) BAHIA, Ligia; SCHEFFER, Mario; POZ, Mario Dal; TRAVASSOS, Claudia
- Surgical care in the public health agenda(2017) SCHEFFER, Mario; SALUJA, Saurabh; ALONSO, NivaldoThe current article examines surgical care as a public health issue and a challenge for health systems organization. When surgery fails to take place in timely fashion, treatable clinical conditions can evolve to disability and death. The Lancet Commission on Global Surgery defined indicators for monitoring sustainable universal access to surgical care. Applied to Brazil, the global indicators are satisfactory, but the supply of surgeries in the country is marked by regional and socioeconomic inequalities, as well as between the public and private healthcare sectors.
- The entry of foreign capital into the health system in Brazil(2022) SCHEFFER, Mario; SOUZA, Paulo Marcos SenraThe study describes the history of legislation, analyzes the trajectory and the amount of foreign capital in the Brazilian health system. The Organic Health Law restricted the participation of foreign capital; sectoral legislation, however, allowed its subsequent entry into supplementary medical care and, in 2015, a new law promoted unrestricted openness, including in hospitals and healthcare services. Our study analyzes documents, legislation, and data obtained from secondary public bases or via the Law on Access to Information. Direct investments and merger and acquisition acts in the private health sector were considered. Five phases were identified: inaugural planning, regulated expansion, legal restriction, sectorized release, and expanded opening. From 2016 to 2020, the amount of foreign resources entering the country's healthcare services was almost ten times more than the previous five-year period. Thirteen companies or funds were identified, most of them from the United States. Regulation allowing for the opening of foreign capital were preceded by business lobbies and public-private interactions that can affect the quality of public policies and the integrity of the legislative process. The invested capital seeks established and profitable companies in various segments of activity. Admission occurs in non-universal private care networks, which serve specific, geographically concentrated clientele. We conclude that foreign capital, an element of health financialization process, is expressed as a possible vector of the expansion of inequalities in the population's access to health services and as an additional obstacle to the consolidation of the Brazilian Unified National Health System.
- More Doctors Program: in search of satisfying answers(2015) SCHEFFER, Mario
- O SUS e o setor privado assistencial: interpretações e fatos(2018) BAHIA, Ligia; SCHEFFER, MarioABSTRACT The essay discusses problems to reflect on, identify contradictions, as well as discern and formulate political strategies on the privatization of the health system in Brazil, especially the multiple meanings of the Unified Health System (SUS) and about what is public and what is private. It is observed that the relations between public and private seized only by measures (quantity of units, activities and human and financial resources) are underlying interests and negotiations between agents and their political decisions and difficulties to discern the structural features of an unequal health system and segmented from the political conjunctures that reproduce them. Thirty years after the 1988 Constitution, there have been advances, impasses and setbacks, as well as adjustments in the understanding of the SUS and the private sector.