??????? s?ed?as

1
??????? s?ed?asµ?? ??a t?? ?a????? ß?µata ?a?
??µata
?. ?. Staµ?t??   ???t??? 2009
2

• ??µ? pa???s?as??
• ? e?d?p???? d?af??? ap? t?? ???e? ???e? t?? ??.
• ?p? s??d?? p????se?? se p????aµµa d??s??.
• ??t??a??????? ??s???µe??.
• ?????????? ???t?? ???pe?a? ??p???

3
Cancer control plans - EU-27 and EEA countries
Source www.acs.min-saude.pt
4

• ???p??µe t? das??
•   
• ? ???e??? s?????t?µ???? s?st?µat?? ??a t??
  ?a????? e??a? ap?t??esµa t?? d???t?µ?µ????
  non-system.
•  
• s?st?µa p??t?ß??µ?a? f???t?da?
• saf?? d?a????sµ?? p??t?ß??µ?a?, de?te??ß??µ?a?
  ?a? t??t?ß??µ?a? pe???a????  
• s?st?µa pa?ap?µp??
• s?st?µa p????f?????
• d?asf???s? p???t?ta? ?a? asf??e?a?
• ???µ?st??? p?a?s??

5

• S?µf????µe ?t? ? ??e?a e??a? a?a?? d?af??et???
  ap? ta ???a
•  
• ?e? ?p???e? e?e??e?? a???? ??a ?p??es?e?
  ??e?a?. ??s??t? µ????? ??a ??????????? ?p??es?e?!

• ????ap??? ????? t?? ???t???
• - ?a????a? ?p??es??? ??e?a?
• - ?a????a? ?p??es??? d?µ?s?a? ??e?a?
• ???µat?d?t?? ? a???ast??
• ???µ?st????
• - ?p?te?????

6
American States with Certificate of Need Programs
7
?????????? ???t?? ???pe?a? ??p??? ?????e?s? ????
as?e??? 2006 - 2008
2006 2007 2008
????????p???? 84 84 81
????????p???? 4 5 6
????te? ????? ?.?. 9 9 11
????te? ????? ????? 3 2 2
S????? 100 100 100
8
(No Transcript)
9
(No Transcript)
10
Monthly and Median Costs of Cancer Drugs at the
Time of Approval by the Food and Drug
Administration (FDA), from 1965 through 2008
Bach P. N Engl J Med 200910.1056/NEJMhpr0807774
11

• ???e? a?t? T?µ??, ????e, ??? ??daµe? p?? ?p??e??
  p?? d???µe?a t?? ?d?? e?d??a? (????. 145)
•  
• St???? st?at?????? ??a t?? ?a?????
•  
• ?e??s? ???s?µ?t?ta?
• ????s? ep?ß??s??
• Te?ape?a ep?st?µ????? te?µ????µ??? ?a?
  ??????µ??? ap?te?esµat??? ?a? ß??s?µ?
• ?s?t?ta p??sßas??

12

• ??de??t??? s???e???µ??a ß?µata ??a t?? ????a
  ?e?ape?a
•  
• ?????aµµa ?p?t??f??? ??a ste????s? t?? ?T
  µ???d??.
• ??d???t?ta ??s??e?t???? ????????a? ap? t? ?????.
• ??a?????s? t?? e?d???t?ta? t?? a?a???f?st????
  ?at?????.
• ?p?t??f?e? se ?at???? ??a ?a ap??t?s??? t??
  e?d???t?ta t?? a?a???f?st???? ?at?????.
• ?p?p??s?et? et?s?a ??????a st??? ?? ?a? ??S???F
  ??a s???e???µ??? ?a? s?µf???µ??? ep??tas? t??
  ?p??es??? ?at ????? ??s??e?a? 365/24.
• ?p?p??s?et? ??????a st??? s??d?sµ??? (ap? ??????)
  µe s??p? t?? d?µ??????a ?a? ?e?t?????a hospice
  st? ?eµes?.

13

• ??t??a??????? ??s???µe??
•  
• ?? d???t?µ?µ??? non-system ?a? ?
  ?ata?e?µat?sµ?? de? µp????? ?a a?t?µet?p?st???
  d?af??et???
•  
• ?? ???sµ?? est?as? st?? ?a?????, p??t?st? µ???µa
  ?? ?a?????pa?e??
•  

14
??t??a??????? ??s???µe??
??e??e?t?µata ??a t??? as?e?e??
??st?? ?e?t?????a?
??e?d??e?s?
??????G?S?
??µ???s? / s?ss??e?s? eµpe???a?
????? ???????? ?p??es???
?p?pt?se?? se ?????? pa???e??
15

• ?????????? ???t?? ???pe?a? ??p???
•  
• ??e? ed?a??se? ?????te????? ?p?d?µ?, a????p???
  d??aµ??? ?a? s?st?µata ??a s??????e? ?e?ape?e?
  (??T ?a? ?T)
• ??e? s?????t?se? ???s?µ? µ??a e?d???? ?at??? ?a?
  ????? ep?st?µ???? ?? ?p???? as??????ta?
  ap???e?st??? µe t? ?e?ape?a t?? ?a??????
• ??e? ???a??se? e?e?d??e?µ??e? µ???de? µe ßa??te??
  e?e?d??e?s? st?? ????e? µ??f?? ?a??????
• ???????e? t?? e?ß?se?? t?? ?e?ape??? t??
• S?µß???e? ?a????st??? st?? a?aß??µ?s? t??
  p??sd????? ?a? t?? ?p??es???
•  
• ?d? ed?a??µ??? st? s??e?d?s? p???t?? ?a?
  ?at??? ?? ???t??? a?af???? ???? ?a? t??
  s?ss??e?µ???? s a?t? ???s?? ?a? eµpe???a?.
•  
• ???ed??? ??S

16
?a?????te? p?? d?aµ??f????? t?? p??te?a??t?te?
?a? t? ?a?a?t??a t?? ??????????? ???t???
?????S
S?S???? ??????S / ??????O?
???S??S ??? ?? ??????????

• S?S???? ??????????S?S OKTK
• ???t??
• ???pe?a ??p???

• Saf??e?a ?p???e?se?? p??? t? ????????? s?????
• ???sd???e? t?? as?e???
• ?a?µ?? a?t???µ?a?
• S?st?µa ????d?s?a?
• S???pe?e? ap? e?de??µe?? ap?t???a

Adapted from A. Harding and A. Preker,
Understanding Organisational Reforms, World Bank,
2000