This field research aimed to identify healthcare integration among four twin cities in Paraná State, Brazil, the determinants of cross-border movements of foreigners, and the obstacles to such integration. Data were collected through in-depth interviews with key informants that were analyzed with thematic content analysis. The results showed that asymmetries in the structure, resources, supply, and quality of the network's health services are determinants of cross-border movements. The experiences with integration are limited basically to emergency measures in health surveillance. Working groups are formed with limited case-resolution capacity, depending on personal, non-institutionalized initiatives. Public underfinancing is a limiting factor for access to health services. Municipal health services managers play a leading role in border areas, and they should be acknowledged as international political actors.

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This essay has the aim of updating discussions on the political perspective and the role played by the World Bank in the development of public health policies in Brazil, seeking to identify continuities and changes in the way this institution acts and suggest hypotheses about action strategies in this new century. To do this, we analyzed a 2007 and a 2013 document published by that institution, and gather data on projects funded by the World Bank from 2000 to 2015 in Brazil, with emphasis on the healthcare industry. We concluded that the traditional mechanisms of action have not changed from those used in the 1980s and 1990s, as well as the guiding principles; what we observed is that the World Bank's actions have shifted from the national level to the state and municipal level. We indicate the need for specific studies of the agreements between the Bank and subnational governments, since the Brazilian federative model and the national health system itself allow implementing decentralized management mechanisms that can alter the setting of the Unified Health System. Keywords: Inter-American Development Bank; Health Care Reform; Brazilian National Health System; Right to Health. Maria Lucia Frizon Rizzotto

RESUMO: Trata-se de pesquisa realizada com o objetivo de construir um instrumento de avaliação para idosos. A pesquisa foi desenvolvida entre março e setembro de 2007 por meio de revisão de literatura, identificação e análise de diferentes instrumentos/escalas propostos para avaliação funcional. A partir da análise de nove escalas, construiu-se o Instrumento de Avaliação Sócio-funcional em Idosos, que se compõe de duas partes, a primeira visa obter dados de identificação, representação do estado de saúde e desempenho social dos idosos; a segunda busca realizar a avaliação funcional propriamente dita. O instrumento foi avaliado por quatro juízes e posteriormente aplicado em 10 idosos com diferentes graus de dependência. Mostrou-se de fácil aplicação e útil na identificação dos fatores que interferem na saúde do idoso e na avaliação do grau de dependência, fornecendo subsídios para o planejamento do trabalho em saúde e para a assistência à pessoa idosa.ABSTRACT:The objective of this study is to build a socio-functional evaluation instrument for elderly people. The research was developed between March and September of 2007 through a literature review, identification, and analysis of different instruments/scales proposed for functional evaluation. From the analysis of nine scales, the Socio-Functional Evaluation Instrument for Elderly was constructed. It is composed of two parts. The first one seeks to obtain identification information, representation of their health states, and social performance of the elderly. The second seeks to complete the functional evaluation per se. The instrument was evaluated by four judges and was then applied to ten elderly people with different levels of dependency. Its easy application and use in identifying factors that interfere in elderly health, as well as evaluating dependency levels were proven, providing sources for planning elderly health care work. RESUMEN:Se trata de una investigación realizada con el objetivo de construir un instrumento de evaluación para ancianos. La investigación fue desarrollada entre marzo y septiembre de 2007, por medio de la revisión de literatura, identificación y análisis de diversos instrumentos/escalas propuestos para la evaluación funcional. A partir del análisis de nueve escalas, se construyó el Instrumento de Evaluación Socio-funcional en Ancianos, que se compone de dos partes: la primera, cuyo objetivo es obtener datos de identificación, representación del estado de salud y desempeño social de los ancianos; la segunda busca realizar la evaluación funcional propiamente dicha. El instrumento fue evaluado por cuatro jueces y después fue aplicado a diez ancianos con diversos grados de dependencia. Se reveló de fácil aplicación y útil en la identificación de los factores que intervienen en la salud de la persona anciana, así como, en la evaluación del grado de dependencia, ofreciendo subsidios para la planificación del trabajo en salud y asistencia a los ancianos.

RESUMO Pesquisa com abordagem qualitativa que objetivou analisar as mudanças nos processos de adesão, avaliação externa e organização do processo de trabalho de 21 equipes na 10a Região de Saúde do Paraná, as quais participaram dos dois primeiros ciclos do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). Os resultados apontaram melhor organização e registro das informações; planejamento a partir da autoavaliação e a avaliação externa como estratégia de mobilização da gestão e das equipes. Todavia, é necessário maior envolvimento das equipes na contratualização e monitoramento dos indicadores do PMAQ, assim como melhor uso das ferramentas da autoavaliação no planejamento local.