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Autore principale:	Edgar Jarillo Soto
Natura:	Artículo científico
Lingua:	es
Pubblicazione:	Universidad Autónoma Metropolitana 2005
Soggetti:	Educación Profesión médica Autonomía profesional
Accesso online:	https://www.redalyc.org/articulo.oa?id=34004408
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Sommario:

Repercusiones de los nuevos sistemas de pago profesionales en la profesión y la formación médica Edgar Jarillo Soto Juan Manuel Mendoza Rodríguez Ma. del Consuelo Chapela Mendoza Educación Profesión médica Autonomía profesional Las formas de pago y financiamiento a los proveedores de servicios médicos, especialmente a los profesionales de la salud, se han constituido actualmente en un aspecto dinamizador de los cambios que se presentan al interior de la profesión médica. El modelo tradicional de pago a un médico (proveedor) por un servicio que recibe un demandante de su servicio (paciente) está modificándose tanto por los costos que la provisión del servicio implica, como por las formas de atención. En respuesta, las organizaciones complejas públicas o privadas de atención médica desarrollan modelos de pago que rompen con la estructura tradicional. De esos modelos destacan cuatro que parecen tener mayor impacto sobre la autonomía profesional médica. En este trabajo se analizan y señalan algunas implicaciones que tienen para la formación de personal y para la profesión, la intervención gerencial, los cambios organizacionales, el estatuto de afiliación, y los estímulos y la retribución salarial. Se analizan los Grupos Relacionados de Diagnóstico (GRD) como forma que parece tocar el centro de la profesión. 2005 artículo científico 0188-168X https://www.redalyc.org/articulo.oa?id=34004408 es http://www.redalyc.org/revista.oa?id=340 REencuentro. Análisis de Problemas Universitarios application/pdf Universidad Autónoma Metropolitana REencuentro. Análisis de Problemas Universitarios (México) Num.44

if (filemtime($filename) + $maxlifetime < time()) { unlink($filename); $count++; } } return $count; } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ protected function saveSession($sessId, $data): bool { $sessFile = $this->path . '/sess_' . $sessId; if ($handle = fopen($sessFile, 'w')) { $return = false; // Lock the file for exclusive access to avoid issues with multiple // processes writing session simultaneously: if (flock($handle, LOCK_EX)) { $return = fwrite($handle, $data); // Make sure that there's no trailing data by truncating the file to // the correct length: ftruncate($handle, strlen($data)); fflush($handle); flock($handle, LOCK_UN); } fclose($handle); if ($return !== false) { return true; } } // If we got this far, something went wrong with the file output... // It is tempting to throw an exception here, but this code is called // outside of the context of exception handling, so all we can do is // echo a message.

// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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Registered Handlers

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Environment & details:

Environment & details: