Work and income instability and retirement financial wellbeing for women and men.

Financial wellbeing in retirement is contingent on realizations of financial expectations developed earlier in life and may differ substantially by gender. People's standard of living in retirement is tied to stability in work and income trajectories during working years along with retirement benefits and savings. Women have a greater overall income disadvantage relative to men, including reduced life course labor force exposure that may restrict retirement savings and benefits. Using the Canadian Longitudinal and International Study of Adults (LISA) and 20 years of linked tax record data (N = 2,353), we explore the association between instability in work and income histories and lower perceived retirement standard of living (PRSOL), net of retirement benefits, for women and men in Canada. Results show that for women, life course effects shaping PRSOL are driven by cumulative disability exposure and bouts of social assistance. For men, PRSOL is influenced more by cumulative unemployment. Although retirement benefits do not offset histories of work and income instability for either gender, income assistance is protective for women in retirement while personal investments are protective for men. Overall, our findings suggest that despite Canada's relatively generous pension program in later life, life course instability in work and income have persisting, gendered effects on financial wellbeing in retirement that underscore financial and health disadvantage for women across the life course.

Costs of Forced Retirement: Measuring the Effect of Lost Work Opportunity on Health.

OBJECTIVE: Unemployment is a known health stressor that also increases early retirements. This study addresses mixed literature on retiree health and underreporting of forced retirement to better identify potential health impacts of lost work opportunity. METHODS: A Lost-work Opportunity Score (LOS) was created using variables from the Health and Retirement Study assessing unemployment, forced retirement, and earlier-than-planned retirement for 2576 respondents. Reliability and unidimensionality of the score with multivariate regression analyses examined health impacts controlling for demographics and prior health status. RESULTS: The LOS possessed unidimensionality with a Cronbach's alpha of a = 0.76 while predicting self-reported health declines (LOS = 2; ß = 0.381, OR = 1.464, P < 0.05) and depression increase (LOS = 2; ß = 0.417, OR = 1.517, P < 0.05). CONCLUSIONS: LOS predicts 46% increased odds of negative self-reported health change after retirement associated with two LOS events, with implications to support aging workers.

Welfare effect analysis of pay-as-you-go pension system: Deconstruction from the perspective of relative utility and social equality.

This paper studies the redistributive effects of two major pay-as-you-go pension systems by constructing an intergenerational iterative model which does not only considers standard utility but also relative utility. The study find that the two main pay-as-you-go pension systems are both sustainable. If we consider different preferences, then the choice of pension system should depend on the question of whether individuals are more interested in the absolute level of consumption or in the consumption related to a reference group. If the latter is more important, the Beveridgean system is superior, it provides greater protection for vulnerable groups than the Bismarck pension system, and the pension income after retirement is relatively more balanced, but the price is a lower level of consumption in the long run compared to an economy with Bismarckian system. If individuals prefer instead the absolute level of consumption, the Bismarckian system is better, because it guarantees a comparable higher level of consumption, but the disadvantaged groups face a higher risk of poverty and the degree of social inequality will be relatively higher. However, it is important to note that in the long run, only the level of consumption differs, not the speed of growth or number of children.

Long-run consequences of informal elderly care and implications of public long-term care insurance.

We estimate a dynamic structural model of labor supply, retirement, and informal caregiving to study short and long-term costs of informal caregiving in Germany. Incorporating labor market frictions and the German tax and benefit system, we find that in the absence of Germany's public long-term insurance scheme, informal elderly care has adverse and persistent effects on labor market outcomes and, thus, negatively affects lifetime earnings and future pension benefits. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that while public long-term care insurance policies are fiscally costly and induce negative labor market effects, they can largely offset the personal costs of caregiving and increase welfare, especially for low-income individuals.

Impact of eliminating retirement earnings test on labor supply and pension benefit claims.

This study explores the hypothetical elimination of Japan's retirement earnings test (ET) for public pensions, focusing on its implications for older workers' labor supply and pension-claiming behaviors. The ET currently reduces public pension benefits for individuals aged 65 and older if their earnings exceed specified thresholds, potentially discouraging employment in this demographic. Notably, the Japanese ET influences both immediate and future pension benefits, thus diminishing current payouts for working pensioners and foregoing beneficial actuarial adjustments-adjustments based on actuarial calculations that would otherwise increase future benefits to account for delayed pension claims. This dual impact may discourage the labor supply and influence pension-claiming behavior among older workers. Through a survey-based experiment with male workers aged 40-59 years expected to face the ET upon retirement, we assess three reform scenarios as the first study in the literature: (1) eliminating future benefit reductions through actuarial adjustments, thereby enhancing the value of deferred pension claims; (2) removing immediate benefit suspensions to increase current pension payments directly; and (3) a comprehensive reform combining both approaches. Our findings reveal that eliminating reductions through actuarial adjustments increases the intensive margin (labor hours and income) and encourages delayed pension claims. Conversely, removing immediate benefit suspensions influences both the extensive margin (decision to work) and the intensive margin but leads to earlier pension claims. By highlighting the importance of differentiating between immediate and future benefit components in designing ET reforms, this study demonstrates their significant impact on labor supply and pension-claiming decisions.

Pathways to retirement in West Germany: Does divorce matter?

The aim of this paper is to explore how divorce is linked to pathways to retirement in West Germany and to understand whether and how patterns are gendered. Using German pension insurance data, I employ sequence and cluster analysis to map and group pathways to retirement of women and men who retired in 2018. Pathways to retirement are defined based on monthly pension insurance histories from age 50 to 65. I find nine distinct pathways to retirement, ranging from unemployment to stable low to high income pathways and to an early retirement pathway through the reduced-earnings-capacity pension, the latter representing 9.3% of the sample. Based on multinomial logistic regression models, I analyse how marital status, distinguishing between divorced and (re)married, was related to different pathways to retirement. The results show that divorced people were more likely than married people to retire through indirect and unstable pathways to retirement characterised by early exit from the labour market and receipt of reduced-earnings-capacity pensions and/or unemployment benefits. Whereas the relationship between divorce and pathways to retirement seemed to be overall unfavourable for men, the results for women are more ambiguous. Divorced women were also more likely to retire through a stable high-income pathway than married women. Nevertheless, the results suggest that divorce is associated with an early retirement pathway through the reduced-earnings-capacity pension for both women and men.

The impact of long-term care insurance on family care for older adults: The mediating role of intergenerational financial support.

Rapid population aging has been placing heavy tolls on Chinese family caregivers. Previous empirical evidence from multiple countries have shown that establishing national long-term care insurance was effective in reducing family care burdens. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) wave 2011 to 2018, this study examined the effects of implementing the pilot long-term care insurance program on family care received by the Chinese older adults, by using a time-varying Difference-in-Differences (DID) method. The results showed that: (1) the implementation of the pilot long-term care insurance program has led to a 17.2% decline in general for family care received by the Chinese older adults. (2) The effect of participating in the pilot program on family care received differed by respondent's household registration, health status, marital status, and possesion of retirement pension, and were specifically pronounced among those who were urban residents, having spouse, living with disabilities, and living with no retirement pension. (3) Further results from the mechanism analyses showed that the pilot long-term care insurance program decreased the level of family care by reducing the dual intergenerational financial support between older adults and their adult children. (4) Although participating in the pilot program decreased older adult's dependence on their adult children, their physical and mental health status were not negatively affected. This study contributes to the existing literature by evaluating the effects of implementing the pilot long-term care insurance program on family care received by the Chinese older adults, and lends supports to the previous studies that participating in long-term care insurance significantly reduces old adults' demand for family care, but not in sacrifice of their physical and mental well-being.

Inflation, Economic Policy Changes, and Access to Essential Drugs by Retirees in Argentina.

This cross-sectional study investigates whether there are associations between inflation, economic policy changes, and retirees' access to medicines in Argentina.

Os sentidos do aposentar-se na visão de sujeitos aposentados / The senses of retirement in the perspective of retired subjects

O artigo tem o objetivo de investigar como se dá o processo de interrupção do trabalhar no momento da aposentadoria e como os sujeitos passam por essa experiência em um cenário em que o trabalho é considerado fundamental na vida das pessoas. Foi utilizada metodologia qualitativa, composta por análise de narrativa de entrevistas realizadas com 20 sujeitos aposentados. Os resultados da pesquisa evidenciam que o fator financeiro é bastante relevante, no entanto existem aspectos subjetivos que não são ponderados no momento de parar de trabalhar. De maneira complementar, percebeu-se que ficar sem trabalho em uma sociedade produtivista faz com que os sujeitos se sintam desconfortáveis, mesmo tendo o direito legitimado para o descanso. Eles dizem se sentir julgados como inúteis e improdutivos pela sociedade, o que torna o ócio penoso em muitos momentos. Por fim, as narrativas demonstraram que se aposentar é percebido como ficar velho e sem perspectiva de futuro

The article aims to investigate how retirement occurs and is perceived by subjects in a society in which work is seen as fundamental in people's lives. A qualitative approach was used and data were collected and analysed through interviews with 20 subjects and narrative analysis. Results show that finances is quite a relevant factor when choosing to retire, while subjective aspects to this process are disregarded. Complementarily, not working in a productivity-bound society makes subjects uncomfortable, despite their legitimized right to rest. The participants reported feeling judged as useless and unproductive by society, which makes idleness painful in many moments. Finally, the narrative analysis showed that retiring is perceived as getting old and having no perspective for the future

Saída precoce do mercado de trabalho: aposentadoria ou discriminação? / Exiting the labour market early: retirement or discrimination?

Resumo Estudos mostram que, a despeito da queda das taxas de mortalidade e das melhorias nas condições de saúde, os trabalhadores têm saído mais cedo da atividade econômica. Esperar-se-ia que uma vida mais longa aumentasse os retornos aos investimentos em capital humano. A literatura associa a saída precoce do mercado de trabalho à cobertura da seguridade social. O adiamento da idade à aposentadoria é considerado uma alternativa para conter o desequilíbrio fiscal em muitos países. No entanto, estudos sugerem a existência de barreiras que inibem a permanência do trabalhador mais velho na atividade econômica. Entre elas, cita-se o preconceito por parte dos empregadores. O objetivo deste trabalho é buscar entender a não participação de homens brasileiros de 50-64 anos nas atividades econômicas, aí incluídos os que não estão aposentados (nem-nem). São o primeiro grupo a ser afetado pela reforma previdenciária proposta pelo governo. A proporção desses no total desta faixa etária aumentou de 3,5% para 10,2%, entre 1984 e 2017. Baixa escolaridade e piores condições de saúde em relação aos demais homens podem dificultar essa inserção. Isso sugere uma discriminação com relação aos trabalhadores mais velhos e a falta de políticas públicas que visem reforçar a capacidade destes indivíduos para conseguir um emprego.

Abstract Several studies show that despite a decline in mortality and improvements to health conditions, workers have left the economic activities early. The literature associates precocious exit from the labour market to the widespread coverage of Social Security. One alternative to contain the fiscal imbalance in most countries has been to postpone the minimal age to be entitled to a pension benefit. Nevertheless, many studies suggest the existence of barriers that make it difficult for older workers to remain in economic activity. Among them are prejudices among employers.This paper aims to understand the non-participation of Brazilian men aged 50-64 in economic activities. The focus on this age group is because they would be the first group to be affected by the pension reform proposed by the Government. These are those who are neither in the labour market nor retired (neither-nor). The proportion of these men of the total number of men in this age group increased from 3.5% to 10.2% between 1984 and 2015. Very low schooling and worse health conditions compared to other men can contribute to difficulties for insertion. This suggests discrimination in relation to the older worker and the lack of public policies aimed at reinforcing the ability of these individuals to obtain a job.

Impacto do afastamento do trabalho por doenças inflamatórias intestinais no Brasil / Impact of work disability due to inflammatory bowel diseases in Brazil

As doenças inflamatórias intestinais (DII) podem ter impactos sociais e econômicos no Brasil, onde sua prevalência aumentou recentemente. Este estudo tem como objetivo principal avaliar a incapacidade por DII na população brasileira, descrevendo proporções com fatores demográficos e como objetivo secundário, a avaliação de possíveis fatores de risco de afastamento do trabalho por Doença de Crohn (DC) em um centro de referência em DII da Universidade do Estado do Rio de Janeiro (UERJ), cujo resultado pode refletir outras regiões do país. A análise foi realizada utilizando-se a plataforma do Sistema Único de Informações sobre Benefícios da Previdência Social, com um primeiro cruzamento de dados de auxílios doença e aposentadorias por invalidez com DC e Retocolite Ulcerativa (RCU) entre 2010-2014. Dados adicionais como valores médios de benefícios, duração do benefício, idade, sexo e região foram obtidos através da mesma plataforma. Um segundo cruzamento entre auxílios doença e aposentadorias por invalidez foi feito somente para DC entre 2010-2018 no estado do Rio de Janeiro e foram pesquisados os mesmos dados adicionais. Uma subanálise foi realizada nos casos de incapacidade em comum com os pacientes com DC da UERJ, para avaliação das características que teriam maior chance de atuar como fator de risco para afastamento do trabalho, se comparando com a população de DC desse ambulatório que não teve afastamento pelo Instituto Nacional do Seguro Social (INSS). No Brasil, a incapacidade temporária ocorreu com maior frequência na RCU enquanto a permanente na DC. A DC afastou pacientes mais jovens que a RCU e ambas mais mulheres que homens. As ausências temporárias do trabalho por DC e RCU foram maiores no Sul e as menores ausências por DC foram observadas no Norte e Nordeste. A média de dias de incapacidade foi longa, de quase um ano, sendo maiores na DC em comparação à RCU, porém ambos tenderam a diminuir de 2010 à 2014. O valor dos benefícios pagos pelas DII representou aproximadamente 1% de todos os benefícios da mesma natureza no país, sendo 51% dos gastos com DC. No RJ, a prevalência da DC foi de 26 por 100.000/habitantes, com custo indireto de 0,8% dos benefícios totais, apresentando taxa de 16,6% de incapacidade, similar a encontrada no grupo de pacientes da UERJ. Os fatores de risco de incapacidade por DC na UERJ foram idade menor que 40 anos a época do diagnóstico, tempo de duração da doença, cirurgia intestinal prévia e fístula anovaginal. Dos afastados, 19% apresentaram depressão ou ansiedade associados. A média de tempo entre o diagnóstico de DC e a incapacidade foi de 3 anos. No Brasil, as DII frequentemente causam incapacidade prolongada e podem gerar aposentadorias precoces, com programas de reabilitação profissional ainda pouco explorados. As tendências de redução das taxas de incapacidade no Brasil podem refletir melhorias no acesso a cuidados de saúde e a medicamentos. Os custos indiretos baseados apenas no absenteísmo em empregos foram significativos e a demonstração desse impacto socioeconômico e de fatores de risco de incapacidade podem auxiliar no planejamento de políticas públicas para o país.

Inflammatory bowel diseases (IBD) can lead to Brazil's social and economic impacts, where their prevalence has recently increased. This study's main objective is to evaluate the disability due to IBD in the Brazilian population describing proportions with demographic factors. Secondly, it assesses possible risk factors of absence from work due to Crohn's disease (CD) in a referral center of IBD of the State University of RJ (UERJ), which results may reflect other regions of the country. The analysis was performed using the Unified Social Security Benefits Information System platform, with the first crossing of data on sickness benefits and disability pensions with CD and Ulcerative Colitis (UC) between 2010- 2014. Additional data, such as average benefit values, benefit duration, age, sex, and region of the country, were obtained through the same platform. A second crossing between sickness benefits and disability pensions was made only for CD between 2010-2018 in the state of Rio de Janeiro (RJ) for the evaluation of the same additional data. A subanalysis was made in cases of CD disability in common with patients at UERJ, to assess the characteristics that would have a greater chance as a risk factor for absence from work, compared to the population of CD of this clinic that had no disability by the Institute National Social Security (INSS). In Brazil, temporary disability occurred more frequently in the UC while the permanent one in CD. Disability occurred in patients with CD younger than UC and both more in women than in men. Temporary absences from work due to CD and UC were more significant in the South, and the lowest absences due to CD were observed in the North and Northeast. The average number of days of disability was long, almost one year, being higher in CD than in UC, but both tended to decrease from 2010 to 2014. IBD's benefits represented approximately 1% of all the benefits of sickness in the country, with 51% of DC spending. In RJ, the prevalence of CD was 26 per 100,000 / inhabitants, with an indirect cost of 0.8% of total benefits, with a rate of 16.6% of disability, similar to that found in the group of patients at UERJ. The risk factors for CD disability in UERJ were age under 40 at the time of diagnosis, duration of the disease, previous intestinal surgery, and anovaginal fistula. Of those on absence from work 19% had associated depression or anxiety. The average time between the diagnosis of CD and disability was three years. In Brazil, IBDs often cause prolonged disability and can lead to early retirements, with professional rehabilitation programs still little explored. Trends in the reduction of disability rates in Brazil may reflect improvements in access to healthcare and medicines. The indirect costs with IBD in Brazil, based only in absenteeism, were significant, and demonstrating this socioeconomic impact and risk factors for disability can help plan public policies for the country.

A relação entre renda e composição domiciliar dos idosos no Brasil: um estudo sobre o impacto do recebimento do Benefício de Prestação Continuada / The relationship between income and living arrangements of elderly persons in Brazil: the impact of the Continuous Cash Benefit Transfer Program (BPC) / La relación entre ingresos y composición domiciliaria de los ancianos en Brasil: un estudio sobre el impacto de la recepción del Beneficio de Prestación Continuada

Este trabalho analisa o impacto do recebimento do Benefício de Prestação Continuada (BPC) sobre a composição dos arranjos domiciliares dos idosos pobres no Brasil. O BPC corresponde ao benefício mensal no valor de um salário mínimo (SM) destinado a idosos acima de 65 anos, cuja renda familiar per capita seja inferior a » de SM. Essa discussão é bastante oportuna no atual contexto brasileiro, que vem sendo marcado por um acelerado envelhecimento populacional, por profundas mudanças nos arranjos domiciliares e pela ampla cobertura de seguridade social do idoso. Utilizando o método estatístico da "diferença em diferença" e os dados da PNAD de 2002 e 2004, são investigadas duas hipóteses discutidas na literatura sobre o tema: o recebimento de uma transferência incondicional de renda elevaria a probabilidade de os idosos viverem sozinhos, em função da autonomia conferida pela renda, ou aumentaria a probabilidade da corresidência com familiares devido à atração exercida pela renda. O resultado sugere a hipótese de que o recebimento do BPC, no Brasil, tem aumentado a probabilidade de formação de domicílios unipessoais.

This paper analyzes the impact of income for the elderly from the Continuous Cash Benefit Transfer Program (BPC) on the living arrangements of elderly poor persons. This benefit consists of income received monthly, equivalent to one minimum wage, by elderly persons over age 65 whose monthly per capita family income is below one-fourth of the minimum wage. This discussion is relevant in the current Brazilian context, which has been marked by rapid population aging, broad changes in living arrangements and an expansion of social security benefits for the elderly. Two hypothesis discussed in the literature were investigated, using the difference-in-difference statistical method and based on data from the 2002 and 2004 PNADs. It was seen that this unconditional income transfer would either (i) increase the probability of the elderly persons involved to live independently, or (ii) increase the probability of co-residence with family due to the attraction exerted by this additional income. The results obtained show that the receiving of the BPC income increases the probability that beneficiaries will tend to seek independents living arrangements.

Este trabajo analiza el impacto de la recepción del Beneficio de Prestación Continuada (BPC) sobre la composición de los arreglos domiciliarios de los ancianos pobres en Brasil. El BPC corresponde al beneficio mensual de un salario mínimo (SM) destinado a personas con más de 65 años, cuyos ingresos familiares per capita sean inferiores a » del SM. Esta discusión es bastante oportuna en el actual contexto brasileño, marcado por un acelerado envejecimiento poblacional, por profundos cambios en los arreglos domiciliarios y por la amplia cobertura de seguridad social del anciano. Utilizando el método estadístico de la "diferencia en diferencia" y los datos del PNAD de 2002 y 2004, se investigan dos hipótesis discutidas en la literatura sobre el tema: la recepción de una transferencia incondicional de renta elevaría la probabilidad de que los ancianos vivieran solos, en función de la autonomía otorgada por los ingresos, o aumentaría la probabilidad de la co-residencia con familiares debido a la atracción ejercida por la renta. El resultado sugiere la hipótesis de que la recepción del BPC, en Brasil, ha aumentado la probabilidad de formación de domicilios unipersonales.

O impacto da reforma da previdência social rural brasileira nos arranjos familiares: uma análise para entender a composição dos domicílios dado o aumento da renda dos idosos / The impact of the Brazilian rural social insurance reform on family composition: an analysis of the structure of homes after the increase in the income of the elderly / /El impacto de la reforma de la Seguridad Social rural brasileña en las estructuras familiares: un análisis para entender la composición de los domicilios por el aumento de renta en la tercera edad

Esta pesquisa explorou o efeito de uma variação exógena na renda, devido à reforma da previdência social brasileira de 1992 para os trabalhadores rurais, nos arranjos domiciliares rurais no Brasil. Realizou-se uma avaliação do impacto do aumento da renda dos idosos sobre a composição dos domicílios, nos termos de mudanças possíveis nos arranjos familiares. Especificamente, esta pesquisa tratou os arranjos familiares (ou a composição dos domicílios) como uma variável endógena em contraste com a literatura sobre o tema, a qual costuma abordar a composição do domicílio como uma variável exógena ao ambiente econômico do domicílio. Os objetivos foram: estimar as diferenças, em termos de arranjos familiares, entre domicílios com presença de idosos aptos a receberem o benefício da reforma e domicílios que não possuem idosos, antes da reforma (1989) e após (1998); estimar em que medida as diferenças em termos de arranjos familiares podem ser explicadas pela mudança causada pela reforma da previdência rural; e verificar se os efeitos da presença de pessoas elegíveis para receberem a aposentadoria nos arranjos domiciliares variam em função do sexo da pessoa que recebe aposentadoria. Quanto à relevância da pesquisa, a mesma está centrada no fato de que os resultados poderão ser úteis para a compreensão dos impactos primários e secundários de uma política que visa incrementar a renda de um segmento da população que vem crescendo aceleradamente no Brasil: os idosos. E mais, tal impacto, em termos do tipo de arranjo mais preponderante, apresenta um componente relacionado com o sexo da pessoa elegível, em que as mulheres que recebem os benefícios da reforma (com características elegíveis) tendem a viver em arranjos mais complexos do que seu oposto (homens ou mulheres fora do critério de elegibilidade).

This study aimed to assess the effect of an exogenous change in income, due to the 1992' reform of Brazilian social insurance for rural workers, on the structure of rural homes in Brazil. We assessed the impact of the increase in the income of the elderly on the composition of homes, regarding possible changes in family arrangements. In particular, this study considered household arrangement (or household composition) as an endogenous variable, contrasting to the existing literature that considers it an exogenous variable to the economic environment of the household. The objectives of the study were: to estimate differences in family arrangement between families with an elderly member eligible to receive the reform benefits, and families without an elderly member, before (1989) and after (1998) the reform; to assess how the differences in family arrangements can be explained by the changes caused by the rural social insurance reform; and to assess if the effects of the presence of a member eligible for retirement in family arrangements vary as a function of the gender of the beneficiary. The importance of the study is that its results might help understand the primary and secondary impacts of a policy that aims to increase the income of a growing segment of the Brazilian population: the elderly. According to the results, it is possible to state a statistically significant impact on household arrangements due to the 1992 rural social insurance reform. This is showed by the differences in family composition between the groups that are eligible and non-eligible for benefits of the reform. Additionally, when the most predominant type of family composition is considered, this impact is associated to the gender of the eligible member, that is, when the eligible individual is a female, the household composition tends to be more complex than for non-eligible males or females.

Esta investigación trató sobre el efecto de una variación exógena en la renta, debido a la reforma de la Seguridad Social brasileña de 1992, en el grupo de los trabajadores rurales y sus estructuras domiciliarias rurales en Brasil. Se realizó una evaluación del impacto en el aumento de la renta de la tercera edad sobre la composición de los domicilios, en lo referente a posibles cambios en las estructuras familiares. Esta investigación se centró en las estructuras familiares como una variable endógena, en contraste con la literatura sobre el tema, que solía abordar la composición del domicilio como una variable exógena al ambiente económico del domicilio. Los objetivos fueron: estimar las diferencias, en términos de estructuras familiares, entre domicilios con presencia de miembros de la tercera edad aptos para recibir los beneficios que les corresponden por la reforma, y domicilios que no poseen miembros de la tercera edad, antes de la reforma (1989) y después (1998); estimar en qué medida las diferencias, en términos de estructuras familiares, pueden ser explicadas por el cambio causado por la reforma de la Seguridad Social rural; y verificar si los efectos de la presencia de personas susceptibles de recibir la pensión en las estructuras domiciliarias varían en función del sexo de la persona que recibe la pensión.

United States-Mexico cross-border health insurance initiatives: Salud Migrante and Medicare in Mexico / Iniciativas transfronterizas de seguro de salud entre México y los Estados Unidos: Salud Migrante y Medicare en México

While U.S. health care reform will most likely reduce the overall number of uninsured Mexican-Americans, it does not address challenges related to health care coverage for undocumented Mexican immigrants, who will remain uninsured under the measures of the reform; documented low-income Mexican immigrants who have not met the five-year waiting period required for Medicaid benefits; or the growing number of retired U.S. citizens living in Mexico, who lack easy access to Medicare-supported services. This article reviews two promising binational initiatives that could help address these challenges-Salud Migrante and Medicare in Mexico; discusses their prospective applications within the context of U.S. health care reform; and identifies potential challenges to their implementation (legal, political, and regulatory), as well as the possible benefits, including coverage of uninsured Mexican immigrants, and their integration into the U.S. health care system (through Salud Migrante), and access to lower-cost Medicare-supported health care for U.S. retirees in Mexico (Medicare in Mexico).

Aunque la reforma del sector sanitario de los Estados Unidos muy probablemente reducirá el número global de ciudadanos estadounidenses de origen mexicano sin cobertura de atención de la salud, esta reforma no afronta los problemas relacionados con esta cobertura para los inmigrantes mexicanos indocumentados, quienes seguirán sin tener seguro aun tras la aplicación de las medidas de la reforma; para los inmigrantes mexicanos documentados de bajos ingresos que no han cumplido el período de espera de cinco años requerido para recibir las prestaciones de Medicaid; o para el número cada vez mayor de ciudadanos estadounidenses jubilados que viven en México y no pueden acceder con facilidad a los servicios de Medicare. En este artículo se analizan dos iniciativas binacionales prometedoras que podrían ayudar a afrontar estos retos: Salud Migrante y Medicare en México. Se tratan además sus futuras aplicaciones dentro del contexto de la reforma del sector sanitario de los Estados Unidos y se señalan los posibles retos para su ejecución (legales, políticos y reglamentarios), al igual que las posibles prestaciones, como la cobertura de los inmigrantes mexicanos no asegurados y su integración en el sistema de atención de la salud de los Estados Unidos (mediante Salud Migrante), y el acceso a atención de la salud de bajo costo, con el apoyo de Medicare, para los jubilados estadounidenses residentes en México (Medicare en México).

Perfil socioeconômico dos portadores de glaucoma no serviço de oftalmologia do hospital universitário da Universidade Federal de Juiz de Fora - Minas Gerais - Brasil / Socioeconomic profile of individuals presenting with glaucoma in the service of ophthalmology of the University Hospital of the Federal University of Juiz de Fora - Minas Gerais - Brazil

OBJETIVO: Avaliação do perfil socioeconômico dos pacientes portadores de glaucoma primário em acompanhamento no serviço de oftalmologia do hospital universitário da Universidade Federal de Juiz de Fora (MG), Brasil. MÉTODOS: Aplicação de um questionário em 100 pacientes durante suas consultas no serviço de oftalmologia do hospital universitário da Universidade Federal de Juiz de Fora, no período de abril de 2005 a junho de 2006. RESULTADOS: Observou-se que 84 por cento dos pacientes eram pensionistas ou aposentados, 86 por cento recebiam de 1 a 2 salários mínimos, 29 por cento gastavam de 26 a 75 reais/mês com o tratamento do glaucoma, 78 por cento apresentavam co-morbidades e 41 por cento já haviam suspendido o tratamento por falta de condições financeiras para a compra das medicações. CONCLUSÃO: A população em estudo, de baixo nível socioeconômico, apresenta dificuldades de adesão terapêutica por, principalmente, problemas financeiros e presença de co-morbidades. Os autores reforçam a urgente necessidade de adoção de medidas sociopolíticas que facilitem o acesso à medicação antiglaucomatosa, determinando maior aderência terapêutica.

PURPOSE: To assess the socioeconomic profile of individuals presenting with primary glaucoma at the ophthalmology service of the university hospital of the Feredal University of Juiz de Fora (MG), Brazil. METHODS: Submission of a questionnaire to 100 individuals during consultation in the ophthalmology service of the university hospital of Federal University of Juiz de Fora (MG), Brazil. RESULTS: Eighty-four per cent of individuals were pensioners or retired, 86 percent had a monthly income of 1 to 2 salaries, 29 percent had been spending 26 to 75 reais per month with glaucoma therapy, 78 percent presented with comorbidities and 41 percent had already abandoned treatment due to financial difficulties in buying the medication. CONCLUSION: The low-socioeconomic-level studied population presents with therapeutic compliance difficulties mainly due to financial situation and presence of comorbidities. The authors reinforce the urgent need of adopting sociopolitical measures that facilitate access to antiglaucoma medication, which prompts a better therapeutic compliance.

The economic survival of long stay institutions for impoverished aged people

OBJECTIVE: Identify structural couplings of Retirement Institutions for the Aged (RIA) with the economic system, in order to maintain those institutions that shelter the poor aged in the Brazilian context. METHOD: Qualitative, exploratory-descriptive study. The data collection was carried out through interviews with seven leading people and eight aged people, analysis of communication of 52 non-profit Brazilian RIAs, both public and private. The content analysis was performed based on the Niklas Luhmann's Systems Theory. RESULTS: It was verified that in face of the aged scarce resources, a considerable share of the maintenance costs are supported by the institutions themselves, whose search for resources is done by leaders, team, the aged and communities. CONCLUSIONS: The excessive involvement of these institutions in the elaboration of programs for searching funds can harm the performance of their essential function which is to care for the poor aged.

OBJETIVO: Identificar acoplamentos estruturais da instituição de longa permanência para idosos (ILPIs) com o sistema econômico, para a manutenção das instituições que abrigam idosos pobres, no contexto brasileiro. MÉTODO: Estudo exploratório-descritivo, de abordagem qualitativa. A coleta de dados foi realizada por meio de entrevistas com sete dirigentes e oito idosos, análise de comunicações de 52 ILPIs sem fins lucrativos, de caráter público ou privado. A análise de conteúdo foi processada com base nos referenciais da teoria de sistemas de Niklas Luhmann. RESULTADOS: Foi verificado que, diante da escassez de recursos econômicos dos idosos, parte importante das despesas para a manutenção das ILPIs é assumida pelas próprias Instituições e a busca desses recursos dirigentes, equipe, idosos e comunidades. CONCLUSÕES: O excessivo envolvimento das instituições na elaboração de programas em busca de fontes de recursos pode prejudicar o desempenho da função essencial de cuidado ao idoso pobre.

OBJETIVO: Identificar acoplamientos estructurales de Hogares para Ancianos (HA) con el sistema económico, para la manutención de las instituciones que abrigan ancianos pobres, en el contexto brasileño. MÉTODO: estudio de aproximación cualitativa de tipo exploratorio descriptivo. La recolecta de datos fue realizada mediante entrevistas con 7 dirigentes y 8 ancianos y análisis de comunicaciones de 52 HAs sin fines lucrativos, de carácter público o privado. El análisis del contenido fue procesado con base en los referenciales de la Teoría de Sistemas de Niklas Luhmann. RESULTADOS: Se verificó que, ante la falta de recursos económicos de los ancianos, una parte importante de los gastos para la manutención de las Has es asumida por las propias instituciones y la búsqueda de esos recursos involucra a dirigentes, equipo, ancianos y comunidades. CONCLUSIONES: El excesivo comprometimiento de las instituciones en la elaboración de programas en búsqueda de fuentes de recursos puede perjudicar el desempeño de la función esencial de cuidado al anciano pobre.

Condiçäo previdênciária, saúde e incapacidade de idosos residentes no município de Säo Paulo / Social security situation, health and disability of aged residents in Säo Paulo city

Descreve e analisa as condiçöes sócio-econômicas, de saúde e de incapacidade de grupos previdenciários entre idosos residentes no Município de Säo Paulo, no período de 1988-89. Estudo transversal, onde uma amostra aleatória de 1557 indivíduos foi categorizada em quatro grupos previdenciários: aposentados, 53,3 por cento; pensionistas, 14,8 por cento; economicamente ativos, 10 por cento e donas de casa, 22 por cento. Para a análise multivariada, as categorias tomadas como referência foram: sexo masculino, faixa etária de 60 a 69 anos, nível superior de escolaridade, indivíduos economicamente ativos, grupo ocupacional I (administradores, técnicos e profissionais de nível superior) e renda familiar igual ou superior a US$ 100 mensais. Conclui que as pensionistas, os aposentados por invalidez e os aposentados por velhice constituem os grupos mais vulneráveis do ponto de vista social e de saúde; que variáveis sócio-econômicas estäo associadas à hipertensäo e incapacidade e que a ocupaçäo anterior dos idosos näo se associa a estas condiçöes de saúde

La población en edad avanzada en el Perú: situación actual, perspectivas y políticas / The population in advance age in Peru: present situation, perspectives and policies

Contiene tres objetivos: presentar una descripción de la situación socioeconómica de la población en edad avanzada; efectuar un primer análisis de las posibles causas y efectos de esta situación y señalar de manera tentativa las perspectivas de evolución de este grupo de población y formular un esbozo de propuestas para mejorar su bienestar