Front-of-Pack Labeling in Chile: Effects on Employment, Real Wages, and Firms' Profits after Three Years of Its Implementation.

This study evaluates the impact of Chile's innovative law on Food Labeling and Advertising, enacted in June 2016, on employment and real wages and profit margins for the food and beverage manufacturing sectors in the 2016-2019 period, using unique company-specific monthly data from Chile's tax collection agency (measuring aggregate employment, real wages, average size of firms, and gross profit margins of the food and beverage manufacturing sector). Interrupted-time series analyses (ITSA) on administrative data from tax-paying firms was used and compared to synthetic control groups of sectors not affected by the regulations. ITSA results show no effect on aggregate employment nor on the average size of the firms, while they show negligible effects on real wages and gross margin of profits (as proportion of total sales), after the first two stages of the implementation (36 months), despite significant decreases in consumption in certain categories (sugar-sweetened beverages, breakfast cereals, etc.). Despite the large declines found in purchases of unhealthy foods, employment did not change and impacts on other economic outcomes were small. Though Chile's law, is peculiar there is no reason to believe that if similar regulations were adopted elsewhere, they would have different results.

Assessing the educational performance of different Brazilian school cycles using data science methods.

Educational indicators are metrics that assist in assessing the quality of the educational system. They are often associated with economic and social factors suggested to contribute to good school performance, however there is no consensus on the impact of these factors. The main objective of this work was to evaluate the factors related to school performance. Using a data set composed by Brazilian schools' performance (IDEB), socioeconomic and school structure variables, we generated different models. The non-linear model predicted the best performance, measured by the error and determination coefficient metrics. The heterogeneity of the importance of the variable between school cycles and regions of the country was detected, this effect may contribute to the development of public educational policies.

Gestão do trabalho de equipes da saúde da família / Family health team work management

RESUMO: Objetivos Descrever o perfil, formação complementar, aspectos sobre educação permanente, vínculo e plano de carreira de profissionais de equipes da Saúde da Família. Método Pesquisa descritiva de abordagem quantitativa. Participaram 78 membros de equipes multiprofissionais. Os dados foram coletados em 2016, por meio de um instrumento para caracterizar o profissional e as dimensões de tempo de atuação e qualificação dos profissionais das equipes, formas de contratação e modalidades de vínculos profissionais, plano de carreira e remuneração variável e educação permanente. As análises foram geradas no software IBM SPSS versão 21. Resultados A distribuição de médicos e enfermeiros é homogênea, percebe-se uma redução de agentes comunitários de saúde. Foram mais frequentes as características: vínculo trabalhista regulado pela Consolidação das Leis Trabalhistas, baixa formação complementar para a atenção primária à saúde, até um ano de trabalho na equipe, com baixa formação complementar para área e iniciativas de ações de educação pela gestão. Conclusões e implicações para a prática Existem fragilidades que podem interferir na organização do processo de trabalho influenciada pelos eixos da formação e formas de contratação.

RESUMEN Objetivos Describir el perfil, la capacitación complementaria, los aspectos sobre la educación permanente, el vínculo y el plan de carrera de los profesionales de los equipos de salud familiar. Método Investigación descriptiva con enfoque cuantitativo. Participaron 78 miembros de equipos multidisciplinarios. Los datos se recopilaron en 2016, utilizando un instrumento para caracterizar al profesional y las dimensiones de tiempo de actuación y calificación de los profesionales del equipo, formas de contratación y modalidades de vinculo profesional, plan de carrera y remuneración variable y la educación permanente. Los análisis se generaron en el software IBM SPSS versión 21. Resultados La distribución de médicos y enfermeras es homogénea, se observa una reducción en los agentes comunitarios de salud. Las características más frecuentes fueron: vinculo de trabajo través de la Consolidación de las Leyes del Trabajo, baja capacitación complementaria para la atención primaria en salud, hasta un año de trabajo en el equipo, con baja capacitación complementaria para el área e iniciativas de acciones educativas por parte de la gerencia. Conclusiones e implicaciones para la práctica Existen debilidades que pueden interferir en la organización del proceso de trabajo influenciado por los ejes de la capacitación y las formas de contratación.

ABSTRACT Objectives To describe the profile, complementary training, aspects about permanent education, bond and career plan of professionals from Family Health teams. Method Descriptive research with a quantitative approach. Seventy-eight members of multi-professional teams participated. Data were collected in 2016, using a tool to characterize the professional and the dimensions of time of work and qualification of the team's professionals, ways of hiring and modalities of professional bonds, career plan and variable remuneration and permanent education. The analyzes were generated by using IBM SPSS software version 21. Results The distribution of physicians and nurses is homogeneous, one notices a reduction of community health agents. The most frequent characteristics were: legal and formal employment relationship, low complementary training for primary health care, up to one year of work in the team, with low complementary training for the area and initiatives of educational actions by management. Conclusions and implications for practice There are weaknesses that can interfere in the organization of the work process influenced by the training axes and forms of hiring.

Medical labour under neoliberalism: an ethnographic study in Colombia.

OBJECTIVES: In order to increase the knowledge about the impacts of neoliberal market forces on physician's labour, this article's objectives are to analyse how and why the labour of physicians is transformed by neoliberalism, and the implications of these transformations for patient care. METHODS: Ethnographic investigation is carried out through semi-structured interviews with 20 general practitioners at public and private facilities in Colombia. The interviews were contrasted with national studies of physician's labour since the 1960s. A "mock" job search was also simulated. The analysis was guided by Marxian frameworks. The study was approved by a Human Research Ethics Committee, and informed consent was obtained from all participants. RESULTS: The overpowering for-profit administration of the Colombian healthcare system imposes productivity mechanisms on physicians as a result of a deregulated labour market characterized by low salaries, reduced and self-funded social security benefits, and job insecurity. Overworked physicians with reduced autonomy become frustrated for not being able to provide the care their patients need according to clinical standards. CONCLUSIONS: Under neoliberal conditions, medical labour becomes exploitable and directly productive through its formal and real subsumption to Capital. The negative consequences of a progressive loss in physician's autonomy unveil the incompatibility between neoliberal health systems and people's health.

Gender imbalance in executive management positions at the Mexican National Institutes of Health.

BACKGROUND: Around the world, there is a significant difference in the proportion of women with access to leadership in healthcare with respect to men. This article studies gender imbalance and wage gap in managerial, executive, and directive job positions at the Mexican National Institutes of Health. METHODS: Cohort data were described using a visual circular representation and modeled using a generalized linear model. Analysis of variance was used to assess model significance, and posterior Fisher's least significant differences were analyzed when appropriate. RESULTS: This study demonstrated that there is a gender imbalance distribution among the hierarchical position at the Mexican National Health Institutes and also exposed that the wage gap exists mainly in the (highest or lowest) ranks in hierarchical order. CONCLUSIONS: Since the majority of the healthcare workforce is female, Mexican women are still underrepresented in executive and directive management positions at national healthcare organizations.

Obesity and hiring discrimination.

We implement a correspondence audit study that uses a non-paired design to test the effect of obesity on employment discrimination in Mexico. In Mexico it is common practice to include a photograph in a resume, and job advertisements often specify personal and physical characteristics. We use both types of information to evaluate discrimination against the obese and identify its potential channels. We send two fictitious resumes, one of a woman and another of a man, one obese and the other non-obese, in response to advertisements for job openings. The obese photograph is a digital manipulation of the picture of the same non-obese person. We send a total of 3202 resumes in response to 1696 job advertisements. There is clear evidence of discrimination against obese women, but not obese men. The callback rate for the non-obese women is 29.1 %; for obese women it is 21.3 %. The difference is statistically and economically significant. An obese woman would need to send 37 % more resumes to obtain the same number of callbacks as a non-obese woman. We explore different channels that could explain this result, including customer discrimination (employer discrimination based on perception of customer expectations), productivity and salary, the gender of the person making the hiring decision, and the proportion of women in the occupation. We find no strong evidence in favor of any one channel. Advertisements with men identified as the contact person discriminate more than those with women, but replacing those men with women would reduce the observed gap in callback rate no more than 25 %.

Redistribution of salary or professional recognition? The difficult construction of a profession, the Peruvian nursing / Redistribuição de salário ou reconhecimento profissional? A difícil construção de uma profissão, a enfermagem peruana

Abstract The study presents the current profile of Peruvian nursing, its professional construction and its dilemmas, emphasizing its socio-cultural features. To this end, an extensive literature was reviewed, interviewing nurses in key positions and analyzing secondary source data. This study keeps its distance from other studies on health care professions as a workforce, to analyze the low social legitimacy of the nursing profession despite being the great operator of health care services in Peru. This resulting psychological overload, additionally to the work overload is reflected in job dissatisfaction, stress, burnout, intention of changing careers, and a strong desire to migrate. As a result, Peruvian nursing has opted for three alternatives: a) resilience, which means to adapt to this unfavorable situation; b) abandoning the profession, or leaving the country; and c) reaction, which gathers all manifestations of the profession against abandonment, informality, and mediocrity. In conclusion, the biggest challenge of professions given low social value is the recognition and not only the salary redistribution. This significant challenge for Peruvian nursing does not mainly relate to legal professionalization, but professionalism, which must result in greater legitimacy and autonomy.

Resumo O estudo apresenta o perfil atual da enfermagem peruana, sua construção profissional e seus dilemas, enfatizando suas características socioculturais. Para tanto, foi realizada extensa revisão de literatura, entrevistas com profissionais de enfermagem em posições-chave e análise de dados de fontes secundárias. O estudo distancia-se dos estudos das profissões da saúde como força de trabalho, a fim de analisar a baixa legitimidade social da profissão de enfermagem, apesar de ser a grande operadora de serviços no Peru. Isso produz uma sobrecarga psicológica, que se soma à sobrecarga de trabalho e se reflete em insatisfação no trabalho, estresse, burnout, desejo de mudar de carreira ou migrar. Diante disso, a enfermagem peruana optou por três saídas: a) resiliência, que representa adaptação; b) abandono, ou saída do país ou profissão; e c) a reação, que agrupa todas as manifestações contra o abandono à informalização e à mediocrização. Conclui-se que as profissões de baixo valor social têm como desafio central o reconhecimento profissional e não apenas a redistribuição salarial. Esse desafio central da enfermagem peruana não está centralmente ligado à sua profissionalização legal, mas ao seu profissionalismo, que trará maior legitimidade e autonomia.

Redistribution of salary or professional recognition? The difficult construction of a profession, the Peruvian nursing.

The study presents the current profile of Peruvian nursing, its professional construction and its dilemmas, emphasizing its socio-cultural features. To this end, an extensive literature was reviewed, interviewing nurses in key positions and analyzing secondary source data. This study keeps its distance from other studies on health care professions as a workforce, to analyze the low social legitimacy of the nursing profession despite being the great operator of health care services in Peru. This resulting psychological overload, additionally to the work overload is reflected in job dissatisfaction, stress, burnout, intention of changing careers, and a strong desire to migrate. As a result, Peruvian nursing has opted for three alternatives: a) resilience, which means to adapt to this unfavorable situation; b) abandoning the profession, or leaving the country; and c) reaction, which gathers all manifestations of the profession against abandonment, informality, and mediocrity. In conclusion, the biggest challenge of professions given low social value is the recognition and not only the salary redistribution. This significant challenge for Peruvian nursing does not mainly relate to legal professionalization, but professionalism, which must result in greater legitimacy and autonomy.

The internal brain drain: foreign aid, hiring practices, and international migration.

Building on empirical material gathered in Haiti, this paper advances a new and innovative understanding of the internal brain drain phenomenon-the poaching of local skilled workers by international organisations (IOs) or international non-governmental organisations (INGOs)- by conceptualising it as an equilibrium. This equilibrium is composed of two sets of tensions: (i) those between the salary conditions in the public sector and those on offer to local personnel working for IOs and INGOs; and (ii) those inherent in the dual salary scale used by IOs and INGOs for local and international staff. These two sets of tensions contribute in their specific ways to international migration, and, as such, the internal brain drain has a bearing on external brain drain dynamics. In addition, the paper addresses the difficult policy choices facing development and humanitarian organisations, since every set of policies that impacts on one side of the equilibrium is bound to affect its other side.

Socioeconomic status impacts postoperative productivity loss and health utility changes in refractory chronic rhinosinusitis.

BACKGROUND: Social determinants of health can have a substantial impact on treatment outcomes. Prior study has shown that socioeconomic status influences the likelihood of improvement in quality-of-life (QOL) following endoscopic sinus surgery (ESS). However, the impact of socioeconomic factors on changes in productivity loss and health utility after ESS remains unknown. METHODS: Adult patients (≥18 years of age) with chronic rhinosinusitis (CRS) who underwent ESS were prospectively enrolled into a multi-institutional cohort study. Productivity losses were calculated using the human capital approach and monetized using U.S. government-estimated wage rates. Health utility values (HUVs) were derived from the Medical Outcomes Study Short-Form-12 survey using University of Sheffield algorithms. Independent socioeconomic factors of interest included: age, gender, ethnicity, insurance status, educational attainment, and household income categorized via the Thompson-Hickey model. RESULTS: A total of 229 patients met inclusion criteria, and 163 (71%) provided postoperative follow-up. All subjects reported significant, within-subject improvement in both mean monetized productivity loss (p < 0.001) and HUV postoperatively (p < 0.001). Using paired sample statistics, patients with lowest income (≤$25,000/year) and with Medicare insurance did not report significant improvement in productivity loss (p ≥ 0.112) or HUV (p ≥ 0.081), although sample size limitations may have contributed to this finding. Patients in higher income tiers ($25,001 to $100,000/year and $100,001+/year) and those with employer-provided/private health insurance reported significant postoperative improvements in productivity loss and HUV (all p ≤ 0.003). CONCLUSION: Socioeconomic factors, including income and insurance provision, may impact improvements in productivity loss and HUV following ESS. Further research to validate these findings, ascertain mechanisms behind these results, and improve these outcomes is warranted.

The gender differences in highly paid wage: a case study of Peruvian physicians.

In recent decades, the number of women pursuing careers in health has significantly increased. However, the physician labor market is still characterized by gender differences regarding payment. Using a nationally representative Peruvian sample of health providers (3,219 male and 1,063 female physicians), we estimated the gender gap in the likelihood of earning high wages for physicians and decomposed this gap in a proportion related to differences in individual characteristics (e.g. specialty, labor experience), and a residual proportion related to differences in returns to these characteristics. Our main results reveal that male physicians have on average an 81% higher likelihood of earning high salaries (monthly earning level > 5,000 PEN) relative to their female counterparts. Further, the main proportion of this gap is associated to the unexplained component (among 57% and 77%, according to the model specification), which may be associated to unobservable characteristics and discrimination in the Peruvian labor market.

What explains wage differences between male and female Brazilian physicians? A cross-sectional nationwide study.

OBJECTIVE: In many countries an increase in the number of women in medicine is accompanied by gender inequality in various aspects of professional practice. Women in medical workforce usually earn less than their male counterparts. The aim of this study was to describe the gender wage difference and analyse the associated factors in relation to Brazil's physicians. PARTICIPANTS: 2400 physicians. SETTING: Nationwide, cross-sectional study conducted in 2014. METHODS: Data were collected via a telephone enquiry. Sociodemographic and work characteristics were considered factors, and monthly wages (only the monthly earnings based on a medical profession) were considered as the primary outcome. A hierarchical multiple regression model was used to study the factors related to wage differences between male and female physicians. The adjustment of different models was verified by indicators of residual deviance and the Akaike information criterion. Analysis of variance was used to verify the equality hypothesis subsequently among the different models. RESULTS: The probability of men receiving the highest monthly wage range is higher than women for all factors. Almost 80% of women are concentrated in the three lowest wage categories, while 51% of men are in the three highest categories. Among physicians working between 20 and 40 hours a week, only 2.7% of women reported receiving >US$10 762 per month, compared with 13% of men. After adjustment for work characteristics in the hierarchical multiple regression model, the gender variable estimations (ß) remained, with no significant modifications. The final effect of this full model suggests that the probability of men receiving the highest salary level (≥US$10 762) is 17.1%, and for women it is 4.1%. Results indicate that a significant gender wage difference exists in Brazil. CONCLUSION: The inequality between sexes persisted even after adjusting for working factors such as weekly workload, number of weekly on-call shifts, physician office work, length of practice and specialisation.

Continuation of Gender Disparities in Pay Among Academic Emergency Medicine Physicians.

OBJECTIVES: The objective was to identify the effects of gender and other predictors of change in the salary of academic emergency physicians over a four sequential time period of survey administration, across a sample of physicians within different emergency departments (EDs) and within states representing the four main geographical regions of the United States. METHODS: This was a successive cross-sectional observational study of EDs in the United States using an annual salary survey distributed to all Association of Academic Chairs in Emergency Medicine (AACEM) and Academy of Administrators in Academic Emergency Medicine (AAAEM) members in 2013, 2015, 2016, and 2017 with a sample size of 7,102 respondents over all time periods. The primary variable of interest was the adjusted base salary, calculated to be the full-time effort of the physician without any enhancements (e.g., without stipend, release time, extra hours). Institutional predictive variables included U.S. region that ED was in and if the site was an academic or community academic hybrid ("community") ED. Individual level variables included gender, academic rank, years at academic rank, years at rank within the ED, and primary duty (clinical or other). A series of Wilcoxon tests were conducted to determine if the unadjusted difference in salaries by gender for each year of the survey were significantly different. The effects of relative change in adjusted base salary over time were assessed using a mixed-effects regression model, with institutional- and individual-level predictors included in the model. RESULTS: Data were provided by 81 departments across the four geographic regions of the United States (Northeast, South, West, and Midwest). Most of the survey respondents across the four time periods of administration were male (65%) and reported primary clinical appointments at an academic ED (94%). Overall salaries increased across the four time points of the data with an overall relative 10.8% (95% confidence interval [CI] = 9.6%-12%) change in median salary between 2013 and 2017; the relative percentage change for female respondents was 10.6% (95% CI = 9.4%-11.85%) and 11.1% (95% CI = 10.2%-12%) for males. Within survey years, not adjusting for academic rank, the median salary increase for males was higher ($226,746 in 2013 to $252,000 in 2017) than females ($217,000 in 2013 to $240,000 in 2017), with significance at all four time points (Z = 6.33, p < 0.001), with a median average salary gap of $12,000 in 2017. In the predictive model that adjusted for covariates, gender significantly predicted median adjusted salary, with males earning significantly more than females (F(1) = 22.5, p < 0.001). CONCLUSIONS: Despite previously published data showing an inappropriate gender salary gap in emergency medicine, this gap has remained essentially unchanged over the past 4 years.

The gender differences in highly paid wage: a case study of Peruvian physicians / Las diferencias de género en los sueldos de mejor remuneración: el estudio de caso de los médicos peruanos / Diferenças de gênero em salários altos: um estudo de caso de médicos peruanos

Abstract: In recent decades, the number of women pursuing careers in health has significantly increased. However, the physician labor market is still characterized by gender differences regarding payment. Using a nationally representative Peruvian sample of health providers (3,219 male and 1,063 female physicians), we estimated the gender gap in the likelihood of earning high wages for physicians and decomposed this gap in a proportion related to differences in individual characteristics (e.g. specialty, labor experience), and a residual proportion related to differences in returns to these characteristics. Our main results reveal that male physicians have on average an 81% higher likelihood of earning high salaries (monthly earning level > 5,000 PEN) relative to their female counterparts. Further, the main proportion of this gap is associated to the unexplained component (among 57% and 77%, according to the model specification), which may be associated to unobservable characteristics and discrimination in the Peruvian labor market.

Resumen: En décadas recientes, el número de mujeres realizando su carrera en el ámbito de salud se ha incrementado significativamente. No obstante, el mercado laboral de los médicos está todavía caracterizado por diferencias de género respecto a los salarios. Utilizando una muestra peruana nacionalmente representativa de proveedores de salud (3.219 hombres y 1.063 mujeres médicos), estimamos la brecha de género en la probabilidad para los médicos de ganar sueldos altos y la desglosamos según los porcentajes vinculados a las diferencias relacionadas con las características individuales (p.ej. especialidad, experiencia laboral) y un porcentaje residual vinculado a las diferencias relacionadas con estas características. Nuestros resultados principales revelaron que los médicos hombres contaban en promedio con un 81% mayor probabilidad de ganar sueldos más altos (nivel mensual de renta > 5.000 PEN) frente a sus compañeras mujeres. Asimismo, gran parte del porcentaje de esta brecha está asociado a un componente inexplicable (entre un 57% y un 77%, según la especificación del modelo), lo que tal vez esté relacionado con las características no observables y la discriminación en el mercado laboral peruano.

Resumo: Nas últimas décadas, o número de mulheres atuando em carreiras da saúde aumentou significativamente. Contudo, o mercado de trabalho médico continua caracterizado por diferenças de gênero nos salários. Usando uma amostra nacional representativa de profissionais da saúde peruanos (3.219 médicos e 1.063 médicas), nós estimamos a diferença de gênero na probabilidade de receber altos salários para médicos e decompomos essa diferença em uma proporção relacionada a diferenças em características individuais (p.ex.: especialidade, experiência profissional) e uma proporção residual relacionada a diferenças de retornos dessas características. Nossos resultados principais revelam que os médicos têm, em média, uma probabilidade 81% maior de receber salários altos (nível de rendimentos mensais > 5.000 PEN) em relação às médicas. Adicionalmente, a principal proporção dessa diferença está associada ao componente não-explicado (entre 57% e 77%, de acordo com a especificação do modelo), o que pode estar associado a características não-observadas e discriminação no mercado de trabalho peruano.

A satisfação profissional de cirurgiões-dentistas da atenção básica em um município no sul do Brasil com diretrizes municipais de saúde bucal / The professional satisfaction of primary health care dentists in a city in southern Brazil with municipal oral health guidelines

Objetivo: identificar a satisfação profissional de cirurgiões-dentistas atuantes na atenção básica do Sistema Único de Saúde em um município do sul do Brasil, que foi pioneiro na implantação de diretrizes municipais de saúde bucal. Sujeitos e método: para a coleta dos dados, foram utilizados componentes descritivos a partir de dados secundários obtidos por meio de um questionário aplicado para todos os cirurgiões-dentistas atuantes no referido serviço. Resultados: no total, 46 profissionais foram incluídos na amostra, sendo que 82,5% estavam satisfeitos em seu trabalho e, desses, o reconhecimento dos usuários do serviço foi o fator que os cirurgiões-dentistas mais associaram à felicidade. Já os fatores mais relacionados à infelicidade no trabalho são as críticas ao salário e os usuários não colaboradores; 97,8% acreditavam que seu trabalho fazia diferença na comunidade em que estavam inseridos. Conclusão: este estudo sugere que estabelecer diretrizes no processo de trabalho pode ter um impacto positivo na prática e na satisfação dos profissionais, e essas estratégias podem ser utilizadas como amparo para planejamento em gestão de saúde bucal de forma sistematizada. (AU)

Objective: to identify the professional satisfaction of dentists working in the primary health care of the public health system, in a city in southern Brazil, which was a pioneer for implementing municipal oral health guidelines. Subjects and method: the data were collected by descriptive components from secondary data obtained through a questionnaire applied to all dentists working in the referred service. Results: a total of 46 professionals were included in the sample, whereas 82.5% were satisfied with their work, and the acknowledgment from service users was the factor that these professionals mostly associated with happiness. On the other hand, the factors most associated with unhappiness in the workplace are complaints of low wages and uncooperative patients. In addition, 97.8% of the professionals believed that their work made a difference in the community in which they were inserted. Conclusion: this study suggests that establishing guidelines in the work process may have a positive impact on the practice and the professional satisfaction and that these strategies may be used as a planning support for the systemic management of oral health. (AU)

Nurse practitioners' time on nonbillable activities.

BACKGROUND AND PURPOSE: During the provision of patient care delivery, all providers, including nurse practitioners (NPs), spend some time in activities that are not reimbursable. Understanding these nonbillable activities is crucial to the economic viability and success of existing and projected practice models. This study explored and compared seven nonbillable activities occurring in the practices of NPs in various settings. METHODS: Using a nonexperimental, descriptive design, 509 NPs were surveyed about nonbillable activities encountered in daily practice. Binomial regression analyses and incidence rate ratios were used to interpret relationships between each variable and nonbillable time. CONCLUSIONS: Although not every variable had significance, there were significant differences found in the amount of time spent in certain nonbillable activities depending on workplace setting, number of support staff, and primary care provider role. IMPLICATIONS FOR PRACTICE: The uncertainty of health care reform, including reimbursement, provider shortage, and the expanding roles of NPs, requires a closer look at both billable and nonbillable care activities. Understanding how nonbillable time affects work efficiency, costs, and the value of NPs will allow NPs to influence future health care reimbursement policies and delivery care models.

The hidden costs of informal work: lack of social protection and subjective well-being in Colombia.

OBJECTIVES: To examine the association between informal work and subjective well-being in Colombia. METHODS: Repeated cross-sectional study based on data from three nationally representative surveys of 1997, 2005 and 2011 (n = 4485). Life satisfaction was measured with a Likert scale ranging from 1 to 10 points. Informal work was defined as paid work without pension/unemployment contributions. Individual-level pooled Generalized Estimating Equation (GEE) models were used to assess the association between informal work and life satisfaction. Propensity Score Matching (PSM) was applied to address potential selection into informal work. RESULTS: Informal work increased from 52 % in 1997 to 68 % in 2011. Informal workers averaged significantly lower life satisfaction than formal (GEE: b = -0.14, 95 % CI -0.26, -0.01, p < 0.05). These results were confirmed in PSM models that controlled for selection by measured confounders (PSM: b = -0.15, 95 % CI -0.23, -0.03, p < 0.05). CONCLUSIONS: Informal workers who are not covered by social security systems had lower subjective well-being than workers in the formal economy. Results suggest that recent increases in informal work may also translate into reduced subjective well-being.

Variable compensation in Primary Healthcare: a report on the experience in Curitiba, Rio de Janeiro, Brazil, and Lisbon, Portugal. / Remuneração variável na Atenção Primária à Saúde: relato das experiências de Curitiba e Rio de Janeiro, no Brasil, e de Lisboa, em Portugal.

How professionals are compensated may affect how they perform their tasks. Fixed compensation may take the form of wages, payment for productivity or capitation. In addition to fixed compensation, there are numerous mechanisms for variable compensation. This article describes the experience of Curitiba and Rio de Janeiro in Brazil, and Lisbon in Portugal, using different models of performance-based compensation. In all three of these examples, management felt the need to offer monetary reward to achieve certain goals. The indicators analyzed the structure, processes and outcomes, and assessed professionals individual and as part of healthcare teams. In Lisbon, variable compensation can be as high as 40% of the base wage, while in Curitiba and Rio de Janeiro it is limited to 10%. Despite the growing use of this management tool in Brazil and the world, further studies are required to analyze the effectiveness of variable compensation.

Remuneração variável na Atenção Primária à Saúde: relato das experiências de Curitiba e Rio de Janeiro, no Brasil, e de Lisboa, em Portugal / Variable compensation in Primary Healthcare: a report on the experience in Curitiba, Rio de Janeiro, Brazil, and Lisbon, Portugal

Resumo A forma de remuneração dos profissionais pode ter implicação no modo como desempenham suas atividades. A remuneração fixa pode ser realizada por meio de salário, pagamento por produção ou por capitação. Além da remuneração fixa, diversos sistemas têm utilizado a variável. Neste artigo são apresentadas as experiências de Curitiba e do Rio de Janeiro, no Brasil, e de Lisboa, em Portugal, na utilização de diferentes modelos de pagamento por performance. Os gestores nesses três exemplos sentiram a necessidade de utilizar uma premiação monetária para alcançar determinados objetivos. Os indicadores analisam estrutura, processo e resultados e avaliam profissionais individualmente e equipes de saúde. Em Lisboa, o pagamento pode representar até 40% do vencimento base, enquanto em Curitiba e no Rio de Janeiro vai até 10%. Apesar da crescente utilização dessa ferramenta de gestão no Brasil e no mundo, mais estudos são necessários para avaliar a efetividade dessas iniciativas.

Abstract How professionals are compensated may affect how they perform their tasks. Fixed compensation may take the form of wages, payment for productivity or capitation. In addition to fixed compensation, there are numerous mechanisms for variable compensation. This article describes the experience of Curitiba and Rio de Janeiro in Brazil, and Lisbon in Portugal, using different models of performance-based compensation. In all three of these examples, management felt the need to offer monetary reward to achieve certain goals. The indicators analyzed the structure, processes and outcomes, and assessed professionals individual and as part of healthcare teams. In Lisbon, variable compensation can be as high as 40% of the base wage, while in Curitiba and Rio de Janeiro it is limited to 10%. Despite the growing use of this management tool in Brazil and the world, further studies are required to analyze the effectiveness of variable compensation.