Consideraciones de actualidad sobre el alta médica individual y colegiada en la evaluación de la prestación de incapacidad temporal de un año de duración, en el ámbito médico del Instituto Nacional de la Seguridad Social / Current considerations on individual and collegiate medical discharge in the evaluation of the temporary disability benefit of one year, in the medical field of the National Social Security Institute

El Real Decreto-ley 2/2023, de 16 de marzo, de medidas urgentes para la ampliación de derechos de los pensionis-tas, simplifica las actuaciones que conducen al alta médica en los trabajadores que permanecen en situación de incapacidad temporal entre un año y año y medio de duración. Aunque puede ser eficiente en muchos casos, en los procesos de incapacidad temporal de especial complejidad, el hecho de perder el trabajo de un equipo colegiado como el Equipo de Valoración de Incapacidades, podría dificultar la toma de decisiones eficaces, justas y eficientes. Se expone la definición de estos procesos de especial complejidad y la necesidad de poner a disposición del médico inspector una serie de datos laborales para la mejora en el proceso de la toma de decisiones sobre el alta médica, así como abrir legalmente la posibilidad del trabajo en equipo para evaluar determinados supuestos (AU)

Royal Decree-Law 2/2023, of March 16, on urgent measures to expand the rights of pensioners, simplifies the actions that lead to medical discharge in workers who remain in a situation of temporary disability between one year and one year and medium duration. Although it can be efficient in many cases, in temporary disability processes of spe-cial complexity, the fact of losing the work of a collegiate team such as the Disability Assessment Team could make it difficult to make effective, fair, and efficient decisions.The definition of these particularly complex processes is explained and the need to make a series of labor data available to the medical inspector to improve the decision-making process regarding medical discharge, as well as legally open the possibility of work in team to evaluate certain assumptions (AU)

Esquistossomose mansônica como doença profissional: a importância de estabelecer o nexo / Schistosomiasis mansoni as an occupational disease: the importance of establishing the link

Resumo Este ensaio destaca o perfil do trabalhador de área rural, portador da Esquistossomose mansônica, doença endêmica adquirida durante suas atividades laborais em áreas alagadas da baixada maranhense. Faz-se uma análise da legislação previdenciária e trabalhista utilizada para fins de concessão de benefícios e do nexo causal que estabelece a relação entre a situação de trabalho e o surgimento da doença. Para tal, utilizamos pesquisa bibliográfica sobre a temática e pesquisa documental do plano jurídico formal da previdência. O estudo aponta para a necessidade de reconhecer esta relação nas regiões endêmicas, no sentido de aprimorar o proposto na "Lista de Doenças Relacionadas ao Trabalho".

Abstract This study highlights the profile of rural workers with schistosomiasis mansoni, an endemic disease acquired during their work activities in flooded areas in the Baixada Maranhense. In order to analyze the social security and labor legislation used to grant benefits and the causal link that establishes the relationship between the work situation and the onset of the disease, we performed a bibliographical research on the topic and a documentary research on the formal legal plan of social security. This study addresses the need to recognize this relationship in endemic regions in order to improve what is proposed by the List of Work-Related Diseases.

Income security during periods of ill health: a scoping review of policies, practice and coverage in low-income and middle-income countries.

The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory income-security schemes is low, especially for informal and low-income workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illness-related income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.

Leaving half the population behind-the continued fight to cover America's mothers: a call to action.

For the last century, healthcare coverage in the United States has been a debated topic. The passage of the Social Security Act Amendments and the Patient Protection and Affordable Care Act has improved the available coverage of vulnerable populations, but access to healthcare is still fraught with barriers. This is particularly true for women in the postpartum period. It is widely accepted that the postpartum period is the optimal time to address health issues that developed during pregnancy or predated pregnancy. With more than half of maternal deaths occurring in the year after a birth and disproportionately affecting women of color, the postpartum time period is critical. The United States is the only industrialized country with a rising maternal mortality rate and therefore must take advantage of the 12 months postpartum, or "fourth trimester," to aid in addressing this national health crisis. As an incentivized provision, most states have expanded Medicaid since the signing of the Patient Protection and Affordable Care Act. However, pregnancy-related coverage still ceases after 60 days postpartum. Although states can apply for a waiver to extend this coverage, this process is unnecessarily laborious. The time has far passed for the federal government to act. Presently, there are numerous pieces of legislation before Congress to provide Medicaid coverage for pregnant patients through 365 days postpartum. Insurance coverage alone will not reverse the rising maternal mortality rate in this country, but it is a crucial first step.

Impacto de la Ley de Dependencia sobre el gasto autonómico en servicios sociales / Impact of the Dependency Act on regional spending on social services

OBJETIVO: En este trabajo se cuestiona si el desarrollo del Sistema de Autonomía y Atención a la Dependencia (SAAD) contribuyó a incrementar el volumen de recursos del sistema público de servicios sociales (efecto desplazamiento) o, por el contrario, si dicho desarrollo se produjo a costa del resto de prestaciones de servicios sociales (efecto sustitución). MÉTODO: Se realiza una aproximación de datos de panel, orientada a explicar el comportamiento del gasto per cápita en servicios sociales para las comunidades autónomas españolas de régimen común en el periodo 2002-2016. RESULTADOS: La introducción del SAAD se asocia con un incremento del 14% en el gasto por habitante en servicios sociales. Este efecto se acerca al 25% cuando la variable explicada es el gasto en transferencias corrientes de carácter social. También se constata que los cambios legislativos introducidos en 2012 y 2013 se asociaron a una reducción del gasto per cápita en transferencias corrientes del 10%. CONCLUSIONES: Esta evidencia refutaría la hipótesis de que el SAAD ha originado meramente un efecto de «sustitución» en el gasto autonómico en servicios sociales

OBJECTIVE: In this paper we address whether the System for Personal Autonomy and Care of Dependent Persons contributes to increasing the volume of resources of the public social services system (displacement effect) or, on the contrary, whether this development has taken place at the expense of other social services (substitution effect). METHOD: Panel data analysis is used to explain how per capita expenditure on social services evolves in the Spanish Regions under the common regime in the period 2002-2016. RESULTS: The implementation of the Dependency Act is associated with a 14% increase in the level of per capita expenditure on social services. This effect raises 25% when the variable explained is expenditure on current transfers of a social nature. On the other hand, law changes introduced in 2012 and 2013 were associated with a reduction in per capita expenditure on current transfers of around 10%. CONCLUSIONS: This evidence would refute the hypothesis that the System for Personal Autonomy and Care of Dependent Persons had merely a "substitution" effect on autonomous spending on social services

El cáncer ocupacional: una realidad oculta y un desafío pendiente / Occupational cancer: A hidden reality and an awaiting challenge

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[Examining competencies for labor and social security attorneys in the field of occupational mental health].

AIM: Labor and social security attorneys (LSSAs) are involved in the field of occupational mental health. However, little attention has been paid to the involvement of LSSAs in this field. This study investigated the occupational mental health competencies that are expected of LSSAs. SUBJECTS AND METHODS: Our investigation utilized the Delphi method. In Step 1, we conducted semi-structured interviews with LSSAs and then created an initial list of competencies based on the interviews and a previous investigation. In Step 2, we recruited LSSAs with 10 or more cases related to occupational mental health. They completed a questionnaire assessing the importance of their work (how important they felt it was to conduct work related to mental health) and level of achievement (how much they felt they had achieved). The respondents were also asked to provide additional competencies (not listed on the questionnaire) if they regarded them as necessary for their work, and these were later added to the list of proposed competencies. In Step 3, we presented the results of Step 2 to the same respondents and asked them to rate their agreement with the proposed competencies. Items with agreement of 80% or higher were set as competencies. We also asked LSSAs about the level of importance of their work and their perceived level of achievement with regard to the additional items created in Step 2. Items for which the level of achievement fell below the median were extracted even if the level of importance of the work fell at or above the median. RESULTS: We recruited 8 LSSAs in Step 1 and created a list of 68 preliminary competencies in 20 fields. We recruited 57 LSSAs in Step 2, and 45 LSSAs completed the survey (response rate: 78.9%). Seven competencies were added to the list as a result. We recruited 34 LSSAs in Step 3 (response rate: 75.6%) . Two items with an agreement rate of less than 80% were removed, resulting in 73 competencies in 20 fields. One of the items with an agreement rate of 100% was "The plan is based on the merits and disadvantages (risks) for both labor and management." CONCLUSIONS: This study identified the competencies required of LSSAs in the field of occupational mental health. Our findings suggest that specifying these competencies will enable efficient training of LSSAs.

Impact of changes in welfare legislation on the incidence of disability pension. A cohort study of construction workers.

Aims: Study objectives were to investigate how changes in social insurance legislation influenced the incidence of disability pension. Methods: The study included 295,636 male construction workers who attended health examinations between 1971 and 1993, aged 20-60 years and without previous disability pension. Via the Swedish National Insurance Agency national register we identified 66,046 subjects who were granted disability pension up until 2010. The incidence rates were calculated and stratified according to age and diagnosis. Results: The incidence rate of disability pension was fairly stable until the 1990s when large variations occurred, followed by a strong decreasing trend from the early 2000s to 2010. Trends in incidence rates, stratified by age and diagnosis, showed a consistent decrease in cardiovascular disease for all age groups. In subjects aged 30-49 years there was a high peak around 2003 for musculoskeletal diseases and psychiatric diseases. For the age group 50-59 years, musculoskeletal diagnosis, the most common cause of disability pension, had a sharp peak around 1993 and then a decreasing trend. In the 60-64 age group, the incidence rate for psychiatric diagnosis was stable, while incidence rates for musculoskeletal diagnosis varied during the 1990s. Conclusions: There are considerable variations in the incidence rate of disability pension over time, with different patterns depending on age and diagnosis. Changes in social insurance legislation, as well as in administration processes, seem to influence the variation.

Homeless and Helpless: How the United States has Failed Those With Severe and Persistent Mental Illness.

The United States has failed its citizens who suffer from severe and persistent mental illness (SPMI). Homelessness is one of the most obvious manifestations of this failure. The combination of a lack of effective treatment, inadequate entitlement programs such as Social Security Disability Insurance (SSDI), and subpar housing options form systemic barriers that prevent people suffering from mental illness from being able to obtain adequate housing. Cultural beliefs within the United States regarding who is homeless and what homelessness means also play a significant role in the development of positively impactful social welfare programs. Part II of this Note reviews the history of treatment for persons with SPMI--specifically how that treatment has evolved, the history of federal policies regarding SSI, SSDI and housing, and societal beliefs regarding homelessness and mental illness that have impacted policymaking decisions. Part III looks at these same areas from a current perspective and addresses the current issues and some possible solutions. Part IV discusses how lack of effective treatment, poor disability programs, and the need for better housing options work together to form systemic barriers for people with SPMI. Part IV also address how the cultural beliefs in the United States regarding people who have SPMI and are homeless serve as an independent barrier to policy change. Ultimately, this Note argues that homelessness is a product of system failures rather than individual factors.

Erosão orçamentário-financeira dos direitos sociais na Constituição de 1988 / Budgetary-financial erosion of social rights in the Constitution of 1988

Resumo Ao longo das três décadas de vigência da Constituição Federal, redesenhos normativos e fiscais foram introduzidos pela União nas garantias de organização federativa solidária e de custeio dos direitos sociais, a pretexto de resguardar a sustentabilidade intertemporal da dívida pública brasileira. Para equalizar a tensão entre estabilidade econômica e efetividade dos direitos sociais e sua repercussão para o processo de endividamento, foram mitigados paulatinamente os pisos de custeio da saúde e educação e o orçamento da seguridade social, os quais operavam, tanto no campo simbólico, quanto no pragmático, como uma espécie de contrapeso fiscal à necessidade de custo alegadamente ilimitado para as políticas monetária e cambial. Desvincular receitas, reduzir o escopo dos regimes de gasto mínimo e restringir o alcance interpretativo de transferências intergovernamentais equalizadoras das distorções federativas tornou-se estratégia, assumida - direta ou indiretamente - pela União desde o início da década de 1990, de estabilização macroeconômica, sobretudo, monetária. Assim tem sido empreendido um longo e ainda atual processo de desconstrução orçamentário-financeira dos direitos sociais, que restringe a identidade estrutural da CF/1988, a pretexto de consolidação fiscal cada vez mais exigente da redução do tamanho do Estado.

Abstract Throughout the three decades of the Federal Constitution, normative and fiscal redesigns were introduced by the Union in the guarantees of solidary federative organization and of social rights costing, under the pretext of safeguarding the intertemporal sustainability of the Brazilian public debt. In order to equalize the tension between economic stability and the effectiveness of social rights and their repercussion for the indebtedness process, the health and education minimum spending and the social security budget were gradually mitigated, which operated both in the symbolic field and in the pragmatic, as a kind of fiscal balance to the need for allegedly unlimited cost for monetary and cambial policies. Unlink taxes, reduce the scope of minimum spending regimes and restrict the interpretative scope of intergovernmental equalization transfers of federative distortions has become a strategy, assumed - directly or indirectly - by the Union since the early 1990s, of macroeconomic stabilization policy, above all, monetary. Thus, a long and still ongoing process of budgetary and financial deconstruction of social rights has been undertaken, which restricts the structural identity of the FC/1988, under the pretext of increasingly demanding fiscal consolidation of the reduction of the size of the state.

Budgetary-financial erosion of social rights in the Constitution of 1988. / Erosão orçamentário-financeira dos direitos sociais na Constituição de 1988.

Throughout the three decades of the Federal Constitution, normative and fiscal redesigns were introduced by the Union in the guarantees of solidary federative organization and of social rights costing, under the pretext of safeguarding the intertemporal sustainability of the Brazilian public debt. In order to equalize the tension between economic stability and the effectiveness of social rights and their repercussion for the indebtedness process, the health and education minimum spending and the social security budget were gradually mitigated, which operated both in the symbolic field and in the pragmatic, as a kind of fiscal balance to the need for allegedly unlimited cost for monetary and cambial policies. Unlink taxes, reduce the scope of minimum spending regimes and restrict the interpretative scope of intergovernmental equalization transfers of federative distortions has become a strategy, assumed - directly or indirectly - by the Union since the early 1990s, of macroeconomic stabilization policy, above all, monetary. Thus, a long and still ongoing process of budgetary and financial deconstruction of social rights has been undertaken, which restricts the structural identity of the FC/1988, under the pretext of increasingly demanding fiscal consolidation of the reduction of the size of the state.

Ao longo das três décadas de vigência da Constituição Federal, redesenhos normativos e fiscais foram introduzidos pela União nas garantias de organização federativa solidária e de custeio dos direitos sociais, a pretexto de resguardar a sustentabilidade intertemporal da dívida pública brasileira. Para equalizar a tensão entre estabilidade econômica e efetividade dos direitos sociais e sua repercussão para o processo de endividamento, foram mitigados paulatinamente os pisos de custeio da saúde e educação e o orçamento da seguridade social, os quais operavam, tanto no campo simbólico, quanto no pragmático, como uma espécie de contrapeso fiscal à necessidade de custo alegadamente ilimitado para as políticas monetária e cambial. Desvincular receitas, reduzir o escopo dos regimes de gasto mínimo e restringir o alcance interpretativo de transferências intergovernamentais equalizadoras das distorções federativas tornou-se estratégia, assumida ­ direta ou indiretamente ­ pela União desde o início da década de 1990, de estabilização macroeconômica, sobretudo, monetária. Assim tem sido empreendido um longo e ainda atual processo de desconstrução orçamentário-financeira dos direitos sociais, que restringe a identidade estrutural da CF/1988, a pretexto de consolidação fiscal cada vez mais exigente da redução do tamanho do Estado.

Act now: The effects of the 2008 Spanish disability reform.

The 2008 reform of the Spanish disability system reduced the benefits for individuals who have a short contributory history relative to their age. It also unintentionally introduced an incentive for individuals to apply for disability in the present. We use a lifecycle model and an empirical analysis to understand the overall impact of the reform. Our baseline estimates suggest that men and women who were affected by the reform were 46% and 22% more likely to be on permanent partial disability following the reform, respectively, and 55% and 46% more likely to be on total disability, respectively.

El sistema de reducción de las cotizaciones (bonus) por contingencias profesionales por disminución de la siniestralidad laboral. ¿Una solucion o una desincentivacion? / No disponible

No disponible

El seguro chileno contra accidentes del trabajo y enfermedades profesionales: lecciones y desafíos a 50 años de su creación / Chilean insurance against workplace accidents and occupational diseases: lessons and challenges 50 years after its creation

El sistema chileno de salud laboral sobrevivió a las enormes transformaciones que introdujo en materia de seguridad social la Dictadura Militar, y se suele presentar como un modelo a seguir en otras latitudes. En el presente artículo se expone un breve análisis de dicho sistema, comenzado por la ley del Seguro contra Accidentes del Trabajo y Enfermedades Profesionales que le da origen, para luego evaluar la operación del sistema, a fin de identificar sus mayores fortalezas y debilidades. También se revisan algunas propuestas de cambio que han aparecido en los últimos años. Se concluye que el sistema cuenta con un alto nivel de reconocimiento y legitimidad, y que presenta un desarrollo importante en el plano curativo para las tres cuartas partes de los trabajadores que están afiliados. En contraste con la cobertura que reciben los accidentes del trabajo, presenta baja sensibilidad ante las enfermedades profesionales, además de importantes desafíos en el plano preventivo, que podrían llevar a revisar algunos supuestos sobre los cuales se construyó(AU)

The Chilean occupational health system survived the enormous transformations introduced by the Military Dictatorship with regard to social security. This system is often suggested as a model to emulate overseas. In this article, I analyze the system, beginning with the law that regulates the Insurance against work accidents and occupational diseases which origins the system. Then, I examine its performance, and as a whole I identify its strengths and weaknesses. I also review some of the proposals of modification that have appeared in the last years. I conclude that the system counts on a high level of recognition and legitimacy, and that it presents an important level of development at the therapeutics sphere three fourths parts of those workers who are affiliated. In contrast with the coverage given to accidents at work, the system presents low sensibility with regard to occupational diseases, on top of important challenges in the preventive sphere. These critical elements could take us to review the basic assumptions under which the system was built on(AU)

Hot Topic: Title IV-E MSW Education and "Intent to Stay" in Public Child Welfare.

The 2018 proposed Family First Prevention Services Act suggests a change in the funding formula of Title IV-E of the Social Security Act-from entitlement to block grants. This study aimed to support the continuation of entitlement support based on the evidence that Title IV-E educational programs are effective in improving retention after the workers have obtained an MSW degree. Using a multigroup, multiple regression approach, this study analyzed secondary data collected from an e-survey sent to public child welfare (PCW) workers in a southern state. Data from 1,025 workers compare "intent to stay" (ITS) factors between PCW workers who received and those who did not receive the Title IV-E MSW educational stipend. The main analysis was conducted using Mplus version 7.4, with R version 3.3.2 used for data screening. Findings indicate that Title IV-E-supported education moderates the strength of the following ITS factors: respect from coworkers, team cohesion, self-assessed skills in working with special needs clients, and holding an MSW degree. MSW holders expressed lower ITS levels unless they had received Title IV-E stipends. These results provide evidence that Title IV-E education could help retain MSW graduates in PCW.

Comparing Older Persons' Human Rights: Exploratory Study of the International Older Persons' Human Rights Index (IOPHRI).

BACKGROUND AND OBJECTIVES: Over the last 2 decades, several international indices have been developed to describe the status of older persons. None, however, have examined their human rights. The International Older Persons' Human Rights Index (IOPHRI) fills in this gap by analyzing the formal legislative foundation of human rights for older people. The objective of this exploratory study is to examine the IOPHRI while comparing the legislation in 6 countries. RESEARCH DESIGN AND METHODS: A comparative international exploratory study comparing the human rights legislation of 6 countries: United States, Chile, Ireland, South Africa, India, and Australia in 5 different human rights domains: constitutional, protection, familial and informal support, planning, and empowerment. RESULTS: The findings suggest that the actual relationship between formal human rights of older persons and the real world is complex: for example, while the IOPHRI index places South Africa in first place, it is far behind compared with all other participants in the Global AgeWatch Index (which measures objective elements such as life expectancy at 60, or poverty rates in old age). DISCUSSION AND IMPLICATIONS: Measuring and indexing human rights of older persons reveal significant methodological issues. Beyond these methodological challenges, comparing the ranking of the IOPHRI to nonlegalistic indices raises significant questions about the relationship between formal human rights and the actual living experiences of older persons.

[Blindness and social security in Italy: critical issues and proposals.] / La cecità civile in Italia: criticità e proposte.

In Italy, blindness and low vision are ruled by Law 138/2001: two categories of blindness (corresponding to the one in the current WHO classification), receiving economical remuneration, and three categories of low vision, not directly remunerated. The problem ensues that low vision patients, who better gain from rehabilitation, have no economical contribution to undergo such care pathways; moreover, in Italy the evaluation has not yet shifted from "visual function" to "functional vision", thus lacking a holistic evaluation of visual dysfunction impact on the patient's daily life skills. To quantify the visual function of the examinee, only subjective performance (visual acuity and/or visual field) is evaluated in accordance with Law 138/2001, thus paving the way to malingerers: the "false blinds" phenomenon has recently reached the media. The Authors suggest that a correlation between the individual anatomical picture of the pathology/ies and the visual performance, obtained in patients with similar lesions undergoing controlled clinical studies reported in the ophthalmological literature, could offer more objective values to quantify the visual function.

Intervention policies and social security in case of reduced working capacity in the Netherlands, Finland and Germany: a comparative analysis.

OBJECTIVES: Working age disability is a major challenge for policymakers in European countries. This pertains to both occupational reintegration and social benefits for work incapacity. In many states reforms have been initiated aimed at reducing disability scheme inflow and fostering return to work. Our study was motivated by the question as to which aspects of these reforms seem to have been effective. METHODS: Three different approaches were utilized: case vignettes, interviews and expert workshops in the respective countries (Netherlands and Germany in 2012; Finland in 2015), and a systematic search for relevant studies on occupational reintegration was performed. RESULTS: We found considerable differences as to the assessment of work incapacity and resulting monetary benefits in the three countries. Also, organisation and practices of occupational reintegration vary from one country to another. Major differences concern (1) the timing of interventions, (2) employer responsibility and workplace involvement, (3) incentives and sanctions and (4) organisational and procedural issues. CONCLUSIONS: Our results may partly explain why some reform strategies have been more successful than others, and thus contribute to the further development of social and labour policies in Europe.