Desafios da reabilitação profissional desenvolvida pelo Instituto Nacional do Seguro Social (INSS): uma perspectiva histórico-cultural / Challenges of the vocational rehabilitation developed by the Brazilian Social Security Institute (INSS): a cultural-historical approach

Resumo Introdução: transformações ocorridas na prestação do serviço de Reabilitação Profissional (RP) pelo Instituto Nacional do Seguro Social (INSS) fizeram emergir contradições entre seus resultados e o que se espera de uma política pública de inclusão social. Objetivo: compreender como tais transformações afetaram a atividade de trabalho e como o serviço de RP está lidando com as mudanças e problemas decorrentes. Métodos: realizada análise histórica das contradições entre elementos do sistema de atividade da RP em serviço do INSS localizado no interior do estado de São Paulo. Foram utilizados dados etnográficos e discursivos de intervenção baseada no método Laboratório de Mudança. Resultados: evidenciou-se que o objeto da RP foi historicamente reduzido à orientação e capacitação profissional. Foram identificadas dificuldades do sistema de atividade da RP em lidar com determinações judiciais, além da diminuição da capacidade instalada e acúmulo de tarefas que impactam no atendimento aos trabalhadores. Conclusão: a redução administrativa do objeto da RP, bem como o sistema de atividades apoiado em ações de atores externos à Previdência Social, sem articulação institucional e protocolos de cooperação entre os serviços, demonstra o descompasso entre o desmonte histórico da RP no INSS e a demanda social dos trabalhadores com incapacidades para o trabalho

Abstract Introduction: changes in the Vocational Rehabilitation (VR) service provided by the Brazilian Social Security Institute (INSS) led to contradictions between their results and what is expected from a social inclusion policy. Objective: to investigate how these changes affected work activity and how the VR service is facing the consequent issues. Methods: we conducted a historical analysis of the contradictions between the VR system elements based on the provision of this service by an INSS agency in the state of São Paulo. Ethnographic and discursive data were collected using the Change Laboratory method. Results: we evidenced that the VR service was historically reduced to vocational guidance and professional training. We identified the VR system had difficulties in addressing judicial orders, as well as there was a diminished installed capacity and task accumulation that hinder a proper assistance to workers. Conclusion: administrative reduction of the VR service, and the system of activities supported by social actors outside Social Security, without institutional articulation and cooperation protocols between services, demonstrates there is a gap between the VR historical dismantling and the disable workers' social demands.

What are the potential advantages and disadvantages of merging health insurance funds? A qualitative policy analysis from Iran.

BACKGROUND: In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran. METHODS: In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results. RESULTS: The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization's unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system. CONCLUSION: Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents' objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.

Unclaimed Defined Benefit Pensions Can Help COVID-19 Economic Recovery.

The COVID-19 economic crisis makes it vitally important that workers who earned defined benefit pensions receive them at retirement. Unfortunately, billions of dollars that could help cushion the financial shock are sitting unclaimed, because the people who they belong to cannot locate the company responsible for paying them. As defined benefit pension plans have been terminated, merged and moved over the years, large numbers of deferred vested participants have not been notified about their benefits. The widespread and growing practice of insurance company pension buy-outs can be especially problematic for participants without notice. Broader use of electronic disclosures for pensions also threatens to make the situation worse. In the wake of COVID-19, policy makers should take steps to ensure that pension benefits are part of the economic recovery.

[Haitian health system]. / Sistema de salud de Haití.

The Haitian health system includes a public and a private sector. The public sector comprises the Ministry of Health and Population (MSPP) and a social security institution (Ofatma). The private sector includes private insurance agencies and providers. MSPP provides health services to the non-salaried population, while Ofatma provides services to the salaried population. Health expenditure in Haiti in 2016 was 5.4% of gross domestic product. Expenditure per capita in health was 38 American dollars. There is a great dependency on foreign resources. The MSPP is in charge of most stewardship functions. The main challenge faced by the Haitian health system is the provision of comprehensive health services with financial protection to all the population. This goal will not be met without additional financial resources, mostly public, and an effort to strengthen health institutions.

El sistema de salud haitiano se conforma por un sector público y un sector privado. El primero está compuesto por el Ministerio de Salud Pública y Población (MSPP) y la Caja de Seguro de Accidentes de Trabajo, Enfermedades y Maternidad (Ofatma). El sector privado incluye a los seguros y prestadores de servicios de salud privados. El MSPP ofrece servicios básicos a la población no asalariada (95% de la población total), mientras que la Ofatma ofrece seguros contra accidentes de trabajo, enfermedades y maternidad a los trabajadores del sector formal privado y público. El gasto total en salud enmHaití representó 5.4% del producto interno bruto en 2016 y el gasto en salud per cápita fue de 38 dólares estadunidenses. Hay una enorme dependencia de los recursos externos. El MSPP es el responsable de la mayor parte de las actividades de rectoría. El mayor reto que enfrenta el sistema de salud de Haití es ofrecer servicios integrales de salud con protección financiera a toda la población. Esta meta no podrá alcanzarse sin mayores recursos financieros, sobre todo públicos, y sin un importante esfuerzo de fortalecimiento institucional.

Combining health insurance funds in a fragmented context: what kind of challenges should be considered?

BACKGROUND: Iran's Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran. METHODS: A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework. RESULTS: This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to "the justification of the consolidation process" in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system. CONCLUSIONS: Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations.

[Occupational factors associated with suicide among French employees from the special agricultural social security scheme (MSA) working between 2007 and 2013]. / Facteurs professionnels en lien avec le suicide au sein des salariés affiliés à la Mutualité sociale agricole (MSA) et en activité entre 2007 et 2013.

BACKGROUND: Work and related exposures may play a role in suicide and there has been evidence in the literature that some occupational factors may be associated with suicide. The identification of occupational risk factors of suicide mortality among employees affiliated to the French special agricultural social security scheme (MSA), an understudied population, appears important. The objective of this study was to identify the occupational factors associated with suicide mortality among French employees from the MSA working between 2007 and 2013. METHODS: The study population included all the employees affiliated to the MSA working between 1st January 2007 and 31st December 2013, i.e. 1,699,929 men and 1,201,017 women. The studied occupational factors included: economic activity, skill level, and work contract. Survival analyses (Cox models) stratified on gender were performed using age as time scale and region and year of contract as adjustment variables. RESULTS: Among men, the factors associated with an elevated suicide risk were: economic activities of forestry, agriculture and related activities, and manufacture of food products and beverages (e.g. meat, wine), low-skilled level and working in the regions of Brittany, Burgundy Franche-Comté, Pays de la Loire, Normandy, Grand Est and Centre-Val-de-Loire. No association was observed among women. CONCLUSION: These results suggest that economic activity and low-skilled level may be associated with suicide among men affiliated to the MSA and may contribute to the implementation of prevention interventions. Further studies are needed to confirm and better understand these associations.

Understanding and improving the experience of claiming social security for mental health problems in the west of Scotland: A participatory social welfare study.

A growing body of literature links claimant interactions with the UK social security system and negative psychological consequences. Psychologists for social change developed a framework to outline proposed mechanisms of psychological impact from austerity. This codesigned study aimed to make an informed comment on areas of dis(agreement) between the Austerity Ailments framework and how people claiming for mental health problems describe their own experiences. In line with the participatory social welfare design of the study, qualitative analysis was performed by both claimants and academics. The overall findings indicate that existing framework mostly captured claimant experiences. However, some aspects of the claimant experience (particularly social aspects) were not well captured. Claimants were keen to utilise this study as an opportunity to gather claimant ideas on how to improve the system. Therefore, we report their suggestions that may be useful for those designing and improving social welfare systems.

Recaídas en incapacidad temporal: impacto de su regulación y control / Relapses into temporary disability: impact of its regulation and control

Tras el alta médica finaliza un proceso de incapacidad temporal. se considera que existe recaída en un mismo proceso de incapacidad temporal cuando se produce una nueva baja médica, por la misma o similar patología, dentro de los ciento ochenta días naturales siguientes a la fecha de efectos del alta médica anterior. Cuando estas recaídas ocurren tras altas médicas emitidas por el Instituto Nacional de la Seguridad Social española quedan sometidas a especiales requerimientos reglamentarios que consisten en un sistema de inspección directa llevada a cabo por los inspectores médicos adscritos a la Seguridad Social, así como por los Equipos de Valoración de Incapacidades. Las recaídas afectan directamente a la delimitación de la duración máxima del subsidio de incapacidad temporal en cada trabajador. Su número, y por tanto el gasto económico que ocasionan al sistema de seguridad social, puede disminuir al colaborar con los Servicios de Prevención de las empresas y su control puede verse favorecido aplicando modelos de inteligencia artificial

A process of temporary disability concludes once a medical discharge takes place. A relapse in the same temporary disability process is considered to take place when a new sick leave happens because of the same or a similar pathology within the 180 calendar days following the previous sick leave. If these relapses appear after the medical discharge issued by the Spanish Social Security National Institute, they will be submitted to special statutory requirements consisting of a direct inspection system carried out by Social Security medical inspectors as well as by the Disabilities Assessment Board. Relapses affect directly the definition of the maximum duration of temporary incapacity benefit for each worker. The number of such workers, and thus the Social Security economic costs are lowered by collaborating with the Prevention Services of companies. Its control could benefit from applying artificial intelligence models

Rural-urban disparity in risk exposure to involuntary social health insurance transition in China: An investigation of chronic disease patients' mental health problems.

Chronic disease patients have long suffered from mental health problems because of the long-lasting and costly treatments. Although the multilevel social health insurance system in China attempts to provide them with full-fledged health insurance coverage, the increasing prevalence of gig economy unexpectedly disrupts this situation. As the social health insurance system in China is closely associated with employment status, unemployed rural-to-urban migrant workers/regular urban workers have to accept the transition from urban employee basic medical insurance (UEBMI) to new cooperative medical scheme (NCMS)/urban resident basic medical insurance (URBMI). This study investigates the influence of this involuntary health insurance transition on the mental health of chronic disease patients. Empirical results show that the experience of transition from UEBMI to NCMS would significantly deteriorate the mental health of chronic disease patients, while the transition from UEBMI to URBMI would not. Accordingly, chronically ill rural-to-urban migrant workers are vulnerable to the involuntary health insurance transition that further deteriorates their mental health, and the multilevel social health insurance system in China cannot cope well with the emerging phenomenon of frequent employment change in labor market.

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)

The 'elephants in the room' for New Zealand's health system in its 80th anniversary year: general practice charges and ownership models.

The 2018 year signalled the 80th anniversary of the Social Security Act 1938. In order to implement this legislation, a historic compromise between the government and the medical profession created institutional arrangements for the New Zealand health system that endure to this day. The 2018 year also marked the commencement of a Ministerial review of the New Zealand health system. This article considers two intertwined arrangements which stem from the post-1938 compromise that the Ministerial review will need to address if goals of equity and, indeed, the original intent of the 1938 legislation are to be delivered upon: general practice patient charges; and ownership models. It describes the problems patient charges create, and options for ownership that the Ministerial review might contemplate.

Securing Social Security Solvency Addressing an important social determinant of the health of seniors and the American polity.

Adequate income is a social determinant of health. In the United States, only Social Security beneficiaries receive inflation-protected guaranteed income. Social Security needs another 1983 compromise in which stakeholders accepted "shared pain" to avoid insolvency. We propose indexing the benefit using the chained consumer price index (CPI) for all urban consumers and providing a one-time bonus of 8% to 10% for beneficiaries in their mid-80s, when needs become greater. The chained CPI has little impact when beneficiaries start receiving benefits, but older beneficiaries need protection. The estimated 75-year savings from this restructured benefit amount to 14.2% to 18% of Social Security deficits. Modest increases in payroll taxes and maximum earnings taxed should make up most of the shortfall. Including unearned income with wages and salaries subject to the 6.2% individual tax would produce much more revenue. The discussion explores the proposal's political feasibility, grounding in current policy and political science literature, and the role of income as a social determinant of health.

The Uneven Foci of Work Disability Research Across Cause-based and Comprehensive Social Security Systems.

This scoping review identified what kinds of work disability policy issues are critiqued in articles published in countries with cause-based versus comprehensive welfare systems. Drawing on a review of work disability policy research, we identified 74 English-language, peer-reviewed articles that focused on program adequacy and design. Articles on cause-based systems dwelled on system fairness and policies of proof of entitlement, while those on comprehensive systems focused more on system design complexities relating to worker inclusion and scope of medical certificates. Overall, we observed a clear difference in the nature of problems examined in the different systems. Gaps in work disability policy literature are identified, and challenges for comparative policy research are discussed.

Long-term care systems as social security: the case of Chile.

Similar to many other countries, Chile is facing the challenges of rapid ageing and the increase in long-term care (LTC) needs for this population. Implementation of LTC systems has been the response to these challenges in other countries, however, Chile still lacks a strategy for addressing LTC needs. This article advocates for the implementation of a LTC system in Chile, demonstrating that this could be an effective and efficient response to cope with the current and future challenges faced by the country. The rationale for implementing a LTC system is based on the principles of the country's social security system and on the fact that not having a LTC in place is not costless.