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2.
N Z Med J ; 132(1489): 8-14, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30703775

RESUMO

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.


Assuntos
Assistência à Saúde , Medicina Geral , Previdência Social/organização & administração , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Medicina Geral/economia , Medicina Geral/legislação & jurisprudência , Programas Governamentais , Humanos , Modelos Organizacionais , Nova Zelândia , Propriedade
3.
Int J Health Serv ; 49(1): 142-164, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30428268

RESUMO

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.


Assuntos
Políticas , Previdência Social/organização & administração , Previdência Social/estatística & dados numéricos , Indenização aos Trabalhadores/organização & administração , Indenização aos Trabalhadores/estatística & dados numéricos , Documentação/normas , Definição da Elegibilidade/normas , Órgãos Governamentais/organização & administração , Órgãos Governamentais/estatística & dados numéricos , Humanos , Indústrias/organização & administração , Indústrias/estatística & dados numéricos , Seguradoras/estatística & dados numéricos , Retorno ao Trabalho , Fatores de Risco , Previdência Social/normas , Avaliação da Capacidade de Trabalho , Indenização aos Trabalhadores/normas
5.
Health Policy Plan ; 33(9): 1018-1025, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30371780

RESUMO

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.


Assuntos
Assistência de Longa Duração/economia , Previdência Social/economia , Envelhecimento , Chile , Assistência à Saúde/economia , Feminino , Humanos , Assistência de Longa Duração/organização & administração , Masculino , Dinâmica Populacional/tendências , Política Pública , Previdência Social/organização & administração
6.
Rev. Asoc. Esp. Espec. Med. Trab ; 27(3): 132-140, sept. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-175362

RESUMO

La identificación de sujetos con alto riesgo cardiovascular constituye un desafío en población laboral. El proyecto IberScore ha derivado una función predictiva para eventos cardiovasculares a partir de una cohorte de 774.404 trabajadores, sin enfermedad cardiovascular previa y con 10 años de seguimiento. Durante el seguimiento, se identificaron 3.762 primeros eventos cardiovasculares en la cohorte de derivación (6‰; varones 90,7%; media edad=46,9±9,19 años). En el grupo con eventos se observó una presencia importante de factores de riesgo cardiovascular en la evaluación basal (tabaquismo 63,2%; dislipemia 20,6%; hipertensión 21,8%; diabetes 7,9%). Los resultados sugieren la utilidad clínica de un sistema de predicción del riesgo cardiovascular desarrollado específicamente en población trabajadora española. En esta población se produce un número no desdeñable eventos y hay una importante presencia de factores de riesgo, que pueden pasar desapercibidos debido al peso de la edad en los sistemas predictivos desarrollados para la población general


Identification of subjects at high cardiovascular risk is a challenge among working population. The IberScore Project has calculated a predictive function for cardiovascular events from a cohort of 774,404 Spanish workers without prior cardiovascular diseases, and 10-year follow-up. At follow-up, 3,762 first cardiovascular events were identified in the cohort of derivation (6‰; 90.7% men; mean age=46.9±9.19 years-old). In the group with events, it was observed a relevant presence of cardiovascular risk factors at baseline assessment (smoking 63.2%; dyslipidaemia 20.6%; hypertension 21.8%; diabetes 7.9%). The results suggest the clinical usefulness of a system to predict cardiovascular risk among specifically developed in Spanish working population. Among such population a significant number of events take place and there is a relevant presence of risk factors, which may go unnoticed due to the weight that age has in the predictive systems developed for the general population


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Previsões , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco , Prevenção Primária , Avaliação em Saúde , Previdência Social/organização & administração , Agentes Comunitários de Saúde/estatística & dados numéricos
7.
Int J Equity Health ; 17(1): 89, 2018 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-29940956

RESUMO

BACKGROUND: China has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to the inadequate funds, the social health insurance system reimbursed the inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted in a rapid rising hospitalization rate but poor health outcomes among the Chinese population. A redistribution of social health insurance funds has become one of the main challenges for the performance of Social Health Insurance. METHODS: Two comparable counties, Dangyang County and Zhijiang County, in Hubei Province of China, were sampled as the intervention group and the control group, respectively. The Social Health Insurance Management Department of the intervention group budgeted 600 yuan per capita per year to the patients with 3rd stage hypertension to cover their outpatient expenditures. The outpatient spending in the control group were paid out-of-pocket. The inpatient expenditures reimbursement policies in both groups were not changed. Besides, the Social Health Insurance Management Department of the intervention group budgeted 100 yuan per patient per year to township physicians and hospitals to provide health management services for the patients. While, the health management services in the control group were still provided by health workers. A Propensity Score Matching model and Difference-in-differences model were used to estimate the net effects of the intervention in dimensions of medical services utilization, medical expenditures, SHI reimbursement, and health outcomes. RESULTS: One thousand, six hundred and seventy three pairs of patients were taken as valid subjects to conduct Difference-in-differences estimation after the Propensity Score Matching. The net intervention effect is to increase outpatient frequency by 3.3 (81.0%) times (P < 0.05), to decrease hospitalization frequency by 0.075 (- 60.0%) times (P < 0.05), and to increase the per capita total medical service utilization frequency by 3.225 (76.8%) times (P < 0.05). The per capita total medical expenditure decreased 394.2 (- 27.7%) yuan. The SHI reimbursed 90.3 yuan more per capita for the outpatient spending, but the per capita inpatient expenditure reimbursement and per capita total medical expenditure reimbursement decreased significantly by 282.6 (- 44.0%) yuan and 192.3 (- 28.5%) yuan, respectively (P < 0.05). The intervention reduced the per capita inpatient out-of-pocket expenditure and the per capita total out-of-pocket expenditure by 192.8 (- 36.7%) yuan and 201.9 (- 29.9%) yuan, respectively (P < 0.05). The intervention significantly decreased the diastolic blood pressure of the intervention group by 2.9 mmHg (P < 0.05) but had no significant impact on the systolic blood pressure (- 7.9 mmHg, P > 0.05). CONCLUSION: For China and countries attempting to establish a universal coverage SHI with inadequate funds, inpatient services were expensive but might not produce good health outcomes. Outpatient care for patients with chronic diseases should be fundamental, and outpatient expenditures should be reimbursed with a higher ratio.


Assuntos
Gastos em Saúde/tendências , Assistência Médica/organização & administração , Pacientes Ambulatoriais , População Rural , China/epidemiologia , Feminino , Programas Governamentais , Reforma dos Serviços de Saúde , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Masculino , Assistência Médica/economia , Previdência Social/organização & administração
8.
Int J Public Health ; 63(9): 1081-1088, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29926126

RESUMO

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.


Assuntos
Pessoas com Deficiência/legislação & jurisprudência , Políticas , Previdência Social/organização & administração , Previdência Social/estatística & dados numéricos , Finlândia , Alemanha , Humanos , Masculino , Países Baixos , Previdência Social/economia , Previdência Social/legislação & jurisprudência , Fatores de Tempo , Avaliação da Capacidade de Trabalho , Local de Trabalho
9.
Int J Technol Assess Health Care ; 34(3): 248-253, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29888698

RESUMO

OBJECTIVES: Latin American countries are taking important steps to expand and strengthen universal health coverage, and health technology assessment (HTA) has an increasingly prominent role in this process. Participation of all relevant stakeholders has become a priority in this effort. Key issues in this area were discussed during the 2017 Latin American Health Technology Assessment International (HTAi) Policy Forum. METHODS: The Forum included forty-one participants from Latin American HTA agencies; public, social security, and private insurance sectors; and the pharmaceutical and medical device industry. A background paper and presentations by invited experts and Forum members supported discussions. This study presents a summary of these discussions. RESULTS: Stakeholder involvement in HTA remains inconsistently implemented in the region and few countries have established formal processes. Participants agreed that stakeholder involvement is key to improve the HTA process, but the form and timing of such improvements must be adapted to local contexts. The legitimization of both HTA and decision-making processes was identified as one of the main reasons to promote stakeholder involvement; but to be successful, the entire system of assessment and decision making must be properly staffed and organized, and certain basic conditions must be met, including transparency in the HTA process and a clear link between HTA and decision making. CONCLUSIONS: Participants suggested a need for establishing clear rules of participation in HTA that would protect HTA producers and decision makers from potentially distorting external influences. Such rules and mechanisms could help foster trust and credibility among stakeholders, supporting actual involvement in HTA processes.


Assuntos
Tomada de Decisões , Avaliação da Tecnologia Biomédica/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração , Indústria Farmacêutica/organização & administração , Política de Saúde , Humanos , Seguro Saúde/organização & administração , América Latina , Formulação de Políticas , Previdência Social/organização & administração , Fatores de Tempo
11.
Annu Rev Clin Psychol ; 14: 453-469, 2018 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-29734828

RESUMO

The Social Security Administration (SSA) oversees two disability programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Adults with mental impairments represent a very large component of the programs. Policy makers and SSA are concerned about the accuracy of disability determination and also about low levels of labor force participation among individuals with disabilities. Adults with mental impairments are challenging to assess for work-related functional limitations. They are also a challenge to return to labor force participation. SSA has sponsored several demonstration research programs focusing on improving the accuracy of disability determination and on interventions in supported employment to return individuals with mental impairments to competitive employment. This article reviews the demonstration research focused on both entry into the disability system (at the "front door") and potential exit from it (through the "back door"). All of the research holds promise to "right-size" the SSA disability program.


Assuntos
Avaliação da Deficiência , Readaptação ao Emprego , Programas Governamentais , Seguro por Invalidez , Pessoas Mentalmente Doentes , Previdência Social , United States Social Security Administration , Programas Governamentais/organização & administração , Humanos , Seguro por Invalidez/organização & administração , Previdência Social/organização & administração , Estados Unidos , United States Social Security Administration/organização & administração
13.
Rev Med Inst Mex Seguro Soc ; 56(Suppl 1): S4-S5, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29624333

RESUMO

For the Instituto Mexicano del Seguro Social (IMSS), population aging represents a major challenge as a social security institution. This is why the Epidemiological Research and Health Care Services Unit/Aging Area has developed multi-disciplinary research concerning the older adult population, in order to contribute with programs of prevention, detection and attention of that age group and develop policies with plural perspective in which the voices of the older adults can be heard.


Assuntos
Envelhecimento , Promoção da Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Dinâmica Populacional , Academias e Institutos/organização & administração , Idoso , Idoso de 80 Anos ou mais , Promoção da Saúde/métodos , Humanos , México , Previdência Social/organização & administração
14.
Enferm. clín. (Ed. impr.) ; 28(supl.1): 250-255, feb. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-173098

RESUMO

Objective: Indonesia Medika has established "Garbage Clinical Insurance" (GCI), which enables the population below the poverty line (BPL) to obtain health insurance by donating their garbage to pay the premium. The objective of this paper was to critically examine the implementation of GCI in Indonesia by reviewing the background, effects, and sustainability of this program. Method: A literature search of studies related to GCI, other types of micro health insurance, and their applications in developing countries was conducted. Recent news (post 2014) related with the implementation of GCI was also consulted. Results: The literature revealed that the foundation of GCI was informed by the Declaration of Alma Ata with the ideal of making health care services accessible to everyone. Unlike most health insurance, the mechanisms of GCI seem less likely to trigger moral hazard among its beneficiaries. However, as a micro insurance program, the sustainability of GCI continues to be called into question. Conclusions: The critical analysis of the present study has highlighted the application of GCI, a micro health insurance initiative, and its relevance to Indonesia. GCI tended to work well as it was able to utilise Indonesia's social capital. However, GCI should aim to increase the benefits package available to its members in order to maintain the sustainability of the program


No disponible


Assuntos
Humanos , Previdência Social/organização & administração , Seguro Saúde , Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Indonésia , Reciclagem/tendências , Áreas de Pobreza
15.
Technol Health Care ; 26(2): 343-347, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29332060

RESUMO

We examine, from a medical-legal perspective, the pro and cons of the information technology procedures that the Italian Institute of Social Security (INPS) has implemented to manage the provision of social disability assistance, meaning that separate from the payment of pension contributions, being welfare, anchored to an administrative requirement by way of the compulsory payment of a minimum social security contribution.


Assuntos
Pessoas com Deficiência , Tecnologia da Informação , Assistência Pública/organização & administração , Telemedicina/organização & administração , Avaliação da Deficiência , Humanos , Itália , Previdência Social/organização & administração , Fatores de Tempo
16.
J Occup Rehabil ; 28(2): 357-364, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28856559

RESUMO

Purpose Motivational interviewing (MI) is a conversational method to support clients in need of behavioral change. In an organizational reform, most Swedish sickness insurance officials were trained in MI to promote clients' return to work (RTW) after sick leave. The aim of this article is to investigate experiences of introducing MI as a tool to promote clients' RTW within a sickness insurance context, with special focus on the translation and implementation of the method. Methods A qualitative approach, comprising 69 interviews with officials, managers, and regional coordinators on two occasions. The material was analyzed through qualitative content analysis. Results Officials were positive about MI, but the application was limited to using certain tools with extensive individual variation. Officials struggled with translating MI into a sickness insurance context, where the implementation strategy largely failed to offer adequate support, due to low managerial priority, competing initiatives, and a high workload. Results of the educational intervention could therefore be seen on an individual but not an organizational level. Conclusions In order to translate MI into a sickness insurance context, training needs to be supported by organizational approaches that promote collective learning and sharing of experiences among officials. The results also illustrate how a method cannot be assumed to be implemented simply because training has been provided. Consequently, the application of the method needs to be carefully monitored in studies of interventions where MI is claimed to be used, in order to measure its effectiveness.


Assuntos
Entrevista Motivacional/métodos , Desenvolvimento de Programas , Previdência Social/organização & administração , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Retorno ao Trabalho , Licença Médica , Suécia
17.
Gerontologist ; 58(3): 588-597, 2018 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-28379357

RESUMO

Background and Objectives: Since 1995, Germany has operated one of the longest-running public programs providing universal support for the cost of long term services and supports (LTSS). Its self-funding, social insurance approach provides basic supports to nearly all Germans. We discuss its design and development, including recent reforms expanding the program and ensuring its ongoing sustainability. Research Design and Methods: The study reviews legislative and programmatic changes, using program data, as well as legislative documents and program reports. Results: The program is widely accepted among citizens and has achieved many of its original goals: ensuring access to LTSS and reducing reliance on the locally-funded safety-net social assistance program, which can be used to cover nursing home costs. It also strengthened the LTSS provider infrastructure and expanded access to home care. Recent reforms have addressed some of the program's key issues: the benefit's decreasing value, the eligibility and benefit structure that largely excluded cognitive impairment, and the program's longer-term financial sustainability-particularly its ability to sustain newly expanded benefits, which provide stronger protections to caregivers, index-link benefits, and more systematically incorporate cognitive impairment via a new assessment system. It has addressed financing issues by increasing premiums, introducing subsidies for the purchase of private insurance, and creating a "demographic reserve fund." Discussion and Implications: The reforms constitute a significant strengthening of the program, remarkable in an era of retrenchment. Overall, the program provides evidence for the financial viability of a social insurance model, although longer-term challenges may yet arise.


Assuntos
Seguro de Assistência de Longo Prazo/legislação & jurisprudência , Previdência Social/legislação & jurisprudência , Idoso , Idoso de 80 Anos ou mais , Alemanha , Política de Saúde , Humanos , Seguro , Assistência de Longa Duração , Pessoa de Meia-Idade , Previdência Social/organização & administração
18.
Ann Glob Health ; 84(3): 348-359, 2018 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-30835374

RESUMO

BACKGROUND: Mexico has a great diversity and richness of natural resources, but evaluations of the quality of life of Mexicans show the deep inequalities and the gap between rich and poor. While 5% of families concentrate 58% of the wealth, the health spending in environment and health is 0.2 and 2.7 of the GDP respectively. This has repercussions both on the gradual deterioration of the environment and on the insufficient health and social security coverage of the working population. OBJECTIVE: To describe the current situation of occupational and environmental health in Mexico. METHODS: A bibliographic review was performed on the socioeconomic, demographic, environmental, legal and health status of the Economically Active Population (EAP). FINDINGS: There is a constant deterioration of terrestrial and marine ecosystems, accompanied by an increase in environmental pollution in large cities. The unemployment rate of the EAP has decreased in one year to 3.4%, but the informal labor rate reached 57.3%, which translates into population without social security. Compliance with legislation for the protection of workers' health is insufficient. The recent amendments to the law have meant a setback in these respects. The reported information on accidents and occupational diseases corresponds to only 34% of workers. There has been a decrease in the rate of work accidents in the last six years, but an increase in diseases and permanent disabilities. During 2016, the first cause of occupational illness was hearing loss, but the profile was dominated by musculoskeletal diseases, which together reached 36.5%. CONCLUSIONS: To improve the occupational and environmental health situation, it is necessary to implement general and particular measures against inequalities, increase the budget in health and environment, enforce legislation and expand social security coverage to the population. These measures should be part of public policies as well as actions of academics and researchers.


Assuntos
Saúde Ambiental , Doenças Profissionais , Saúde do Trabalhador , Saúde Ambiental/organização & administração , Saúde Ambiental/estatística & dados numéricos , Política de Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , México/epidemiologia , Programas Nacionais de Saúde/organização & administração , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Saúde do Trabalhador/legislação & jurisprudência , Saúde do Trabalhador/normas , Saúde do Trabalhador/estatística & dados numéricos , Previdência Social/organização & administração , Fatores Socioeconômicos
20.
Bogotá; Ministerio de Salud y Protección Social; 2018. 1-73 p. tab.
Monografia em Espanhol | LILACS, MOSAICO - Saúde integrativa | ID: biblio-995195

RESUMO

El Ministerio de Salud y Protección Social (MSPS), conforme a los avances de la Mesa de Trabajo del MSPS para el Desarrollo de las Medicinas1 y las Terapias Alternativas y Complementarias (MTAC), presenta los lineamientos técnicos, a través de los cuales se busca articular las MTAC en el marco del Sistema General de Seguridad Social en Salud (SGSSS) del país. Para lo anterior, el documento describe el contexto internacional y nacional de las MTAC, realiza una aproximación a las MTAC, presenta las afinidades entre las MTAC y el SGSSS, plantea los principios, objetivos, estrategias, líneas de acción, los indicadores y responsables, así como la progresividad esperada para la implementación, seguimiento y evaluación de los lineamientos técnicos. En información complementaria se amplía el contexto y la normatividad, se hace una breve exposición de los paradigmas de las MTAC y una aproximación a las MTAC. Estos lineamientos consideran las estrategias de la Organización Mundial de la Salud (OMS) sobre medicina tradicional y demás orientaciones formuladas sobre el tema. Reconocen las políticas actuales del SGSSS, sobre todo las basadas en la Atención Primaria en Salud (APS) y el enfoque intercultural y diferencial. Atiende lo dispuesto en la Ley 1164 de 2007 "Por la cual se dictan disposiciones en materia del Talento Humano en Salud" y demás normatividad vigente en salud. Así mismo, retoma las reflexiones, desarrollos, conceptos y perspectivas en MTAC de expertos colombianos y avances internacionales en MTAC. (AU)


Assuntos
Humanos , Previdência Social/organização & administração , Terapias Complementares , Medicina Tradicional , Sistemas de Saúde , Colômbia , Acesso aos Serviços de Saúde
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