Social Security Coverage Research Articles

The role of mutuals and community‐based insurance in social health protection systems: International experience on delegated functions

AbstractThe institutional architecture for the provision of social health protection varies across countries, as do the actors and organizations involved. In some countries, mutual benefit societies and community‐based health insurance organizations (CBHI) play a role in this area. In the 1990s, these were promoted particularly as a means of extending social security coverage, especially in sub‐Saharan Africa. In the current context, the adoption of the 2030 Agenda for sustainable development, as well as renewed political will to realize universal coverage, has led to a questioning of the role of mutuals/CBHI. However, the literature on the roles they play in national social security systems remains limited. For this scoping review, 49 documents were analysed, covering 18 countries worldwide, focused on the delegation of functions to mutuals/CBHI in national social health protection systems. The results reveal the dynamics of the delegation of functions within social protection systems over time and their implementation processes. These provide areas for reflection that can inform policy processes.

노인 자살률은 왜 감소하고 있는가?

The elderly suicide rate in South Korea has declined sharply over the past decade. This study inferred that the decrease in the elderly suicide rate is due to the achievement of expanding the coverage of major social security systems rather than demographic changes. Therefore, we analyzed whether the expansion of the service guarantee and income security system had an impact on the elderly suicide rate. The research method is a panel fixed-effects analysis with the dependent variable of the elderly suicide rate from 2011 to 2020 at the county level and the independent variables of the long-term care for the elderly, the national pension (old-age pension), and the basic pension. The results show that all but 12 of the nation's 228 cities and counties experienced a decrease in the elderly suicide rate, and that the expansion of the elderly long-term care coverage over the past decade has contributed significantly to the decrease in the elderly suicide rate. In the model with social security coverage, a one percentage point increase in long-term care coverage was associated with a 2.26 percentage point decrease in the suicide rate, and a one percentage point increase in old-age pension coverage was associated with a 1.35 percentage point decrease in the suicide rate. In the model that included the amount of benefits, the additional amount of old-age pension was statistically significant, with a 1.5 percentage point decrease in the suicide rate for every 100,000 won per capita increase. The results suggest that the challenge of responding to elderly suicides is to strengthen the security of the social security system rather than individual welfare programs in the city and county, and that the main way to do so is to expand the entitlement of the universal social insurance system.

Analyzing the effect of health reforms on the efficiency of Ecuadorian public hospitals.

This study aims to assess whether Ecuadorian health reforms carried out since 2008 have affected the efficiency performance of public hospitals in the country. We contribute to the literature by shedding new light on the effects on public healthcare efficiency for developing countries when policies move toward health equity and universal coverage. We follow a two-stage approach, wherein the first stage we make use of factor and cluster analysis to obtain three clusters of public hospitals based on their technological endowment; we exploit Data Envelopment Analysis for panel data in the second stage to estimate robust efficiency measures over time. Our innovative empirical strategy considers the heterogeneity of healthcare institutions in the analysis of their efficiency performance. The results show a significant decrease in the average efficiency of low and intermediate technology hospitals after the new constitution was adopted in 2008. The decline in efficiency coincides with the two reforms of 2010 and 2011 that brought on higher social security coverage.

Recurrence and profile of reconsultants: descriptive study of 162 patients

IntroductionEmergency psychiatric consultation requests present certain specificities both in the situations encountered and in their management, due to a close relationship between the consultant and his environment. They do not only correspond to psychiatric emergencies, in the strict sense of the term, but also to psychological emergencies with their possible social dimension. They require an adapted response that can be decisive for the futureObjectivesTo determine the epidemiological and clinical characteristics of patients reconsultants in the emergency medical department.MethodsThis is a cross-sectional study, conducted over a period of 12 months, from 01 April 2020 to 31 March 2021, in the emergency medical department of Mahdia University Hospital.ResultsDuring the study period, 162 reconsultations for psychiatric emergencies were recorded. the age ranged from 18 to 61 years with an average of 35 years. The level of education was primary or secondary in 78.8% of cases. The majority of reconsultants had single marital status (70%). The absence of professional activity and social security coverage was found in 72.3 and 49% of cases respectively. The presence of family and personal psychiatric history was noted in 29.8% and 91.5% of reconsultants respectively. Heteroaggressiveness followed by instability were the most frequently encountered reasons for consultations with 23.4% and 12.8% of cases respectively. The presence of a triggering factor was found in 63.8% of cases where problems with the main support group followed by those related to the social environment and those related to access to health services were the most reported with 49.23 and 13% respectively. The syndromic psychiatric diagnoses were, in decreasing order of frequency, psychomotor excitement (23.4%), delusional syndrome (17%), dissociative syndrome (12.8%) and somatic conversion (12.8). For reconsultants, relational approach and/or injectable treatment were the most used therapeutic means immediatly (49%). Neuroleptics and benzodiazepines were prescribed in 38% and 13% of cases, respectively. The decision to hospitalize in a psychiatric department concerned 45% of reconsultants.ConclusionsReferral decisions favored the organization of ambulatory follow-up, with a decrease in the rate of hospitalization. These results make it possible to identify the evolutionary trends of the population consulting in emergencyDisclosure of InterestNone Declared

Cushing’s disease and bipolar disorder: study of medicopsychiatric intricacies from a clinical vignette

IntroductionCushing’s syndrome is a relatively rare condition that results from chronic hypercortisolism. This syndrome is characterized by the presence of various psychiatric manifestations that can accompany it at all its stages of evolution. They can either inaugurate the clinical picture, or appear during the course of the disease, as they can persist even after the resolution of the syndrome. of Cushing. Through a clinical vignette, we report a case of Cushing’s syndrome in a 52-year-old patient who presented with a picture of melancholic depression as part of a bipolar disorder and who had preceded the discovery of Cushing’s disease.Objectivesestablish the relationship between Cushing’s syndrome and bipolar disorder and identify the main pillars of care.MethodsIt was proposed to present the clinical case of a 52-year-old patient in whom psychiatric manifestations of the psychotic and thymic types preceded the discovery of Cushing’s disease, to recall the main psychiatric symptoms that can be encountered during such endocrine disorders and their possible entanglement with psychiatric pathologies.ResultsMrs. F. is 52 years old. married and mother of 3 children, without social security coverage for medullary carcinoma of the thyroid, having benefited from thyroidectomy with radiotherapy, admitted for treatment of paraneoplastic Cushing’s syndrome. The beginning of his troubles goes back to 6 months before his consultation with psychiatry. The initial symptoms were typical of a progressive weight gain noticed by the entourage. There was the installation of thymic symptoms such as an elation of mood, self-esteem, multiple projects. One month before admission to the internal medicine department, the patient presented with a depressed mood, anhedonia , a disgust for life, and dark thoughts. She had stopped all drug treatment.Cushing’s disease is the most common cause of endogenous hypercortisolism (>85%). Corticotropic micro-adenomas , are the most frequently observed, i.e., in 90% of cases, and are sometimes not visible on magnetic resonance imaging . Its first-line treatment is neurosurgical with trans-sphenoidal excision. In its second intention, it uses drugs whose targets are pituitary or adrenal, as well as radiotherapy.Conclusionswe present the case of a patient with a picture of bipolar mood disorder and Cushing’s disease. Thymic and psychotic psychiatric symptoms preceded the discovery of endocrine disease whose symptoms were not apparent at first. The hypotheses of comorbidity or rather of the inauguration of the endocrine disease by a psychiatric picture, in particular bipolar mood disorder, remain advanced and the limits betweenDisclosure of InterestNone Declared

Assessment of quality of life in children with epilepsy in Oman

PurposeThe study aims to describe the quality of life (QoL) in Omani children with epilepsy at Sultan Qaboos University Hospital, Oman.MethodsOne hundred and one Omani children, with an age range from 5 to 18 years, diagnosed with epilepsy were enrolled in the study over 3 months. Descriptive epidemiology was used to characterize QoL in these children. QoL was measured using the PedsQL (4.0) questionnaire, a 23-item child and parent report questionnaire. Analysis of variance (ANOVA) was used to compare mean QoL scores, and agreement between the QoL reports of children and parents was evaluated using Spearman’s rho; while, Multivariate analysis of variance (MANOVA) was performed to determine differences in subscale ratings.ResultsFactors affecting QoL included family status, income level, social security coverage, type of treatment, seizure frequency, age of onset, and seizure-free duration in years. Children between 5 and 7 years and females, in general, were most affected, as reflected by the overall QoL subscale. Consistency between the children's self-reports and parent proxy reports on the PedsQL™ was moderate to low.ConclusionOmani children with epilepsy have poor QoL, and their psychosocial function is severely affected. Therefore, QoL should be an important outcome measure in managing children with epilepsy rather than just seizure control.

The Pass, a medical and social device for vulnerable people

The permanence of access to health care is a system that aims to facilitate access to ambulatory medical care for poor and vulnerable people who do not have social security or health insurance coverage, or who have incomplete social security coverage (neither mutual insurance, nor complementary health insurance from the primary health insurance fund). A health care team from the Ile-de-France region shares its know-how and expertise with the most disadvantaged.

Social security coverage for couriers who work through digital platforms in Mexico: A role for a special scheme?

AbstractThe socio‐demographic characteristics of couriers who work through digital platforms in Mexico reveal that more than 85 per cent of these workers have completed full‐time secondary education and 83 per cent of these workers are young (aged 14 to 44). However, only 25 per cent are covered for health services and social security benefits. Against this backdrop, and guided by international experience, we set out a proposal to provide these workers with a tailored package of social security benefits. The proposal would require to categorize couriers who work through digital platforms as “digital workers”, introduce a special scheme for these workers based on voluntary affiliation, and offer a specific portfolio of benefits.

Assessment of the direct hospital cost of medical care for patients hospitalized for a stroke in Gabon.

While the incidence of stroke is increasing in developing countries, resulting in an extremely high economic burden, very few costing studies have been carried out to date. This study aims to measure the direct hospital costs of stroke management in Gabon. The study adopts a retrospective approach, based on a review of patient records in the Neurology and Cardiology Departments of the University Hospital of Libreville (CHUL) between January 2018 and December 2019. It focuses on all patients received for stroke at the CHUL during the study period, regardless of the outcome, analyzing direct hospital costs. Three hundred and thirteen (313) patients were admitted during the period in question, 72.52% in neurology and 27.48% in cardiology. The average age was 58.44 (±13.73 years). Fifty-six percent (56.23%) had health coverage. Ischemic stroke was more common than hemorrhagic stroke, at 79.55% and 20.45%, respectively. The average expenditure per patient was estimated at 619,633 CFA francs (€944.62). From the point of view of social security coverage, the average out-of-pocket expense per patient was 147,140 CFA francs (€224.31), for a reimbursement of 422,883 CFA francs (€644.68). The average direct cost of stroke is very high for both patients and administrations. This argues for the implementation of prevention programs for the disease. The results of this study may be useful for work on the efficiency of such programs.

The Impact of Social Security on Fertility Willingness in OECD Countries

The low fertility rate is a common problem faced by all countries in the world today. All countries in the world have adopted different policies to improve the fertility rate. Based on the panel data of 36 OECD member countries from 1995 to 2019, this paper studies the impact of social security level on fertility through a two-way fixed effect model, and also examines the impact of other influencing factors on fertility. The results show that there is a U-shaped relationship between social security expenditure and fertility rate, and the social security coverage rate and fertility rate have a negative relationship, and the impact effect is more indirect. The research results of this paper are helpful to understand the impact mechanism of fertility rate from a macro perspective, and provide reference for the Chinese government to improve fertility rate through multiple channels.

Kontrowersje wokół podlegania ubezpieczeniom społecznym artystów wykonawców

Controversy over the social security coverage of performing artists Judgments of the Polish Supreme Court on the subject of social insurance for performing artists have caused controversy in the doctrine. It was criticized that the Court avoided assessing the creative or artistic nature of the work, because these are not elements determining the legal nature of the contract covered by the insurance. In this text, the author analyzes the views of the doctrine expressed in response to the judgments of the Supreme Court. He presents the opinion that the assessment of the legal qualification of a contract the subject of which is artistic activity is the domain of civil law. Neither copyright law nor social security law justify an autonomous interpretation of this agreement.

O direito humano à seguridade social e o controle de convencionalidade: análise da reforma da previdência à luz das diretrizes de Maastricht e princípios de Limburgo

The paper analyzes the new social security system, through the prism of the international norms of protection to the human rights and of those that recommend the conventionality control. The general objective of the research is to examine aspects of the social security’s reform, following the Maastricht guidelines and Limburg principles, to assess whether there was a violation of the human right to social security to motivate the respective control of conventionality. The specific objectives are: to analyze the conventionality control and its cogent application in the management of internal norms; outline brief notions about the distinction between constitutionality and conventionality blocks; demonstrate the modalities of conventionality control, the antinomies solution and application of the sources dialogue; and, finally, to examine the implications of the welfare reform regarding the human right to social security. The importance of the theme is revealed by the consequences of a decrease in the coverage of social security in the legal sphere of the brazilian population’s human rights. With descriptive-deductive research method and normative, jurisprudential and bibliographic, the matter is deepened by mentioning the Inter-American Court’s judgments, including the case of Muelle Flores v. Peru, leading case in the pronouncement of the right to social security, as an autonomous right derived from article 26 of the American Convention.

Evaluation of Kartepe Village Production Patterns and Farmer Profiles

The aim of this study was to provide necessary agricultural extension support while carrying out agricultural activities by revealing the production patterns and farmer profiles in the villages of the Kartepe district of the Kocaeli province. The farmers registered in the Farmer Registration System (FRS) were taken into account. A total of 260 farmers participated in a two-month study, answering a questionnaire during face-to-face interviews, and the data obtained were evaluated through performing statistical analyses. The data were interpreted by applying frequency tables and the Kruskal-Wallis test. A total of 89.6% of the farmers are male, 10.4% are female, 40.8% are 56 years old and over, and 34.6% are between 45 and 55 years old. In terms of education levels, 61.9%, the highest proportion, graduated from primary school, followed by 15.8% who graduated from secondary and high schools, those who graduated from university with a Bachelor/Associate Degree, and, finally, those who graduated with a postgraduate degree as well as those who are illiterate. A total of 69.2% of the farmers are retired, and 24.7% are workers. The land of 68.8% of the respondents is their own property, and the land of 11.9% of them is common land. This land ranges as follows: 32.7% consists of 1–10 acres and 11–20 acres, and 17.3% consists of 21–30 acres. More than half of the participants (51.9%) produce 4 tons or more of their product annually. The social security coverage of the respondents is as follows: 42.7% SSK, 21.2% Bagkur, and 16.5% Pension Fund. The analyses show that the differences in terms of occupation, land size, property status, number of workers and worker status, social security, the fight against diseases and pests, and the relationships between them are important.

Socio-demographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: a data-driven analysis of 1 069 174 death certificates in Mexico.

In 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent of non-COVID deaths on excess mortality, its regional distribution and the association between socio-demographic inequalities have not been characterized. We conducted a retrospective municipal and individual-level study using 1 069 174 death certificates to analyse COVID-19 and non-COVID-19 deaths classified by ICD-10 codes. Excess mortality was estimated as the increase in cause-specific mortality in 2020 compared with the average of 2015-2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. Correlates of individual and municipal non-COVID-19 mortality were assessed using mixed effects logistic regression and negative binomial regression models, respectively. We identified a 51% higher mortality rate (276.11 deaths per 100 000 inhabitants) compared with the 2015-2019 average period, largely attributable to COVID-19. Non-COVID-19 causes comprised one-fifth of excess deaths, with acute myocardial infarction and type 2 diabetes as the two leading non-COVID-19 causes of excess mortality. COVID-19 deaths occurred primarily in-hospital, whereas excess non-COVID-19 deaths occurred in out-of-hospital settings. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization and social marginalization. At the individual level, lower educational attainment, blue-collar employment and lack of medical care assistance prior to death were associated with non-COVID-19 deaths. Non-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual- and municipal-level socio-demographic inequalities.

Measuring Well-Being of Migrant Gig Workers: Exampled as Hangzhou City in China.

The consistent innovations and applications of information technology drive the vigorous development of the gig economy, and generate gig workers such as food delivery workers and couriers, and make a great contribution to stabilizing employment and increasing income. Gig workers, mostly made up of migrants, and suffer from job and status difficulties. Research on the well-being of migrant gig workers can reveal the practical problems and provide suggestions for narrowing the wealth gap to promote social fairness and justice. Taking Hangzhou city in China as an example, this paper explores the well-being of food delivery workers, couriers, and online car-hailing drivers as representatives of migrant gig workers. Firstly, the relevant data are acquired through the questionnaire. Secondly, the characteristics of this group are analyzed through descriptive analysis, namely: most of them are migrant workers aged between 20 and 39 with low occupation satisfaction due to insufficient social security coverage and limited well-being, despite relatively high income. Based on the analysis of differences in demographic variables and structural equation modeling, the factors affecting the well-being of migrant gig workers are studied, which mainly are occupation satisfaction, social interaction, and social security. The results show that occupation satisfaction is positively affected by family characteristics, social interaction, and social security. In addition, family characteristics and social security positively impact social interaction, but the former has no significant effect on well-being. Finally, this paper enriches the research on the well-being of specific migrant gig workers and gives policy suggestions for enhancing the well-being of migrant gig workers in Hangzhou city from the perspective of optimizing the mechanism, pilot construction, and platform provision.

Transition from the Informal to the Formal Economy: The Need for a Multi-faceted Approach.

The recent international attention paid to the formalization of the informal economy finds reflection in ILO Recommendation No. 204 concerning the transition from the informal to the formal economy and the Sustainable Development Goals (Target 8.3). There is great diversity within the categories of the informal sector, informal employment, and informal economy in India. This paper examines the category of the ‘informal economy’ as understood in international instruments as well as in international statistics and maps these onto legal categories recognized within Indian law. The categories of ‘employed’, ‘engaged’, and ‘work arrangement’ used in Indian laws, and their interpretation by the courts, are useful to understand the links between the concepts of work, employment, and livelihoods. The paper also focuses on the diversity of the informal economy, focusing on wage employment, self-employment, including the diverse forms of own-account work and contributing (unpaid) family labour. The categorization of gig and platform workers as own-account or waged workers continues to pose a normative challenge. The regulatory responses for formalization of each segmented category of informal workers and informal enterprises cannot be uniform, and neither do they need to be linked to any particular domain of the law. Moving beyond the extension of social security coverage as the key vehicle for formalization, the paper suggests various entry points through which law and policy can improve conditions of work and protect the livelihood of those in the informal economy as measures to achieve formalization.

Mental health gaps characteristics in the management of schizophrenia in a developing upper middle-income South-East Asian country

The Mental Health Gap Action Program (mhGAP) was launched by the World Health Organization (WHO) in 2008 to address the lack of care of people in low and middle-income countries The purpose of this narrative review is to examine Mental Health Gaps in the management of Schizophrenia in Malaysia. A search was conducted using the five keywords in the following databases: Embase, MEDLINE, Web of Science, PubMed and Google Scholar. A review of the mental health system in Malaysia was conducted through the lens of the mhGAP context with a particular focus on Schizophrenia. Gaps in service delivery and lack of fidelity to evidence-based practices to this population of patients are examined in context of social security and health coverage, evidenced-based practices in Schizophrenia and health and allied delivery systems. and Implications for Practice: Mental health service delivery and associated systems in Malaysia are found wanting in several aspects of mental health management of schizophrenia. There is an urgent need for a thorough review and realignment of the management of Schizophrenia by all stakeholders involved in the multi-sectoral inter-system delivery of services to people with schizophrenia i.e. Mental health professionals, Social Welfare officers, policy makers, local and federal government agencies involved in education, employment, transport and housing.

Harnessing the Power of Labour Law and Social Security Law to Achieve the Goal of Formalizing Labour Markets in the BRICS Countries

The Declaration by the Labour and Employment Ministers of the BRICS countries, “Quality Jobs and Inclusive Employment Policies,” guarantees that formalization of labor markets is a global priority for the BRICS countries, as informal employment hampers productivity, potential economic growth and efforts to improve the welfare of populations worldwide. Taking into account this strategic goal, the authors analyze the informal employment processes in the BRICS countries and speculate on the transition from informal to formal employment. The article addresses the issues of inhomogeneous notional ranges used to define informal employment and recommends that the possibilities provided by labor legislation and government employment policy (such as increasing the number of formal working places and dynamic development of labor legislation directed at regulation of new employment forms) be used to tackle these issues. The potential of the social security right for achieving the goals of transition to a formal economy and social security coverage is characterized in detail; various legal forms of social security (for example, government social security, social insurance (mandatory as well as voluntary) and social support) are analyzed; and the possibilities of their application to informal workers in the BRICS countries are defined.

Introduction: Making the case to formally revise the international social security standards to include long‐term care for the elderly

AbstractFirst published in April 1948 as the Bulletin of the International Social Security Association, this year marks the 75th anniversary of what, since January 1967, we have all come to know as the International Social Security Review. To mark this important anniversary, this special double issue, “The human right to long‐term care for the elderly: Extending the role of social security programmes”, talks to current debates on social security coverage extension in a context of population ageing. There is a case to be made for revising the international social security standards to formally recognize long‐term care for the elderly, possibly as a distinct branch of social security. At the heart of this discussion, the questions to be addressed by all countries are the roles that social security systems can and should play in helping to meet the long‐term medical and social care needs of elders.

Quality of Employment Index for the tourism sector in developing countries

Although job quality has become an active field of study over the last two decades in developed countries, it still remains an under discussed concept in developing regions such as Latin America, where the incidence of work informality and low wages are particularly high. As quality of employment is a multidimensional concept and not homogeneously defined in the literature, we follow a Principal Component Analysis (PCA) to build a Quality of Employment (QoE) Index for salary earners using household survey micro data of Uruguay from 2016-2019. Uruguay leads the Better Jobs Index launched by the Inter American Development Bank in 2017, which constitutes the only index with a macro-approach to measure quantity and quality employment conditions in the region. We consider several aspects of working conditions: employment, earnings, hours worked, occupational safety and social security coverage. We focus on the tourism sector, which presents low job quality characteristics at the same time it accounts for 7.2% of employment in Uruguay. Furthermore, we found a sex-based gap of employment quality against women in tourism, a difference that is not observed in the trade sector. QoE in tourism shows a greater dispersion in the distribution of employees, indicating the presence of more inequalities among these workers compared to those of trade. Other results show that job quality in tourism is lower for those unskilled, but that there are still many skilled workers facing low quality. Finally, if we consider the activities that conform tourism, workers do better in hotels and travel agencies rather than in restaurants and entertainment.