General Social Security System Research Articles

Proposal of a Knowledge Management Model for Complex Systems: Case of the Supervision and Control Subsystem of the Colombian Health System.

Considering regulatory, supervision, and control health policy, an innovative knowledge management model is proposed for the Colombian health system, which is recognized as a complex system. A model is constructed through a comparative analysis of various theoretical and conceptual frameworks, and an original methodology is proposed based on an analysis of the macroprocesses of the Supervision and Control System (SSC) of the Colombian General Social Security System in Health (SGSSS). After formulating hypotheses and conceptual references, information errors are determined within the different macroprocesses of the SGSSS, including those of governance and the SSC. The risks of generating duplicate, wrong, hidden, or non-existent information arise when the associated regulations need more specificity to be applied in all cases, thus leading to the risk of different interpretations by some actors. In this way, it is possible to hinder the generation of unified information, as there is no clarity as to who is responsible for the generation or creation of certain data. The proposed model is characterized by its flexibility and adaptability, integrating several processes that can be executed simultaneously or cyclically (depending on the system's needs) and allowing for the generation and feedback of knowledge at different stages, with some processes simultaneously executed to complement each other.

Jurisdictional limitations on the configuration of the causal link between work and grievance

The present study aims to discuss a current and necessary topic in the field of law: jurisdiction and jurisdictional limits to establish the causal link between work and injury, which concerns both labor law and social security law. Although distinct. These sections of law have points of intersection that can generate doubts and conflicts in applying legal norms, compromising the legal security of relations between employees, employers, and the State. The social security reform, which changed important aspects of benefit rights, but did not modify the residual competence of ordinary justice to judge accidental actions, makes evident the need for unification and adequacy of the procedural means to resolve these demands. The study aims to clarify the constitutional rules that define the competence to process and judge matters related to accidents at work and occupational diseases of workers insured by the General Social Security System (RGPS), seeking to delimit the limits of this jurisdictional action.

Mental and behavioral disorders related to work in Brazil: temporal trends and the impact of the Social Security Technical Nexus.

This article aimed to assess the temporal trend of work-related mental and behavioral disorders in Brazil, as well as to measure the effect of changes in the implementation of the Social Security Technical Nexus (NTP, acronym in Portuguese) on the incidence of these disorders among beneficiaries of the General Social Security System (RGPS, acronym in Portuguese). It is an analysis of time series and interrupted time series with data from the Brazilian Ministry of Social Security information system on cases of work-related mental and behavioral disorders from 2003 to 2019. The Prais-Winsten method was employed to calculate the annual percent change (APC) of the incidence rates for the conditions under study. The average incidence of work-related mental and behavioral disorders was 35.48 per 100,000 RGPS links during the period 2003-2019, with an increasing trend (APC = 9.67%; p = 0.033) for Brazil. Before the implementation of changes in the NTP (2003-2007), this value was 15.59, with an increasing trend (APC = 29.28%; p < 0.001), and it more than doubled (43.77) after the RGPS modified the way of establishing the nexus between illness and work (2008-2019). The post-NTP trend for work-related mental and behavioral disorders was a decrease in the country (APC = -23.73%; p < 0.001), a pattern that was repeated for all regions of the country. The findings suggest that the changes in the way of establishing the NTP between illness and work represented an advancement in the system of recording and notifying work-related mental and behavioral disorders in Brazil.

Loss ratio of the capitation payment unit of the health-promoting entities in Colombia between 2017 and 2021: a financial–actuarial approach

BackgroundBecause of a change of government, the Colombian Ministry of Health and Social Protection is in the process of presenting a structural reform for the General System of Social Security in Health (GSSSH), in order to implement a ‘preventive and predictive health model’. However, it will always be relevant to review and analyze the fiscal implications of any proposed public policy program, to protect financial sustainability and to promote the better functioning of the system in question.MethodsTo contribute to this topic, we have calculated, using a financial–actuarial approach, the loss ratio for the years 2017 to 2021 for the Capitation Payment Unit (CPU) for all the Health-Promoting Entities (HPE) for both contributory and subsidized schemes. This information, derived from public reports available on the official website of the National Health Superintendency, allows us to estimate the financial burden of the institutions that guarantee access to and provision of health services and technologies in Colombia.ResultsThe study shows that close to half of the HPEs in Colombia (which represent 11.6 million affiliates) have CPU loss ratios of more than 100% for the year 2021, evidencing insufficient resources for the operation of health insurance.ConclusionsFinally, we propose some policy recommendations regarding the strengthening of informed decision-making to allow the healthy financial sustainability of the Colombian GSSSH.

Costo de las incapacidades por trastornos mentales y del comportamiento en Colombia, 2016-2018

AimTo determine the costs of temporary disability due to mental and behavioral disorders for the period 2016–2018 in Colombia. MethodsDescriptive-correlational observational cross-sectional study, using the totality of disability records of contributors to the Colombian General System of Social Security in Health between 2016 and 2018, reported according to ICD-10 as mental and behavioral disorders (F00–F99) and provided by the Ministry of Health and Social Protection. ResultsThe highest number of incapacities corresponds to anxiety disorders and depressive episode with a participation of more than 20% each. The average per disability was 2.68 days, with schizophrenia (4.09), bipolar affective disorder (3.48) and recurrent depressive disorder (3.23) generating the highest number of disabilities. The average daily cost for each incapacity was $27,178; and for each patient, taking into account the average number of days of incapacity, the cost rises to $411,278 per person. ConclusionsWomen most frequently presented some type of illness and the greatest number of records occurred in the central-eastern area and coffee-growing region of Colombia; it was established that anxiety and depressive disorders are the most common and, finally, the analysis indicated that people with salaries of less than 2 SMLMV were more disabled than those with higher salaries.

Acceder a los servicios de salud: la mirada de migrantes del Chocó a Medellín

Introduction: Internal migration implies facing a series of conditions that prevent or delay the use of health services; objective: Understand barriers to health services access from the perspective of Chocó migrants living in Medellín.; methodology: Qualitative study, two focus groups were carried out in which 13 people with migratory experience from the department of Chocó to Medellín participated-; results: Afro-Colombian migrant population experiences barriers to entry due to not being insured by the general social security system in health, denial of service provision, lack of information, and unfavorable geographical accessibility. In health services, the barriers are associated with the color of skin and barriers due to delay or denial of authorization for procedures; conclusions: Migrant population experiences barriers to access to health services. An intersectoral approach to this problem is required, considering the particularities of the migratory context in the country where issues such as employment, education, and violence by armed actors, amongothers, are mainstreamed.

MECANISMO ALTERNATIVO A NÃO INCIDÊNCIA DO FATOR PREVIDENCIÁRIO NA APOSENTADORIA POR TEMPO DE CONTRIBUIÇÃO

The pension factor is a multiplicative factor to the amount of pension benefit retirement contributions, and optionally will retirement age, the General Social Security System. On November 4, 2015 was sanctioned by the President of Brazil to the Republic Act nº 13.183, which in its Article 29-C presents an alternative the incidence of social security factor. Given this perception, this article aims to conduct an analysis of the alternative mechanism to no impact of this factor in retirement by contribution time, talking about the security factor and how your calculation as well asdeal with the rules of the new method 85/95 in order to demystify what is the most beneficial factor for individuals in society that seek retirement.

Statistical actuarial estimation of the Capitation Payment Unit from copula functions and deep learning: historical comparability analysis for the Colombian health system, 2015–2021

The Capitation Payment Unit (CPU) financing mechanism constitutes more than 70% of health spending in Colombia, with a budget allocation of close to 60 trillion Colombian pesos for the year 2022 (approximately 15.7 billion US dollars). This article estimates actuarially, using modern techniques, the CPU for the contributory regime of the General System of Social Security in Health in Colombia, and compares it with what is estimated by the Ministry of Health and Social Protection. Using freely available information systems, by means of statistical copulas functions and artificial neural networks, pure risk premiums are calculated between 2015 and 2021. The study concludes that the weights by risk category are systematically different, showing historical pure premiums surpluses in the group of 0–1 years and deficits (for the regions normal and cities) in the groups over 54 years of age.

Possible future scenarios of the general health social security system in Colombia for the year 2033

This article formulates possible future scenarios for the Colombian General Health and Social Security System (GHSSS) in 2033 when it reaches its 40th anniversary. The research draws on intuitive logic from the School of Human and Social Foresight (Masini, Penser le futur, 2000). The approach considers that in contexts of high instability and high conflict of interests, a combination of methods is required for the analysis of relevant transformations. It entails applying methods based on evidence, expertise, interaction, and creativity as discussed by Keenan and Popper (Foresight 10:16–36, 2008). Three scenarios are devised with the participation of real actors representing a plurality of visions from the public, private, academic, and social sectors. Finally, two future scenarios are featured, the one chosen by the experts before the triumph of the current government and the one that the Ministry of Health will present to the Colombian Congress for approval in 2023.

The social security system in health in Colombia and the noncompliance of the principles of universality, solidarity and integrality

The current Pandemic has exposed the crisis in the health system and the urgency that, once the trance is over, structural problems be addressed to increase the quality and opportunity of access to the health system. This article seeks to analyze whether, during the pandemic, the principles of universality, solidarity and integrality, established in the General System of Social Security in Health and that respond to the content of the Political Constitution of 1991, were ignored. For the above, the proposed objectives correspond to the review of the current state of health care and the elements available to the State in the face of the health crisis, to understand the dangers that a global crisis such as Covid-19 can represent for compliance with the principles of the Social Security System in Health in Colombia, as well as the implications in the paradigm shift from a health model as a public policy to a fundamental right, to finally analyze the right to health of the elderly in the face of the pandemic. The social security health system in Colombia was not designed to deal with crises like the current one, and fortunately there have not been the mortality rates that were expected. However, it is necessary to rethink the rights around the health care of the vulnerable population in catastrophic situations, since the government risk of violating the enjoyment of life in decent conditions is latent, given the potential prioritization of intermediate care. and intensive in health centers in the face of the crisis generated by the Coronavirus pandemic.

Diferenciais de mortalidade, beneficiários do Instituto Nacional do Seguro Social do Brasil em 2015

ABSTRACT This paper aims to estimate mortality and analyze its differentials by sex, age, and groups of beneficiaries of the Brazilian National Institute of Social Security (INSS) in 2015 and make comparisons with official estimates for the general population, assessing the distribution of deaths by age and of survival after 65 years old. The results reinforce the need for more studies on mortality differentials between beneficiary groups and for continuous investment to improve the quality of the data. Population aging, among other aspects, puts pressure on the Brazilian social security system, and there is real concern about its sustainability. Life tables by population subgroups are fundamental as a tool for analyzing the financial and actuarial equilibrium of the system. The results contribute to the debate on the mortality differentials between groups of beneficiaries of the general pension and social security system in Brazil. The death and population data derive from the administrative records of the INSS. We used Gompertz and Van de Maen models and Topals regression to estimate the mortality rates above the age of 65, according to the following beneficiary groups: retirees through age of the General Social Security Regime (Regime Geral de Previdência Social - RGPS) - disaggregated by urban and rural clienteles; retirees through period of contribution; and beneficiaries of welfare support for low income seniors. Among the main results, it was possible to minimize the crossover in the mortality rates of older ages, when the mortality of the less advantaged population becomes lower than the mortality of populations with better social indicators. Cross-checking the results with the official mortality estimates, it was observed that life expectancies for the 65 and 75 year old age groups of the target population of this study are higher than in the general population.

Eating behavior in a group of overweight pregnant women in two municipalities of Antioquia, Colombia: qualitative study

RESUMENObjetivo: Describir el comportamiento, frente a la alimentación, de un grupo de gestantes con exceso de peso.Materiales y métodos: Estudio cualitativo, desde la perspectiva de etnografía enfocada. Se incluyeron mujeres gestantes mayores de 18 años con sobrepeso u obesidad, o ganancia excesiva de peso en el embarazo, y que asistieron al programa de control prenatal de dos instituciones públicas de salud pertenecientes al régimen subsidiado por el Estado en el Sistema General de Seguridad Social, en dos municipios del departamento de Antioquia (Colombia). Se realizaron 13 entrevistas semiestructuradas individuales y tres entrevistas grupales. Análisis por triangulación y codificación abierta y axial. Resultados: Participaron 22 mujeres gestantes. Se encontraron cinco factores que condicionan el comportamiento alimentario de esta población: el nivel socioeconómico bajo que limita el acceso a una alimentación variada, la red social de apoyo, el estado de salud en los embarazos previos o en la gestación actual, las recomendaciones genéricas brindadas por el personal de salud sobre alimentación y nutrición, y, por último, los conocimientos de las participantes sobre alimentación y las implicaciones del exceso de peso materno en la salud madre-hijo.Conclusión: Es imperante que la atención y educación alimentaria y nutricional sean brindadas desde las particularidades que inciden en la adopción de cambios del comportamiento alimentario de las mujeres embarazadas con exceso de peso; los profesionales del control prenatal deben contar con capacitación que promueva la unificación de criterios y una atención adaptada a la realidad social de la gestante.

Ocular toxoplasmosis in immunocompetent adults: current cost-effectiveness of four treatment regimens in Colombia

BackgroundOcular toxoplasmosis is an infection caused by Toxoplasma gondii. In South America, the clinical course of ocular toxoplasmosis is more severe than in Europe and North America because virulent strains of the parasite are present. Ocular toxoplasmosis is the leading cause of posterior uveitis and retinochoroiditis in Colombia, requiring timely and appropriate treatment. However, there is no standardized therapy protocol based on economic studies for the country. PurposeTo compare the cost-effectiveness of four first-line treatment regimens for active ocular toxoplasmosis in immunocompetent adults in Colombia, using the number of averted therapeutic failures as the outcome. MethodsWe performed an economic and cost-effectiveness analysis to compare four first-line treatment regimens for ocular toxoplasmosis from the perspective of a third-party payer (Colombian General System of Social Security in Health). A decision analysis tree was used over a 24-week time horizon, considering only direct costs. Additionally, we performed a discrete sensitivity analysis and a probabilistic sensitivity analysis with 10,000 iterations in the Monte Carlo simulation. ResultsFor the base case, trimethoprim/sulfamethoxazole showed 86% effectiveness at a cost of <57 United States Dollars, resulting in the most cost-effective first-line alternative. When performing the probabilistic sensitivity analysis and maintaining the willingness to pay 466.00 United States Dollars, the trimethoprim/sulfamethoxazole regimen remained the most cost-effective alternative. ConclusionOcular toxoplasmosis is a public health issue in Latin America. Despite severe visual consequences for affected patients, there are no standardized treatment guidelines in countries such as Colombia. Our evidence supports the use of trimethoprim/sulfamethoxazole as first-line treatment in Colombia because of its availability and optimal cost-effectiveness performance; it reduces recurrences and complications, while averting therapeutic failure. Furthermore, our evidence can be generalized to other Latin American countries with similar frequencies and severities of Toxoplasma gondii ocular infection and health systems similar to the Colombian system.

Prevalence of adult female acne in Colombia: A population-based study.

BackgroundAcne is a common inflammatory skin disease with adolescents being the most affected by this condition; however, acne also occurs frequently in the adult population. Adult acne is defined as late-onset acne or acne that persists beyond age 25 years. In terms of epidemiologic data, reports of adult female acne prevalence range from 5.5% to 61.5% around the world.ObjectiveThe aim of this study was to estimate the prevalence and trace the trend of adult female acne in Colombia over the last 5 years.MethodsUsing nationwide data from the General System of Social Security and Health in Colombia through the Sistema Integrado de Información de la Protección Social database and International Classification of Diseases, 10th Revision, diagnostic codes, a cross-sectional study was conducted to estimate the prevalence of adult female acne in outpatients in Colombia from 2015 to 2019.ResultsFor the 5-year study period, overall acne prevalence was 2.14 per 1000 population. The highest annual prevalence (2.94 per 1000 population) was in 2019 and the lowest prevalence (1.71 per 1000 population) was in 2015. Prevalence peaked in patients age 25 to 29 years, and decreased to <1 per 1000 population in those age <50 years.ConclusionThis nationwide study of adult female acne in Colombia suggests an increasing trend in prevalence over the last 5 years. We recommend further studies to determine risk factors involved in this condition.

Programa Bolsa Atleta: antes, durante e depois dos Jogos Olímpicos e Paralímpicos Rio 2016

The objective of this research is to provide a retrospective view of the Bolsa Atleta Program, from the perspective of its legislation, taking into account the periodization proposed by the authors. Official documents on the Bolsa Atleta program served as a basis for consultation. The analysis of selected documents was based on the following categories: beneficiaries, financial resources, control, and penalties. The creation of the Bolsa Atleta program took place in the Pre-Games Rio 2016 phase and was intended to establish a direct relationship between the Ministry of Sport and athletes, serve the beneficiaries according to technical criteria defined by Law and enable financing for the needs of athletes with a good technical level, but without financial support to maintain your sport activity. Due to the country's achievement in hosting the Rio 2016 Olympic and Paralympic Games, changes were made to the program. The most significant of these was the lifting of the ban on receiving sponsorship in cash and salary. Two other changes that took place during the Games phase were greater control of the criteria and choice of competitions by the Ministry of Sport and the impediment of athletes caught in the doping test from receiving the benefit. After the completion of Rio 2016, Post-Games phase, there was only one change in the legislation, which was the athlete's faculty to join the General Social Security System.

Institutional practices in maternal health according to social class. Bogotá, Colombia, 2018.

To understand institutional practices in healthcare as relates to women during pregnancy, childbirth and the postpartum period according to social class in Bogota. Qualitative study based on the critical hermeneutics paradigm. Critical ethnographic method with theoretical sampling. The participants included 9 women and 8 health-care professionals from the city of Bogotá, attending public and private healthcare institutions that serve populations under both the subsidized as well as the contributive regimes of the General Social Security System. Overall, 38 in-depth interviews were conducted during a 13 month period, with 62 instances of support to the mothers in terms of prenatal care, vaccination, labor, postpartum visits, follow-up tests, psychoprophylactic course, hospitalization and waiting room. Triangulation analysis on Atlas Ti. Taking into account the discourse of the different players, observations and context, two categories were found to be determining factors of inequities: "Market-regulated health" and "Over- sight and control in health services". It is advisable in medical practice to build competencies in the population in order to ensure the realization of the rights of women and healthcare personnel. Qualitative research offers the opportunity to promote the transformation of medical rationale affecting women.

Técnica extraperitoneal comparada con IPOM plus: Análisis de costos evitados para optimizar el manejo de la hernia ventral por laparoscopia

Introducción. Analizamos los costos en el reparo extraperitoneal de la hernia ventral por laparoscopia, desde la perspectiva del sistema general de salud de Colombia, con el fin de mostrar los beneficios de dicho abordaje y su impacto económico, al compararlo con la técnica más implementada, el IPOM plus. Métodos. Se realizó un análisis económico de costo-beneficio, desde la perspectiva del Sistema General de Seguridad Social en Salud (SGSSS) de Colombia, comparando los costos del reparo de hernia ventral con la técnica extraperitoneal, TAPP o TEP, versus el IPOM plus. Se tomaron como costos de referencia lo establecido en el manual tarifario de Instituto de Seguros Sociales. Los datos fueron analizados con Stata V.15 Resultados. Se recolectó y analizo información de 109 procedimientos; 59 del grupo extraperitoneal TAPP/TEP y 50 del grupo IPOM plus, realizados durante los años 2015 a 2018, por el grupo de pared abdominal de Clínica Colsanitas, identificando un ahorro del 69,8 % o resultados de costo-beneficio a favor del grupo extraperitoneal. Discusión. El abordaje extraperitoneal en el reparo de hernia ventral se consideró una estrategia de alto costo-beneficio para el sistema de salud, validado por la experiencia del grupo de pared abdominal de Clínica Colsanitas, al compararla con el abordaje habitual. Teniendo en cuenta que los insumos utilizados para la disección no cambian, la prótesis utilizada para cada una de las técnicas representa un costo importante a considerar, tanto para el sistema como para las instituciones de salud

Factores que explican el apoyo social del adulto mayor en tres ciudades de Colombia. 2016

Objective: Identify the factors that explain the social support components of the elderly. Methods: quantitative, cross-sectional, analytical study of a source of primary information, obtained from surveys of older adults. The sample was 1452 people selected by probabilistic sampling by cluster, two-stage. In Medellín, Barranquilla and Pasto. To measure the perceived social support, the Medical. Results Study Social Support Survey was applied. Univariate, bivariate and multivariate analyzes were performed, statistical and epidemiological measures were calculated. Statistical associations considered with a p value of less than 5% were considered. Results: In relation to the social support components of the elderly, with an adequate condition: emotional support (92%); instrumental support (93.2%); positive social interaction (92.2%); affective support (93.2%) and in the total evaluation (91.9%). The city of Pasto was the one that selected the lowest percentages, in the different components. Perceiving good social support was a predominant condition in older adults: with a partner, without depression, affiliated with the General System of Social Security in Health, happy (through the Lima happiness scale), who live with at least two relatives, with proper family functioning, they do not perceive ill-treatment within their family, they have at least four close friends, they do not feel discriminated against, they do not leave them constantly alone and they have someone to take care of them permanently. Conclusion: being from the city of Medellín, having a partner, feeling happy, not being alone, as well as not having depression, important factors in each of the components of social support.

Mortality dynamics and the statutory retirement age proposal: an actuarial view

ABSTRACT This paper aimed to apply (dynamic and static) actuarial models to calculate the balanced contribution rates for the planned (at the minimum age) retirement benefit of the General Social Security System, based on the original and substitutive texts of the reform proposed by Michel Temer’s government. Even with the regular increases in life expectancy and the long-term nature of the analyses, national studies on social security are typically based on the static mortality hypothesis. The relevance of this study is evident due to the demographic changes, particularly the increase in life expectancy, experienced by the Brazilian population in recent decades and which put in question the sustainability of the national pension system. The use of dynamic actuarial models allows for more accurate discussions about the future of social security, besides contributing to the still scarce national literature. Static and dynamic actuarial models were applied to a representative individual, adjusting mortality tables from the United Nations covering 1950 to 2100. It was verified that the actuarially fair rates calculated by the dynamic actuarial model are typically higher than those obtained by the static model, especially for women. This difference is expected to increase as gains in life expectancy become more influenced by the reduction in mortality at more advanced ages. Moreover, if the social security reform is approved (in accordance with either the original or the substitutive text), there are indications from the dynamic model that the contributions rates currently charged would be excessive for men. In turn, these rates would be excessive for women considering the original text, and closer to the actuarially fair value considering the substitutive text. The development, disclosure, and regular updating of official dynamic tables (whether for mortality or other biometric assumptions) are also recommended.

Incapacidad permanente y mortalidad prematura en una cohorte de afiliados a la Seguridad Social en España, 2004-2015

ObjectiveTo describe a surveillance and monitoring system based on the analysis of the incidence rate of permanent disability (PD) and premature mortality (PM) in a sample of members of the Spanish Social Security. MethodStudy of three birth cohorts (1950-1959, 1960-1969 and 1970-1979) of people affiliated to the general Social Security system, included in the Continuous Sample of Labour Lives, who has been active for at least one day between 2004 and 2015 (N = 753,341). For each cohort, the annual incidence rates of PD and MP were estimated according to occupation and economic activity in women and men. ResultsBetween 2004 and 2015 the rates of PI and MP showed higher values in men with respect to women in practically all cohorts of births, occupations and economic activities groups. The trend throughout the observation period was increasing, both in the incidence of PD and PM in men and women, for the three birth cohorts and for all occupational categories. ConclusionsThe results derived from this work allows the continuous monitoring of the temporal evolution of the incidence of permanent disability and premature mortality in a representative sample of social security affiliates.