National Social Insurance System Research Articles

The History of Psychiatric Epidemiology in Finland: From National Needs to International Arenas, 1900s-1990s.

Psychiatric epidemiology has significantly influenced public health policies all around the world. This article discusses how Finnish epidemiologists reacted to local needs, which were born in specific circumstances and were controlled by science policy and funding opportunities. The development between the 1900s and 1990s is divided into three stages. The first Finnish studies in the field focused on the prevalence of mental illnesses in the country. The focus was to gain information for service planning, most of all to estimate the need for new hospitals and to set up the national social insurance system. After the Second World War, structural changes and social engineering fueled epidemiological interest. From the 1960s until the late 1980s, psychiatric epidemiology was interconnected with social psychiatry, which held a strong position in Finland. Since the 1990s, Finnish psychiatric epidemiology has been integrated with international epidemiology by using shared methodologies and through participation in transnational studies.

Development of National Social Insurance Systems in Ukraine and European Countries as a Factor in the Evolution of Human Rights to Social Security

"The purpose of this study is to investigate the state of social security in Ukraine and its comparative analysis in comparison with European countries, as well as to establish the concept, content, features, and purpose of this sphere in Ukraine. The methods used to study this subject can be distinguished as follows: dialectical method, formalisation method, law-cognising method, formal legal method, hermeneutical method, logical legal method, systemic, structural-functional method, axiomatic method, methods of analysis and synthesis, induction and deduction, etc. The results of this study are the definition and clarification of the characteristics and features of legal regulation of social security in Ukraine; established the list of types of social security in Ukraine. The authors investigated the development of social security in Ukraine since 1990; analysed the development of social security in Europe and identified four main models of social protection through the implementation of social security; identified the main problems in the field of social security as one of the factors of social protection of the population. The authors defined the term “social security”, established the content and features of the national social security system of Ukraine; investigated the development of social security in Ukraine and in European countries."

ІМПЛЕМЕНТАЦІЯ СВІТОВОГО ДОСВІДУ ЗАГАЛЬНООБОВ’ЯЗКОВОГО СОЦІАЛЬНОГО СТРАХУВАННЯ ДО ВІТЧИЗНЯНИХ РЕАЛІЙ

The article substantiates the role and importance of mandatory social insurance in developed countries. Special attention has been paid to the importance of active orientation towards the social insurance policy. The world experience of implementing social protection of the population and regulation of social development has been analyzed. The article identifies the priority areas of social policy reform in Ukraine in the context of adaptation to the standards of highly developed countries. Common and distinctive features with the system of mandatory social insurance have been identified and the possibility of implementing positive experience during the reformation has been substantiated. All this actualizes the issue of studying the world experience of raising the living standards of the population of Ukraine. The main problems that may arise in the process of implementing the global experience of universally mandatory social insurance to domestic realities and will stand in the way of achieving its main goals have been analyzed. Key institutional features of national social insurance systems, conceptual components of the formation of a civilized institute of social protection based on advanced achievements have been studied. The financing mechanism of social protection and social security has been substantiated. The features of the financing of social services at the local level that is generally accepted for all developed foreign countries is the division of local budgets into two functional types of local budgets. These are the local current (administrative) budget and local development budgets (investment funds). Each of these types has its own expenses and revenues of the budget. The experience of the development of social relations shows that social security is an objective and necessary phenomenon. The objectivity of social insurance is determined by the risky nature of the market economy and the need to establish financial guarantees to provide for persons who, for certain reasons, do not have the opportunity to participate in the process of material production and receive payment for their work. The analysis of world experience and its comparison with state realities made it possible to make a number of proposals for improving the state practice of social insurance. An important place is the possibility of using foreign experience of social protection in the national economy. It has been proven that the integration processes in Ukraine led to the actualization of the issue of improvement of domestic legislation and adaptation to European legislation, in particular social legislation.

REFORMING THE SOCIAL INSURANCE SYSTEM IN UKRAINE: PROBLEM ASPECTS AND KEY TASKS

Introduction. In modern conditions, Ukraine faced the issue of ensuring an adequate level of social protection of citizens against the background of their impoverishment and mass resettlement, as well as the rapid increase in prices and the number of those who lost their jobs and housing. Social insurance is an important component of the social protection system. It provides for the receipt by insured persons of various types of social benefits in the event of the occur rence of certain negative events caused by social risks. In this context, the question of increasing the effectiveness of the functioning of the social insurance system within the framework of the assessment of problematic aspects and key tasks of its further reform is brought up to date. The purpose of the article is a comprehensive analysis of the main principles of reforming the social insurance system in Ukraine in order to raise the standard of living of the population and protect it from new social upheavals and threats; identification of problematic aspects that accompany the specified changes; outlining promising directions for further improvement of the national social insurance system to ensure effective insurance protection and decent financial support for each insured person. Results. It has been established that social insurance is evidence of the sociality of any state that recognizes the supremacy of social values, cares for its citizens and adheres to declared social standards. It is argued that social challenges accompanying social transformations in the country, intensified by ATO, a pandemic and a full-scale war, necessitated the need for effective social security of citizens, the basis of which is social insurance itself. It is shown that the social insurance system has undergone many changes over the years of its existence. A critical analysis of the main reforms, which most affected the sphere of pension provision of the population and the health care system, reorganization of social insurance funds, was carried out. It has been proven that this transformation did not give the desired result, and social problems are only increasing. It is indicated that the important determinants of ensuring the effectiveness of the further reform of the social insurance system are: flexibility and adaptability of the system, its ability to adapt to the conditions of today; ensuring effective management of financial resources of social insurance funds, ensuring their non-deficit; systematic implementation of improvements and their compliance with international standards and social guarantees; deep awareness by employees and employers of the need to conduct labor activities honestly and openly. Conclusions. According to the results of the study, it was established that the main organizational and legal form of social security is social insurance within the framework of support and material stimulation of economically active citizens and improvement of the material situation of vulnerable population groups. The prospect of reforming the social insurance system in Ukraine depends on the effective cooperation of the state, employers and employees in the form of open dialogue and social responsibility of the parties to achieve the desired result – raising the level of social standards and high-quality social protection of citizens, intensification of labor activity and overcoming social upheavals.

Social insurance schemes: foreign experience in the realities of Ukraine

The article is devoted to the justification of the role and importance of compulsory social insurance in developed countries. Special attention is paid to the importance of active orientation to public policy in social sphere. Foreign practices in the implementation of social protection of population and regulation of social development are analyzed. The priority directions for reforming the public social policy in Ukraine in the context of adaptation to the standards of highly developed countries are determined. Key institutional features of national social insurance systems are studied. Conceptual components of forming civilized social security institute, based on the advanced achievements. Substantiated mechanism for financing social protection and social security. Features of financing social services at the local level generally accepted for all developed foreign countries is a division of local budgets into two distinct functional types of local budgets. This local current (administrative) budget and local budgets Development (Investment Funds). Each of these types has its own budget expenditures and revenues. Experience in the development of public relations reveals that social security is an objective and necessary phenomenon. The objectivity of social insurance due to the risky nature of the market economy and the need to establish financial guarantees to ensure that persons who for certain reasons are unable to participate in the process of material production and to get paid for their work. The analysis of foreign experience and its comparison with state realities is allowed the author to make a number of proposals to improve the state practice of social insurance.

Demographic and economic aspects of the pension system in Poland — a dynamic modelling approach

Demographic and economic aspects of the pension system in Poland —a dynamic modelling approachThe paper considers a hypothesis that some dynamic features of the Polish national and public pension system follow typical mental, generic and archetypal models, as a result of many demographic, macroeconomic, political and also global factors, particularly closed-loop feedback relations with delays and amplifi cations. There are some important messages in the paper for social insurance policies design, structures and management, the meaning of data mining and collection, and for model refi nement with modelling approaches in a systems’ thinking way. The shortcomings of national social insurance systems in dealing more eff ectively with upstream social insurance risk prevention in the population are systemic and include also a postulate to empower members of the population in order to involve them in their own, entrepreneurial downstream care. The paper contains a system dynamics SD point of view, as a method of macroscopic, continuous simulation modelling, to surface and explain some cycles and discrepancies between demography, policies, as well as the system’s aspects of the national pension system. The conceptual, formal and simulation model presented in the paper, followed by some experiments’ results, applies the SD method approach with causal loop diagrams CLD and stock-and-fl ow diagrams SFD, displaying delays, amplifi cations and structure cycle dynamics in the national pension system. Further research should concentrate on the detailed analysis of additional modelling requirements in order to conduct more profound multi-factor experiments to forecast and evaluate contemporary national politics, and to test some new concepts in social insurance.

Analisis Hubungan Clinical Autonomy Terhadap Kepuasan Kerja Dokter Spesialis Obstetri dan Ginekologi Dalam Tindakan Seksio Sesarea Pada Sistem Jaminan Kesehatan Nasional

Background: In Indonesia, the National Health Insurance System (NHIS) is an implementation of law No. 40 of 2004 on the National Social Insurance System in health sector with universal health coverage (UHC) concept. Therefore, the satisfaction of specialist’s work will be very influence towards hospital works. The previous research (Nasruddin, 2017) about factor analysis related to job satisfaction of doctor specialist for obstetrics and gynecology (SpOG) toward Sectio Caesarea (SC) on NHI showed that medical service (transparency and remuneration) and working condition have significant correlation towards work satisfaction of doctor SpOG in SC on NHI. Objective: to analyze the correlation of clinical autonomy on job satisfaction of doctor SpOG on Sectio Caesarea on National Health Insurance system.Method: A quantitative research by applying analytic observational study with cross sectional design.Materials and Research: This research was conducted in Makassar. A number of sample was 73 doctors SpOG. Data was obtained by clinical autonomy questionnaire having been tested its validity and reliability. The result of the research was analyzed by using chi-square test. Result: Based on the correlation of characteristics towards work satisfaction of doctor SpOG in SC on National Health Insurance system found that age category between 36 – 45 years old is satisfied, female is satisfied, working duration more than 5 years is dissatisfied and public hospital status is dissatisfied. There is no correlation between clinical autonomy in this case is control overwork (p = 0.170) and prerogative obtain need service (p = 0.240) on job satisfaction of doctor SpOG in Sectio Caesarea on National Health Insurance System.Conclusion: There is no relation between clinical autonomy on job satisfaction of doctor SpOG in Sectio Caesarea on National Health Insurance System. Even though the doctors SpOG are not satisfied with NHI (medical service and working condition) but the doctors are able to work professionally with clinical autonomy. Keywords: clinical autonomy, doctor SpOG, National Health Insurance System

Analisis Faktor Yang Mempengaruhi Pemilihan Kelas Kepesertaan Jaminan Kesehatan Nasional

Akhir Tahun 2004 pemerintah menetapkan Undang-Undang No. 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional, dengan salah satu programnya adalah Jaminan Kesehatan Nasional (JKN). Diharapkan dengan adanya JKN pembiayaan pelayanan kesehatan masyarakat dilaksanakan dalam sistem asuransi dan JKN menjadi sistem jaminan yang bersifat wajib. Data dari Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan Kota Tarakan diketahui bahwa desa tertinggi yang terdaftar dalam BPJS Kesehatan adalah Desa Sei Pancang Kecamatan Sebatik Utara sebanyak 1.017 jiwa peserta mandiri. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang memengaruhi masyarakat Desa Sei Pancang dalam pemilihan kelas kepesertaan JKN. Metode yang digunakan dalam penelitian ini adalah metode penelitian observasional dengan pendekatan cross sectional study. Populasi dalam penelitian ini adalah warga Desa Sei Pancang yang terdaftar sebagai peserta Mandiri BPJS Kesehatan dengan sampel sebanyak 156 responden yang dipilih secara simple random sampling. Data dianalisis menggunakan uji univariat dan uji bivariat dengan Chi Square. Hasil analisis Chi Square menunjukkan adanya hubungan antara pendapatan (p value = 0,001) dengan pemilihan kelas kepesertaan JKN dan tidak ada hubungan antara aksesibilitas (p value = 0,131) serta mutu pelayanan (p value = 0,091) dengan pemilihan kelas kepesertaan JKN. Dalam hal ini, diharapkan pihak BPJS Kesehatan melakukan sosialisasi kepada masyarakat tentang manfaat dan fasilitas yang didapatkan dalam setiap kelas kepesertaan JKN dan diharapkan masyarakat untuk memilih kelas kepesertaan JKN sesuai dengan pendapatan yang didapatkan demi terwujud pembiayaan kesehatan secara adil.

Fraud in Healthcare Service

In Indonesia, the fraud of healthcare service implementation occurs widely in hospitals, thereby harming the participants of social insurance. The objectives of research were to find out, to analyze, and to give solution to the fraud in the healthcare service. This research was taken place in several hospitals in Central Java Indonesia using non-doctrinal or empirical method on stakeholders related to national health insurance. The result of research showed that the substance of the ratification of Health Minister’s Regulation Number 36 of 2015 about Fraud Prevention in National Health Insurance in National Social Insurance System becomes the government’s attempt in suppressing fraud in healthcare service. In its structure, healthcare service occurs due to the pressure of enacted costing system, limited supervision, and justification in committing fraud and the imbalance between health service system and burden among clinicians, service provider not giving adequate incentive, inadequate medical equipment supply, system inefficiency, less transparency in health facilities, and cultural factor. Those who are responsible for the attempt of eradicating fraud such as Health Ministry, Regency/City Health Service, Hospital’s Board of Directors, Hospital Supervision Agency and Council, Social Insurance Administration Organization, professional organization, and Social Insurance participants should walk in the cycle starting from building awareness, reporting, detecting, investigating, sanction imposing, to building awareness.

Expansion of the Sphere of Social Insurance for Self-Employed Citizens in the BRICS Countries (on the Example of Brazil)

The article analyzes the change in the social insurance system for self-employed Brazilian citizens, thanks to two programs introduced in the 2000s, which showed a high result in terms of legalization and inclusion in the social security system of such employees. The self-employed Brazilians are, to a large extent, excluded from the national social insurance system. The programs provide an opportunity for micro-entrepreneurs and the selfemployed to simplify administrative procedures and adapt the level of social insurance contributions to their incomes. The data presented by the Author illustrates the effectiveness of programs that can also be implemented in other countries that are part of the BRICS organization.

The end of the hepatitis C burden: Really?

The end of the hepatitis C burden: Really?

The Difference of Satisfaction Level in BPJS Health Insurance Patient and Non Insurance Patient toward Health Service

National Health Insurance (JKN) developed in Indonesia is part of the National Social Insurance System (SJSN). One way to assess the services quality is to measure the patient satisfaction level. This research is a quantitative research with the <em>cross sectional </em>research design. The subjects of this research were the BPJS health insurance patients and non insurance patients with 200 people as the samples. The data was analyzed by the independent t-test, gap analysis,<em> CSI (Customer satisfation index) </em>and <em>IPA (Importance performance analysis).</em> The result showed that significant (ρ value >0,05) in all dimensions which mean that there is no difference of patient satisfaction level in Social Security Organizing Body (BPJS) participants and non insurance patients toward health services in Negara General Hospital. The biggest satisfaction in non insurance patients is on the <em>Assurance</em> variable (-1,002) and the smallest satisfaction is on the <em>Tangibles</em> variable<em> </em>(-1,357) and the biggest satisfaction of BPJS health insurance patients is on <em>Assurance </em>variable (-1,085) and their smallest satisfaction is on <em>Responsiveness</em> variable<em> </em>(-1,367). The non insurance patients gap is (-0,217) and the BPJS health insurance patients gap is (-1,206), both of them were classified into low satisfaction level. The result of Importance performance analysis value of non insurance patient showed <em>Responsiveness</em> attributes that should be prioritized and improved while in BPJS health patients showed <em>Responsiveness</em> and <em>Reliability</em> attributes that should be prioritized and improved by Negara General Hospital.

The Difference of Satisfaction Level in BPJS Health Insurance Patient and Non Insurance Patient toward Health Service

National Health Insurance (JKN) developed in Indonesia is part of the National Social Insurance System (SJSN). One way to assess the services quality is to measure the patient satisfaction level. This research is a quantitative research with the <em>cross sectional </em>research design. The subjects of this research were the BPJS health insurance patients and non insurance patients with 200 people as the samples. The data was analyzed by the independent t-test, gap analysis,<em> CSI (Customer satisfation index) </em>and <em>IPA (Importance performance analysis).</em> The result showed that significant (ρ value >0,05) in all dimensions which mean that there is no difference of patient satisfaction level in Social Security Organizing Body (BPJS) participants and non insurance patients toward health services in Negara General Hospital. The biggest satisfaction in non insurance patients is on the <em>Assurance</em> variable (-1,002) and the smallest satisfaction is on the <em>Tangibles</em> variable<em> </em>(-1,357) and the biggest satisfaction of BPJS health insurance patients is on <em>Assurance </em>variable (-1,085) and their smallest satisfaction is on <em>Responsiveness</em> variable<em> </em>(-1,367). The non insurance patients gap is (-0,217) and the BPJS health insurance patients gap is (-1,206), both of them were classified into low satisfaction level. The result of Importance performance analysis value of non insurance patient showed <em>Responsiveness</em> attributes that should be prioritized and improved while in BPJS health patients showed <em>Responsiveness</em> and <em>Reliability</em> attributes that should be prioritized and improved by Negara General Hospital.

Kajian atas Pemenuhan Hak Jaminan Sosial Melalui BPJS sebagai Perwujudan Negara Kesejahteraan (Walfare State)

Study of Sistem Jaminan Sosial Nasional (SJSN)–National Social Insurance System is new, given embodiment SJSN beginning with the creation of the newly passed through Badan Penyelenggara Jaminan Sosial (BPJS)-Implementing Bodies Social Insurance on November 25, 2011. Social insurance is the mandate of the CONSTITUTION Article 28 H UUD NRI 1945, paragraph (3) States that everyone is entitled to social security that allows the development of her intact as human dignity. In addition, article 34 paragraph 2 state, that the State develop a social insurance system for the whole people and empowering nation with the dignity of humanity. Social insurance is also a Human Right that is present on the International Covenant on economic, social and Cultural. ( ICCESC) though its fulfillment as well as interdependent with civil and Political Rights. The Covenant recognizes the need for the fulfilment of these rights are gradually, some of the obligations that a burden countries are urgent.Social insurance is currently not yet covered all citizens of Indonesia, itsconvinience is very limited. It’s still limited to formal sector workers (private, civil servant, and TNI/Polri), the poor population are covered only partly which were classified under the poverty line and no design minimum standards for many forms of insurance and social assistance, in addition to the management of National Social insurance Systems (SJSN) derect by many institutions that not integrated. To more understand the scheme-a scheme there is good legal basis, scope of benefits, beneficiaries, as well as their funding systems, needs to be done the mapping the current social protection systems. Since November 12, 2011 there is already a legal umbrella for managing social insurance through Act No. 24 of the Badan Penyelenggara Jaminan Sosial (BPJS) but in terms of coverage of social insurance there are still some areas that have not been done by existing schemes.

Incidência cumulativa anual de doenças musculoesqueléticas incapacitantes relacionadas ao trabalho em uma área urbana do Brasil

This study focused on the annual cumulative incidence (ACI) of disabling work-related musculoskeletal disorders affecting the neck and/or upper limbs (ULMSD) among workers covered by the National Social Insurance System in the city of Salvador, Bahia State, Brazil. Cases were workers who received disability compensation benefits when unable to work due to ULMSD, during the year 2008. The data were obtained from the administrative systems of the National Social Insurance Institute and Ministry of Labor and Employment. ACI was 15 per 10,000 workers. Increased ACI of ULMSD was associated with female gender, lower income, and work in financial activities or manufacturing. Women earning the minimum wage (US$ 64.00 per month) or less had the highest ACI of ULMSD (123 per 10,000), suggesting inequalities in the occurrence of these disorders. The study indicates the need to prioritize preventive actions focusing on ergonomics and work organization, early diagnosis, treatment, and rehabilitation.

The Swiss social insurance system: Social security and grass-roots democracy

The foundations of Switzerland's social insurance system can be traced to 1890 when a public referendum voted the inclusion of an article into the Federal Constitution that gave the executive the task of creating a sickness and accident insurance scheme. Currently, as in other European countries, the Swiss social insurance system is facing challenges as a result of rising health costs and demographic shifts, which are placing a growing burden on both public finances and private households. To reach policy decisions to address these challenges, the Swiss system is distinguishable from those of its European neighbours because of a continuing tradition of political decision-making based on grass-roots democracy: through referenda, the Swiss people remain directly responsible for the development of the national social insurance system. Importantly, not only might this unique feature of Swiss democracy lead the Swiss people more readily to accept and identify with their social insurance system but it may offer a sound democratic base upon which to build a consensual approach to address the policy challenges that lie ahead.

The difficult transition to national health insurance in Bulgaria

Health sector reform in Bulgaria aims to enhance sector efficiency, increase resources allocated to the health sector and target public resources to the most cost-effective interventions. The health system is however currently being changed in two directions-social and commercial. Transition processes in health include the simultaneous creation of market-based behaviour of all participants in the health market, and the establishment of a national social insurance system that should prevent some aspects of the market from emerging. By definition and in practice, those two processes are working quite separately and they are not necessarily compatible, although features of one process can traced within the other. The Bulgarian model of health care retains an emphasis on a dominant public sector. This model requires significant as well as sustainable financing from the government side. However in practice the model is being undermined by financial difficulties in financing the national social health insurance that arise in good part from the commercialised elements of the system. These in turn generate very substantial inequalities in access to care, through inability of part of the population to pay official and unofficial charges. Copyright © 2006 John Wiley & Sons, Ltd.

Pension Reform and Saving

We estimate the impact of increased pension funding on national saving, both in public budgets and in the private sector. First, the experience of U.S. state governments in managing their employee pension funds suggests that their pension accounts are managed apart from the non-pension operating budget and that it is possible to fund a pension system within the public sector. On the other hand, an examination of the experience of national-level governments indicates that a large proportion (60-100 percent) of the fund accumulation in national social insurance systems is offset within the government sector by larger deficits in other budgetary accounts. We argue that the contrasting results for U.S. states and OECD nation states can be traced to differences in the governance of the pension systems and the degree of effort that is made to separate the pension funding from other budget activities. We also examine the cross-national evidence on saving responses within the private sector to fluctuations in private insurance and pension fund accumulation. We find substantial evidence that pension saving substitutes for other forms of private saving.

Modernization, globalization and the welfare state: a comparative analysis of old and new convergence of social insurance since 1930

Convergence of policies and institutions across countries has been a recurrent theme within social sciences. ‘Old’ and ‘new’ convergence hypotheses have been associated with changing concepts and catchwords, such as modernization, logic of industrialism, post-industrialism, post-Fordism and globalization, but share some underlying theoretical perspectives. The purpose of this paper is to analyse tendencies towards convergence of social insurance systems in 18 OECD countries between 1930 and 1990, a period which has seen our sample of countries develop from predominantly agricultural societies to industrial or post-industrial market democracies. Data from the Social Citizenship Indicator Program (SCIP) are used to examine the development of institutional variables within the various national social insurance systems. Sub-samples of larger and smaller countries are examined separately, in order to test the open-economy hypothesis that smaller countries, being more exposed to international pressures than larger ones, could be expected to show higher degrees of social protection and also more convergence. Hypotheses on differentiated institutional barriers against pressures from the processes of transnationalization of the economy, as well as possible convergence effects of the supra-national policy making within the European Union, are dis-cussed in the last section.

Employment, Industrial Relations and Social Policy: New Life in an Old Connection

The purpose of this paper is to account for the revival of both academic and substantive interest in what had long been seen as an unimportant byway of social policy: the role of social partners, especially trade unions, in the management of national social insurance systems. The answer is found in the budgetary crises facing these systems along with the frequent embedded role of the social partner organizations in their governance. Meanwhile, this welfare state role of trade unions then has implications back on to the conduct of industrial relations. The diversity of national experiences is considered, including the reasons for British exceptionalism on this question. Particular use is made of a comparison between Italy and the Netherlands on the one hand (cases of some success in the role of social partners in managing change in social insurance arrangements), and France and Germany on the other (at the time of writing, cases of stalemate).