Pension Insurance Scheme Research Articles

The impact of tax‐financed pensions on poverty reduction in Latin America: Evidence from Argentina, Brazil, Chile, Costa Rica and Uruguay

In many Latin American countries, tax‐financed pensions (TFPs) have expanded, mainly resulting from growing informalization of employment and stagnating or declining pension insurance coverage. In the five countries examined in this article, TFPs have generally been effective in reducing poverty and indigence. In Brazil rural social assistance pensions cut the incidence of destitution among poor older people by 95 per cent. In Chile TFPs considerably improved their poverty reduction effectiveness between 1990 and 2000. Tax‐financed pensions have therefore been seen as an instrument to supplement contributory pension coverage and boost overall social security coverage. A key challenge is to increase pension insurance coverage through existing statutory pension insurance or special contributory schemes targeted on workers in the informal economy. Otherwise, TFPs could become financially and socially unsustainable in the future. There are also various ways to improve the financing, administration and eligibility criteria of TFPs, particularly because it is necessary to define consistent structure and benefit policies between these and contributory schemes.

Further development of peer-review-procedures in medical rehabilitation

In 2002, the peer review for the somatic indications of medical rehabilitation was further developed. This process was aimed at adjusting the peer review checklist to the "Guide for the Uniform Medical Report of the Statutory German Pension Insurance Scheme" ("Leitfaden zum einheitlichen Entlassungsbericht der Rentenversicherung"), at harmonising the peer review with the version used in the quality assurance programme of the German health insurance and at reducing requirements by focusing on criteria relevant in the individual case. This paper reports on the consensus process carried out and outlines the modifications of the peer review procedure.

Criteria of quality of structure in rehabilitation units with inpatient treatment

The structure of a rehabilitation unit is an important feature of the quality of care. Adequate and qualitatively good structures provide the basis for appropriate therapy offers and treatment and eventually, a better health for rehabilitants. The quality of structures is generally recorded without any evaluation of the aspects in particular. The definition of standards is the basis for such an evaluation. The project presented is aimed at the definition of relevant structural standards for rehab units with inpatient treatment for musculoskeletal, cardiac, neurological, gastroenterological, oncological, pneumological and dermatological diseases. Here, the distinction between basal criteria which have to be fulfilled by every rehab unit with inpatient treatment and criteria important for a well-aimed assignment of patients with specific needs ("assignment criteria") should be made. Apart from the documentation of structural attributes, the structural quality of a rehab unit can be described individually as well as in comparison with other units. Relevant structural criteria were defined in expert meetings by means of a modified Delphi-technique with five inquiries. Overall, 199 "basal criteria" and "assignment criteria" were defined. All criteria can be assigned to the two domains general structural characteristics (general characteristics and equipment of rooms; medical/technical equipment; therapy, education, care; staff) and process-related structures (conceptual frames; internal quality management; internal communication and personnel development). The structural standards are applicable to units for musculoskeletal, cardiac, neurological, oncological, gastroenterological, dermatological and pneumological rehabilitation financed by the two main providers of rehabilitation, the statutory pension insurance scheme and the statutory health insurance scheme for all other five indications. The definition of structural standards agreed by experts in a formal consensus process, provides comprehensive and concrete requirements for German rehab units with inpatient medical rehabilitation. If the two main providers of rehabilitation both use the standards this can be regarded as a hallmark on the path to a unitary programme for quality management. The results enable units to analyse their weak points not just on an individual basis but allow also for a comparison between units, along with contributing to optimizing the structural quality of rehab units.

Bargaining Credibility and the Limits to Within‐firm Pensions

Abstract**: A simple bargaining model highlights the role of commitment to a low‐risk investment policy for firms which offer within‐house pension and health insurance schemes. The roles of this commitment level plus bargaining power, and the ability of a failing firm to misappropriate pensions funds, are studied and their influence on the equilibrium pension determined.

Evaluating the rehabilitation process by means of peer review: examination of the methods used and findings of the 2000/2001 data collection in the somatic indications

This paper reports the results of a peer review system that was implemented in the context of the quality assurance programme of the statutory German Pension Insurance scheme. The data reported refer to the 2000/2001 data collection period for medical rehabilitation in the somatic indications. Examination of inter-rater reliability for judgements of individual raters shows satisfactory results only in orthopaedics. In the quality assurance programme, rehabilitation centres are usually evaluated by the mean of 20 rater judgements. The reliability of this aggregated measure is satisfactory in all indications. The results of 561 rehabilitation centres show that those quality criteria are in particular need of improvement that refer to subjective concepts of patients (e. g., subjective theories of illness). Between peer review procedures in 1998 and 1999, the quality scores of rehabilitation centres had improved whereas between 1999 and 2000/2001, no further improvement can be shown. However, those rehabilitation centres with a low quality score in 1999 (lowest quartile of the distribution) underwent a positive development between 1999 and 2000/2001. Reasons for this trend and possibilities for improving interrater reliability of the peer review process as an element of the quality assurance programme of the German Pension Insurance scheme are discussed.

The significance of clinical guidelines for rehabilitation

Clinical practice guidelines are relevant to all parties involved in the health system. For rehabilitation under the German pension insurance scheme, there are two main aspects: the integration of rehabilitation into the curative guidelines in terms of "local tailoring" on the one hand and the development of guidelines for rehabilitative processes, demand-oriented control of rehabilitation access, and rehabilitative aftercare on the other hand. The elaboration of effective standards is aimed at avoiding over-provision, under-provision or misdirected provision of care and, simultaneously, at ensuring that quality assured treatment is offered to the rehabilitees. Also, it is intended to increasingly implement evidence-based medicine in a sector of the health system in which research has so far been underrepresented. Implementation of guidelines in the rehabilitative sector will allow to disseminate existing knowledge in targeted manner, to systematically fill the gaps and to broaden the knowledge base as a whole. Furthermore, guidelines can facilitate integration of the different sectors in health care provision by operationalising the interfaces both with curative medicine and primary prevention. Throughout the process of guideline development for rehabilitation the specific characteristics of this sector must be kept in mind. Since therapeutic interventions are multidisciplinary and multimodal in nature guidelines have to be comprehensible and applicable for all members of the multiprofessional team. Corresponding to the relative paucity in rehabilitation research there is no sufficient evidence base for numerous therapeutic interventions. Accordingly, guidelines in rehabilitation will--initially--consist of a mixture of evidence- and consensus-based recommendations. Also, the specific goal of rehabilitation under the German pension insurance scheme, namely maintenance or recovery of the capacity at work, has to be borne in mind. There are many initiatives by the providers of rehabilitation as well as the scientific medical societies to develop and implement rehabilitative clinical practice guidelines, e. g. the guidelines programme of the BfA (Federal Insurance Institute for Salaried Employees), which is aimed at developing rehabilitation process guidelines for selected indications, the guidelines activities of the VDR (Federation of German Pension Insurance Institutes), and the input of the "Guidelines" commission of the DGRW (German Society of Rehabilitation Science). It is hoped that in the years to come the parties involved in German health care provision will be open to the advantages of clinical practice guidelines. Rehabilitation under the German pension insurance scheme, with respect to its experience with quality assurance, its responsibilities for structure and concept and a growing acceptance on the part of care providers, already holds a well-founded starting position.

How high are the costs of eating disorders - anorexia nervosa and bulimia nervosa - for German society?

Anorexia and bulimia are relatively rare psychogenic illnesses, which nevertheless are of great concern for society since they affect a mostly very young population and are accompanied by a significantly raised mortality risk. This cost-of-illness analysis for eating disorders in Germany considers hospitalization, rehabilitation services, and indirect costs through inability to work and premature death. The cost estimates are based on projections derived from benefit data as listed by health insurance schemes and pension insurance schemes and from epidemiological studies on the prevalence of eating disorders and mortality rates. For anorexia the cost of illness amounts to approximately 195 million euros (73 direct costs and 122 mortality costs, for bulimia it comes to around 124 million euros (12 direct costs and 112 mortality costs). The annual cost per anorexia and bulimia patient is approximately 5,300 and 1,300 euros, respectively. This cost-of-illness analysis underlines the significance of indirect costs due to premature death, but also highlights the extremely cost-intensive treatment. The hospitalization cost of 12,800 euros per anorexia patient is markedly higher than the average hospitalization cost of 3,600 euros.

Rehabilitation score for patients with type 2 Diabetes mellitus: An instrument to standardize assessment of the need for rehabilitation

Type 2 diabetes is considered a multidimensional health impairment which includes several components like risk factors, cofactors and complications. The early and consequent therapy of all of these components reduces secondary complications. Instead of simply applying drug treatment, a more holistic concept including behavioural medicine therapy and empowerment of patients has been found much more effective. The facilities required for such a multifactorial therapy by different health care professions could easily be provided by the medical rehabilitation services available under the German pension insurance scheme. However, this emphasizes the demand for standardized protocols to achieve an objective allocation of rehabilitation services to individuals in need. In an epidemiological study on 12 429 working insurants (age 41 - 60 years) of the pension insurance fund in the region of Luebeck, persons suffering from type 2 diabetes were identified and evaluated regarding a need for medical rehabilitation. Therefore, an algorithm was developed quantifying the multidimensional disturbances which accumulate in type 2 diabetes mellitus. The following indicators are taken into consideration: risk factors like eating behaviour, lack of physical activity, smoking and stress; metabolic parameters such as HbA1c and plasma lipids; cofactors like hypertension and depression and, additionally, the acute complication of hypoglycaemia. Based on this rehabilitation score, 19 % of cases in a preliminary evaluation of 79 patients with type 2 diabetes showed a need for medical rehabilitation therapy.

Expanding outpatient rehabilitation

Up to now, the majority of rehabilitative measures in Germany has been performed in inpatient programmes. In the past 10 years an extension of outpatient rehabilitation can be noted. Because of new social welfare legislation the legal disadvantages for participants in outpatient rehabilitation have been eliminated on the 1st July 2001. In the past year, the Federal Rehabilitation Council as well as various rehabilitation providers have developed further and specified their concepts in outpatient rehabilitation. Concept requirements include still the principles of holism, interdisciplinarity, goal-oriented rehabilitation and team-work of rehabilitation staff. The extension of outpatient rehabilitation in the sphere of German pension insurance scheme is documented by the increase in models respectively regular services and rehabilitative measures. The results of the evaluation suggest, that the outpatient realisation of a comprehensive rehabilitation concept yields comparable results as the inpatient realisation. In some regions there is a strong cooperation between pension insurance institutes and corresponding health insurance companies in order to extend outpatient rehabilitation. A quality assurance program for outpatient rehabilitation will be developed. It can be expected, that the extension of outpatient rehabilitation goes on and that thereby the possibilities of a more flexible medical rehabilitation grow.

Income security for older people: An Asian perspective

In Asia and the Pacific, as in other developing regions, the continuing growth of the aged population has a great impact on social security programmes generally and, in particular, on the income security of older persons. In societies where traditional support systems are breaking up, their need for social security protection is increasingly important. A system of social security for the elderly population exists in most countries of the region. Many are provident fund schemes, which are basically saving schemes, and their coverage is low. Where social insurance pension schemes exist, the levels of benefits provided are also low. The focus for future development, therefore, lies in converting the savings schemes into multitiered pension schemes, extending their coverage and raising the level of benefits. In this context the critical question concerns the role of the State and the type of schemes used. The need for public pension schemes is great in Asia and the Pacific, where the level of poverty is comparatively high. Building pension schemes, whether public or private, involves a set of issues that need to be addressed. This article considers the systems currently in place and the challenges and limitations faced when considering the future development of social security in this area.

Predictors of return to work after inpatient cardiac rehabilitation under workers' compensation plan

Vocational reintegration is one of the major goals of cardiac rehabilitation. 70 % of blue-collar workers under 50 years of age resume their job after in-patient cardiac rehabilitation. 10 % are hindered to do so by cardiac problems. Specific measures exist that may facilitate work resumption. As these measures should be started as soon as possible there is a need for predictors of return to work which can be obtained easily and at an early stage. Subjects of this prospective study were 650 patients (10 % female) under 50 years of age who participated in an in-patient cardiac rehabilitation programme under the workers' pension insurance scheme. At the beginning of programme participation, problems in work resumption as expected by the patient and by his physician were obtained, as well as depression and anxiety scores (HADS-D). Physicians' and patients' expectations concerning problems in resuming work turn out to be significant predictors of the vocational situation of the male patients six months following medical rehabilitation. The depression score obtained at the outset of the programme is the only predictor of return to work in female patients.

Economic crisis and social policy reform in Korea

The economic crisis that broke out in Korea in December 1997 has had a chilling impact on social development in the country. Today unemployment is the highest that Korea has experienced in the past thirty years. This paper aims to examine the impact of the economic crisis on social development and the role of public policy to mitigate the problems caused by the crisis. The economic crisis has hit vulnerable groups harder, increased the proportion of part‐time and daily workers, and reversed the trend of steady improvement of income distribution. The economic crisis along with the trend of aging population, globalization, and competition calls for an expanded role of social policy, which the Korean government has neglected for a long time. The main targets of social policy reform in Korea include the expansion of government programs and safety nets for the unemployed and redesigning the national pension and health insurance scheme to provide adequate income security as well as to improve the system sustainability.

Legislational and Structural Advancement of Rehabilitation - Positions of the Statutory Pension Insurance Scheme and Recommendations Submitted to Politics

Legislational and Structural Advancement of Rehabilitation - Positions of the Statutory Pension Insurance Scheme and Recommendations Submitted to Politics

The emerging pension fund management market in Latin America

This article examines the emergence of a pension fund management market in Latin America following extensive pension reform in the region. The key feature of pension reform in Latin America has been the partial or total replacement of unfunded social insurance pension schemes with individual capitalisation pension plans. The establishment and development of a pension fund management sector is key to the success of the reforms.

Pension systems and prospects in Asia and the Pacific

There is a diversity of pension systems in the Asia and Pacific region. A growing number of countries have social insurance pension schemes, but many others which have provident funds have not set up any mandatory pension system at all. Demographic, social and economic changes mean the need for a regular income in old age will increase enormously. Existing schemes should be extended to all employees, benefits should meet certain minimum standards, administrative arrangements must adapt to structural change, and the budgeting both of governments and of households must be adjusted to take account of changing age dependency ratios.

Evolution in the structure of employment and unemployment and its consequences for general pensions schemes1

The statutory pension insurance scheme in the Federal Republic of Germany has been financed by the allocation procedure de jure for some time now and de facto for a considerable period. Consequently, the annual expenditures have to be covered by revenues in a given year. As a result, the allocation procedure implies a contract between generations. In 1987, the main sources of revenue were: 83.2 per cent revenue from contributions and 15 per cent from the Federal subsidy.

Über den Zerfall einer geschlossenen Aktivengesamtheit bei säkularer Änderung der Sterblichkeit

The author shows and briefly discusses the fundamental relation which consists between the „rates of changing“ of the probabilities of death of active and invalid persons if the general population mortality depends on time. A central feature of the analysis is the so-called „burden index“ — here also denoted as „degree of splitting“ (“Zerfallsgrad”) — in a closed community split up into active and invalid persons in course of time. The result of the investigations, also interpreted geometrically, is of great importance in studying alterations in the structure of communities of persons in pension and social insurance schemes when the decremental rates are functions of time.