Crise do capital e o desmonte da Previdência Social no Brasil / Crisis of the capital and dismantling of Social Security in Brasil

Resumo: Discute-se a reforma em curso relativa ao desmonte da Previdência Social (PS) (PEC n. 287/2016), com atenção especial para a redução dos direitos dos trabalhadores, sob a justificativa do déficit da PS. Trata-se de um ensaio teórico, a partir de pesquisa bibliográfica e documental, cuja análise abarca as medidas "reformistas" também dos governos Fernando Henrique, Lula e Dilma. Observa-se que tais medidas evidenciam que, como uma real contrarreforma, regem-se pela lógica do setor privado, transformando direitos sociais em mercadorias com a redução drástica desses direitos.

Abstract: This article discusses the Social Security System (SSS) (PEC n. 287/2016), with particular attention to the reduction of workers' rights, under the justification of the SSS deficit. The analysis, based in legal documents and bibliography revision, includes the "reformists" measures adopted also by the Fernando Henrique, Lula, and Dilma governments in relation to SSS. It is concluded that the measures, like a real counter-reform are based on the logic of the private sector, and transforms social rights into goods and beckons for the drastic reduction of such rights.

Perfil dos beneficiários do Instituto Nacional do Seguro Social aposentados por invalidez no Estado do Rio Grande do Sul no período de 2010 a 2015 / Profile of the National Institute of Social Security beneficiaries retired due to disability in Rio Grande do Sul from 2010 to 2015

Resumo Introdução O presente estudo investigou o perfil epidemiológico dos aposentados por invalidez no Estado do Rio Grande do Sul durante o período de 2010 a 2015. Método Foi realizada uma pesquisa descritiva e quantitativa, utilizando o método de levantamento de corte transversal de dados secundários obtidos pelo Sistema Único de Benefícios (Suibe). As variáveis utilizadas para este estudo foram: faixa etária; sexo; tempo de contribuição antes da aposentadoria; faixa salarial do aposentado após a invalidez; e Classificação Internacional de Doenças (CID-10). Resultados Do total de 94.670 aposentados por invalidez, 55,6% eram do sexo masculino, 64,4% estavam na faixa de 40 a 59 anos, 44,3% possuíam média salarial de 1 salário-mínimo e 25,3% das concessões foram associadas a doenças do sistema osteomuscular e do tecido conjuntivo. Conclusão A partir das patologias identificadas pelo estudo, pode-se direcionar o desenvolvimento de ações que frisem a importância da prevenção, do diagnóstico precoce e correto tratamento, a fim de evitar as patologias e/ou o seu agravamento, bem como o afastamento do mercado de trabalho.

Abstract Introduction The present study investigated the epidemiological profile of disability retirees in Rio Grande do Sul from 2010 to 2015. Method A descriptive and quantitative research was carried out using the cross-sectional survey method based on secondary data obtained by Sistema Único de Benefícios (SUIBE). The variables used for this study were age, sex, contribution period before retirement, salary range of the retiree after the disability, and International Classification of Diseases (ICD-10). Results Of the total of 94,670 disability retirees, 55.6% were male, 64.4% were between 40 and 59 years old, 44.3% had an average income of 1 minimum wage and 25.3% of concessions were associated to musculoskeletal system and connective tissue diseases. Conclusion From the pathologies identified in the study, it is possible to direct the development of actions to emphasize the importance of prevention, early diagnosis and correct treatment, in order to avoid pathologies and/or their aggravation, as well as the withdrawal from the labor market.

La enfermedad renal crónica en Colombia: necesidades en salud y respuesta del Sistema General de Seguridad Social en Salud / Chronic Kidney Disease in Colombia: Health Needs and Response of the General System of Social Security in Health / Doença Renal Crônica na Colômbia: necessidades em saúde e de resposta do Sistema Geral de Segurança Social em Saúde

La enfermedad renal crónica (ERC) es una enfermedad de alto costo, progresiva, no trasmisible y estrechamente ligada a otras enfermedades, como las cardiovasculares (ECV) y la diabetes mellitus (DM). La incidencia, prevalencia y mortalidad de la ERC va en aumento en Colombia, a pesar de que existen políticas que orientan el proceso de prevención y manejo. En el Sistema General de Seguridad Social en Salud, la ERC se ha manejado bajo un modelo de atención individual y biomédico que desestima la importancia de la prevención de la enfermedad. La autoridad sanitaria no ejerce eficazmente la vigilancia y control de los actores y privilegia la compensación económica a las Empresas Promotoras de Salud (EPS), sin que medie una verdadera evaluación de los resultados en salud. Este ensayo muestra la situación de la ERC en el país y la respuesta del SGSSS, con el propósito de incentivar la reflexión hacia la necesidad de introducir un nuevo modelo de atención.

Chronic Kidney Disease (CKD) is a high-cost illness, non-transmissible and progressive disease, closely related to others diseases such as cardiovascular ones and diabetes. Incidence, prevalence and mortality are increasing in Colombia, despite the existence of policies tempting to orientate the prevention, and healthcare process. In The General Social Security System, CKD has been treated preferably under a model of individual and biomedical attention that dismisses the importance of prevention of the disease. The health authority seems to be weak to exert an actual surveillance and control of actors involved in the System, and encourage economic compensation to Health Insurance Companies without taking into account an actual assessments of health results. This essay shows both, CKD situation in the country, and the response of the General System of Social Security in Health, with the purpose of encourage the reflection on the need to introduce a new model of healthcare.

A Doença renal crônica (DRC) é uma doença de alto custo, progressiva, não transmissível e intimamente ligada a outras patologias, tais como as cardiovasculares (DCV) e a diabetes mellitus (DM). A incidência, prevalência e mortalidade da DRC estão aumentando na Colômbia, embora existam políticas que orientem o processo de prevenção e gestão. No Sistema Geral de Segurança Social em Saúde (SGSSS), a DRC tem sido gerida sob um modelo de atenção individual e biomédico descartando a importância da prevenção de doenças. A autoridade de saúde não exerce efetivamente a fiscalização e o controle dos atores, e ainda privilegia a compensação econômica para as companhias de seguros da Saúde (EPS), sem que haja uma verdadeira avaliação dos resultados em saúde. Nesta dissertação pretende-se mostrar a situação da DRC na Colômbia, e a resposta do SGSSS, com o objetivo de incentivar a reflexão sobre a necessidade.

Gasto de bolsillo para salud en pacientes hipertensos / Pocket health expenditure in hypertension patients

Establecer la relación entre el gasto de bolsillo en salud de pacientes hipertensos del municipio de San José de Caldas de los regímenes contributivo y subsidiado del Sistema General de Seguridad Social (SGSSS) en salud. Métodos: Se realizó un estudio comparativo del gasto de bolsillo en salud de 278 pacientes hipertensos con y sin lesión en órgano blanco. A través de un modelo econométrico se estimó la propensión marginal al consumo en salud. Resultados: Una prueba chi cuadrado de 7,88 y un valor de p=0,029 hay dependencia entre la lesión en órgano blanco y la severidad de la hipertensión arterial. Se observan diferencias estadísticamente significativas para todos los gastos destinados a la atención en salud, excepto en medicamentos, servicios dentales y atención hospitalaria al comparar los pacientes según lesión en órgano blanco. La propensión marginal al consumo en salud muestra que por cada mil pesos de ingreso familiar los pacientes sin afectación de órgano blanco dedican 2 pesos a gastos en salud; en cambio, los pacientes con lesión en órgano blanco por cada mil pesos de ingreso familiar dedican 43 pesos al gasto en salud. Conclusiones: El gasto de bolsillo para el tratamiento de pacientes hipertensos se incrementa en pacientes que presentan lesión en órgano blanco. Si bien dicho gasto no alcanza a ser catastrófico, el seguimiento y la vigilancia da estos pacientes es una prioridad en el SGSS dado el impacto en la calidad de vida y costos de atención en salud.

Objective: To measure the pocket spending on health in hypertensive patients(278) of the municipality of San José department of Caldas, contributory andsubsidized regimes of the Social Security System in health (SHSS) accordingto clinical and socioeconomic conditions. Methods: Study to establish therelationship between the pocket health spending in hypertensive patients withand without target organ injury through econometric model that estimates themarginal propensity to consume health. Results: With a Chi2 of 7.88 and p =0.029 no dependence between target organ injury and severity of hypertension.Statistically significant differences for all expenditures on health care, exceptfor medication, dental and hospital care when comparing patients accordingto target organ damage are observed.The marginal propensity to consume health shows that for every thousanddollars of household income patients without involvement of target organ 2pesos devoted to health spending ; however , patients with target organ injuryper thousand pesos of 43 pesos household income devoted to health spending.Conclusions: The pocket expense for treatment of hypertensive patients isincreased in patients that present white organ injury. While this spending isnot enough to be catastrophic, monitoring and surveillance of these patients isgiven a high priority in the SHSS because of the impact on quality of life andhealth care costs.

The long-term care insurance system in Germany:Origin, planning, effects and reflections / 中国卫生政策研究

Confronted with many problems such as the aged population, increase in the demand for long-term care and financial pressure resulted from the previously defective social security system, after years of efforts, Germa-ny eventually succeeded in putting forward an effective national compulsory long-term care system in 1994 . The sys-tem which is based on the original health insurance system and supports multiple payments involves both local govern-ments and private organizations. Specific rules are clarified in terms of the insurance relations, application qualifica-tions, payment conditions and financial mechanism. Shares and contributions of the long-term care have been in-creased after years of practice. Besides, the number of applicants and beneficiaries is rising. Yet on the other hand, problems and controversies still exist in service quality, qualifications and contents for application and financial mech-anism. Germany’s experience in improving the social security system, the quality management of long-term care and effective control of financial balance serves as a significant reference for China in planning and implementing long-term care insurance system.

Reflexiones suspicaces a raíz de las nuevas propuestas de "Reforma a la Salud" / Suspicious thoughts on the new "Health reform" proposals in Colombia

Dada la reciente profusión de noticias, comentarios y propuestas acerca de una nueva ''Reforma a la salud'' se presentan unas breves reflexiones sobre algunos aspectos relacionados con el tema, en las que se incluyen: consideraciones sobre algunos asuntos semánticos de la Ley 100, la importancia que para mejorar la salud de la población tienen los determinantes sociales de la salud ajenos a la medicina, el escenario contradictorio y costoso que se instauró con el actual sistema y los inconvenientes derivados de la medicalización que caracteriza nuestro sistema de Seguridad Social, pues hacen que este descuide otros de sus componentes importantes.

In view of the overwhelming amount of news, statements and proposals concerning the new Colombian ''Health Reform'', some commentaries are presented in this article regarding conflictive semantic issues of the law that created the Colombian Social Security System, the impact of different social issues on public health, the contradictory and expensive scenario of the current Colombian health system, and the improvisation and difficulties in implementing such law, which have contributed to neglect in other important aspects of the Social Security System.

Gasto por procedimiento en la especialidad de cardiología intervencionista en pacientes con enfermedad coronaria del seguro social, seccional Valle del Cauca: noviembre 2003-diciembre 2004 / Costs of processing in the interventionist cardiology field in patients of coronary illness in seguro social, Valle del Cauca section, November 2003-December 2004

Introducción: La enfermedad coronaria afecta a una gran proporción de afiliados al Seguro Social (ISS) Valle del Cauca. Aquí se describe el gasto en la especialidad de cardiología intervencionista que asumió esta empresa promotora de salud (EPS) por cuenta de la enfermedad entre noviembre 2003-diciembre 2004. El gasto sobrepasa lo presupuestado por el ISS y este desequilibrio se produce bajo el régimen contributivo del actual sistema de seguridad social colombiano, que actúa en contra del ISS pues un alto número de sus afiliados son mayores de 45 años. La población compensada del ISS Valle del Cauca es de 423,440 personas de las cuales 43% superan los 45 años de edad, segmento donde se observa mayor riesgo de enfermedad coronaria. Metodología: El estudio es descriptivo. Se analizó la distribución de la población compensada por edad y sexo y el pago hecho por el ISS Valle del Cauca a las instituciones prestadoras de salud (IPS) en la especialidad de cardiología intervensionista en el período señalado. La información se obtuvo de la facturación presentada por las IPS al Seguro Social y se cruzó con los registros individuales de procedimientos en salud (RIPS) para identificar los pacientes afectados por enfermedad coronaria y clasificarlos teniendo en cuenta los Códigos Internacionales de Enfermad (CIE 10) así como el Manual de Actividades, Procedimientos e Intervenciones del Plan Obligatorio de Salud (MAPIPOS). Se practicaron 1,349 procedimientos a 1,103 pacientes del ISS con diagnóstico de enfermedad coronaria. Análisis y resultados: La población compensada del ISS Valle del Cauca representa 9.3% de la población vallecaucana (4’532,378 habitantes en el Departamento/423,400 compensados).

Introduction: Coronary illness affects a high proportion of affiliated with the Seguro Social (ISS) Departamento (=State) Valle del Cauca. This paper describes the costs in the specialty of interventionist cardiology of the Health Promoter Enterprise (EPS) because of this illness among November 2003-December 2004. The costs are larger than the budget of the ISS for this illness. This unbalance inside security social system contemporary in Colombia, that is a contributive regime, affects to the ISS because a high number of affiliated are adults of 45 years. The compensated population of the ISS Valle del Cauca is 423,440 people of which 43% is older 45 years, segment of age that concentrates the risk of coronary illness. Metodology: It is a descriptive study. It analyses the distribution of compensated population by age and sex; besides the payment of ISS Valle del Cauca to the Health Institutions (IPS) in the interventionist cardiology specialty. The information was taken of the register made by the IPS to the Social Secure Institute and crossed with the Individual Registers of Procedures in Health (RIPS) to identify the patients with coronary illness and to rate them in accordance with the International Illness Codes (CIE 10) likewise the book about activities, Processing and Interventions of the Obligatory Health Program (MAPIPOS). Universe: 1,349 processing. The population was 1,103 affiliated patients with the  Seguro Social with coronary illness diagnoses. Analysis and results: The compensated population of ISS represents 9.3% of Valle del Cauca population (4’532,378 inhabitants in the Departamento and 423,400 compensated).

Proyecto de reforma al sistema de seguridad social en salud (SGSSS) / Social security system reform proyect

La expedición de la Ley 100 de 1993 otorgó muchos beneficios a la población colombiana, sin embargo, la implementación de la misma tuvo muchos inconvenientes, los cuales se reflejaron tanto en los temas de aseguramiento, como en los casos de corrupción, principalmente en las A.R.S. y en los temas de salud pública, pues reaparecieron enfermedades como la malaria, el sarampión y la fiebre amarilla; es así, como se llegó a la elaboración y radicación de proyectos ante el Senado de la República, los cuales plantean: creación del Plan de Salud Pública colectiva en reemplazo del Plan de Atención Básica, universalidad en la cobertura a través del aseguramiento, la reorganización del SGSSS, y el fortalecimiento del Sistema de Vigilancia y Control. Como también, eliminación de la integración vertical por parte de las E.P.S., creación del Fondo Territorial Colombia para la salud (FOCOS) para el financiamiento de la prestación de los servicios de salud, creación del Fondo de Garantía para la prestación de servicios de salud y desarrollo de un Sistema Único de códigos de procedimientos. Debido a la importancia que reviste éste tema tan crucial para los colombianos y especialmente para el sector salud, todos los profesionales debemos tener conocimiento de los posibles cambios que se avecinan, y como afectarían nuestro quehacer profesional.

The issuing of law 100 of 1993 granted lots of benefits to Colombian population. Nevertheless, its implementations had lost of inconvenients, which reflected either on insurance matters as well as on corruption cases, meanly inside the ARS on Public Health issus. This was evident due to the re-emergence of diseases such as Malaria, Measles, yellow fever. All of these facts, led to the elaboration of proyects before the Senate. These proyects include themes such as the creation of a Colective Public Health Plan instead of the current PAB: Besides this, the proyects include universal coverage in health through insurance; reorganization of the SGSSS as well as the Control and Surveillance System. On the other hand, these new proyects pretend to eliminate vertical integration by EPS; creation of the Colombian Territorial Fund for health (Focos) which is created to finance health care4delivery. Finally, the new proyects aim to create the Guarantee Fund for health care delivery as well as the development of an Unique System for Procedures Code. Due to the highly importance of this subject to Colombians and especially for the Health Care Sector, all health professionals shall be aware of possible incoming changes as well as the way them will change our professional life.