I Plano Municipal de Segurança Alimentar e Nutricional de Duque de Caxias (2017-2020): uma avaliação com base no ciclo das políticas públicas / I Duque de Caxias, Brazil, Municipal Plan for Food and Nutrition Security (2017-2020): an assessment based on the public policy cycle

Introdução: O I Plano Municipal de Segurança Alimentar e Nutricional (PLAMSAN) é uma ferramenta de planejamento, gestão e implementação da Política de Segurança Alimentar e Nutricional. Em Duque de Caxias, RJ, o I PLAMSAN foi sancionado em 2016. Objetivo: Realizar avaliação do I PLAMSAN-DC (2017-2020), utilizando como procedimentos metodológicos uma aproximação do "Ciclo de Políticas Públicas". Métodos: Estudo de avaliação usando elementos da ferramenta "ciclo de políticas públicas" com base nos seguintes procedimentos metodológicos: 1) Análise documental; 2) Revisão de literatura; 3) Avaliação do cumprimento das metas com base nas respostas advindas das Secretarias que compõem a Câmara Intersetorial de Segurança Alimentar e Nutricional. Resultados: Verificou-se que, dentre as 42 metas do Plano, 14,7% foram cumpridas, 34,1% foram parcialmente cumpridas, e 51,2% não foram cumpridas. Conclusões: Observou-se que ainda não há acentuado papel por parte do nível municipal para a concretude de inúmeras ações que necessitam de recursos financeiros. Além disso, verifica-se a necessidade de superação de entraves, sobretudo em relação ao alcance da intersetorialidade e fortalecimento das estruturas componentes do sistema de segurança alimentar e nutricional.

Introduction: The I Plano Municipal de Segurança Alimentar e Nutricional (PLAMSAN, I Municipal Plan for Food and Nutrition Security) is a planning, managing and implementing tool of the Food and Nutrition Security Policy. In Duque de Caxias, RJ, the I PLAMSAN was sanctioned in 2016. Objective: To carry out an evaluation of the I PLAMSAN-DC (2017-2020), using as methodological procedures an approximation of the "Public Policies Cycle". Methods: Evaluation study using elements of the "Public Policies Cycle" tool based on the following methodological procedures: 1) Document analysis; 2) Literature review; 3) Assessment of achievement of goals based on responses from the secretariats that make up the Intersectoral Chamber for Food and Nutrition Security. Results: Among the 42 goals of the Plan, 14.7% were met, 34.1% were partially met, and 51.2% were not met. Conclusions: The municipality still does not play an important role in the implementation of a number of food and nutrition initiatives that require financial resources. In addition, there is a need to overcome barriers, especially in terms of achieving intersectoriality and of strengthening the structures that make up the food and nutrition security system.

The Exploration and Analysis of Constructing a Multiple Health Security System for Rare Diseases in China / 罕见病研究

Health security for rare diseases has aroused much attention in the society nowadays, In this article, we analyzed in-depth the construction of rare diseases health security in China by studying the literature reviews, expert interviews, and reports of pilot policy investigations. We conclude in the study that it is an important step to constructing a multiple health security system for the rare disease making the basic health security as the cornerstone. For rare medications and treatments that cannot be covered by the current national health insurance, it is necessary to build an specific funding for rare disease funding as a means of safeguard. Finally, for those who are financially disadvantages, the system should involve relief and philanthropy to help them. By constructing a multiple health security system, rare diseases patients in our country will get a well-covered health care.

Research on medical insurance data sharing mode based on " City-customized Medical Insurance" / 中华医院管理杂志

With the explosive growth of " City-customized Medical Insurance" products, the voice of commercial health insurance needs medical insurance data support is increasing.The authors took " City-customized Medical Insurance" as the representative of commercial health insurance, analyzed the demands and motivations of stakeholders in medical insurance data sharing through the power-interest matrix model, and summarized the medical insurance data sharing path at the commercial insurance product design end and claim settlement end. It is suggested to strengthen the top-level design, build the implementation path of standardized sharing of medical insurance data and the operation mechanism of hospital data docking, to realize the value increment of all stakeholders.

Relato de Experiência: Percurso e desafios para adesão municipal ao Sistema Nacional de Segurança Alimentar e Nutricional / Experience Report: Paths and challenges of a municipality to join the National Food and Nutrition Security System

Introdução: O Sistema Nacional de Segurança Alimentar e Nutricional possibilita a gestão intersetorial e participativa, e a articulação entre os entes federados para a implementação das políticas promotoras de Segurança Alimentar e Nutricional. Objetivos: Relatar a experiência municipal de Duque de Caxias-RJ para adesão ao Sistema Nacional de Segurança Alimentar e Nutricional e as principais perspectivas e desafios após essa conquista. Métodos e Resultados: No percurso para adesão ao sistema, os técnicos do Departamento de Segurança Alimentar e Nutricional Sustentável realizaram ações para efetivação da Política de Segurança Alimentar e Nutricional desde 2009, quando foi realizado o primeiro encontro com gestores municipais para mapear as ações, até 2015, quando foram publicadas a Lei Orgânica de Segurança Alimentar e Nutricional e a Lei do Conselho de Segurança Alimentar e Nutricional do município de Duque de Caxias revisadas. Além disso, foi realizado um encontro com secretários municipais visando criar a Câmara Intersetorial de Segurança Alimentar e Nutricional, instância responsável pela elaboração do Plano Municipal de Segurança Alimentar e Nutricional. Após árduo trabalho, Duque de Caxias formalizou a criação da Câmara e instituiu os membros de dez secretarias afetas ao tema. Em 2016, após esse longo percurso, o município obteve a adesão ao Sistema Nacional de Segurança Alimentar e Nutricional de forma pioneira no Estado do Rio de Janeiro. Alcançada essa etapa, as principais expectativas foram o fomento à participação social, o fortalecimento da intersetorialidade juntamente com debate sobre a alocação de recursos municipais, e o acesso aos recursos federais. Conclusão: O cenário nacional mudou o que se refletiu nos demais entes federados. Mesmo diante de tantos desafios, ter (e manter) todas as instâncias que compõem o Sistema Nacional de Segurança Alimentar e Nutricional em nível municipal é de extrema importância para a efetivação do Direito Humano à Alimentação Adequada. (AU)

Introduction: The National Food and Nutrition Security System permits intersectoral and participatory management, and the articulation between the affiliated entities to implement and promote its policies. Objectives: To report the experience of the municipality of Duque de Caxias/RJ to join the National Food and Nutrition Security System and the main subsequent prospects and challenges. Methods and Results: Since 2009, towards adhering to the system, technicians of the Department of Sustainable Food and Nutrition Security carried out actions to establish the Food and Nutrition Security Policy. These continued from the first meeting held with municipal managers to map the actions, up to 2015 when the Organic Law on Food and Nutrition Security and the Law of the Security Council of the municipality of Duque de Caxias on Food and Nutrition were published. In addition, a meeting was held with municipal secretariats to create the Intersectoral Chamber of Food and Nutrition Security, the body responsible for the preparation of the Municipal Plan for Food and Nutrition Security. After hard work, Duque de Caxias formalised the creation of the Chamber and instated the members of ten secretariats associated to the plan. After such a long journey, in 2016, the municipality pioneered the affiliation to the National System of Food and Nutritional Security in the State of Rio de Janeiro. Conclusion: The main aspirations were the promotion of social participation, the strengthening of intersectoral work along with a debate on the allocation of municipal resources, and access to federal resources. The national scenario changed also affecting federated entities. Even in the face of so many challenges, to forge and maintain all the rankings of the National System of Food and Nutrition Security at the municipal level is extremely important for the fulfillment of the Human Right to Adequate Food. (AU)

Construction of emergency material support system in institutions for modern disease prevention and control / 上海预防医学

The center of disease prevention and control (CDC) is an emergency agency with semi-militarized management.It serves like scouts and commandos in handling various public health emergencies, and CDC members are in close contact with pathogens and harmful substances.Due to different nature of public emergencies such as prevention and control of infectious diseases, chemical poisoning, occupational poisoning, natural disasters and food safety accidents, the response measures of CDC emergency team are also different.In handling epidemic emergencies, there are different special requirement for the supplies, including equipment and consumables, used in sampling, disinfection, laboratory tests, and personal protection as well as vaccines and drugs.Therefore, it is necessary to establish a unified modern emergency supply system in CDC at levels of state, provinces, cities and counties.Internet of things + technology will be used to establish a set of intelligent platform for emergency material support in disease prevention and control institutions based on centralized management, combinational use in both peacetime and wartime, and unity and high efficiency.Setting up such an emergency material reserve would not only ensure quick response in emergency but also achieve mobility, cost saving and high efficiency.Combining big data, blockchain technology and smart city construction, we will integrate emergency material support for disease prevention and control in different institutions into the national unified emergency material support system which would ensure that disease prevention and control institutions can effectively handle major public health emergencies.

Status quo, challenges and prospects of health security in Macao: based on the perspective of universal health coverage / 中华医院管理杂志

Universal health coverage is a common pursuit of all levels of development. We have analyzed the challenges faced by Macao′s health security in light of the current situation of Macao′s health security development and the status of the national health coverage of developed economies indicators in the form of representative security systems, with a view to providing reference for the policy perspectives of Macao′s future reform and development.

Exploration of the transformation of medical insurance system to health security system under Healthy China / 中国卫生政策研究

The national strategy of Healthy China clearly establishes the health insurance system,which would control health risk factors and enhance hygiene factors to safeguard the citizens's; health. There are some difference in goals,forces,contents, and compensation mechanism between health insurance system and medical insurance sys-tem. The conversion from medical security system needs to take actions including of extending the security contents, health-centered medical insurance,a combination of medical treatment and endowment. Health-centered medical in-surance reform needs to start with extending health contents and payments reform,enhancing the controlling and guid-ing the health delivery system. This is also the inevitable direction for the development of medical insurance.

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.

Research on Obstacles and Countermeasures of the Citizenization about the Health Rights and Interests of the Agricultural Transfer Population in the Perspective of New Urbanization / 中国医学伦理学

This paper concluded the health status of the population migrated from agriculture areas as well as the existing problems of health rights and interests in the process of new urbanization, and proposed the following suggestions:it must strengthen the government responsibility, adhere topeople-oriented, and firm social ethics construction. It also should plan health resource allocation, adjust the medical security policy, improve service quality according to the characteristics of population migrated from agriculture areas, and build up a multi-level and joint health service system.

Necessity of Setting Up Security System of Assistive Technology in China / 中国康复理论与实践

There is a huge demand of assistive service from persons with disabilities in China. To set up a security system of assistive technology at nation level will help the disabled to get service. This paper introduced the function of assistive device, discussed the necessity of setting up assistive service security system from the perspective of human right, social civilization, government duty, social security, in-dustry.

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.

Research on the medical insurance system and operating mode in South Korea / 中国卫生政策研究

Objectives To provide reference for the improve of health care system and healthcare insurance con-trolling method, through researching on the value-based healthcare paying system in South Korea. Methods The basic characteristics of the Korean health care system was researched, Specifically, its reform experiences of value-based health insurance review and assessment paying system,which government took. Results South Korea’s health care pay-ing system had achieved both good social and policy effects. Conclusions Value-based health care paying system is the main reason for the reducing of health care expenditures and making of scientific health policy.

International experiences in medical assistance system and implications for China / 中国卫生政策研究

Medical assistance systems are an integral part of the health security system and they represent the integrity and adequacy of health risk protection. The overwhelming majority of developed countries have already es-tablished medical assistance systems to improve the accessibility of healthcare services and provide catastrophic pro-tection for families, especially for the poor. The paper conducts a comparative study of typical foreign medical assis-tance systems, where in the general method by which developed countries embed catastrophe protection mechanisms into public healthcare security systems and provide tilt protection to the needy is described. Medical assistance is pro-vided on a means-test basis and the development of private health insurance is encouraged to alleviate pressure on the public side. Corresponding implications for China are also warranted, including the provision of tilt protection to the needy, to re-define objects and standards of medical assistance, and enhance the coordination of different medical se-curity systems.

Travestis e segurança pública: as performances de gênero como experiências com o sistema e a política de segurança no Rio Grande do Sul / Transvestites and public safety: the performance of gender as experiences with the system and security policy in Rio Grande do Sul

O artigo discute como vêm se construindo as experiências sociais de travestis e transexuais na relação com o Sistema de Segurança Pública. A relevância do tema relaciona-se com o compromisso ético-político do assistente social em desenvolver análises que contribuam para dar visibilidade às experiências sociais de sujeitos cujos direitos são violados em razão de suas identidades sexuais e de gênero. Percebe-se que há uma desconexão entre a identidade incorporada e construída pelas travestis e transexuais e aquilo que é percebido e atribuído pela sociedade em geral. A relação normalmente dissonante entre a apresentação e a identificação pública legitimada - oficial ou não - da população trans, a partir de seu gênero, expressa consequências não só no tratamento recebido cotidianamente, como também nas políticas públicas e ações afirmativas voltadas a esses grupos, o que não é diferente na relação com o Sistema de Segurança Pública...

This article discusses how the social experiences of travesties and transgender are being built in relation to the Public Security System. The relevance of the subject relates to the ethical and political commitment of social workers in developing analyzes that contributes with the visibility of social experiences of individuals whose rights are violated because of their sexual and gender identities. It is noticed that there is a disconnection between the incorporated and built identity by transvestites and transsexuals and what is perceived and assigned by society in general. The usually dissonant relationship between the presentation and legitimized public identification – either formal or not - of the trans population, regarding their gender, expresses consequences not only in the treatment received daily, but also in public policies and affirmative actions aimed at these groups, what is no different in relation to the Public Security System...

Practice and reflection on the construction of archive security system in research institutes / 中华医学科研管理杂志

Construction of security system plays an important role in the management of archive in research institute.With years' practice and exploration,we summarize our experiences in building up the security system of our institute here.This article involves two aspects of archive work,one is the conscious awareness of archive security and security system building.Suggestion on security cultural construction,digital file safety and data backup are also given.

Present development and thoughts on China's health system / 中华医院管理杂志

This paper made an analysis of China's health system,regarding the present development and questions in the medical security system,the health service system,the health financing system and health management system.Based on the studies,the author proposed overall planning and accelerated reform in an effort to distinguish the role boundaries of the government and the market,streamline the health management system and enhance service functions.Furthermore,the author recommended to build a sustainable health financing system,build and better the urban-rural health security system,and promote health service system reform centering on public hospital reform,achieving the Pareto improved efficiency.

How to better the medical insurance compensation mechanism in China / 中华医院管理杂志

Given the significant improvement in terms of its coverage and compensation depth,China's basic medical insurance system has inherent setbacks in its structure as held by the authors.They hold that the medical insurance as the most important source of compensation for medical institutions,should further reform its structure of financing and reasonably raise the percentage of compensation; adjust the time reference and space reference for prepayment estimation such as the total prepaid amount; deepen supportive reforms for the payment manner.All these measures aim at minimizing impact of the payment control mechanism on routine medical activities and exploring diversified payment manners that are feasible.