Crisis, austeridad y áreas rurales: estudio cualitativo de las percepciones sobre los impactos en el sistema sanitario y la salud en Navarra, España / Economic crisis, austerity and rural areas: a qualitative study exploring perceptions of the effects on health care system and health in Navarra, Spain

Resumen La crisis financiera ha impulsado severas medidas de austeridad al sistema español de atención a la salud, entre las que se destacan la reducción del gasto público, la modificación del principio básico de cobertura universal, el copago y las reformas laborales. En este artículo se presentan los resultados de un estudio cualitativo sobre la percepción del personal sanitario y de la población de los impactos de la crisis en el sistema sanitario y de la salud en las áreas rurales. Se consideró la metodología cualitativa como la opción idónea para el estudio de un fenómeno complejo, en el que se buscó profundidad en su comprensión, teniendo en cuenta los significados y el contexto. El estudio se realizó en tres valles del Pirineo navarro. Se llevaron a cabo 22 entrevistas semiestructuradas a informantes clave y de perfiles no expertos, que fueron analizadas según el análisis sociológico del discurso. La desigual accesibilidad a los servicios de salud por parte de la población rural fue el factor identificado de forma unánime como la mayor amenaza y desafío para estos territorios. Una desigualdad que se consideró agravada en la población más envejecida. Las personas entrevistadas no refirieron un impacto negativo en la calidad del servicio de atención primaria, sino que lo localizaron en el entorno urbano y en la asistencia especializada. Los impactos diferenciados de las políticas en las zonas rurales exigen más investigación atendiendo a sus particularidades y de esta forma comprender el impacto específico de la crisis en estos territorios.

Abstract The financial crisis has led to severe austerity measures in the Spanish health care system, among which are the reduction of public spending, the modification of the basic principle of universal coverage, the co-payment and labor reforms. This article presents the findings from a qualitative study that explores the perceptions of primary health care professionals and population of the effects of the crisis on the health system and health in rural areas. The qualitative methodology was considered ideal for the study of a complex phenomenon. We looked for depth in the understanding considering meanings and context. The study was carried out in three valleys of the Spanish Pyrenees (Navarra). We conducted 22 semi-structured interviews with key informants and non-expert profiles analyzed according to the sociological analysis of the speech. The unequal accessibility to health services by rural population was unanimously identified as the greatest threat and challenge for these territories. An inequality that was considered aggravated in older population. The people interviewed did not mention a negative impact on the quality of rural primary care service. They noticed that quality of health care had become worse in urban centers and in specialized healthcare. The differential impacts of policies in rural areas require more research, considering their particularities and thus understanding the specific impact of the crisis on these territories.

The Impact of the Financial Crisis on Lifestyle Health Determinants Among Older Adults Living in the Mediterranean Region: The Multinational MEDIS Study (2005-2015) / 예방의학회지

OBJECTIVES: By the end of the 2000s, the economic situation in many European countries started to deteriorate, generating financial uncertainty, social insecurity and worse health status. The aim of the present study was to investigate how the recent financial crisis has affected the lifestyle health determinants and behaviours of older adults living in the Mediterranean islands. METHODS: From 2005 to 2015, a population-based, multi-stage convenience sampling method was used to voluntarily enrol 2749 older adults (50% men) from 20 Mediterranean islands and the rural area of the Mani peninsula. Lifestyle status was evaluated as the cumulative score of four components (range, 0 to 6), that is, smoking habits, diet quality (MedDietScore), depression status (Geriatric Depression Scale) and physical activity. RESULTS: Older Mediterranean people enrolled in the study from 2009 onwards showed social isolation and increased smoking, were more prone to depressive symptoms, and adopted less healthy dietary habits, as compared to their counterparts participating earlier in the study (p<0.05), irrespective of age, gender, several clinical characteristics, or socioeconomic status of the participants (an almost 50% adjusted increase in the lifestyle score from before 2009 to after 2009, p<0.001). CONCLUSIONS: A shift towards less healthy behaviours was noticeable after the economic crisis had commenced. Public health interventions should focus on older adults, particularly of lower socioeconomic levels, in order to effectively reduce the burden of cardiometabolic disease at the population level.

Construction and Application of Hospital Financial Early Warning System Based on Sustainable Growth / 中国卫生经济

Objective: Through the application of the financial early warning system based on sustainable growth, prevent financial risks and promote the sustainable development of the hospital. Methods:Correct single variable early warning model, add the sustainable growth rate index and build up financial early warning system based on sustainable growth. Results: New financial early warning system could make judgement on the potential financial risk in hospital and the early warning effect is good. Conclusion: The new financial early warning system provides identification method of intuitive financial risk for hospital managers, the financial risk of the hospital sustainable development could provide advance warning to avoid further crisis.

Experiencia cubana en Cooperación Sur-Sur / The Cuban experience in the south-south cooperation

Hoy se viven situaciones de crisis a nivel mundial pero la económica financiera es la que amenaza con serias repercusiones a nivel global sobre todos los aspectos del desarrollo de una nación, incluida la salud. Una de las peores consecuencias ya palpable es la reducción de la Ayuda Oficial al Desarrollo que proviene de las 22 naciones más ricas del mundo y se dirige hacia los países pobres y de bajos recursos. Se pretende profundizar en la importancia de la Cooperación Sur-Sur para enfrentar situaciones de crisis y dentro de ella, un buen ejemplo de la efectividad en este tipo de cooperación lo constituye Cuba. Esta cooperación se realiza mediante la colaboración triangulada entre países del sur, transferencia de tecnologías y ayuda médica, derivados del desarrollo del Sistema Nacional de Salud cubano, además de ser parte de la política exterior del país. Cuba es un ejemplo de ayuda solidaria y desinteresada que se desarrolla desde el año 1963 con buenos resultados y demuestra que la cooperación es una vía eficaz de solución a los problemas de salud de las poblaciones siempre y cuando se trate de una ayuda justa y solidaria, dirigida a fortalecer las capacidades nacionales y acorde con las prioridades del país que la recibe.

The people are living today amid difficult situations caused by the world crisis; however, the financial-economic crisis is the one threatening the nations with serious global impacts, mainly in all aspects of development including health. One of the worst tangible consequences is the reduction of the Official Assistance for Development given by the 22 wealthiest countries to the poor and the resource-limited nations. This paper was intended to delve into the importance of the south-south cooperation to face crisis situations and a good example of the effectiveness of this type of collaboration is Cuba. This cooperation is based on the triangled collaboration among the southern countries, the transfer of technologies and the medical assistance derived from the development of the Cuban Health Care System, which is also part of its foreign policy. Cuba is an example of solidarity and unselfish assistance that has been put into practice since 1963 with good results. At the same time, it has proved that cooperation is an effective way of solving the health problems of the populations whenever this assistance is just and cooperative and aimed at strengthening the national capacities according to the priorities of the recipient country.

The late Prof. Byung Yik Kim's suggestions on financial stability of the Korea's national health insurance in 2001 and 2002: what is changed in 10 years?

The late Professor Byung Yik Kim published an analysis of the financial crisis of Korea's National Health Insurance (NHI) in 2001, which derived from the introduction of the separation of prescribing and dispensing. Subsequently, Kim published another paper on policy suggestions to achieve financial stability of the national health insurance in 2002. In his paper of 2001, he had analyzed two causes of the crisis. First, the stepwise integration of health insurance funds had brought about financial instability since 1998, when regional health insurance funds were integrated into one fund. Second, the introduction of the separation of prescribing and dispensing without recognition of financial instability led to financial crisis. In his 2002 paper, he proposed several policy recommendations, including postpone of financial integration among insurance funds, increasing government subsidies, introducing new financing sources for health insurance, such as an alcohol tax, and implementing cost-containment policies. This paper reviews what was changed in accordance with his policy suggestions over the past 10 years. Many policymakers agreed with his analysis on the causes of financial crisis, however, they did not accept his policy recommendations. Consequently, the Korea National Health Insurance is still financially unstable.

A crise financeira, a guerra cultural e as transformações do espaço econômico Brasileiro em 2009 / Financial crisis, cultural war, and transformations in the economic field in Brazil in 2009 / La crise financière, la guerre culturelle et les transformations de l'espace économique Brésilien en 2009

The financial crisis that broke out in 2008-09 sparked or unveiled a series of internal transformations in the world of finance and its relations with the rest of Brazilian society, especially between the financial elites and the political field. The article aims to begin to analyze these new trends and thereby help explain some less obvious points in the concept of "field" in Bourdieu's sociology, as well as to highlight the notion of "cultural war" in the sense of demonstrating its pertinence for explaining the Brazilian social scene in recent decades.

La crise financière qui a éclaté en 2008-2009 a déclenché ou mis à nu une série de transformations intérieures dans le monde des finances et des relations de ce monde avec l'ensemble de la société brésilienne, surtout dans les rapports entre les élites financières et le champ politique. Dans cet article, on cherche à saisir ces nouveautés et par leur biais, aider à expliquer certains points moins évidents de la notion de "champ" de la sociologie de Bourdieu, tout en approfondissant l'idée de "guerre culturelle" et en montrer la pertinence pour mieux comprendre la scène sociale brésilienne des dernières décennies.

Discussion on Financial Crisis Attacks to College and University Libraries and Its Countermeasures / 医学信息学杂志

The paper discusses financial crisis attacks to hardware and software construction in college and university libraries, li-brarians and readers, explores effective countermeasures to confront the influences, including improving the quality of acquisition, mobilizing the enthusiasm of librarians, helping readers to adjust their attitudes, in order to do well in library work.

State of mind analysis and career guidance of college graduates under the financial crisis / 中华医学教育探索杂志

The financial crisis has made the graduate of grade 2009 career have undergone profound changes in mentality,How to strengthen the ideological and political education of graduates and career guidance is a new task we have to face.In this paper,through a questionnaire survey,students’collective conversation,individual visits,the case summary,we understand the mental state of college graduates in 2009 session in Shenyan,and have analyzed it to provide a basis for career guidance for the targeted colleges and universities under the new circumstances.