Custos sociais da DPOC: o impacto sobre os anos de vida saudável e a perda de produtividade no Brasil entre os anos de 2017 e 2022 / Social costs of COPD: The impact on healthy life years and productivity loss in Brazil from 2017 to 2022

Objetivo: Estimar as perdas de produtividade causadas pela doença pulmonar obstrutiva crônica (DPOC) na população brasileira. Métodos: O estudo utilizou dados obtidos do Datasus, IBGE, indicadores previdenciários, óbitos e aposentadorias precoces por DPOC no Brasil de 2017 a 2022. Para estimar o impacto da DPOC, foram utilizados: anos de vida saudável perdidos (DALYs) e anos de vida ajustados por produtividade (PALYs), assim como as métricas de perda de produtividade salarial (PPS) e perda de produtividade nacionalizada (PPN), que avalia a perda em função do PIB. Resultados: Mais de 196 milhões de dias de trabalho foram perdidos devido à DPOC. As principais fontes são: óbitos precoces (95.264.088), afastamentos permanentes (67.314.232) e aposentadoria precoce (30.304.490). Diárias hospitalares (3.221.591) têm uma contribuição minoritária. O valor total de DALYs observado no período do estudo foi de 2.819.332,63 anos de vida saudável perdidos causados pela DPOC; um total de 14.997.166 PALYs foi perdido por conta da DPOC ou um valor anual equivalente de R$ 230,7 bilhões. Considerando a PPS, estimamos que a DPOC acarretou perdas de produtividade associadas à reposição da mão de obra de R$ 1,38 bilhão anual e, em relação à PPN, de R$ 8,28 bilhões por ano. Conclusões: Afastamentos de pacientes com DPOC podem acarretar maiores dispêndios com pagamentos de benefícios previdenciários. Este estudo atualiza e amplia correlações entre dados socioepidemiológicos, custos de saúde e previdenciários da DPOC no Brasil. Considerando todas as perdas, a DPOC pode causar perdas de R$ 240 bilhões por ano.

Objective: To estimate productivity losses due to workdays lost caused by chronic obstructive pulmonary disease (COPD) in the Brazilian population. Methods: The study used data from DATASUS, IBGE, social security indicators, deaths, and early retirements due to COPD in Brazil from 2017 to 2022. To estimate the impact of COPD, the following were used: Disability-Adjusted Life Years (DALYs) and Productivity-Adjusted Life Years (PALYs), as well as metrics for wage productivity loss (PPS) and nationalized productivity loss (PPN), which evaluates the loss in relation to GDP. Results: More than 196 million workdays were lost due to COPD. The main sources are premature deaths (95,264,088), permanent absences (67,314,232), and early retirement (30,304,490). Hospitalization days (3,221,591) had a minor contribution. The total DALYs observed during the study period was 2,819,332.63 years of healthy life lost due to COPD; a total of 14,997,166 PALYs were lost due to COPD, equivalent to an annual value of R$ 230.7 billion. Considering PPS, we estimate that COPD resulted in productivity losses associated with workforce replacement of R$ 1.38 billion annually; and in relation to PPN, R$ 8.28 billion per year. Conclusions: Absences in COPD patients can lead to higher expenditures on social security benefit payments. This is the first study to correlate socioepidemiological data, health, and social security costs of COPD in Brazil. Considering all losses, COPD can cause losses of R$ 240 billion per year.

Whoever wants better healthcare simply pays more: citizens' perception about voluntary private health insurance in Colombia.

OBJECTIVES: To explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems. METHODS: A qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines. RESULTS: We developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities. CONCLUSIONS: These findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.

RESUMEN: OBJETIVOS: Explorar las percepciones que tienen los colombianos sobre los planes de seguro de salud privados voluntarios (VPHI) en el sistema de salud para identificar las tensiones que existen entre los sistemas público y privado. MéTODOS: Un estudio cualitativo de caso con 46 entrevistas semiestructuradas a pacientes, trabajadores de la salud, administradores de salud, tomadores de decisiones y ciudadanos. Las entrevistas se grabaron, transcribieron y almacenaron de manera anónima. El análisis se hizo siguiendo conceptos de la teoría fundamentada. RESULTADOS: Desarrollamos una matriz paradigmática que explora cómo, en un contexto mediado tanto por la mercantilización de la salud como por la estratificación social, las percepciones sobre las fallas en el sistema de salud público relacionadas con la falta de atención oportuna, procedimientos administrativos extensos y la búsqueda de atención privilegiada llevaron a posicionar los VPHI como una solución a estas fallas. Los entrevistados identificaron tres consecuencias del uso de los VPHI: primero, el empeoramiento de los problemas de acceso oportuno a la atención en el sistema público; segundo, mayores costos para los ciudadanos, traducidos en un pago doble por tecnologías y servicios a los que tienen derecho; tercero, el aumento de las brechas de equidad en el acceso a los servicios de salud entre personas con necesidades similares pero diferentes capacidades de pago. CONCLUSIONES: Estos hallazgos pueden ayudar a los tomadores de decisiones a comprender las percepciones de los ciudadanos sobre las implicaciones que el VPHI puede tener en el empeoramiento de las brechas de equidad en el sistema de salud colombiano. También muestra cómo el VPHI se percibe como un pago doble por servicios cubiertos dentro de los planes de seguridad social y sugiere que la falta percibida de acceso oportuno a la atención en los sistemas públicos y el miedo que los ciudadanos tienen por sí mismos o por sus familiares cuando utilizan una atención sanitaria subóptima son factores importantes para adquirir estos seguros privados.

Austeridade e financeirização: a construção do discurso reformista no campo previdenciário brasileiro / Austeridad y financiarización: la construcción del discurso reformista en el campo de la seguridad social brasileña / Austerity and financialization: the construction of the reformist discourse in the Brazilian social security field

Resumo O artigo busca traçar um panorama na construção dos discursos reformistas no campo previdenciário brasileiro pós-Constituição Federal de 1988. Para tanto, estabelece uma análise das exposições de motivos anexadas às Propostas de Emendas Constitucionais (PECs) e que justificam os projetos submetidas ao Parlamento brasileiro. O estudo tem como pressupostos teórico-metodológicos a análise de discurso crítica (ADC), buscando responder em que medida as concepções de austeridade e financeirização permeiam o processo de construção dos discursos que justificam a proposição das reformas previdenciárias. É também objetivo deste trabalho desvelar as ideologias presentes nos discursos. Os resultados apontam que os ideais capitalistas pautados pela lógica da financeirização e da austeridade aparecem na construção dos discursos das reformas, o que demonstra sua influência sobre a construção discursiva de seus autores, inferindo uma filiação das reformas a essas concepções hegemônicas. Conclui-se que a ADC é um importante meio para compreender os processos que envolvem as políticas públicas, desde sua formulação até sua avaliação.

Resumen El artículo busca esbozar un panorama en la construcción de discursos reformistas en el campo de la seguridad social brasileña después de la Constitución Federal de 1988. Con este fin, establece un análisis de las exposiciones de motivos adjuntas a las propuestas de enmiendas constitucionales y que justifican los proyectos sometidos al Parlamento brasileño. Sus supuestos teóricos y metodológicos son el análisis crítico del discurso (ADC), que busca responder en qué medida las concepciones de austeridad y financiarización impregnan el proceso de construcción de los discursos que justifican la proposición de las reformas de la seguridad social brasileña. También es el objetivo de este trabajo develar las ideologías presentes en los discursos. Los resultados indican que los ideales capitalistas guiados por la lógica de la financiarización y la austeridad aparecen en la construcción de los discursos de las reformas, lo que demuestra su influencia en la construcción discursiva de sus autores, infiriendo una afiliación de las reformas a estas concepciones hegemónicas. Se concluye que la ADC es un medio importante para comprender los procesos que involucran políticas públicas, desde su formulación hasta su evaluación.

Abstract This article seeks to outline a panorama in the construction of reformist discourses in the Brazilian social security field after the 1988 Federal Constitution, unveiling the ideologies present in such discourses. The study conducted an analysis of the explanatory statements that justify constitutional amendment proposals submitted to the Brazilian parliament. The theoretical and methodological method was critical discourse analysis (CDA), seeking to answer to what extent the conceptions of austerity and financialization permeate the process of construction of the discourses that justify the proposition of the Brazilian social security reforms. The results indicate that capitalist ideologies guided by the logic of financialization and austerity appear in the construction of the reformist discourses, which demonstrates their influence on the authors and suggests the affiliation of the reforms to these hegemonic conceptions. It is concluded that CDA is an important tool to understand the processes that involve public policies, from its formulation to its evaluation.

Resgate histórico documental-legislativo das perícias médico-previdenciárias e o papel dos médicos peritos na sua institucionalização / Documentary-legislative historical review of social security medical examinations and the role of medical experts in its institutionalization

Este estudo descritivo parte de pesquisa bibliográfica e documental, visando esboçar uma gênese e constituição das Perícias Médico-Previdenciárias (PMP) no país e buscando ressaltar seu conteúdo crítico. Foi empreendida então a Análise de Conteúdo para categorizar os núcleos temáticos em periodizações históricas que, a partir do método dialético, nos possibilitaram conjugar uma análise diacrônica e sincrônica do papel, do lugar e da função social das PMP. Desvela-se de sua institucionalização legal uma postura historicamente conservadora e antitrabalhadora, que sustenta a ação pericial no âmbito do Instituto Nacional do Seguro Social (INSS) e nos permite afirmar que sequer tal campo de poder têm relação com qualquer resolução dos problemas em Saúde do Trabalhador (ST), pois o paradigma da causalidade dos agravos à saúde se dá pela precedência das condições de trabalho em uma visão (a)histórica e descontextualizada das relações econômicas, políticas, ideológicas e sociais que influem nos nexos entre trabalho e saúde/doença

The descriptive study, based on bibliographic and documentary research, outlines the genesis and institutionalization of Social Security Medical Experts (PMP) in Brazil, highlight its critical content. Content Analysis categorized the thematic cores into historical periods that, based on the dialectical method, allowed us to combine a diachronic and synchronic analysis of the role, place, and social function of PMP. Their legal institutionalization reveals a historically conservative and anti-worker(s) stance that supports the expert action within the National Institute of Social Security (INSS), allowing us to affirm that such a field of power has no intention to solve occupational health issues, for the causality paradigm of health problems is given a priori by the working conditions under an ahistorical and decontextualized view of economic, political, ideological and social relations that influence the link between work and health/disease

Temporal trend and magnitude of previdenciary benefits for workplace accidents in Brazil / Tendência temporal e magnitude dos benefícios previdenciários de natureza acidentária no Brasil

ABSTRACT Objective: To analyze the temporal trend and magnitude of national indicators of previdenciary benefits for workplace accidents issued and granted by the Social Security of Brazil. Methods: Secondary data from Social Security from 2008 to 2019 were used. The trend and percentage variation of the indicators were estimated through Prais-Winsten generalized linear regression. Results: A total of 9,220,372 previdenciary benefits for workplace accidents were issued by the Social Security of Brazil in the period, costing approximately R$ 8.4 billion and representing about 2.0% of the net value of all benefits paid. None of the categories of previdenciary benefits for workplace accidents showed an increasing trend. The highest variation in the benefits granted and issued for workplace accidents occurred in temporary disability benefit (B91), with an annual percentage variation of -54.00% and -29.29%, respectively. Conclusion: A reduction in magnitude and an overall decreasing trend were observed in the historical series of national indicators of benefits granted and benefits issued related to workplace accidents in Brazil from 2008 to 2019.

RESUMO Objetivo: Analisar a tendência temporal e a magnitude dos indicadores nacionais de benefícios previdenciários emitidos e concedidos por acidentes do trabalho pela Previdência Social do Brasil. Métodos: Foram utilizados dados secundários da Previdência Social de 2008 a 2019. A tendência e variação percentual dos indicadores foram estimadas por meio de regressão linear generalizada de Prais-Winsten. Resultados: Um total de 9.220.372 benefícios previdenciários por acidentes do trabalho foi emitido pela Previdência Social do Brasil no período, custando aproximadamente R$ 8,4 bilhões e representando cerca de 2,0% do valor líquido de todos os benefícios pagos. Nenhuma das categorias de incapacidades relacionadas a acidentes do trabalho apresentou tendência de aumento. A maior variação nos benefícios concedidos e emitidos por acidentes do trabalho ocorreu no auxílio por incapacidade temporária (B91), com variação percentual anual de -29,29% e -54,00%, nessa ordem. Conclusão: Verificou-se redução na magnitude e tendência global decrescente em relação as séries históricas dos indicadores nacionais de benefícios concedidos e emitidos de natureza acidentária no Brasil, de 2008 a 2019.

Survival analysis of Chagas disease patients, beneficiaries of social security and social assistance in Brazil, 1942-2016 / Análise de sobrevida de portadores da doença de Chagas, beneficiários da previdência e da assistência social no Brasil, 1942-2016

ABSTRACT Objective To analyze the survival of patients with Chagas disease, beneficiaries of social security and social assistance, in Brazil, from 1942 to 2016. Methods This is a retrospective cohort study with data from the Brazilian Ministry of Social Security. The event of interest was death, and the survival functions were estimated by the Kaplan-Meier and Cox regression methods. Results In the period "onset of the disease until death", women (HR=0.54; 95%CI 0.43-0.53) and receiving social security benefits (HR=0.13; 95%CI 0.11-0.23) were associated with longer survival. Lower survival was associated with the cardiac form of the disease (HR=2.64; 95%CI 2.23-3.12), living in a rural area (HR=1.23; 95%CI 1.14-1.21), and manifestation of the disease between the years 2000 and 2016 (HR=5.32; 95%CI 4.74-5.93). Likewise, in the period "work disability until death", women (HR=0.51; 95%CI 0.41-0.52) and receiving social security benefits (HR=0.24; 95%CI 0,14-0.45) were associated with longer survival, as well as the cardiac form of the disease (HR=1.95; 95%CI 1.83-2.13), living in a rural area (HR=1.31; 95%CI 1.21-1.54), and manifestation of the disease between 2000 and 2016 (HR=1.53; 95%CI 1.33-1.71) were associated with lower survival. Conclusion The main predictors of mortality and survival of patients with Chagas disease who receive social security and assistance benefits in Brazil were presented. These findings can guide the definition of priorities for follow-up actions by Primary Health Care, currently recommended for the longitudinal management of the disease.

RESUMO Objetivo Analisar a sobrevida de portadores da doença de Chagas, beneficiários da previdência e da assistência social no Brasil, 1942-2016. Métodos Estudo de coorte retrospectivo com dados do Ministério da Previdência Social. O evento de interesse foi o óbito, e as funções de sobrevida foram estimadas pelos métodos Kaplan-Meier e de regressão de Cox. Resultados No período "início da doença até o óbito", o sexo feminino (HR=0,54; IC95% 0,43-0,53) e recebimento de benefícios previdenciários (HR=0,13; IC95% 0,11-0,23) foram associados a maior sobrevida. A menor sobrevida esteve associada à forma cardíaca da doença (HR=2,64; IC95% 2,23-3,12), residência em zona rural (HR=1,23; IC95% 1,14-1,21) e manifestação da doença entre os anos de 2000 e 2016 (HR=5,32; IC95% 4,74-5,93). Da mesma forma, no período "incapacidade laboral até o óbito", o sexo feminino (HR=0,51; IC95% 0,41-0,52) e o recebimento de benefícios previdenciários (HR=0,24; IC95% 0,14-0,45) foram associados a maior sobrevida, assim como forma cardíaca da doença (HR=1,95; IC95% 1,83-2,13), residência em zona rural (HR=1,31; IC95% 1,21-1,54) e manifestação da doença entre os anos de 2000 e 2016 (HR=1,53; IC95% 1,33-1,71) associaram-se a menor sobrevida. Conclusão Os principais preditores de mortalidade e sobrevida de portadores de doença de Chagas que recebem benefícios previdenciários e assistenciais no Brasil foram apresentados. Estes achados podem nortear a definição de prioridades de ações de acompanhamento pela atenção primária à saúde, preconizada atualmente para o manejo longitudinal da doença.

Determinantes de la gestión del riesgo en salud en el Régimen Subsidiado en Colombia: estudio cualitativo

Introducción: El Régimen Subsidiado (RS) del sistema de salud colombiano tiene problemáticas estructurales que no han sido solucionadas y son pocos los estudios que profundizan en la explicación de estas. Objetivo: Explorar la experiencia en la dirección estratégica y gestión operativa y financiera de este régimen, sus aspectos operativos y de gestión del riesgo en esta población, así como las diferencias percibidas frente al Régimen Contributivo. Metodología: Estudio cualitativo. Se utilizó el análisis del discurso desde la perspectiva sociohermenéutica como técnica analítica. Se entrevistaron diez participantes, entre directivos de aseguradoras del RS y gestores del sistema de salud. Las entrevistas fueron grabadas y anonimizadas, previo consentimiento informado. Resultados: Emergen tres patrones discursivos que explican la gestión del riesgo en el RS y su diferenciación con el contributivo. Estos patrones se conectan por medio del rol de los determinantes sociales de la salud como ordenador principal de los procesos de salud-enfermedad y de atención en este régimen. A su vez, estas condiciones de vida son las que determinan de manera importante el perfil epidemiológico, acceso, costo de la atención y en general la forma cómo se consumen los servicios de salud por la población afiliada. Discusión: La literatura del aseguramiento en salud reporta que la gestión del riesgo es una función central y supone un ejercicio estratégico para el adecuado manejo de la siniestralidad para optimizar el uso de la Unidad de Pago por Capitación (UPC) asignada. Los hallazgos muestran que los determinantes sociales de la salud no están siendo tenidos en cuenta como ordenador para la atención, por lo tanto, la gestión del riesgo se centra en la atención de patologías en estados avanzados. Conclusiones: los actores perciben que en general, la situación de salud de los afiliados en este régimen es más grave, más complicada y con mayor carga, lo cual genera una tensión en materia de suficiencia de la unidad per cápita. Existe una ausencia discursiva sobre el rol del modelo de atención y su correlación con las necesidades de esta población.

Introduction: The subsidized regime (SR) of the Colombian health system has structural problems that have not yet been resolved and there is a lack of studies that allow the understanding of most of them. The aim of this study was to explore with stakeholders of the subsidized regime the experience about strategic, financial, and health risk management and the differences perceived with the contributory regime. Methods: A qualitative study was performed; the analytic technique used was the discourse analysis under socio-hermeneutic perspective. 10 participants were interviewed, among them directors of insurance companies of SR and health care system managers. The interviews were recorded, prior informed consent, and analyzed according to the discourse analysis. Finding: Three discursive patterns emerged that explain risk management in SR and its differentiation from contributory regime. These patterns are connected through the role of the social determinants of health as the main axis that explain the health-disease and care processes in this regimen. At the same time, these living conditions are what determine the epidemiological profile, access, cost of care and, in general, the way in which health services are consumed by the affiliated population. Discussion: The health insurance literature reports that risk management is a central function, and it is a strategic exercise for the proper management of claims to optimize the use of resources, however, the findings show that the social determinants of health are not being taken into account as a key element for healthcare organization, therefore, risk management focuses on care for pathologies in advanced stages. Conclusions: The actors perceive that the health situation in this regime is more severe, more complicated and with a greater burden disease, which generates a tension in terms of sufficiency of the Per Capita Unit. There is a discursive absence on the role of the care model and its correlation with the needs of this population.

The economic impact of stroke in Brazil, 2010-2019: Increase in public expenses of Unified Health System.

OBJECTIVES: To economically analyze the impact that outpatient and inpatient spending of the Unified Health System and social security expenses of the General Regime of Social Security generated to the Brazilian public system, between 2010 and 2019. MATERIALS AND METHODS: Observational research, in which public data from the SUS Department of Informatics and the Social Security Historical Database were used, according to 10ª International Classification of Diseases code, I-64 (Stroke, not specified if hemorrhagic or ischemic). The Kruskal-Wallis test, complemented by Dunn's post-hoc test, and Spearman's bivariate correlation test were used to check for differences and correlations between variables. The expenditures were adjusted for inflation for the year 2019 and presented in american dollar s(U$). RESULTS: Stroke public spending impacted an average of 120 million dollars per year and increased 15% during the historical series. Eighty-nine percent of these expenditures originated from hospital spending (p<0.05). On average, stroke accounted for 7.3% of spending on cardiovascular diseases and 0.72% of spending on the other codes of 10ª International Classification of Diseases. Total spending showed a positive correlation with the historical series (r=.702; p<0.05), with the increase in the elderly population (over 60 years of age) (r=.676; p<0.05) and with Gross Domestic Product per capita (r=.784; p<0,05). CONCLUSIONS: The impact that stroke generated on public spending increased over the historical series, mainly due to hospital spending and by the prospect of increasing elderly population in Brazil, public spending tends to rise.

Loss ratio of the capitation payment unit of the health-promoting entities in Colombia between 2017 and 2021: a financial-actuarial approach.

BACKGROUND: Because of a change of government, the Colombian Ministry of Health and Social Protection is in the process of presenting a structural reform for the General System of Social Security in Health (GSSSH), in order to implement a 'preventive and predictive health model'. However, it will always be relevant to review and analyze the fiscal implications of any proposed public policy program, to protect financial sustainability and to promote the better functioning of the system in question. METHODS: To contribute to this topic, we have calculated, using a financial-actuarial approach, the loss ratio for the years 2017 to 2021 for the Capitation Payment Unit (CPU) for all the Health-Promoting Entities (HPE) for both contributory and subsidized schemes. This information, derived from public reports available on the official website of the National Health Superintendency, allows us to estimate the financial burden of the institutions that guarantee access to and provision of health services and technologies in Colombia. RESULTS: The study shows that close to half of the HPEs in Colombia (which represent 11.6 million affiliates) have CPU loss ratios of more than 100% for the year 2021, evidencing insufficient resources for the operation of health insurance. CONCLUSIONS: Finally, we propose some policy recommendations regarding the strengthening of informed decision-making to allow the healthy financial sustainability of the Colombian GSSSH.

A precarização jurídica das relações de trabalho como fator de sofrimento das(os) trabalhadoras(es) no setor da saúde durante a pandemia de COVID-19 / The legal precariousness of work relations in the health sector during the COVID-19 pandemic, as a factor of worker suffering

Resumo O artigo analisou o processo de precarização das relações de trabalho no setor da saúde, demonstrando como essa situação gerou sofrimento dos trabalhadores. O texto buscou registrar como a adoção institucional das concepções econômicas neoliberais, de redução das políticas sociais de Estado, acopladas a um histórico de rejeição cultural aos direitos trabalhistas, proporcionou a atração dos mecanismos de precarização do trabalho, notadamente, a terceirização da mão de obra e da prestação de serviços. No segundo momento, o texto aponta as impropriedades jurídicas cometidas, apresentando as consequências da fragilização do vínculo jurídico nas condições de trabalho desses trabalhadores, principalmente no que se refere às jornadas de trabalho e a remuneração, destacando-se, também, o quanto a disseminação desses vínculos representou um fator de rebaixamento geral dos salários e direitos trabalhistas e previdenciários no setor. Foram apresentados, ainda, dados das pesquisas da Fiocruz sobre condições de trabalho durante a pandemia. Conclui mostrando a urgência de se resgatarem os institutos jurídicos trabalhistas que foram abandonados no percurso histórico estudado, para direcionar a novo rumo as políticas públicas na saúde.

Abstract The present article analyzed the process of precarious work relations in the health sector, demonstrating how this situation generated illness and suffering among workers. The text sought to register how the institutional adoption of neoliberal economic conceptions, of the reduction of State social policies, coupled with a history of cultural rejection of labor rights, provided the attraction of mechanisms of precarious work for the public sector, notably, the outsourcing of labor and the provision of services. In a second moment, the text points out the legal improprieties committed, presenting the consequences of the weakening of the legal bond in the working conditions of these workers, mainly regarding working hours and remuneration, also highlighting how much the dissemination of these links represented a factor of a general reduction in wages and labor and social security rights in the sector. Data from Fiocruz surveys on working conditions during the pandemic were also presented. The article concludes by showing the urgency of rescuing the legal labor institutes that were abandoned in the historical path studied in order to guide the public health policies in a new direction.

[Relevance and feasibility of reforms to create a universal health system in ChileRelevância e viabilidade de uma reforma para a criação de um sistema de saúde universal no Chile]. / Pertinencia y factibilidad de reforma para crear un sistema universal de salud en Chile.

The health system in Chile is well developed, with broad national coverage. However, organizational limitations necessitate urgent structural reform due to a lack of resources and poor performance, with segmentation and inequity. The government's program for 2022-2026 proposes substantial reforms aimed at creating a universal health system. Other reform proposals formulated by various government programs and commissions, as well as think tanks, provide useful inputs to contextualize the government proposal.Different types of models coexist in the health system: public insurance is based on a social security model, the public system provides free care to the insured population, and private insurance and private care providers work on a market basis. The proposed system would function on the national health system model, combining a predominant national health service (Beveridge model) with a complementary social security system (Bismarck model), depending on the need for funding. With a focus on social project evaluation, the relevance (internal coherence and external alignment) and political and economic feasibility of the contents of the government program were reviewed. The proposal has internal coherence, but limited external alignment with the prevailing political and economic system, and little State capacity to increase the financing of public enterprises and their coverage. The contents of the proposal do not show sufficient facilitating conditions to reasonably suggest political and economic feasibility in terms of legal approval and effective implementation of the proposed reform.

O sistema de saúde do Chile alcançou grande desenvolvimento e cobertura nacional, mas continua tendo limitações organizacionais que demandam uma reforma estrutural urgente, devido à insuficiência de recursos e do desempenho, com segmentação e iniquidades. O programa do governo para o período 2022-2026 propõe uma reforma substancial com vistas a criar um sistema de saúde universal. Há outras propostas de reforma, formuladas por diversos programas e comissões governamentais e centros de estudo, que fornecem contribuições úteis para contextualizar a proposta do governo. Diferentes tipos de modelos coexistem no sistema de saúde, pois o seguro público é do tipo previdenciário, o sistema assistencial público oferece atendimento gratuito às pessoas que têm seguro público, e os planos e operadoras de assistência privada seguem uma lógica de mercado. A proposta seria um sistema nacional de saúde que combinaria um serviço nacional de saúde predominantemente estatal (modelo de Beveridge) com um sistema de seguridade social (modelo de Bismarck) complementar, conforme a necessidade de financiamento. Com base em uma abordagem de avaliação de projetos sociais, foram analisados os critérios de relevância (coerência interna e consistência externa) e de viabilidade política e econômica do conteúdo do programa do governo. A proposta tem coerência interna, mas pouca consistência externa com o sistema político e econômico predominante, e o Estado tem capacidade limitada para aumentar o financiamento e a cobertura das empresas públicas. O conteúdo da proposta não permite identificar condições facilitadoras suficientes para sustentar um nível razoável de viabilidade política e econômica da aprovação legal e implementação efetiva da reforma proposta.

Evaluación quinquenal de los ejes sanitarios de un programa nacional de Atención Primaria de la Salud / Five-year evaluation of the sanitary axes of a national program of Primary Health Care

Se realizó una evaluación quinquenal de los ejes sanitarios (que dan lugar a objetivos estratégicos con sus correspondientes metas e indicadores, áreas de intervención y líneas de acción) dentro del marco de la gestión sanitaria de uno de los 10 principales agentes de la seguridad social argentinos quien implementaba desde hacía 20 años un Programa Nacional de Atención Primaria de la Salud (PNAPS). El mismo promedió alrededor de 800 mil beneficiarios anuales dentro de una red asistencial nacional propia en el primer nivel de atención compuesta por 45 Centros de Atención Primaria (CAPs). Se implementó una investigación evaluativa que incluyó un trazado de línea de base con la valoración de cinco Ejes Sanitarios (ES). Se trata de un diseño de corte transversal de un periodo de 5 años. Se definieron metas, indicadores y recomendaciones para cada uno de los ES, recopilando información de fuentes diferentes y complementarias para su análisis. Los resultados mostraron una evolución favorable en el período evaluado, aunque el cumplimiento de las metas estuvo bastante alejado de lo propuesto de manera teórica. Conclusiones: este trabajo aporta información valiosa y original para subsidiar la toma de decisiones e incentivar la investigación en el ámbito de la APS, buscando reformular los actuales modelos de gestión y de atención de la salud (AU)

A five-year evaluation of the health axes (which give rise to strategic objectives with their corresponding goals and indicators, areas of intervention and lines of action) was carried out within the framework of health management of one of the 10 main argentine social security agents who had been implementing a National Primary Health Care Program (PNAPS) for 20 years. It averaged around 800,000 annual beneficiaries within its own national care network at the first level of care made up of 45 Primary Care Centers (CAPs). An evaluative investigation was implemented that included a baseline drawing with the assessment of five Sanitary Axis (ES). It is a cross-sectional design of a period of 5 years. Goals, indicators and recommendations were defined for each of the ES, collecting information from different and complementary sources for analysis. Results: they showed a favorable evolution in the period evaluated, although the fulfillment of the goals was quite far from what was theoretically proposed. The results of this work provides valuable and original information to support decision-making and encourage research in the field of PHC, seeking to reformulate current management and health care models (AU)

Migration, work, and retirement: the case of Mexican-origin populations.

Mexico and the United States both face rapid population aging as well as older populations with high poverty rates. Among the most vulnerable populations of retirement age in either nation are Mexican immigrants to the United States. This work uses data from the U.S. Health and Retirement Study and the Mexican Health and Aging Study to assess retirement decisions among persons born in Mexico and working in either nation as well as such decisions by non-Hispanic Whites in the United States. Social security system incentives matter for the retirement of Mexican immigrants in the U.S. but not for return-migrants in Mexico.

Impacto económico de medicamentos de alto precio/costo en la seguridad social de Argentina. El caso del instituto de obra social para las Fuerzas Armadas y de Seguridad / Economic impact of high-price/cost medicines on social security in Argentina. The case of the Institute for the Armed and Security Forces

Resumen Introducción: En Argentina, los medicamentos de alto costo (MAC) generan una carga económica elevada que deben afrontar las instituciones sanitarias. Sin embargo, no existe a la fecha un estu dio en Argentina que indique la magnitud del real problema de los MAC para la Seguridad Social. El presente trabajo, explora cuál es su impacto económico para una de las principales Obras Sociales del país. Métodos: Se realizó un estudio descriptivo con etapa analítica a partir de datos obtenidos en gerencia de prestaciones, área farmacia y área contable de la institución. Cada medicamento fue clasificado según recomendación de OMS (clasificación Anatómica-Terapéutica- Química-ATC). Los precios fueron consignados en tres valores: nominal al momento de adquisición, actualizado a pesos fin de 2021 utilizando el CER (coeficiente de estabilización de referencia), y en dólares (USD). Se evaluaron 105 324 dispensas de MAC, correspondientes a 258 011 unidades para 10 450 afiliados. Resultados: El gasto total anualizado fue 57 millones de dólares (USD), y por usuario 6220 USD. Solo 1.9% de los afiliados requirieron MAC, aunque el gasto fue del 21.9% de los ingresos (aportes + contribuciones). Los primeros 5 medicamentos que generaron el mayor gasto fueron enzalutamida, bevacizu mab, nivolumab, palbociclib, pembrolizumab. Las enfermedades oncológicas y reumatológicas representaron el 62.8% del gasto. Conclusión: A la luz de los resultados, se deduce que los MAC constituyen un riesgo potencial de desfinanciación del sistema de salud si son abordados de manera atomizada por cada subsector. Los MAC requieren de políticas globales de carácter nacional y/o regional.

Abstract Introduction: In Argentina, high-cost drugs (HCD) induce a high economic burden for all the health system sec tors. However, it does not exist in Argentina any data that indicates the real problem of HCD for Social Security. That is why, the present study explores the economic impact of the HCD for one of the main Institutions of the country. Methods: A descriptive study with an analytical stage was carried out based on data obtained from management, pharmacy and accounting area. Each drug was classified according to WHO recommendation (Anatomical-Therapeutic-Chemical-ATC classification). The prices were expressed in three ways: nominal value at the time of acquisition in local currency, updated using the CER (reference stabilization coefficient), and in US dollars. A total of 105 324 HCD dispensed were evaluated, which corresponded to 258 011 units destined to 10 450 patients. Results: Total annualized spend was US$57 million (US$6220 per patient). Only 1.9% of affiliates required HCD, although those expenses represented 21.9% of the institutions´ total income. The first 5 drugs associated to the highest expenditure were enzalutamide, bevacizumab, nivolumab, palbociclib, pembrolizumab. Oncological and rheumatological diseases represented 62.8% of the HCD costs. Conclusion: Considering the results obtained, it can be deduced that if the HCD problem is approached in a scattered way by each subsec tor, it will become a potential risk for health system defund. The HCD topic requires of global policies at national or even regional level.

Asociación entre patrones alimentarios y factores sociodemográficos en la población adulta de Antioquia, Colombia

Objetivo: identificar los patrones alimentarios de la población adulta Antioqueña y su asociación con variables socioeconómicas. Métodos: estudio transversal con muestra aleatoria de 1.394 adultos de 18 a 59 años, derivados del estudio Perfil alimentario y nutricional de Antioquia 2019. El consumo alimentario fue evaluado con recordatorio de consumo en 24 horas (R24h) y un segundo R24h en día no consecutivo al 25% de la muestra, se cuantificó el consumo de alimentos en gramos, los patrones alimentarios se establecieron mediante análisis factorial por Componentes principales con rotación ortogonal varimax. Para verificar la asociación entre los patrones alimentarios y las variables socioeconómicas se empleó regresión de Poisson por varianza robusta. Resultados: se definieron tres patrones alimentarios que representan el 28,1% de la varianza: "Tradicional" (9,8%), "Regional" (9,7%) y "Prudente" (8,6%). Los dos primeros se asociaron con variables demográficas, como sexo, edad y etnia; mientras que el último se asoció con variables socioeconómicas como escolaridad, ingresos familiares, régimen de seguridad social y clasificación de seguridad alimentaria. Conclusiones: Los hallazgos del presente estudio muestran que la dieta de la población estudiada, sigue unos referentes de tradición alimentaria, reflejados en los patrones Tradicional y Regional, mientras que el patrón Prudente, corresponde a la parte de la población que tiene mejores condiciones socioeconómicas y probablemente lo siguen por recomendación de salud.

Objective: to identify the eating patterns of the adult population from Antioquia, Colombia, and their association with socioeconomic variables. Methods: a cross-sectional study was performed with a random sample of 1,394 adults aged 18 to 59 years, derived from the Antioquia Food and Nutritional Profile 2019 study. Food consumption was evaluated with a 24-hour consumption recall (R24h) and a second R24h on a non-consecutive day at 25% of the sample, food consumption was quantified in grams, and food patterns were established by factorial analysis by Principal Components with varimax orthogonal rotation. To verify the association between eating patterns and socioeconomic variables, Poisson regression was used for robust variance. Results: three eating patterns were defined that represent 28.1% of the variance: "Traditional" (9.8%), "Regional" (9.7%), and "Prudent" (8.6%). The first two were associated with demographic variables, such as gender, age, and ethnicity; while the latter was associated with socioeconomic variables such as schooling, family income, social security system, and food security classification. Conclusions: The findings of this study show that the diet of the population of the study, follows some references to food tradition, reflected in the Traditional and Regional patterns, while the Prudent pattern corresponds to the part of the population that has better socioeconomic conditions, and they probably follow it for health recommendation.

Evolution of differences in clinical presentation across epidemic waves among patients with COVID-like-symptoms who received care at the Mexican Social Security Institute.

Background: Timely monitoring of SARS-CoV-2 variants is crucial to effectively managing both prevention and treatment efforts. In this paper, we aim to describe demographic and clinical patterns of individuals with COVID-19-like symptoms during the first three epidemic waves in Mexico to identify changes in those patterns that may reflect differences determined by virus variants. Methods: We conducted a descriptive analysis of a large database containing records for all individuals who sought care at the Mexican Social Security Institute (IMSS) due to COVID-19-like symptoms from March 2020 to October 2021 (4.48 million records). We described the clinical and demographic profile of individuals tested (3.38 million, 32% with PCR and 68% with rapid test) by test result (positives and negatives) and untested, and among those tested, and the changes in those profiles across the first three epidemic waves. Results: Individuals with COVID-19-like symptoms were older in the first wave and younger in the third one (the mean age for those positive was 46.6 in the first wave and 36.1 in the third wave; for negatives and not-tested, the mean age was 41 and 38.5 in the first wave and 34.3 and 33.5 in the third wave). As the pandemic progressed, an increasing number of individuals sought care for suspected COVID-19. The positivity rate decreased over time but remained well over the recommended 5%. The pattern of presenting symptoms changed over time, with some of those symptoms decreasing over time (dyspnea 40.6 to 14.0%, cough 80.4 to 76.2%, fever 77.5 to 65.2%, headache 80.3 to 78.5%), and some increasing (odynophagia 48.7 to 58.5%, rhinorrhea 28.6 to 47.5%, anosmia 11.8 to 23.2%, dysgeusia 11.2 to 23.2%). Conclusion: During epidemic surges, the general consensus was that any individual presenting with respiratory symptoms was a suspected COVID-19 case. However, symptoms and signs are dynamic, with clinical patterns changing not only with the evolution of the virus but also with demographic changes in the affected population. A better understanding of these changing patterns is needed to improve preparedness for future surges and pandemics.

Results and Feasibility of the Virtual Inspection of Clinical Trials During Pandemic of COVID-19 in Peru.

OBJECTIVE: This study aimed to describe the results of inspection of clinical trials (CTs) and the feasibility of conducting inspections virtually in Peruvian Social Security hospitals during the pandemic of COVID-19. METHODS: This study described 25 CTs that were inspected during August 2021-November 2021. The data for the variables were obtained from the CT inspection database of the Social Security Sub-directorate of Regulation and Management of Health Research which includes minutes and inspection reports. We describe the characteristics of the CT included and findings during the inspections using relative and absolute frequencies. Likewise, we evaluated the feasibility of virtual inspection through a self-administered questionnaire. RESULTS: According to the findings of the inspection, 60% of CTs were on biological products, and 60% were focused on infectiology. Additionally, 64% of CTs were implemented in Lima, 52% were conducted in level IV health facilities, and 72% were funded by the pharmaceutical sector. The lack of submission of requested documents (16/25) and inadequate access to the internet (9/15) and source documents (4/15) were the primary observations during the inspection. Regarding the feasibility of virtual supervisions, most interviewees rated their understanding of instruction form as "normal" and its content as "adequate." Similarly, in the virtual self-assessment matrix, a large proportion of interviewees rated comprehension as "normal" (7/15) and its content as "adequate" (13/15). The quality of the virtual supervision process was 8.6 ± 1.1 on a scale of 1-10. CONCLUSION: Discrepancies in records and failure to submit requested documents were the main observations. Most interviewees considered the material to be adequate and gave an overall good rating to the virtual inspection process.

[Economic impact of high-price/cost medicines on social security in Argentina. The case of the Institute for the Armed and Security Forces]. / Impacto económico de medicamentos de alto precio/costo en la Seguridad Social de Argentina. El caso del Instituto de Obra Social para las Fuerzas Armadas y de Seguridad.

INTRODUCTION: In Argentina, high-cost drugs (HCD) induce a high economic burden for all the health system sectors. However, it does not exist in Argentina any data that indicates the real problem of HCD for Social Security. That is why, the present study explores the economic impact of the HCD for one of the main Institutions of the country. METHODS: A descriptive study with an analytical stage was carried out based on data obtained from management, pharmacy and accounting area. Each drug was classified according to WHO recommendation (Anatomical-Therapeutic-Chemical-ATC classification). The prices were expressed in three ways: nominal value at the time of acquisition in local currency, updated using the CER (reference stabilization coefficient), and in US dollars. A total of 105 324 HCD dispensed were evaluated, which corresponded to 258 011 units destined to 10 450 patients. RESULTS: Total annualized spend was US$57 million (US$6220 per patient). Only 1.9% of affiliates required HCD, although those expenses represented 21.9% of the institutions' total income. The first 5 drugs associated to the highest expenditure were enzalutamide, bevacizumab, nivolumab, palbociclib, pembrolizumab. Oncological and rheumatological diseases represented 62.8% of the HCD costs. CONCLUSION: Considering the results obtained, it can be deduced that if the HCD problem is approached in a scattered way by each subsector, it will become a potential risk for health system defund. The HCD topic requires of global policies at national or even regional level.

Introducción: En Argentina, los medicamentos de alto costo (MAC) generan una carga económica elevada que deben afrontar las instituciones sanitarias. Sin embargo, no existe a la fecha un estudio en Argentina que indique la magnitud del real problema de los MAC para la Seguridad Social. El presente trabajo, explora cuál es su impacto económico para una de las principales Obras Sociales del país. Métodos: Se realizó un estudio descriptivo con etapa analítica a partir de datos obtenidos en gerencia de prestaciones, área farmacia y área contable de la institución. Cada medicamento fue clasificado según recomendación de OMS (clasificación Anatómica-Terapéutica- Química-ATC). Los precios fueron consignados en tres valores: nominal al momento de adquisición, actualizado a pesos fin de 2021 utilizando el CER (coeficiente de estabilización de referencia), y en dólares (USD). Se evaluaron 105 324 dispensas de MAC, correspondientes a 258 011 unidades para 10 450 afiliados. Resultados: El gasto total anualizado fue 57 millones de dólares (USD), y por usuario 6220 USD. Solo 1.9% de los afiliados requirieron MAC, aunque el gasto fue del 21.9% de los ingresos (aportes + contribuciones). Los primeros 5 medicamentos que generaron el mayor gasto fueron enzalutamida, bevacizumab, nivolumab, palbociclib, pembrolizumab. Las enfermedades oncológicas y reumatológicas representaron el 62.8% del gasto. Conclusión: A la luz de los resultados, se deduce que los MAC constituyen un riesgo potencial de desfinanciación del sistema de salud si son abordados de manera atomizada por cada subsector. Los MAC requieren de políticas globales de carácter nacional y/o regional.

Benefícios acidentários e previdenciários concedidos a portadores de câncer no Brasil, 2008-2014 / Accident and social security benefits granted to cancer patients in Brazil, 2008-2014

Resumo O objetivo deste artigo é descrever a distribuição do câncer entre os benefícios concedidos pelo Registro Geral da Previdência Social (RGPS), de 2008 a 2014, no Brasil. Estudo ecológico com dados cedidos pelo Instituto Nacional do Seguro Social (INSS). Determinou-se a proporção de benefícios acidentários (relacionados ao trabalho) e previdenciários (gerais) concedidos por câncer no Brasil, entre os benefícios concedidos por todas as causas e realizou-se uma análise espacial para avaliar a distribuição geográfica dessas proporções, tendo os estados brasileiros como unidade de análise. O câncer foi motivo de concessão de 533.438 benefícios (2,9% do total de benefícios concedidos por todas as causas), com predomínio do sexo feminino nos benefícios previdenciários (53,7%) e do sexo masculino nos benefícios acidentários (71,6%). As maiores proporções de benefícios previdenciários por câncer ocorreram nas regiões Norte e Centro-Oeste. Em 19 dos 26 estados brasileiros e no Distrito Federal não houve concessão de benefício acidentário por câncer. A análise das ocorrências de câncer que geraram concessões de benefícios do RGPS sugere uma desproporcionalidade da concessão de benefícios previdenciários em relação aos acidentários, principalmente nas regiões Norte, Nordeste e Sul do Brasil.

Abstract This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.

Perfil do segurado submetido a reabilitação profissional oferecida pelo inss: uma análise de caso / Profile of the worker received vocational rehabilitation service of inss: a case analysis / Perfil del trabajador acogido al servicio de reinserción profesional del inss: análisis de un caso

Introdução: O Instituto Nacional do Seguro Social (INSS) é a autarquia federal legalmente incumbida de concretizar as políticas públicas da previdência social. A reabilitação profissional é um dos serviços oferecidos pelo INSS, e deve proporcionar meios para a (re)educação e (re)adaptação profissional e social do segurado incapacitado, com vistas a possibilitar o seu reingresso no mercado de trabalho e sua inclusão social no contexto em que vive. Percebe-se, assim, que a reabilitação profissional envolve conceitos de trabalho, de saúde e de educação. Objetivo: Este artigo tem por objetivo analisar o perfil básico do trabalhador acolhido no serviço de reabilitação profissional do INSS em Uberlândia/MG. Metodologia: Em termos metodológicos, trata-se de um estudo de caso, de natureza quantitativa. A unidade de análise são os segurados desligados no ano de 2017 e foram analisados dados secundários extraídos pelo INSS de processos físicos de acompanhamento dos reabilitandos. Descreveram-se o procedimento adotado pelo setor de reabilitação profissional do INSS e o perfil do segurado submetido a reabilitação profissional. Principais resultados: Concluiu-se que alguns aspectos da amostra contrariavam os prognósticos fornecidos pelo referencial teórico e que outros os confirmavam. Conclusão: O universo da amostra é semelhante ao dos estudos anteriores (composição etária, remuneração média, nível de escolaridade). Contudo, alguns resultados contrariam os indicados por eles, tais como quantidade de inelegíveis por possibilidade de retorno ao trabalho, quantidade de segurados desligados do programa sem passar por nenhum curso de capacitação ou treinamento profissional. Além disso, os resultados sugerem que a responsabilidade pelo sustento da família tem importância no sucesso da reabilitação profissional e que o fato de o segurado receber um benefício de valor superior prejudica o sucesso da reabilitação profissional. Contribuições teóricas e práticas: Ao final, foi possível contribuir com um bom diagnóstico da situação. Estas informações podem subsidiar a tomada de decisões administrativas.

Introduction: The National Social Security Institute (INSS) is the federal authority legally responsible to implement public policies of social welfare. The labour rehabilitation is one of the services offered by INSS, and should provide means for (re) education and (re) professional and social adaptation of the disabled workers, in order to enable their re-entry into the labour market and their inclusion the social context in which they live. We may affirm that labour rehabilitation involves concepts of work, health and education. Research´s goal: This article aims to analyze the basic profile of the worker received vocational rehabilitation service of INSS in Uberlândia/MG. Methods: In terms of methodology, it is a case study, quantitative oriented. The unit of analysis are workers switched off of the program in the year 2017 and secondary data were extracted by the INSS physical processes. The article describes the procedure adopted by INSS´ labour rehabilitation professionals and the profile of the workers who underwent the program. Main Outcomes: It was concluded that some aspects of the sample denied forecasts provided by theoretical studies and others confirmed them. Conclusion: The sample universe is similar to that of previous studies (age composition, average salary, education level). However, some results contradict those indicated, such as the number of ineligible persons due to the possibility of returning to work, the number of insured persons who were terminated from the program without undergoing any training or professional training courses. In addition, the results suggest that the responsibility for supporting the family is important for the success of professional rehabilitation and that the fact that the insured receives a benefit of higher value jeopardizes the success of professional rehabilitation. Theoretical and practical contribution: In the end, it was possible to generate a good diagnosis of the situation. This information can support administrative decision-making.

Introducción: El Instituto Nacional de Seguridad Social (INSS) es la autoridad federal legalmente responsable de la ejecución de las políticas públicas de asistencia social. La rehabilitación laboral es uno de los servicios ofrecidos por el INSS, y debe proporcionar medios para la (re)educación y (re)adaptación profesional y social de los trabajadores discapacitados, con el fin de permitir su reinserción en el mercado de trabajo y su inclusión el contexto social en el que viven. Podemos afirmar que la rehabilitación laboral implica conceptos de trabajo, salud y educación. Objetivo de la investigación: Este artículo tiene como objetivo analizar el perfil básico del trabajador que recibe el servicio de rehabilitación profesional del INSS en Uberlândia/MG. Metodología: En términos de metodología, se trata de un estudio de caso, de orientación cuantitativa. La unidad de análisis son los trabajadores desconectados del programa en el año 2017 y los datos secundarios fueron extraídos por los procesos físicos del INSS. El artículo describe el procedimiento adoptado por los profesionales de rehabilitación laboral del INSS y el perfil de los trabajadores que se sometieron al programa. Principales resultados: Se concluye que algunos aspectos de la muestra desmienten las previsiones aportadas por los estudios teóricos y otros las confirman. Conclusiones: El universo de la muestra es similar al de estudios anteriores (composición por edad, salario medio, nivel de estudios). Sin embargo, algunos resultados contradicen los indicados, como el número de personas no elegibles debido a la posibilidad de reincorporarse al trabajo, el número de asegurados que fueron dados de baja del programa sin realizar ningún curso de formación o capacitación profesional. Además, los resultados sugieren que la responsabilidad de mantener a la familia es importante para el éxito de la rehabilitación profesional y que el hecho de que el asegurado reciba una prestación de mayor valor pone en peligro el éxito de la rehabilitación profesional. Contribución teórica y práctica: Al final, fue posible generar un buen diagnóstico de la situación. Esta información puede servir de apoyo a la toma de decisiones administrativas.