The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Economic crisis and national health system

The text analyzes the impact of the economic crisis in some critical aspects of the National Health System: outcomes, health expenditure, remuneration policy and privatization through Private Public Partnership models. Some health outcomes related to social inequalities are worrying. Reducing public health spending has increased the fragility of the health system, reduced wage income of workers in the sector and increased heterogeneity between regions. Finally, the evidence indicates that privatization does not mean more efficiency and better governance. Deep reforms are needed to strengthen the National Health System.

Commodification of health care systems: The Catalan case

Commodification of the public healthcare system has been a growing process in recent decades, especially in universal healthcare systems and in high-income countries like Spain.  There are substantial differences in the healthcare systems of each autonomous region of Spain, among which Catalonia is characterized by having a mixed healthcare system with complex partnerships and interactions between the public and private healthcare sectors.  Using a narrative review approach, this article addresses various aspects of the Catalan healthcare system, characterizing the privatization and commodification of health processes in Catalonia from a historical perspective with particular attention to recent legislative changes and austerity measures.  The article approximates, the eventual effects that commodification and austerity measures will have on the health of the population and on the structure, accessibility, effectiveness, equity and quality of healthcare services.

Anthroponyms in health care interventions

Anthroponyms in Health Care Interventions. This research aims to examine the personal names used by health care professionals to refer to and speak with patients in medical consultations. To this end, a large corpus was created with anthroponyms used in this type of settings and extracted from a variety of sources. The data obtained were then analyzed, classified, described and explained. Our hypothesis is that personal names are relevant elements in the relationship between the health care provider and the patient; however, their use is decidedly complex. In the following pages we will discuss this designative complexity by way of an introduction, an analysis of anthroponymic studies and a conclusion.

La vegetación herbácea vivaz climatófila supra y oromediterránea (Koelerio-Corynephoretea) en Gredos occidental, Sistema Central, España

Se ha realizado un estudio fitosociológico de la vegetación herbácea vivaz climatófila supra-oromediterránea perteneciente a la clase Koelerio-Corynephoretea en el macizo occidental de la Sierra de Gredos. Como resultado del mismo se describen las siguientes subasociaciones: Centaureo ornatae-Stipetum lagascae euphorbietosurn oxyphyllae, Arrhenathero baetici-Stipetum giganteae euphorbietosum oxyphyllae, Leucanthemopsio pallidae-Festucetum elegantis stipetosum giganteae y Thymo zygidis-Plantaginetum radicatae euphorbietosum oxyphyllae. Además se aportan datos de Leucanthemopsio pallidae-Festucetum elegantis typicum y Arenario querioidis-Festucetum summilusitanae.

Notas sobre la vegetación del Sistema Central

Como inicio de una serie de notas referentes a la vegetación del Sistema Central, se propone una nueva asociación, Senecio coincyi-Trollietum europaei, incluida en Filipendulion ulmariae.

Piornales, enebrales y pinares oromediterráneos (Pino-Cytision oromediterranei) en el Sistema Central

Se revisan fitosociológicamente los bosques y matorrales oromediterráneos del Sistema Central pertenecientes a la alianza Pino-Cytision oromediterranei. Un suborden, una asociación y seis subasociaciones se proponen como nuevos: Juniperenalia nanae, Echinosparto pulviniformis-Cytisetum oromediterranei, Cytiso-Echinospartetum barnadesii ericetsoum arboreae, Junipero-Cytisetum oromediterranei adenocarpetosum hispanici, arctostaphylletosum crassifoliae, ericetosum aragonensis, genistetosum cinerascentis y populetosum tremulae. Asimismo, se proponen diversas correcciones nomenclaturales y se tipifican los principales sintáxones de la clase. Por último, se presenta un esquema sintaxonómico de la misma en la Península Ibérica hasta el nivel de asociación, con la diagnosis biogeográfica, ecológica y florística de los sintáxones de rango superior.Finalmente, en el apéndice florístico se proponen tres nuevas combinaciones nomenclaturales: Echinospartum ibericum Rivas-Martínez, Sánchez-Mata & Sancho, E. ibericum subsp. pulviniformis (Rivas-Martínez) Rivas-Martínez y Thymus praecox Opiz subsp. penyalarensis (Pau) Rivas-Martínez, Fernández-González & Sánchez-Mata.

Contribución a la tipificación de los sabinares albares (Juniperus thurifera L.) en el Sistema Ibérico meridional

Los sabinares albares, debido a su carácter abierto y a la gran amplitud ecológica de Juniperus thurifera L. presentan problemas para un encuadre fitogeográfico preciso. En este trabajo se pretende un enfoque sintético del estudio de la vegetación y el medio basado en un proceso de inventariación extendido a los sabinares de la porción meridional del Sistema Ibérico (Albarracin, Gúdar. Javalambre) y apoyado en técnicas de análisis fitoecológico. Se trata esencialmente de mostrar que el reparto de los grupos ecológicos, definidos previamente por comparación de inventarios fitosociológicos y ecológicos, puede explicarse por las variaciones dle los factores medioambientales. incluyendo la intervención humana. Como resultado final se ha establecido una tipificación de estos sabinares fundamentada en análisis dc componentes principales y análisis factorial de correspondencias.

Poa feratiana Boiss. & Reuter en el Sistema Central (España)

Se da a conocer la presencia del taxon Poa feratiana Boiss. &  Reuter en el Sistema Central, Se comenta la corologia del taxon en la Península Ibérica.

Sistema integrado para empresas de construcción en Cusco

Actualmente las empresas requieren estrategias innovadoras, que permitan gestionar de forma integral, optimizando los recursos y maximizando los resultados. Siendo el objetivo del presente trabajo de investigación, diseñar un instrumento de gestión integral (gestión de la calidad, ambiental, seguridad y salud ocupacional) para el sector construcción en Cusco. Se realizó un análisis actual de la actividad de construcción, se planteó a diferencia de otras propuestas, el diseño que inicia con el diagnóstico, planificación, organización, ejecución, supervisión y optimización del sistema integral. Los resultados están expresados en el diagnóstico de los 3 sistemas, información clave, para el planteamiento y propuesta de las etapas posteriores; estructurando el planteamiento de los subprogramas basados en el diagnóstico integral, para finalmente determinar los lineamientos estratégicos, de implementación, evaluación y verificación del sistema, teniendo en cuenta la norma ISO 9001: 2008, ISO 14001:2004 y OSHAS 18001:2007; así como la legislación vigente para el Perú.

El modelo del sistema viable: una referencia estratégica para el estudio organizacional del sector cooperativo chileno

The Chilean Cooperative Sector (SCCh) can be explained as a human activity system of high complexity, which seeks to maintain an independent existence, in example, be viable. From this perspective, the Viable System Model (MSV) as conceptual reference presents a real opportunity to study the organization of the cooperative sector in Chile.The central objective of the work refers to study the feasibility of SCCh in a context of sectorial organization, considering the social, legal and economic fabric of the country today.To do this, supported by a systemic methodology were performed: a characterization of the problem situation of the sector -identifying some relevant factors in the areas of market structure, legal regulations and inter cooperation-an organizational diagnosis and proposed a set guidelines for its development.From the above it is concluded that there is relevance between the characteristics of the case study theoretical and methodological approach. The methodology takes tested in other organizational practices such as VIPLAN tools, and applies the SCCh. Its contribution in the field of study is oriented around a holistic view of the organization and promotion of their viability, thereby generating an approach that delivers specific sectorial development strategies, surpassing the approximation of descriptive characterization. Thus, we provide a diagnostic model of the Chilean Cooperative Sector and propose guidelines to support their organizational development.