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.

Pension structural reforms, re-reforms and their effects on social welfare: The case of Chile

This article fi rst summarizes the structural reforms of pensions (total or partial privatization) in Latin America and Central and Eastern Europe, identifying their advantages and disadvantages, and does the same with the international process of re-reforms of pensions with a greater role of the state. Second, chooses Chile as a case study, as a world pioneer in both types of reforms; describes their characteristics and effects on social welfare of the structural reform of 1981 and the re-reform of 2008. Such effects are evaluated based on ten basic principles of social security from the International Labour Offi ce (ILO): 1) social dialogue to approve the reforms, 2) universal coverage of the population, 3) equal treatment of insured persons, 4) social solidarity, 5) gender equity, 6) suffi ciency of benefi ts, 7) effi ciency and reasonable administrative cost, 8) social participation in the management of the system, 9) role of the state and supervision, and 10) fi nancial sustainability. Third, it summarizes the advantages and disadvantages-challenges of the re-reform and informs on the current debate for further reforms.