Social Services in Times of Economic and Social Crisis: The case of Spain

The financial and economic crisis which originated in 2008 has had a severe impact on the population of the Southern European countries. The economic policies of austerity and public deficit control, as well as the neo-liberal and conservative social policies are redefining the public social protection systems, in particular the Social Services. In order to get to understand the current situation, we shall explain how the Social Services were developed in Spain and analyse the causes and consequences of the economic crisis. The working hypothesis is that the greater the increase on the population’s needs, the more developed the Social Services should be. We carried out a descriptive analysis of the situation as far as the social impacts of the crisis per region are concerned. We tested the hypothesis through a parametric model of analysis of variance (one-way ANOVA) triangulating with the non-parametric Kruscal-Wallis test. The working hypothesis failed. The regions with better developed Social Services show a lower level of poverty and social exclusion. The challenges that the public Social Services system faces in times of crisis is three-fold: 1) re-modelling of local administration and transferring of the municipal Social Services responsibilities to the regional administration; 2) an increase of the population at risk of poverty and social exclusion 3) impact on social policies.

El discurso profesional en servicios sociales comunitarios: una aproximación desde la identificación de repertorios interpretativos

Introducción: la presente investigación está orientada a ofrecer un análisis donde se establezcan los recursos lingüísticos utilizados por los participantes sobre el contenido y alcance de la prestación básica de información y orientación en los servicios sociales comunitarios, tal como la desarrollan los trabajadores sociales. Material y métodos: siguiendo una metodología cualitativa y la utilización del análisis del discurso en la propuesta de Wetherell y Potter (1996) con el empleo de la herramienta analítica de los repertorios interpretativos, se intentarán resaltar aquellos elementos definitorios, estrategias profesionales, valores, normas, prácticas organizacionales, elementos de la cultura institucional, entre otros, que dan forma a los escenarios donde desarrollan su labor los profesionales y que configuran el sistema de servicios sociales comunitarios. Resultados: las entrevistas realizadas a veinticinco trabajadores sociales de la provincia de Málaga muestran cuatro repertorios interpretativos que reflejan la construcción del sistema de servicios sociales por parte de los profesionales implicados: el olvido de lo comunitario, la eterna indefinición del sistema, el elefante encadenado y la escasez agudiza el ingenio. Discusión: se pone de manifiesto cómo se construye un modelo de intervención distante a lo establecido en las normas y códigos éticos a causa de los comportamientos organizacionales e institucionales, que los profesionales intentan minimizar mediante la puesta en práctica de habilidades personales.

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

Background: The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods: The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.

Self-rated health and hospital services use in the Spanish National Health System: a longitudinal study

Background: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results: By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

System for robot control inspired by the functionality and organisation of the human nervous system

This paper presents a model of a control system for robot systems inspired by the functionality and organisation of human neuroregulatory system. Our model was specified using software agents within a formal framework and implemented through Web Services. This approach allows the implementation of the control logic of a robot system with relative ease, in an incremental way, using the addition of new control centres to the system as its behaviour is observed or needs to be detailed with greater precision, without the need to modify existing functionality. The tests performed verify that the proposed model has the general characteristics of biological systems together with the desirable features of software, such as robustness, flexibility, reuse and decoupling.

Multi-agent system for control of robots inspired on the distributed activity and hormonal regulation of humans

Robotics is an emerging field with great activity. Robotics is a field that presents several problems because it depends on a large number of disciplines, technologies, devices and tasks. Its expansion from perfectly controlled industrial environments toward open and dynamic environment presents a many new challenges. New uses are, for example, household robots or professional robots. To facilitate the low cost, rapid development of robotic systems, reusability of code, its medium and long term maintainability and robustness are required novel approaches to provide generic models and software systems who develop paradigms capable of solving these problems. For this purpose, in this paper we propose a model based on multi-agent systems inspired by the human nervous system able to transfer the control characteristics of the biological system and able to take advantage of the best properties of distributed software systems. Specifically, we model the decentralized activity and hormonal variation.

Data normalization and integration in robotic systems using web services technologies

The robotics is one of the most active areas. We also need to join a large number of disciplines to create robots. With these premises, one problem is the management of information from multiple heterogeneous sources. Each component, hardware or software, produces data with different nature: temporal frequencies, processing needs, size, type, etc. Nowadays, technologies and software engineering paradigms such as service-oriented architectures are applied to solve this problem in other areas. This paper proposes the use of these technologies to implement a robotic control system based on services. This type of system will allow integration and collaborative work of different elements that make up a robotic system.

A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

Background: Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods: A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results: We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions: Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Will austerity cuts dismantle the Spanish healthcare system?

In the face of austerity, a series of disconnected “reforms” could, without corrective measures, lead to the effective dismantling of large parts of the Spanish healthcare system, with potentially detrimental effects on health. Helena Legido-Quigley and colleagues explain.

Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis

Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.