Integrated care approaches and skills mix policies in Europe

ABSTRACT - Background: Integration of health care services is emerging as a central challenge of health care delivery, particularly for patients with elderly and complex chronic conditions. In 2003, the World Health Organization (WHO) already began to identify it as one of the key pathways to improve primary care. In 2005, the European Commission declared integrated care as vital for the sustainability of social protection systems in Europe. Nowadays, it is recognized as a core component of health and social care reforms across European countries. Implementing integrated care requires coordination between settings, organizations, providers and professionals. In order to address the challenge of integration in such complex scenario, an effective workforce is required capable of working across interdependent settings. The World Health Report 2006 noted that governments should prepare their workforce and explore what tasks the different levels of health workers are trained to do and are capable of performing (skills mix). Comparatively to other European countries, Portugal is at an early stage in what integrated care is concerned facing a growing elderly population and the subsequent increase in the pressure on institutions and professionals to provide social and medical care in the most cost-effective way. In 2006 the Portuguese government created the Portuguese Network for Integrated Care Development (PNICD) to solve the existing long-term gap in social support and healthcare. On what concerns health workforce, the Portuguese government already recognized the importance of redefine careers keeping professional motivation and satisfaction. Aim of the study: This study aims to contribute new evidence to the debate surrounding integrated care and skills mix policies in Europe. It also seeks to provide the first evidence that incorporates both the current dynamics of implementing integrated care in Portugal and the developments of international literature. The first ambition of our study is to contribute to the growing interest in integrated care and to the ongoing research in this area by identifying its different approaches and retrieve a number of experiences in some European countries. Our second goal of this research is to produce an update on the knowledge developed on skills mix to the international healthcare management community and to policy makers involved in reforming healthcare systems and organizations. To better inform Portuguese health policies makers in a third stage we explore the current dynamics of implementing integrated care in Portugal and contextualize them with the developments reported in the international literature. Methodology: This is essentially an exploratory and descriptive study using qualitative methodology. In order to identify integrated care approaches in Europe, a systematic literature review was undertaken which resulted in a paper published in the Journal of Management and Marketing in Health care titled: Approaches to developing integrated care in Europe: a systematic literature review. This article was recommended and included into a list of references identified by The King's Fund Library. A second systematic literature review was undertaken which resulted in a paper published in the International Journal of Healthcare Management titled: Skills mix in healthcare: An international update for the management debate. Semi-structured interviews were performed on experts representing the regional coordination teams of the Portuguese Network for Integrated Care Development. In a last stage a questionnaire survey was developed based on the findings of both systematic literature reviews and semi-structured interviews. Conclusions: Even though integrated care is a worldwide trend in health care reforms, there is no unique definition. Definitions can be grouped according to their sectorial focus: community-based care, combined health and social care, combined acute and primary care, the integration of providers, and in a more comprehensive approach the whole health system. Indeed, models that seek to apply the principles of integrated care have a similar background and are continually evolving and depend on the different initiatives taken at national level. . Despite the fact that we cannot argue that there is one single set typology of models for integrated care, it is possible to identify and categorize some of the basic approaches that have been taken in attempts to implement integrated care according to: changes in organizational structure, workforce reconfiguring, and changes in the financing system. The systematic literature review on skills mix showed that despite the widely acknowledged interest on skills mix initiatives there is a lack of evidence on skills mix implications, constraints, outcomes, and quality impact that would allow policy makers to take sustained and evidence-based decisions. Within the Portuguese health system, the integrated care approach is rather organizational and financial, whereas little attention is given to workforce integration. On what concerns workforce planning Portugal it is still in the stage of analyzing the acceptability of health workforce skills mix. In line with the international approaches, integration of health and social services and bridging primary and acute care are the main goals of the national government strategy. The findings from our interviews clarify perceptions which show no discrepancy with the related literature but are rather scarce comparing to international experience. Informants hold a realistic but narrow view of integrated care related issues. They seem to be limited to the regional context, requiring a more comprehensive perspective. The questionnaire developed in this thesis is an instrument which, when applied, will allow policy makers to understand the basic set of concepts and managerial motivations behind national and regional integrated care programs. The instrument developed can foster evidence on the three essential components of integrated care policies: organizational, financial, and human resources development, and can give additional input on the context in which integrated care is being developed, the type of providers and organizations involved, barriers and constraints, and the workforce skills mix planning related strategies. The thesis was successful in recognizing differences between countries and interventions and the instrument developed will allow a better comprehension of the international options available and how to address the vital components of integrated care programs.

What is the european social model? an aproximation based on Spanish case

The public perception of the EU in Spain varies greatly. The most positive aspects of Spanish membership are associated with the consolidation of democracy, economic growth, the introduction of the euro, the growth in employment and structural and cohesion funds, the increase in the female participation rate, and the equal opportunities policies. The analysts are in favour of common objectives in the employment policy and multi-level government. The less positive aspects of the EU are the risks of losing social protection and loss of employment in some sectors due to mergers of multinationals and delocalization of companies towards Eastern Europe. The continuous demands for reform of the welfare state, the toughening of the conditions of access to social benefit and the reform of the labour market are also seen as problematic issues. Risks of competitive cuts and social dumping.

State-Society Relationships, Social Trust and the Development of Labour Market Policies in Italy and Sweden

The first decade of the twenty-first century may be remembered for the rebirth of consensus on labour market policy. After three decades of bitter political and ideological controversy between a neo-liberal and a traditional social democratic approach, a new model, often labelled flexicurity, has emerged. This model is promoted by numerous political organisations since it promises to put an end to the old trade-off between equality and efficiency. Several countries are embracing the flexicurity model as a blueprint for labour market reform, but others, mostly belonging to the 'Mediterranean Rim', are clearly lagging behind. Why is it so difficult for these countries to implement the flexicurity model? This paper argues that the application of a flexicurity strategy in these countries is complicated by the lack of social trust between social partners and the state as well as political economy traditions that highlight the role of labour market regulation as a source of social protection.

Monnaie, citoyenneté et globalisation financière. Les citoyens entre protection sociale et promesses de la capitalisation boursière

La monnaie a été étudiée par des économistes hétérodoxes, des sociologues et des historiens qui ont souligné ses rapports à l'ordre collectif, mais elle n'est que rarement analysée sous l'angle de la citoyenneté. Notre thèse propose une réflexion théorique sur quatre types de fonctions (politique, symbolique, socioéconomique et psychoaffective) qui permettent à la monnaie de jouer un rôle de médiation de la citoyenneté. A partir d'une perspective qui combine les apports de l'économie politique internationale et de l'école de la régulation, nous montrons que cette médiation ne mobilise pas seulement des mécanismes sociopolitiques nationaux, mais aussi des mécanismes internationaux qui rétroagissent sur la sphère domestique des États et affectent leur capacité à définir leur régime de citoyenneté. Cette relation est analysée dans le contexte de l'institutionnalisation du système monétaire international de Bretton Woods (1944) et du développement de la globalisation financière depuis les années 1970. Si la monnaie a été mise au service d'un principe de protection des droits sociaux des citoyens contre les pressions financières extérieures après la Seconde guerre mondiale, elle contribue aujourd'hui à l'ouverture de la sphère domestique des Etats aux flux de capitaux transnationaux et à la création d'un ordre politique et juridique favorable aux droits des investisseurs. Cette dynamique est impulsée par l'essor de nouveaux intermédiaires financiers (notamment les agences de notation et les investisseurs institutionnels) et l'émergence concomitante d'une nouvelle forme d'Etat légitimée à partir d'un discours politique néolibéral insistant sur la quête de compétitivité, la réduction de la protection sociale et la responsabilisation individuelle. Elle se traduit par la privatisation des régimes de retraite et le développement des politiques d'éducation financière qui incitent les citoyens à se comporter en « preneurs de risques » actifs et responsables, assurant eux-mêmes leur sécurité économique à travers le placement de leur épargne retraite sur les marchés financiers. Nous soulignons toutefois les difficultés institutionnelles, cognitives et socioéconomiques qui rendent cette transformation de la citoyenneté contradictoire et problématique. Money has been studied by heterodox economists, sociologists and historians who stressed its relationship to collective order. However, it has hardly been analysed from the viewpoint of its relationship to citizenship. We propose a theoretical account of four types of functions (political, symbolic, socioeconomic and psychoaffective) enabling money to operate as a mediation of citizenship. From a perspective that combines the contributions of international political economy and the regulation school, we show that this mediation mobilises not only national sociopolitical mechanisms, but also international mechanisms which feed back on the domestic sphere of states and affect their capacity to define their regime of citizenship. This relationship is analysed in the context of the institutionalisation of the international monetary system of Bretton Woods (1944) and the development of financial globalization since the 1970s. If money has served to protect the social rights of citizens against external financial pressures after the Second World War, today it contributes to the opening of the domestic sphere of states to transnational capital flows and to the creation of a political and legal order favorable to the rights of investors. This dynamic is driven by the rise of new financial intermediaries (in particular rating agencies and institutional investisors) and the simultaneous emergence of a new form of state legitimized from a neoliberal political discourse emphasizing the quest for competitiveness, reduced social protection and individual responsibilization. It results in the privatization of pension systems and the development of policies of financial education that encourage citizens to behave as active and responsible « risk takers », ensuring their own economic security through the investment of their savings retirement on financial markets. However, we emphasize the institutional, cognitive and socioeconomic difficulties that make this transformation of citizenship contradictory and problematic. - Money has been studied by heterodox economists, sociologists and historians who stressed its relationship to collective order. However, it has hardly been analysed from the viewpoint of its relationship to citizenship. We propose a theoretical account of four types of functions (political, symbolic, socioeconomic and psychoaffective) enabling money to operate as a mediation of citizenship. From a perspective that combines the contributions of international political economy and the regulation school, we show that this mediation mobilises not only national sociopolitical mechanisms, but also international mechanisms which feed back on the domestic sphere of states and affect their capacity to define their regime of citizenship. This relationship is analysed in the context of the institutionalisation of the international monetary system of Bretton Woods (1944) and the development of financial globalization since the 1970s. If money has served to protect the social rights of citizens against external financial pressures after the Second World War, today it contributes to the opening of the domestic sphere of states to transnational capital flows and to the creation of a political and legal order favorable to the rights of investors. This dynamic is driven by the rise of new financial intermediaries (in particular rating agencies and institutional investisors) and the simultaneous emergence of a new form of state legitimized from a neoliberal political discourse emphasizing the quest for competitiveness, reduced social protection and individual responsibilization. It results in the privatization of pension systems and the development of policies of financial education that encourage citizens to behave as active and responsible « risk takers », ensuring their own economic security through the investment of their savings retirement on financial markets. However, we emphasize the institutional, cognitive and socioeconomic difficulties that make this transformation of citizenship problematic.

La renda mínima d'inserció: una eina útil d’inserció social en el món local

La crisi actual ha agreujat la situació socioeconòmica de nombroses persones i famílies , esdevenint una realitat social cada vegada més complexa . Aquest nou context, ha portat a que aquesta nova bossa de persones hagin de recórrer a demanar suport als serveis socials bàsics. Persones que fins aquest moment havien estat en una situació normalitzada i en aquests moments estan en el llindar de l’exclusió social. El treball Sorgeix de la necessitat del món local, concretament de l’Àrea Bàsica de Serveis Socials del Consell Comarcal de l’Alt Penedès, de disposar d’eines d’inserció social per a les persones perceptores de la renda mínima d’inserció de la comarca, que formen part d’aquest col·lectiu en risc d’exclusió. Planteja la importància que des del món local es creïn aliances amb entitats , associacions diverses i de diferents àmbits , per tal d’adequar les respostes i les mesures d’inserció social segons la realitat de cada persona i família a través de diferents tasques col·laboratives, dins la seva comunitat, el seu entorn més immediat. Presenta la renda mínima com una via útil i necessària per lluitar contra la pobresa i a favor de la inclusió social

A proteção social entre a luz e a sombra

The social protection between the light and the shadow. This article tries to reveal some subject formation traces facing itself and the society that it is inserted to discuss the Social Protection importance in Knowledge Economy as the Human potentialities expansion factor. The assumption is the connection between the individual and the world happens in a dynamic relation where the individual shapes the society and the society is shaped by the individual. So Fromm's Social Psychology (1941) is used to clarify the appearing of the fears and humans passions and Gorz's No material concept (2003).

Idées, institutions et intérêts dans le changement de la protection sociale : les politiques de transfert de revenu au Brésil

Cette thèse porte sur l’introduction des politiques de transfert de revenu au Brésil. L’objectif central de la recherche est de comprendre comment ces politiques se sont imposées dans le cadre des réformes de la protection sociale brésilienne pendant les années 1990, notamment à partir de 1995 et comment elles ont engendré un changement paradigmatique de troisième ordre de la politique nationale d’assistance sociale. Nous posons deux hypothèses de recherche : la première est que l’introduction de telles politiques au Brésil fut le résultat du rôle historique des intellectuels engagés dans la défense du revenu minimum en tant qu’alternative au modèle de protection sociale brésilien. Cette défense du revenu minimum fut soutenue par des intellectuels, des communautés épistémiques et par des politiciens qui ont inscrit le débat sur le revenu minimum à l’agenda politique brésilien. La deuxième hypothèse suggère que la convergence d’idées, d’institutions et d’intérêts a favorisé l’adoption de ces politiques. Cette convergence d’idées, d’institutions et d’intérêts repose sur le rôle de plusieurs acteurs tels les intellectuels, le président Cardoso et d’autres politiciens qui se sont mis à la défense du social au Brésil depuis 1999, des institutions parlementaires brésiliennes et des organisations internationales, notamment le FMI, la Banque mondiale et la Banque interaméricaine de développement – BID. Nous proposons l’approche des trois i pour rendre compte de ce changement. L’apprentissage social, les processus de diffusion et de lesson-drawing sont les facteurs à l’origine de la formation de la convergence autour des programmes de transfert de revenu. Nous montrerons que l’expérience brésilienne de programmes de transfert de revenu a non seulement engendré un processus d’apprentissage social renversé auprès de la Banque Mondiale mais qu'elle a aussi eu un effet aussi sur les actions de la BID. Nous suggérons que le changement paradigmatique de la protection sociale brésilienne a été amorcé par le gouvernement Cardoso dans un processus d’essais et d’erreurs. Ce processus, qui est à l’origine des réaménagements du programme « Comunidade Solidária », a permis la création du « Projeto Alvorada » et du « Réseau de protection sociale » en 2001. Les programmes de transfert de revenu reliés à l’éducation et aux soins de santé ont été les plus influents dans la construction du consensus qui s’est établi autour des programmes de transfert de revenu comme alternative à l’ancien modèle de protection sociale puisqu’ils procurent le renforcement du capital social en même temps qu’ils fonctionnent comme facteur structurant de la protection sociale. Ce legs du gouvernement Cardoso a permis au gouvernement de Luis Inácio Lula da Silva de consolider le nouveau paradigme avec la création du programme national Bolsa-Família. Le gouvernement Lula a donc bénéficié de l’héritage historique des deux mandats de Cardoso et, ironiquement, a récolté les fruits de l’apprentissage social. Le phénomène du « lulismo » en est la preuve. Par ailleurs, cette thèse met en question la paternité du programme Bolsa-Família puisqu’elle montre la création de ce programme d'abord comme la consolidation du processus d’apprentissage et puis comme conséquence de la création d’un nouveau paradigme pour la politique d’assistance sociale au Brésil qui a eu lieu pendant les deux mandats de Cardoso.

Disability as a determinant of access to health care services in Colombia

The relationship between disability and poverty has been described in different contexts. Nevertheless, the basic characteristics of this relationship have not yet been fully established. The social exclusion and discrimination against people with disabilities increase the risk of poverty and reduce the access to basic opportunities such as health and education. This study examines the impact of a health limitation and poverty in the access to health care services in Colombia. Data from the Colombian National Health Survey (2007) was used in the analysis. Variables related with health condition and socio economic characteristics were first generated. Then interactions between health limitations and the lower levels of the asset index were created. This variable gave information related to the relationship between disability and poverty. A probabilistic model was estimated to examine the impact of a health condition and the relation between poverty and disability on the access to health care. The results suggest that living with a physical limitation increases by 10% the probability of access to health care services in Colombia. However, people with a disability and in the lowest quartile of the asset index have a 5% less probability of access to health care services. We conclude that people who live with a physical, mental or sensorial limitation have a higher probability of access to health care services. However, poor and disabled people have a lower probability in access, which increases the risk of having a severe disease and become chronically poor.

Análisis del Espacio Schengen en materia de seguridad como base para la implementación del Protocolo sobre la Facilitación del Movimiento de Personas de la Comunidad para el Desarrollo de África Austral (SADC)

El fin de la Guerra Fría supuso no sólo el triunfo del capitalismo y de la democracia liberal, sino un cambio significativo en el Sistema Internacional; siendo menos centralizado y más regionalizado, como consecuencia de la proximidad y relaciones de interdependencia entre sus actores (no sólo Estados) y permitiendo la formación de Complejos Regionales de Seguridad (CRS). Los CRS son una forma efectiva de relacionarse y aproximarse a la arena internacional pues a través de sus procesos de securitización y desecuritización consiguen lograr objetivos específicos. Partiendo de ello, tanto la Unión Europea (UE) como la Comunidad para el Desarrollo de África Austral (SADC) iniciaron varios procesos de securitización relacionados con la integración regional; siendo un ejemplo de ello la eliminación de los controles en sus fronteras interiores o libre circulación de personas; pues consideraron que de no hacerse realidad, ello generaría amenazas políticas (su influencia y capacidad de actuación estaban amenazadas), económicas (en cuanto a su competitividad y niveles básicos de bienestar) y societales (en cuanto a la identidad de la comunidad como indispensable para la integración) que pondrían en riesgo la existencia misma de sus CRS. En esta medida, la UE creó el Espacio Schengen, que fue producto de un proceso de securitización desde inicios de la década de los 80 hasta mediados de la década de los 90; y la SADC se encuentra inmersa en tal proceso de securitización desde 1992 hasta la actualidad y espera la ratificación del Protocolo para la Facilitación del Movimiento de personas como primer paso para lograr la eliminación de controles en sus fronteras interiores. Si bien tanto la UE como la SADC consideraron que de no permitir la libre circulación de personas, su integración y por lo tanto, sus CRS estaban en riesgo; la SADC no lo ha logrado. Ello hace indispensable hacer un análisis más profundo de sus procesos de securitización para así encontrar sus falencias con respecto al éxito de la UE. El análisis está basado en la Teoría de los Complejos de Seguridad de Barry Buzan, plasmada en la obra Security a New Framework for Analysis (1998) de Barry Buzan, Ole Waever y Jaap de Wilde y será dividido en cada una de las etapas del proceso de securitización: la identificación de una amenaza existencial a un objeto referente a través de un acto discursivo, la aceptación de una amenaza por parte de una audiencia relevante y las acciones de emergencia para hacer frente a las amenazas existenciales; reconociendo las diferencias y similitudes de un proceso de securitización exitoso frente a otro que aún no lo ha sido.

Una aproximación al financiamiento de un sistema de protección social en Colombia

El documento hace una revisión de las principales fuentes de protección social que hay en Colombia y las características de los sistemas de protección de otros países. Se encuentra que gran parte de lo que se conoce como gasto social se destina al tema pensional y que los resultados de los fondos de solidaridad son muy pequeños frente a la autoprotección de los hogares. Se propone tener en cuenta los esfuerzos individuales y privados que hay en Colombia al diseñar un sistema de protección social, pues de lo contrario se estarían desincentivando estos esfuerzos.

Inheritance, access to resources and poverty in Serer families in Senegal

This research explores the relationship between inheritance, access to resources and the intergenerational transmission of poverty among the Serer ethnic group in rural and urban environments in Senegal. In many Sub-Saharan African countries, customary law excludes women from owning and inheriting assets, such as land and property. Yet, assets controlled by women often result in increased investments in the next generation's health, nutrition and schooling and reduce the intergenerational transmission of poverty. Qualitative research with 60 participants in Senegal reveals the important role that land, housing and financial assets may play in building resilience to household shocks and interrupting the intergenerational transmission of poverty. However, the protection afforded by these assets was often dependent on other factors, including human, social and environmental capital. The death of a spouse or parent had major emotional and material impacts on many Serer families. The inheritance and control of assets and resources was strongly differentiated among family members along lines of gender, age and generation. Younger widows and their children were particularly vulnerable to chronic poverty. Although inheritance disputes were rare, the research suggests they are more likely between co-wives in polygamous unions and their children, particularly in urban areas. In addition to experiencing economic and health-related shocks, many interviewees were exposed to a range of climate-related risks and environmental pressures which increased their vulnerability. Family members coped with these shocks and risks by diversifying livelihoods, migrating to urban areas and other regions for work, participating in women's co-operatives and associations and developing supportive social networks with extended family and community members. Policies and practices that may help to alleviate poverty, safeguard women's and young people's inheritance and build resilience to financial, health-related and environmental shocks and risks include: - Social protection measures targeted towards poor widows and orphaned children, such as social and cash transfers to pay for basic needs including food, healthcare and children's schooling. - Micro-finance initiatives and credit and savings schemes, alongside training and capacity-building targeted to women and young people to develop income-generation activities and skills. - Free legal advice, support and advocacy for women and young people to pursue inheritance claims through the legal system. - Raising awareness about women's and children's legal rights and working with government and community and religious leaders to tackle discriminatory inheritance practices and contradictions caused by legal pluralism. - Increasing women's control of land and access to inputs, enhancing their business, organisational, and leadership skills and promoting civic participation in local, regional and national decision-making processes. - Improving access to basic services in rural areas, particularly healthcare, building the quality of education and promoting girls' access to education - Enhancing agricultural production and providing more employment opportunities, apprenticeships and vocational training for young people, particularly in rural areas.

Os serviços de acolhimento institucional para crianças e adolescentes: os desafios e o trabalho com a rede proteção social

O presente artigo tem como objetivo discutir como é realizado o trabalho dos serviços de acolhimento institucional, abordando o Estatuto da Criança e do Adolescente e as normativas estabelecidas para os abrigos - Plano Nacional de Convivência Familiar e Comunitária e as Orientações Técnicas para os serviços de acolhimento para Crianças e Adolescentes. Apresenta também os principais desafios enfrentados, como a adequação das práticas institucionais às legislações e parâmetros técnicos vigentes, a necessidade de empreender respostas institucionais que atendam as demandas dos acolhidos e o permanente trabalho articulado e intersetorial com a rede de proteção social. Apesar dos desafios, os abrigos tendem a caminhar em direção da nova ação pública, que supera as fronteiras da setorialização e permite aglutinar diversificados serviços, programas, atores e instituições.

Os efeitos macroeconômicos das transferências sociais: uma abordagem de matriz de contabilidade social

Government transfers to individuals and families play a central role in the Brazilian social protection system, accounting for almost 14 per cent of GDP in 2009. While their fiscal and redistributive impacts have been widely studied, the macroeconomic effects of transfers are harder to ascertain. We constructed a Social Accounting Matrix (SAM) for 2009 and estimated short-term multipliers for seven different government monetary transfers . The SAM is a double-entry square matrix depicting all income flows in the economy. The data were compiled from the 2009 Brazilian National Accounts and the 2008/2009 POF, a household budget survey. Our SAM was disaggregated into 56 sectors, 110 commodities, 200 household groups and seven factors of production (capital plus six types of labor, according to schooling). Finally, we ran a set of regressions to separate household consumption into ‘autonomous’ (or ‘exogenous’) and ‘endogenous’ components. More specifically, we are interested in the effects of an exogenous injection into each of the seven government transfers outlined above. All the other accounts are thus endogenous. The so-called demand ‘leaks’ are income flows from the endogenous to exogenous accounts. Leaks—such as savings, taxes and imports—are crucial to determine the multiplier effect of an exogenous injection, as they allow the system to go back to equilibrium. The model assumes that supply is perfectly elastic to demand shocks. It assumes that the families’ propensity to save and consumption profile are fixed—that is, rising incomes do not provoke changes in behaviour. The multiplier effects of the on GDP corresponds to the growth in GDP resulting from each additional dollar injected into each transfer seven government transfers. If the government increased Bolsa Família expenditures by 1 per cent of GDP, overall economic activity would grow by 1.78 per cent, the highest effect. The Continuous Cash Benefit, comes second. Only three transfers— the private-sector and public servants’ pensions and FGTS withdrawals—had multipliers lower than unity. The multipliers for other relevant macroeconomic aggregates—household and total consumption, disposable income etc. —reveal a similar pattern. Thus, under the stringent assumptions of our model, we cannot reject the hypothesis that government transfers targeting poor households, such as the Bolsa Família, help foster economic expansion. Naturally, it should be stressed that the multipliers relate marginal injections into government transfers to short-term economic performance either real growth, or inflation if there is no idle capacity which is also useful to analyze. In the long term, there is no doubt that what truly matters is the growth of the country’s productive capacity.

Microinsurance: income risk, social security and the demand for private onsurance by low-income families

Insurance provision against uncertainties is present in several dimensions of peoples´s lives, such as the provisions related to, inter alia, unemployment, diseases, accidents, robbery and death. Microinsurance improves the ability of low-income individuals to cope with these risks. Brazil has a fairly developed financial system but still not geared towards the poor, especially in what concerns the insurance industry. The evaluation of the microinsurance effects on well-being, and the demand for different types of microinsurance require an analysis of the dynamics of the individual income process and an assessment of substitutes and complementary institutions that condition their respective financial behavior. The evaluation of the microinsurance effects on well-being, and the demand for different types of microinsurance require an analysis of the dynamics of the individual income process and an assessment of substitutes and complementary institutions that condition their respective financial behavior. The Brazilian government provides a relatively developed social security system considering other countries of similar income level which crowds-out the demand for insurance and savings. On the other hand, this same public infrastructure may help to foster microfinance products supply. The objective of this paper is to analyze the demand for different types of private insurance by the low-income population using microdata from a National Expenditure Survey (POF/IBGE). The final objective is to help to understand the trade-offs faced for the development of an emerging industry of microinsurance in Brazil.

O psicólogo na proteção social especial: atuação junto às vítimas de violação de direitos no CREAS

The objective of this research was to investigate psychologist‟s practices at the Reference Specialized Center of Social Assistance (CREAS), special social care unit of medium complexity of the Unique System of Social Assistance (SUAS). With the creation of CREAS occurred the reorganization of specialized services and programs which were scattered within the socialassitantial network and began to be part of this center, creating a mosaic of actions directed to people with their rights violated. At the same time, there was a significant arrival of psychologists to the field of Social Assistance and their questioning facing specialized social demands and the (un)definitions of SUAS‟ policy concerning to special social protection. Was aimed in this research to investigate how psychologist‟s practices are developed at CREAS using semi-structured interviews and following the practices developed by three psychologists at a CREAS in the state of Rio Grande do Norte (RN), indicated by the Ministry of Social Development and Fight against Hunger (MDS) as one of the national references in 2008. It was highlighted a complex work field, which is delineated between the user´s rights perspective and the maintenance of historical difficulties concerning to the Social Assistance. In which the professional is requested to act toward the fight against rights violation, but does not find a field where is possible inter-sector and articulated work, in addition of being exposed to the precariousness of work and the weakness of employment ties, associated to the lack of formation to work in the area. Accordingly, there is still a range of challenges to psychologists in the building of a profession which confront risk situations and break off rights violation.