Mental health research in Brazil: policies, infrastructure, financing and human resources

The objective of this descriptive study was to map mental health research in Brazil, providing an overview of infrastructure, financing and policies mental health research. As part of the Atlas-Research Project, a WHO initiative to map mental health research in selected low and middle-income countries, this study was carried out between 1998 and 2002. Data collection strategies included evaluation of governmental documents and sites and questionnaires sent to key professionals for providing information about the Brazilian mental health research infrastructure. In the year 2002, the total budget for Health Research was US$101 million, of which US$3.4 million (3.4) was available for Mental Health Research. The main funding sources for mental health research were found to be the São Paulo State Funding Agency (Fapesp, 53.2%) and the Ministry of Education (CAPES, 30.2%). The rate of doctors is 1.7 per 1,000 inhabitants, and the rate of psychiatrists is 2.7 per 100,000 inhabitants estimated 2000 census. In 2002, there were 53 postgraduate courses directed to mental health training in Brazil (43 in psychology, six in psychiatry, three in psychobiology and one in psychiatric nursing), with 1,775 students being trained in Brazil and 67 overseas. There were nine programs including psychiatry, neuropsychiatry, psychobiology and mental health, seven of them implemented in Southern states. During the five-year period, 186 students got a doctoral degree (37 per year) and 637 articles were published in Institute for Scientic Information (ISI)-indexed journals. The investment channeled towards postgraduate and human resource education programs, by means of grants and other forms of research support, has secured the country a modest but continuous insertion in the international knowledge production in the mental health area.

The use of innovative financial instruments for financing EU policies and objectives: Implications for EU and national budgets. CEPS Special Report, October 2012

This CEPS Special Report analyses the proposed expansion of innovative financial instruments in the EU Multiannual Financial Framework for the 2014–20 period. It presents the economic rationale, governance principles and criteria that these instruments should follow and compares these with proposals from the European Commission. Based on this assessment, it makes recommendations for the proposed instruments.

Assessment of policies for innovative financing in infrastructure systems

Infrastructure systems are drivers of the economy in the nation. A dollar spent on infrastructure development yields roughly double the initial spending in ultimate economic output in the short term; and over a twenty-year period, and generalized ‘public investment’ produces an aggregated $3.21 of economic activity per $1.00 spent [1]. Thus, formulation of policies pertaining to infrastructure investment and development is of significance affecting the social and economic wellbeing of the nation. The aim of this policy brief is to evaluate innovative financing in infrastructure systems from two different perspectives: (1) through consideration of the current condition of infrastructure in the U.S., the current trends in public spending, and the emerging innovative financing tools; (2) through evaluation of the roles and interactions of different agencies in the creation and the diffusion of innovative financing tools. Then using the example of transportation financing, the policy brief provides an assessment of policy landscapes which could lead to the closure of infrastructure financing gap in the U.S and proposes strategies for citizen involvement to gain public support of innovative financing.

O setor privado sem fins lucrativos e as políticas públicas de esporte e lazer (2008-2011) = : The non-profitable private sector and the public policies for sport and leisure (2008-2011)

Universidade Estadual de Campinas . Faculdade de Educação Física

Monetary and fiscal policies interactions in a monetary union with country-size asymmetry

Within a country-size asymmetric monetary union, idiosyncratic shocks and national fiscal stabilization policies cause asymmetric cross-border effects. These effects are a source of strategic interactions between noncoordinated fiscal and monetary policies: on the one hand, due to larger externalities imposed on the union, large countries face less incentives to develop free-riding fiscal policies; on the other hand, a larger strategic position vis-à-vis the central bank incentives the use of fiscal policy to, deliberately, influence monetary policy. Additionally, the existence of non-distortionary government financing may also shape policy interactions. As a result, optimal policy regimes may diverge not only across the union members, but also between the latter and the monetary union. In a two-country micro-founded New-Keynesian model for a monetary union, we consider two fiscal policy scenarios: (i) lump-sum taxes are raised to fully finance the government budget and (ii) lump-sum taxes do not ensure balanced budgets in each period; therefore, fiscal and monetary policies are expected to impinge on debt sustainability. For several degrees of country-size asymmetry, we compute optimal discretionary and dynamic non-cooperative policy games and compare their stabilization performance using a union-wide welfare measure. We also assess whether these outcomes could be improved, for the monetary union, through institutional policy arrangements. We find that, in the presence of government indebtedness, monetary policy optimally deviates from macroeconomic to debt stabilization. We also find that policy cooperation is always welfare increasing for the monetary union as a whole; however, indebted large countries may strongly oppose to this arrangement in favour of fiscal leadership. In this case, delegation of monetary policy to a conservative central bank proves to be fruitful to improve the union’s welfare.

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.

Are tax subsidies for private medical insurance self-financing? Evidence from a microsimulation model for outpatient and inpatient episodes

This paper analyses whether or not tax subsidies to private medicalinsurance are self-financing by means of a structural approach. Weconstruct a simulation routine based on a microeconometric discretechoice model that allows us to evaluate the impact of premium changeson the utilisation of outpatient and inpatient health care services. Wesimulate the 1999 Spanish tax reform that abolished the tax deductionfor expenditures on private health insurance using a representativesample of the Catalan population. Prior to this reform, foregone taxrevenue arising from deductions after the purchase of private insuranceamounted to 69.2 M. per year. In contrast, the elimination of thesubsidies to private policies is estimated to generate an extra costfor the public sector of about 8.9 M. per year.

Role of Commission Agents in the Development of Traditional Marine Fisheries of Kerala with Special Reference to Financing

The study clearly brings out the role of commission agents in the traditional marine fisheries sector and thereby goes to set at rest the controversy regarding their role. The findings of the study has important implications for formulation of policies and development strategies related to the traditional marine fisheries sector. The study points out the need for a thorough review and reformulation of the policies and development strategies for efficiently achieving the development potential of the traditional marine fisheries sector and for improving the economic conditions of the fishermen. The study is based mostly on Alappuzha District of Kerala, covering all the 30 marine fishing villages, spread over the three coastal taluks, namely, Karthikappally, Ambalappuzha and Cherthala

Inflationary financing of public investment and economic growth

a theoretical model is constructed in order to explain particular historical experiences in which inflation acceleration apparently helped to spur a period of economic growth. Government financed expenditures affect positively the productivity growth in this model so that the distortionary effect of inflation tax is compensated by the productive effect of public expenditures. We show that for some interval of money creation rates there is an equilibrium where money is valued and where steady state physical capital grows with inflation. It is also shown that zero inflation and growth maximization are never the optimal policies.

Fostering innovation and entrepreneurship in Brazil through private equity and venture capital public policies

It is well documented the positive impact of the Private Equity and Venture Capital (PE/VC) industry on the creation and development of highly successful innovative companies in a few countries, mainly in the United States. PE/VC firms provide not only capital to startups and small and medium enterprises (SMEs) that usually have financing gap, especially in emerging markets, but also strategic resources that enable these enterprises to commercialize innovation. As consequence, government incentive and nurture of local PE/VC industries would be expected in emerging economies due to innovation‟s importance to economic growth. This paper aims to identify if the Brazilian government has supported local PE/VC industry throughout the years in order to foster favorable conditions to creating and developing successful innovative businesses. It also analyzes Brazil‟s main public policies towards PE/VC and if they encompass all the three stages of its cycle – fundraising, investing and exiting. I conducted an empirical research which collected primary data from a sample of 127 PE/VC firms (90% of the population) operating in Brazil as of June, 2008. All firms answered a webbased questionnaire that collected quantitative data regarding their investment vehicles, portfolio companies, investments and exits. I compared the data obtained from the survey with the main local governmental PE/VC support programs. First, I confirmed the hypothesis that the Brazilian government has been using the PE/VC industry as a public policy towards entrepreneurship and innovation. Second, I identified that although PE/VC public policies in Brazil are mostly concentrated in fundraising phase, they have been able to positively impact the whole cycle. Third, it became clear that the Brazilian government became more concerned about Seed and Venture Capital (VC) Early stages due to their importance to the entire PE/VC value chain. As consequence, I conclude that those public policies have been very important to build a dynamic and strong local PE/VC industry, whose committed capital grew 50% per year between 2005 and 2008 to achieve US$27 billion, which invested US$ 11 billion, which employs 1,400 professionals (75% with postgraduate degrees) and maintains 482 portfolio companies, mostly SMEs. In addition, PE/VCbacked companies represented one third of the Initial Public Offerings (IPOs) that occurred in Brazil between 2004 and 2008 (approximately US$15 billion).

Economic Survey of Latin America and the Caribbean 2009-2010: The distributive impact of public policies

Includes bibliography

Financing for sustainable development: visions and proposals for action from a Latin American and Caribbean perspective

Foreword Throughout the preparatory process for the World Summit on Sustainable Development and at the Summit itself, which was held in Johannesburg, South Africa, from 26 August to 4 September 2002, discussions were dominated by one central concern: the need to define and reach consensus on concrete, quantitative goals, with fixed deadlines for implementation, which were to supplement the Millennium Development Goals and facilitate progress towards an effective transition to sustainable development. Participants at the Summit explicitly affirmed the need, as a matter of urgency, to identify the financial and technical resources whereby sustainable development would become a reality and benefit directly and particularly rural and urban communities in the developing countries. The document we are now presenting is the outcome of extensive discussions held at a high-level forum during the Johannesburg Summit. Led by representatives of the Government of Mexico, the Economic Commission for Latin America and the Caribbean (ECLAC), the United Nations Development Programme (UNDP) and the Andean Development Corporation, those discussions were based on the ECLAC/UNDP study entitled Financing for sustainable development in Latin America and the Caribbean: from Monterrey to Johannesburg, which considers the opportunities and challenges for improving prospects for investment and financing for sustainable development and underscores the need to establish a new balance between the market economy and public interest through joint public/private initiatives that combine market innovation, social responsibility and appropriate regulations. Other eminent persons attending the event included heads of State, such as Gustavo Noboa, then President of Ecuador; Enrique V. Iglesias, President of the Inter-American Development Bank (IDB); José María Figueres, Managing Director of the Global Agenda of the World Economic Forum and former President of Costa Rica; and Gro Harlem Brundtland, the legendary figure who pioneered sustainable development. Valuable contributions to the discussions were made by Yolanda Kakabadse, President of the World Conservation Union; Xóchitl Gálvez Ruiz, head of the Unit for the Development of Indigenous Peoples of the Office of the President of Mexico; Cecilia López, former Minister for the Environment of Colombia; and Juan Carlos Maqueda, then Vice President of Argentina. The views emerging from the forum as set forth in this document are designed to facilitate and promote application of the Plan of Implementation of the World Summit on Sustainable Development within the framework of the Millennium Development Goals and the commitments assumed at the International Conference on Financing for Development, which was held in Monterrey, Mexico. We also aspire to continue moving forward with the adoption of measures and policies to increase investment and financing for sustainable development as well as to foster partnerships between the public and private sectors and nongovernmental organizations. We recognize, in this context, the importance of strengthening and improving public and private institutions in order to meet the operational needs associated with the effort to achieve the Millennium Development Goals and pursue the Plan of Implementation formulated in Johannesburg. We trust that this document will contribute to in-depth discussions on the application of the Plan of Implementation in the relevant forums, in particular the United Nations Commission on Sustainable Development. The Plan of Implementation of the World Summit on Sustainable Development opens up new opportunities for Latin America and the Caribbean to renew and revive their own regional agenda -with emphasis on global and especially regional public goods- and to interweave it more cohesively with the global agenda in order to promote the common interests of Latin America and the Caribbean more forcefully in international development forums. The regional agenda and the global agenda cannot be separated in a contrived manner; indeed, to an increasing degree, what we are witnessing are global environmental processes which call for action at the local level. The achievement of sustainable development in Latin America and the Caribbean, where the necessary economic, social, environmental and geopolitical conditions are combined, requires a subtle balance between the market economy, the State and the citizen. Such a balance will result in the consolidation of democratic governance in the service of human development. VICENTE FOX President of Mexico JOSÉ ANTONIO OCAMPO Executive Secretary, Economic Commission for Latin America and the Caribbean (ECLAC) ELENA MARTÍNEZ Assistant Aministrator and Regional Director for Latin America and the Caribbean of the United Nations Development Programme (UNDP) ENRIQUE GARCÍA Executive President, Andean Development Corporation (ADC)""

Latin America and the Caribbean: policies to improve linkages with the global economy

Includes bibliography