Drug prescribing patterns in the General Medical Services Scheme in Ireland and projected costs to 2026

The primary objective is to investigate the main factors contributing to GMS expenditure on pharmaceutical prescribing and projecting this expenditure to 2026. This study is located in the area of pharmacoeconomic cost containment and projections literature. The thesis has five main aims: 1. To determine the main factors contributing to GMS expenditure on pharmaceutical prescribing. 2. To develop a model to project GMS prescribing expenditure in five year intervals to 2026, using 2006 Central Statistics Office (CSO) Census data and 2007 Health Service Executive{Primary Care Reimbursement Service (HSE{PCRS) sample data. 3. To develop a model to project GMS prescribing expenditure in five year intervals to 2026, using 2012 HSE{PCRS population data, incorporating cost containment measures, and 2011 CSO Census data. 4. To investigate the impact of demographic factors and the pharmacology of drugs (Anatomical Therapeutic Chemical (ATC)) on GMS expenditure. 5. To explore the consequences of GMS policy changes on prescribing expenditure and behaviour between 2008 and 2014. The thesis is centered around three published articles and is located between the end of a booming Irish economy in 2007, a recession from 2008{2013, to the beginning of a recovery in 2014. The literature identified a number of factors influencing pharmaceutical expenditure, including population growth, population aging, changes in drug utilisation and drug therapies, age, gender and location. The literature identified the methods previously used in predictive modelling and consequently, the Monte Carlo Simulation (MCS) model was used to simulate projected expenditures to 2026. Also, the literature guided the use of Ordinary Least Squares (OLS) regression in determining demographic and pharmacology factors influencing prescribing expenditure. The study commences against a backdrop of growing GMS prescribing costs, which has risen from e250 million in 1998 to over e1 billion by 2007. Using a sample 2007 HSE{PCRS prescribing data (n=192,000) and CSO population data from 2008, (Conway et al., 2014) estimated GMS prescribing expenditure could rise to e2 billion by2026. The cogency of these findings was impacted by the global economic crisis of 2008, which resulted in a sharp contraction in the Irish economy, mounting fiscal deficits resulting in Ireland's entry to a bailout programme. The sustainability of funding community drug schemes, such as the GMS, came under the spotlight of the EU, IMF, ECB (Trioka), who set stringent targets for reducing drug costs, as conditions of the bailout programme. Cost containment measures included: the introduction of income eligibility limits for GP visit cards and medical cards for those aged 70 and over, introduction of co{payments for prescription items, reductions in wholesale mark{up and pharmacy dispensing fees. Projections for GMS expenditure were reevaluated using 2012 HSE{PCRS prescribing population data and CSO population data based on Census 2011. Taking into account both cost containment measures and revised population predictions, GMS expenditure is estimated to increase by 64%, from e1.1 billion in 2016 to e1.8 billion by 2026, (ConwayLenihan and Woods, 2015). In the final paper, a cross{sectional study was carried out on HSE{PCRS population prescribing database (n=1.63 million claimants) to investigate the impact of demographic factors, and the pharmacology of the drugs, on GMS prescribing expenditure. Those aged over 75 (ẞ = 1:195) and cardiovascular prescribing (ẞ = 1:193) were the greatest contributors to annual GMS prescribing costs. Respiratory drugs (Montelukast) recorded the highest proportion and expenditure for GMS claimants under the age of 15. Drugs prescribed for the nervous system (Escitalopram, Olanzapine and Pregabalin) were highest for those between 16 and 64 years with cardiovascular drugs (Statins) were highest for those aged over 65. Females are more expensive than males and are prescribed more items across the four ATC groups, except among children under 11, (ConwayLenihan et al., 2016). This research indicates that growth in the proportion of the elderly claimants and associated levels of cardiovascular prescribing, particularly for statins, will present difficulties for Ireland in terms of cost containment. Whilst policies aimed at cost containment (co{payment charges, generic substitution, reference pricing, adjustments to GMS eligibility) can be used to curtail expenditure, health promotional programs and educational interventions should be given equal emphasis. Also policies intended to affect physicians prescribing behaviour include guidelines, information (about price and less expensive alternatives) and feedback, and the use of budgetary restrictions could yield savings.

Green Economy and Employment: employment potential of the ecological transition in Spain

The Green Economy offers real possibilities for productive innovation, economic growth and employment creation in Spain. These three factors are critical to facilitate the necessary change in the productive model to overcome the crisis. However, the measures taken by the current Conservative government have moved in the opposite direction: significant cutting in incentives for renewable, increasing tax burden on renewable energy production to self-consumption and privatizing public spaces of social and environmental interest. This hinders the achievement of the environmental objectives of the Europe 2020 strategy. A strategy that is born already in itself highly limited, unambitious and subordinated to the interests of energy oligopolies and the imperatives of the Stability and Growth Pact (Maastricht) and the Austerity policies imposed from EU institutions to overcome the 2008 financial crisis. So the Ecological Transition goes further, claiming a substantially change in Economic Policy away form the increasing commodification proposed by the Green Economy. Despite these limitations, young and unemployed people have much to gain from a comprehensive development of environmental industries. Therefore, innovative-sustainable plans, investment and training in green sectors are necessary to make easier the transition from a services low-valued economy to an innovative and sustainable model to make our country an environmental reference in Europe.

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.

Return Migration in the Ecuadorian and Bolivian population: motivations, strategies and discourses

This article analyses the motivations for return migration among the Ecuadorians and Bolivians who, after living in Spain, returned to their countries of origin during the economic crisis that started in 2008. From the analysis of 22 interviews in-depth which took place in Ecuador and 38 in Bolivia to women, men and young people from migrant families, this decision-making process is shown to be embedded into a gendered dynamics of relationships. Particular detail is given to affective and economic elements that had an influence on the decision to return, as well as to the strategies deployed to project their readjustment back in origin. Males and females occupy differential positions within the family, work and social circle, their expectations being built in a gendered manner. Despite the fact migration has brought women greater economic power within the family group, their reintegration upon return redefines their role as main managers in the household and the dynamics that allow their social reproduction. Men, for their part, aspire to refresh their role as providers in spite of their frail labour position upon return. Social mobility for females is passed on through generations by a strong investment on education for their daughters and sons, while for males this mobility revolves around setting up family businesses and around their demonstrative abilities.

Ecuadorian migration and family strategies of social mobility: dialectic relation between emotional and financial capital

This text deals with transnational strategies of social mobility in Ecuadorian migrant households in Spain. We apply the capital accumulation model (Moser, 2009) for this purpose. The main target of this article is, beyond thinking in terms of capital stock and accumulation, the analysis in depth of the dynamics of the different types of capital, that is to say, how they interact with each other in the framework of the social mobility strategies of the migrants and their families. We are bringing into light the way some households adopt investing decisions in capitals that don't translate into any addition or earnings in all cases, on the contrary, concentrating all their efforts on the accumulation of a certain asset they may, in some cases, lead to a loss of another. We will concentrate our analysis primarily on the dynamics between the physical and financial capital and the social and emotional capital, showing the tensions produced between these two types of assets. At the same time, we will highlight how migrants negotiate their family strategies of social mobility in the transnational area. Our study is based in empirical material obtained from qualitative fieldwork (in-depth interviews) with families of migrants in the urban district of Turubamba Bajo -(south of Quito) and in Madrid. A series of households were selected where interviews were carried out in the country of origin as well as in the context of immigration, with different family members, analysing the transnational social and economic strategies of families of migrant members. Family members of migrants established in Spain were interviewed in Quito, as well as key informants in the district (school teachers, nursery members of the staff, etc.). The research was framed within the projects "Impact of migration on the development: gender and transnationalism", Ministry of Science and Innovation (SEJ2007/63179) (Laura Oso, dir. 2007-2010),"Gender, transnationalism and intergenerational strategies of social mobility", Ministry of Economy and Competitiveness (FEM2011/26210) (Laura Oso, dir. 201-1-2015) and “Gender, Crossed Mobilities and Transnational Dynamics”, Ministry of Economy and Competitiveness (FEM2015-67164).

Late-career international migration and reproductive work. A comparison between Peruvian and Ukrainian women in the Southern Europe

Research on the relationship between reproductive work and women´s life trajectories including the experience of labour migration has mainly focused on the case of relatively young mothers who leave behind, or later re-join, their children. While it is true that most women migrate at a younger age, there are a significant number of cases of men and women who move abroad for labour purposes at a more advanced stage, undertaking a late-career migration. This is still an under-estimated and under-researched sub-field that uncovers a varied range of issues, including the global organization of reproductive work and the employment of migrant women as domestic workers late in their lives. By pooling the findings of two qualitative studies, this article focuses on Peruvian and Ukrainian women who seek employment in Spain and Italy when they are well into their forties, or older. A commonality the two groups of women share is that, independently of their level of education and professional experience, more often than not they end up as domestic and care workers. The article initially discusses the reasons for late-career female migration, taking into consideration the structural and personal determinants that have affected Peruvian and Ukrainian women’s careers in their countries of origin and settlement. After this, the focus is set on the characteristics of domestic employment at later life, on the impact on their current lives, including the transnational family organization, and on future labour and retirement prospects. Apart from an evaluation of objective working and living conditions, we discuss women’s personal impressions of being domestic workers in the context of their occupational experiences and family commitments. In this regard, women report varying levels of personal and professional satisfaction, as well as different patterns of continuity-discontinuity in their work and family lives, and of optimism towards the future. Divergences could be, to some extent, explained by the effect of migrants´ transnational social practices and policies of states.

Migrant domestic workers, vulnerability and the law: immigration and employment laws in Cyprus and Spain

The intersection of gender, welfare and immigration regimes has been one of the main focus of a rich scholarship on paid domestic work in Europe. This article brings into the discussion the nexus of employment and immigration law regimes to reflect on the role of legal regulation in structuring and reducing the vulnerability of domestic workers. I analyse this nexus by looking at the cases of Cyprus and Spain, two states falling under the cluster of Southern Mediterranean welfare regimes, that share certain characteristics in terms of immigration regimes, but have substantially different employment law regulation models. The first part sketches the debate on the employment law regulation of domestic work. The second part starts by giving an overview of the immigration regimes of Cyprus and Spain in relation to migrant domestic workers and then proceeds to analyse the two countries’ models and substance of employment law regulation in domestic work. The comparison of these two divergent approaches informs the debate on how the legal regulation of domestic work should be best structured. In Spain there have been recent dynamic legislative changes in the employment law regulation of domestic work. The final part of the article traces these changes and reflects on why such processes have not taken place in Cyprus.

Weaving Futures. Family Transnationalism in the migration from Dominican Republic and Brazil to Spain

This article explores forms of migrant families’ reorganization within a (new) global economic crisis and the hardening of migration control in Europe; based on the cases of Dominican and Brazilian migration to Spain.Our goal is not to characterize the wholeness of strategies from these collectives, instead visualize its heterogeneity. Displacement of Dominican and Brazilian population to Spain shares the role of women as the first link of migration chains. In both cases women are the economic support of transnational families and they lead reunification's processes. Nevertheless, differences in the time spent in the destination country, migratory status, origin (rural-urban), level of education, class and labor insertion in destination country, affect differently, the planning and start up of migration projects, the organization of care and family reunification strategies. These findings question the predominant place granted to national origin in the study of international migration.

Immigration in Spain: Integration with Feet of Clay?

The aim of the paper is to analyze the impact of the economic crisis on the integration of the immigrant population in Spain. The Spanish case is singular because during the years of intense immigration achieved a remarkable degree of socio-cultural integration. The paper argues that such integration it has been the result of the confluence of exceptional factors rather than the result of the policy making. From a mixed methodology approach, it shows that, during the period of expansion, two factors of the immigration contribute to their coexistence with native population: finding job and access to public services. But the economic crisis, with its impact in terms of job losses and austerity policies, expose the weaknesses of the Spanish model of integration.

De la moral del sacrificio a la conciencia de la precariedad. Un análisis cualitativo de los discursos sobre la evolución de la crisis en España

La larga crisis económica que padece España está teniendo importantes consecuencias sociales. La más comentada por académicos, mass media y parte del arco político es la fractura social que se está abriendo en el país, ante el aumento de las desigualdades económicas que generan el enorme desempleo y las duras políticas de ajuste del gasto público. Sin embargo, más allá de cuestiones económicas la crisis está haciendo mella de forma muy profunda en el imaginario social del país en relación a las razones y consecuencias de la crisis, tanto a corto como a largo plazo. El objetivo de este artículo es el realizar una valoración de esas percepciones sociales de la ciudadanía en relación con la crisis, centrándonos en un aspecto como es el de la relación de la población española con el consumo de bienes y servicios públicos, en un escenario de hegemonía de la austeridad como única receta anti-crisis. Para ello, realizaremos un análisis de los discursos recogidos en una investigación cualitativa realizada en el año 2014 mediante grupos de discusión. Los resultados muestran un pesimismo enorme de la población en relación al futuro del Estado del Bienestar y de la propia clase media española, junto a una frustración que puede anunciar futuros ciclos de movilización social.

On the integration of Argentinian activist art at exhibition venues

This article examines the institutional integration of activist art in the aftermath of the 2001 economic crisis in Argentina. Following this aim, we begin with a description of the most significant new groups of activist art in the City of Buenos Aires. Then, we elaborate the position these new groups take up in the field with respect to their dispute with the “light art” from the 90s, and in relation to the mutual accusations over the “trend” of political art. Finally, we analyse the reception of these groups of activist art in art exhibitions in the City of Buenos Aires and abroad, and we reflect upon the institutionalization of these specific and situated aesthetic and political practices.

Crisis Económica en África Occidental: el caso de Dakar, 1929-1939

En este artículo se explora el impacto socio-económico de la crisis internacional de 1929 en Senegal y más concretamente en la ciudad-puerto de Dakar. Se analizan las consecuencias de la dependencia externa y la extroversión económica que caracterizaba a las estructuras productivas coloniales, destacando también la respuesta organizada de los movimientos sociales africanos. Por otra parte, se estudia la evolución de las infraestructuras y actividad portuaria, observando la metropolización regional de Dakar durante este periodo.

La ética hacker frente al capitalismo netárquíco: software libre y peer production en las iniciativas de Economía Colaborativa en Andalucía

En los últimos años el término Economía Colaborativa se ha popularizado sin que, hasta el momento, haya sido definido de manera inequívoca. Bajo esta denominación se engloban experiencias tan diversas como bancos de tiempo, huertos urbanos, startups o grandes plataformas digitales. La proliferación de este tipo de iniciativas puede relacionarse con una multiplicidad de factores tales como el desarrollo tecnológico, la recesión económica y otras crisis superpuestas (medioambiental, de cuidados, de valores, de lo político) y un cierto cambio en los valores sociales. Entre 2014-2015 se han realizado dos investigaciones en Andalucía de manera casi paralela y con una metodología similar. La primera de ellas pretendía identificar prácticas de Economía Colaborativa en el entorno universitario. La segunda investigación identificaba experiencias de emprendimiento a nivel autonómico. A luz de los resultados obtenidos se plantea la siguiente cuestión sobre la naturaleza misma de la Economía Colaborativa: ¿nos encontramos ante prácticas postcapitalistas que abren el camino a una sociedad más justa e igualitaria o, más bien, estamos ante una respuesta del capital para, una vez más, seguir extrayendo de manera privada el valor que se genera socialmente? Este artículo, partiendo del análisis del conjunto de iniciativas detentadas en Andalucía, se centra en aquellas basadas en el software libre y la producción digital concluyendo cómo, gracias a la incorporación de ciertos aspectos de la ética hacker y las lógicas del conocimiento abierto, éstas pueden situarse dentro de un escenario de fomento de los comunes globales frente a las lógicas imperantes del capitalismo netárquico. 

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David R. Cole (Hrsg.): Surviving Economic Crises through Education. Global Studies in Education, Vol. 11. New York u.a.: Peter Lang 2011 (267 S.) [Rezension]

Rezension von: David R. Cole (Hrsg.): Surviving Economic Crises through Education. Global Studies in Education, Vol. 11. New York u.a.: Peter Lang 2011 (267 S.; ISBN 978-1433114786)