Visión y análisis de las propuestas de reforma al Sistema General de Seguridad Social en Salud en Colombia, vigencia 2012-2013

Con la Constitución Política de 1991, se inicia una nueva estructura funcional en el país a partir de los preceptos consagrados en la carta magna como un estado social de derecho, situación que no fue ajena al sector salud en el cual se estableció la seguridad social como un servicio público basado en los principios fundamentales de universalidad, solidaridad y eficiencia, enunciados que fueron plasmados entre otros en la Ley 100 de 1993, la cual incorporó estos elementos que resultaban innovadores en el contexto. Hoy después de 18 años de promulgada la Ley, se ha generado un modelo estructural que ha permitido mejorar los resultados en esta área, que si bien posee falencias en algunos de sus componentes (Acceso, Flujo de Recursos, Salud Pública), las mismas pueden ser superadas, con una reforma estructural al sistema que elimine los intereses particulares de los diferentes actores al momento de su elaboración y promulgación. Uno de los avances significativos en la reforma al sistema es la promulgación de la salud como derecho fundamental, inherente al ser humano, otorgando el carácter de inalienable, imprescriptible y sagrado, dejando en segundo plano su condición prestacional establecida. El derecho a la salud tendrá como eje principal la salud pública armonizada con la promoción y prevención, diagnóstico y tratamiento integral de la enfermedad, las cuales deben ser articuladas con las políticas sociales, ambientales, culturales y económicas que permitan incidir en los determinantes sociales de la salud para mejorar la calidad de vida de la población. La reforma a la salud en el eje de la financiación como se encuentra propuesta, no generará cambios sustanciales toda vez que se avanza hacia un sistema en que el estado será el principal actor con las funciones afiliación, recaudo, pago, giro o transferencia de los recursos, responsable de la información. Sin embargo la administración del riesgo en salud seguirá delegada, función que es determinante para la administración de los recursos del sistema, en resumen se demuestra el interés del estado en retomar la gobernanza y su empoderamiento como administrador de lo público, sin que esto responda a las necesidades de cambio en el sistema de salud.

La gestión de relaciones con clientes (CRM): sector de seguridad privada

Esta tesis pretende describir la situación actual del sector de seguridad privada, al implementar y adoptar estrategias de CRM. Con una revisión confiable y el estudio de casos relacionados con el tema, lo cual permitirá constatar la realidad en cuanto la aplicación del modelo, en el sector de seguridad privada, según lo planteado por diversos autores. Los resultados obtenidos permitirán, de este modo, al sector y a sus gerentes, desarrollar estrategias que ayuden a la satisfacción de sus clientes y a la prestación de un mejor servicio. En el campo académico, este estudio servirá como guía teórico-práctica para estudiantes y profesores, de modo que permitirá afianzar conocimientos en cuanto al CRM, al marketing relacional y su uso en el sector de seguridad privada. Según este modelo la información acerca de los clientes, es una información estratégica vital para las organizaciones que ayuda a la toma de decisiones, pronosticar cambios en cuanto a demanda, además de establecer control sobre procesos en los que se involucre el cliente; de modo que la adopción e implementación de CRM, ayude a la empresa, en este caso a las del sector de seguridad privada, a estar atentos a la manera como se interactúa con el cliente y por ende mejorar el servicio, lo que tendrá repercusión en la percepción que tenga de la organización el cliente. De este modo, se ve como en la actualidad las estrategias de CRM definen el rumbo de una empresa, ayudando atraer nuevos clientes y además de esto, ayuda de igual modo a mantener felices a los clientes actuales; lo cual repercute en la demanda o el requerimiento del servicio, y así en una mejor rentabilidad para las empresas del sector. Razones por las que el sector de vigilancia se verá beneficiado por medio de las estrategias del CRM, lo que lo llevara a ofrecer mejores servicios a sus clientes.

Condições e relações de trabalho no serviço público: o caso do governo Lula

Cet article a l'objectif de détailler les diverses initiatives du gouvernement Lula (2003-2010) par rapport à la mise en forme d'une politique de ressources humaines et, de cette façon, vérifier s'il y a eu une amélioration des conditions et relations de travail dans le secteur public brésilien. À partir des années 1990, et dans le sens contraire de la grande croissance de l'emploi public dans les six décennies précédentes, l'adhésion des gouvernements brésiliens aux principes du « Consensus de Washington » souligne le fonctionnalisme comme point fondamental dans l'agenda des réformes nécessaires à la reprise de la croissance économique. Ces gouvernements là se sont penchés sur le traitement de l'emploi public comme étant un problème fiscal et ont agi pour restreindre sa dimension. Simultanément, les conditions et relations de travail se sont présentées plus fragilisées (rendues évidentes par l'absence de réajustement de salaire; la croissance de formes variables de rémunération ; l'élargissement du cadre de travailleurs temporaires et externes, e avec l'attitude autoritaire devant la représentation syndicale). Avec une recherche documentaire et bibliographique, on pourra remarquer que la restructuration de nombreuses carrières, la reprise des concours, la création de la « Réunion Nationale de Négotiation Permanente », la réforme de la sécurité sociale et les réajustements selectifs des rémunérations manifestent l'ambiguïté comme une marque fondamentale des politiques de ressources humaines. Cela parce que, au même temps, les progrès des conditions de travail du serviteur public ont toujours été accompagnés par l'entretien d'une partie de l'agenda conservatrice des années 1990, surtout par rapport à la reproduction de limites fiscaux rigoureux.

Rebalancing the EU-Russia-Ukraine gas relationship. Bruegel Policy Contribution ISSUE 2014/15, DECEMBER 2014

The October 2014 agreement on gas supplies between Russia, Ukraine and the European Union did not resolve the Ukraine-Russia conflict over gas. The differences between parties in terms of objectives, growing mistrust and legacy issues make it unlikely that a long-term stable arrangement will be achieved without further escalation. Without EU pressure and support, Ukraine is likely to enter a new unfavourable gas arrangement with Russia, which could have repercussions beyond the energy sector. Key highlights: To reduce prices and increase the security of imports, the EU as a bloc should redefine its gas relationship with Russia and Ukraine and overcome the diverging interests of EU member states on second-order issues. Implementation of a joint strategy rests on enforcement of EU competition and gas market rules, a strengthened role for the Energy Community and the establishment of a market-based instrument for supply security. For Ukraine, the EU should serve as an anchor for comprehensive gas sector reform. Contingent on Ukraine’s reform efforts, EU financial and technical assistance, the enabling of reverse flows from the EU to Ukraine and pressure on Gazprom, should eventually enable Ukraine to obtain a sustainable gas-supply contract with Russia. This should make a sustainable and mutually beneficial Russia-Ukraine-EU gas relationship possible. However, during the transition, the EU should be prepared for possible frictions.

The Common Security and Defence Policy: National Perspectives. Egmont Paper No. 79, May 2015

FOREWORD. When one looks at the present state of the CSDP, one cannot help but look on with disenchantment at the energy that appears to have abandoned both institutions and Member States. Commentators increasingly take for granted that nothing much should be expected from this field of EU policy. The reasons for this state of mind are well known: the recent economic and financial strains, which have impacted all EU action since 2008, means that most of the Member States will struggle to keep their defence budgets at their present level in the future, and we may even see reductions. Furthermore, and to put it mildly, most of the recent CSDP operations have also experienced a lack of enthusiasm. Adding to this overall trend, the EU is far from presenting a common vision of what security and defence should really mean. Many of the Member States do not want to be involved in all of today’s international turmoils, and they rarely share the strategic culture which inspires those Member States who see themselves as having special responsibilities in dealing with these crises. In the end it may be that Member States diverge fundamentally on the simple question of whether it is relevant for the EU to engage in most of the ‘hot’ crises Europe faces; many prefer to see Europe as a soft power, mostly dedicated to intervening on less dramatic fronts and more inclined to mend than to fight. For whatever reason given, it remains that if there is a lack of common understanding on what CSDP should really be about, it should not come as a surprise if this policy is presently in stalemate. As an additional blow, the Ukrainian crisis, which dragged on for the whole of last year, could only add to the downward spiral the EU has been experiencing, with a new Russia aggressively confronting Europe in a manner not too distant from the Cold War days. This attitude has triggered the natural reaction among EU Member States to seek reassurances from NATO about their own national security. Coupled with the return of France a few years ago into the integrated military command, NATO’s renewed relevance has sent a strong message to Europe about the military organisation’s credibility with regard to collective defence. Surprisingly, this overall trend was gathering momentum at the same time as other more positive developments. The European Council of December 2013 dedicated its main session to CSDP: it underlined Europe’s role as a ‘security provider’ while adopting a very ambitious road map for Europe in all possible dimensions of the security sector. Hence the impression of a genuine boost to all EU institutions, which have been invited to join efforts and give CSDP a reinvigorated efficiency. In the same way, the increasing instability in Europe’s neighbourhood has also called for more EU operations: most recently in Iraq, Libya, Northern Nigeria or South Sudan. Pressure for further EU engagement has been one of the most constant features of the discussions taking place around these crises. Moreover, a growing number of EU partners in Asia, Latin America or Eastern Europe have shown a renewed eagerness to join CSDP missions in what sounds like a vote of confidence for EU capacities. What kind of conclusion should be drawn from this contradictory situation? Probably that the EU has much more potential than it can sometimes figure out itself, if only it would be ready to adapt to the new global realities. But, more than anything else, an enhanced CSDP needs from all Member States strong political will and a clear vision of what they want this policy to be. Without this indispensable ingredient CSDP may continue to run its course, as it does today. It may even grow in efficiency but it will keep lacking the one resource that would definitely help it overcome all the present shortcomings that have prevented Europe from finding its true role and mission through the CSDP. Member States remain central to EU security and defence policy. This is why this collection of essays is so valuable for assessing in no uncertain way the long road that lies ahead for any progress to be made. Pierre VIMONT Senior Associate at Carnegie Europe Former Executive Secretary-General of the European External Action Service

European Bank Resolution: Making it work! Interim report of the CEPS Task Force on Implementing Financial Sector Resolution. CEPS Task Force Report, January 2016

From the start of 2016, new rules for bank resolution are in place – as spelled out in the Bank Recovery and Resolution Directive (BRRD) – across the EU, and a new authority (the Single Resolution Board, or SRB) is fully operational for resolving all banks in the eurozone. The implementation issues of the new regime are enormous. Banks need to develop recovery plans, and authorities need to create resolution plans as well as set the minimum required amount of own funds and eligible liabilities (MREL) for each bank. But given the diversity in bank structures and instruments at EU and global level, this will be a formidable challenge, above all with respect to internationally active banks. In order to explore ways in which the authorities and banks can meet this challenge, CEPS formed a Task Force composed of senior experts on banking sector reform and chaired by Thomas Huertas, Partner and Chair, EY Global Regulatory Network. This report contains its policy recommendations.

Yhteistä turvallisuutta rakentaen : poliisi- ja upseeriprofessioiden yhteiskehittelyn mahdollisuuksista

Poliisin rakenneuudistus Pora III ja Puolustusvoimauudistus 2011–2015 ovat olleet viime vuosien esimerkkejä julkisen sektorin työn tehostamisen vaatimuksista. Sekä Puolustusvoimilla että poliisilla, kahdella turvallisuusalan viranomaistaholla, on lakisääteiset tehtävänsä, jotka tulee työn tehostamisen vaatimuksista huolimatta suorittaa. Turvallisuusala yksityistyy vauhdilla, ja keskustelua käydään siitä, mitä tehtäviä viranomainen hoitaa itse, mitä annetaan kaupallisen toimijan tai järjestöjen hoidettavaksi ja mistä kansalainen vastaa itse jatkossa. Resurssi- ja tehostamisvaatimuksia mietittäessä nousee esille upseereiden kohdalla koko maan puolustus ja turvaaminen. Kyetäänkö tämän tehtävän täyttämiseen mahdollisessa sotatilanteessa enää nykyisellä tai mahdollisesti vähenevällä resursoinnilla? Poliisitoimen osalta vasteajat eri puolilla Suomea puhuttavat, samoin se, miten tehtäviä priorisoidaan hoidettavaksi. Saavatko kansalaiset enää perusoikeuksiinsa kuuluvaa arjen turvallisuutta, jonka vielä tänä päivänä katsotaan kuuluvan valtion perustehtäviin? Viranomaisten pitäisi tutkimukseen valittujen aineistojen sekä lakien perusteella hoitaa tehtävänsä laadukkaasti ja tasa-arvoisesti kaikkialla Suomessa. Nykyiset sisäistä ja ulkoista turvallisuutta käsittelevät asiakirjat, esimerkiksi strategiat, puhuvat laajasta turvallisuuskäsityksestä, sisäisen ja ulkoisen turvallisuuden rajojen hämärtymisestä globalisoitumisen seurauksena ja lisääntyvästä poikkihallinnollisesta yhteistyöstä toimintaa ohjaavana ajattelumallina. Viranomaisyhteisyötä tulisi lisätä osana normaalia toimintaa, samoin yhteistyötä järjestöjen, elinkeinoelämän ja jokaisen kansalaisen kanssa. Valtioneuvoston tulevaisuusselonteossa (2013) peräänkuulutetaan uusia, innovatiivisia tapoja hoitaa sekä valtion että kuntien tehtäviä. Yhteisen toiminnan kohteen eli laajan turvallisuuskäsityksen viitekehyksessä on mahdollisuus pohtia uudenlaista turvallisuusalan viranomaisyhteistyötä, eli etsiä perusteluja upseeri- ja poliisiprofession syvemmälle yhteistyölle – yhteiskehittelylle. Tutkimukseni tavoitteena on herätellä keskustelua siitä, onko yhteisen toiminnan kohteen löytymiselle edellytyksiä. Nähtävissä on, että valtiolle kuuluvia toimintoja tehostetaan jatkossakin. Yksi järkevä tapa tehostamisessa on löytää töiden rajapintoja ja yhdistää resurssit näiden osalta. Jotta toiminta olisi tehokasta, sen pitää olla osa jokapäiväistä toimintaa eikä perustua vain muutamiin yhteistoimintaharjoituksiin tai jo tapahtuneiden poikkeustilanteiden hoitoon. Suurin osa kriisiajan toiminnasta perustuu normaaliolojen toimintaan, jolloin sen lähtökohdat voisivat olla yhteisessä työssä ja alkaa jo koulutuksesta, mikä nostetaan tässä työssä yhtenä mahdollisuutena esille. Koulutuksellinen yhteistyö ja liikkuvuus ovat eurooppalaisen tutkintojen viitekehyksen perusteella mahdollista myös kahden eri hallinnonalan koulutuksessa. Tällaista koulutuksen tehostamista haetaan tällä hetkellä muualla yhteiskunnassa. Mutta halutaanko omasta toiminnasta ja tehtävistä luopua edes osittain ja tehdä yhteistyötä mahdollisesti oman työn hallinnan, vallan tai resurssien menettämisen pelossa? Vai onko kyse vain siitä, että yhteistyön syventämiselle ei ole nähty kovinkaan suurta tarvetta tai hyötyä eikä yhteistyö näytä tuovan mitään uutta ammattikuntien osaamiseen? Tutkimuksen aineisto koostuu valtionhallinnon aineistoista, kuten strategioista, mietinnöistä ja raporteista niin sisäisen kuin ulkoisen turvallisuuden alalta. Aineistona käytetään myös upseeri- (n=71) ja poliisipäällystöopiskelijoille (n=65) suunnattua kyselyä ja kirjoitelmaa tulevaisuuden turvallisuusasiantuntijuudesta vuonna 2030. Lisäksi opiskelijavastauksista tehtyä analyysia syvennetään molempien korkeakoulujen (Maanpuolustuskorkeakoulu ja Poliisiammattikorkeakoulu) rehtoreiden sekä molempien hallinnonalojen (puolustusministeriö sekä sisäministeriö) kansliapäälliköiden haastatteluilla. Aineistojen avulla pyritään herättelemään ajatuksia siitä, voisiko yhteisiä töitä löytyä yhteistyön pohjaksi. Tarkoituksena on perustella, miksi yhteistyötä kannattaa tehdä ja ikään kuin vastata etukäteen vastaväitteisiin, miksi sitä ei voitaisi tehdä. Strategioiden yhteistyön tahtotilaa verrataan muihin strategioiden toimenpide ehdotuksiin ja sitä kautta vielä kyselyaineistoon. Opiskelijakyselyllä haetaan näkemyksiä tulevaisuuden turvallisuusasiantuntijuudesta ja mahdollisesta yhteistyöstä sekä sen painopisteistä. Muilla asiantuntijahaastatteluilla haetaan korkeakoulujen sekä ministeriön tason näkemyksiä opiskelijoiden mielipiteisiin. Opiskelijakyselyn avulla on haluttu selvittää sitä, mitä jo työelämässä olleet mutta vaihteeksi opiskelevat sotatieteiden maisteriopiskelijat Maanpuolustuskorkeakoulussa ja poliisin päällystötutkinnon opiskelijat Poliisiammattikorkeakoulussa ajattelevat turvallisuusalan ja -asiantuntijuuden muutoksesta. Minkälaisena he näkevät oman tulevan työnsä ja yhteistyökentän muiden viranomaisten kanssa? Selvää opiskelijavastausten mukaan on se, että turvallisuus halutaan pitää jatkossakin viranomaisen vastuulla ja välttää viimeiseen asti yksityisen sektorin liiallista vastuuta enempää kuin on pakko. Yhteistyötä halutaan edelleen lisätä, ja erityisesti tämä koskee viranomaisten välistä yhteistyötä. Tutkimus on tietoisesti rajattu koskemaan kahta turvallisuusalan viranomaistoimijaa, ammattikorkeakoulutuksen käyneitä poliiseja ja Puolustusvoimien Maanpuolustuskorkeakoulussa opiskelevia upseereita, joiden tehtävistä ja koulutuksesta on löydettävissä yhteisiä rajapintoja ja yhteistyön alueita. Kiinnostus syventyä valittuun kahteen ammattialaan johtuu myös siitä, että usein esimerkiksi sisäasianhallinnon strategioissa Puolustusvoimat jätetään ulkopuolelle varsinkin normaaliolojen yhteistyötä tarkasteltaessa tai vain yksittäisen maininnan asteelle. Sama huomio on havaittavissa puolustushallinnon strategioista. Tämä nousee esille erityisesti alueellista yhteistyötä tai viranomaisyhteistyötä pohdittaessa. Silti sekä sisäministeriön että puolustusministeriön hallinnonalan strategiat ym. perustuvat laajaan turvallisuuskäsitykseen, ja usein eri ammattikuntia analysoitaessa puhutaan tehtävistä, joita tekevät useat ammattikunnat ja professiot. Puhutaan niin sanotuista harmaista alueista. Ministeriöiden tahtotilassa ja toiminnassa on tutkimukseni mukaan nähtävissä ristiriita. Koulutuksen osalta yhteistyön lisääminen on mahdollista etenkin nyt, kun Poliisiammattikorkeakoulussa peruskoulutus on muuttunut ammattikorkeakoulutasoiseksi ja näin tämän ammattikunnan professioasema koulutuksen näkökulmasta on vahvistunut entisestään. Käsittelenkin tutkimuksessani kahta professiota professiotutkimuksen perinteisiä kriteereitä käyttäen, eli rinnastaessani näitä kahta ammattia. Rinnastettavuus koulujen kesken on tullut mahdolliseksi sekä tutkintojen että osaamisen tarkastelun näkökulmasta. Tämän myötä myös molempia korkeakouluja hyödyttävää yhteistyötä olisi mahdollista miettiä osana muutakin hallinnon tehostamista ja rauhan ajan viranomaistoimintaa.

Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries

Access to basic health services was affirmed as a fundamental human right in the Declaration of Alma-Ata in 1978. The model formally adopted for providing healthcare services was primary health care (PHC), which involved universal, community-based preventive and curative services, with substantial community involvement. PHC,did not achieve its goals for several reasons, including the refusal of experts and politicians in developed countries to accept the principle that communities should plan and implement their own heathcare services. Changes in economic philosophy led to the replacement of PHC by Health Sector Reform, based on market forces and the economic benefits of better health. It is time to abandon economic ideology and determine the methods that will provide access to basic healthcare services for all people.

Access to tuberculosis diagnosis in Itaborai City, Rio de Janeiro, Brazil: the patient`s point of view

SETTING: Itaborai Municipality in Rio de Janeiro, Brazil. OBJECTIVE: To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN : A cross-sectional study was conducted in Itaborai City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing `almost always` and `always`, or `good` and `very good`, were used as a cut-off point to define high quality access to diagnosis. RESULTS: FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION: In Itaborai, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaborai.

Reforma do setor p??blico e participa????o sindical: o caso do sistema de pens??o italiano

O paper estuda o caso da recente reforma da Previd??ncia na It??lia, ilustrando a possibilidade de uma participa????o positiva dos sindicatos ??? tradicionalmente contr??rios ??s reformas ??? no processo de transforma????o do setor p??blico. Ap??s uma revis??o do sistema previdenci??rio italiano, altamente fragmentado e particularista na opini??o dos autores, e o apontamento de suas principais defici??ncias, o estudo concentra-se na an??lise de tr??s propostas de reforma ligadas aos governos de Amato (1992-93), Berlusconi (1994) e Dini (1995), respectivamente. O texto aborda tanto as propostas concretas de mudan??a, trazendo contribui????es sobre uma variedade consider??vel de medidas, seu impacto e aceita????o sociais e por categoria, como os objetivos visados e o processo pol??tico relacionado ?? sua discuss??o e tramita????o. Uma preocupa????o constante dos autores ?? a correla????o entre a postura e a participa????o dos sindicatos em mat??ria de reforma previdenci??ria, por um lado, e o avan??o das propostas governamentais, por outro. Segundo o estudo, a ampla participa????o da for??a sindical na negocia????o do projeto de reforma previdenci??ria do governo Dini representou um fator decisivo para sua aprova????o e implementa????o bem-sucedidas. Ao mesmo tempo, a delibera????o democr??tica para concilia????o de prefer??ncias e interesses (m??ltiplos no caso de assuntos norteados pela dicotomia bem comum/interesse particular) ??? objeto da ??ltima sess??o do estudo ??? ?? vista como uma forma de ampliar a participa????o sindical al??m das lideran??as, passando a incluir os rank-and-file trabalhadores, um procedimento que traz, igualmente, a for??a de uma decis??o majorit??ria. A an??lise da reforma da Previd??ncia italiana ?? ilustrada no paper com tabelas que trazem e comparam dados referentes ?? contribui????o previdenci??ria, ??s categorias de beneficiados e ??s diferentes propostas de reforma formuladas por sucessivos governos italianos.

A (in)segurança privada em Portugal

Along with the food and the comfort, safety has always been one of the human priorities. In pursuit of this objective, man developed self-preservation mechanisms, went to live in society and created rules to control the community life. In the West and in the late eighteenth century, with the creation of states as we know them today, the monopoly of security, among other powers, has been preserved untouched until the last quarter of this century. With the bankruptcy of the welfare state and the rise of the regulatory state, many of the essential tasks for the community have also been carried out by private companies or institutions, including education, health care and security. Although not easy, education and health care have been more opened to be managed by the private sector. Instead, the privatization of the security sector has seen much more resistance. Still, especially in the West, the states have delegated some of the security competences to private companies. Portugal is no exception to the rule and, after a few years of unregulated activity, in 1982 was published the first law regulating the private security. After the initial stages of development (evolution and maturation), which lasted until the early years of the 2000‘s, the private security now seems to have reached maturity. Today, now with a new legal system, composed by Law no. 34/2013, of 16 may, its regulations and complementary legislation, now private security encompasses other activities and competences - becoming, an increasingly complement to public safety. It has also increased the pre-requisites and control mechanisms for private security companies, and strengthened the rules that limit their scope of activity.

A intervenção privada na prestação pública : da expansão do Estado às parcerias público-privadas

Durante séculos o papel do Estado na vida económica e social das nações foi crescendo, atingindo um desenvolvimento assinalável a partir da segunga guerra mundial, em execução do novo paradigma que dela resultou. Desenvolvimento que conheceu fortes críticas com paragem e posterior inversão de sentido durante a década de 80 em que se gerou alguma diluição da intervenção do Estado, criando-se um movimento de relativo cepticismo relativamente à bondade, à eficiência e aos custos daquela intervenção. Foi nesse contexto e paralelamente com o aumento da vontade de intervir do sector privado que surgiram as chamadas três «vagas» de intervenção privada, sucessivamente dirigidas às actividades públicas (i) em sectores industriais, comerciais ou de serviços não estratégicos, (ii) no domínio das infra-estruturas e, finalmente, (iii) na área social, recorrendo com diferentes níveis de sucesso, a diversos processos, da privatização às parcerias público-privadas (PPP), passando pela empresarialização. O movimento de reforma nascido de reservas quanto à eficiência do sector público não passou ao lado da saúde, particularmente do hospital público, em que assumiu objectivos e modos específicos, das «reformas de gestão» às «reformas de financiamento» e às «reformas organizacionais », para, na sequência do movimento anteriormente ocorrido noutros domínios, também recorrer às parcerias público-privadas. Depois de situar estas iniciativas no contexto do movimento que rodeou o aumento da intervenção privada na produção e na prestação pública, o artigo procura identificar os requisitos de compatibilidade das parcerias público-privadas com sistemas de saúde organizados e que perseguem a universalidade da cobertura, a acessibilidade e compreensividade dos cuidados e a equidade do acesso, com especial atenção ao facto de (designadamente em Portugal) a partilha de riscos e tarefas poder atribuir ao sector privado a gestão das dimensões clínicas da prestação.

Work motivation and pro-social behavior in the delivery of public services : theoretical and empirical insights

This Ph.D. dissertation seeks to study the work motivation of employees in the delivery of public services. The questioning on work motivation in public services in not new but it becomes central for governments which are now facing unprecedented public debts. The objective of this research is twofold : First, we want to see if the work motivation of employees in public services is a continuum (intrinsic and extrinsic motivations cannot coexist) or a bi-dimensional construct (intrinsic and extrinsic motivations coexist simultaneously). The research in public administration literature has focused on the concept of public service motivation, and considered motivation to be uni-dimensional (Perry and Hondeghem 2008). However, no study has yet tackled both types of motivation, the intrinsic and extrinsic ones, in the same time. This dissertation proposes, in Part I, a theoretical assessment and an empirical test of a global work motivational structure, by using a self-constructed Swiss dataset with employees from three public services, the education sector, the security sector and the public administrative services sector. Our findings suggest that work motivation in public services in not uni-dimensional but bi-dimensional, the intrinsic and extrinsic motivations coexist simultaneously and can be positively correlated (Amabile et al. 1994). Our findings show that intrinsic motivation is as important as extrinsic motivation, thus, the assumption that employees in public services are less attracted by extrinsic rewards is not confirmed for this sample. Other important finding concerns the public service motivation concept, which, as theoretically predicted, represents the major motivational dimension of employees in the delivery of public services. Second, the theory of public service motivation makes the assumption that employees in public services engage in activities that go beyond their self-interest, but never uses this construct as a determinant for their pro-social behavior. In the same time, several studies (Gregg et al. 2011 and Georgellis et al. 2011) bring evidence about the pro-social behavior of employees in public services. However, they do not identify which type of motivation is at the origin of this behavior, they only make the assumption of an intrinsically motivated behavior. We analyze the pro-social behavior of employees in public services and use the public service motivation as determinant of their pro-social behavior. We add other determinants highlighted by the theory of pro-social behavior (Bénabou and Tirole 2006), by Le Grand (2003) and by fit theories (Besley and Ghatak 2005). We test these determinants on Part II and identify for each sector of activity the positive or the negative impact on pro-social behavior of Swiss employees. Contrary to expectations, we find, for this sample, that both intrinsic and extrinsic factors have a positive impact on pro-social behavior, no crowding-out effect is identified in this sample. We confirm the hypothesis of Le Grand (2003) about the positive impact of the opportunity cost on pro-social behavior. Our results suggest a mix of action-oriented altruism and out-put oriented altruism of employees in public services. These results are relevant when designing incentives schemes for employees in the delivery of public services.

The slow transformation of Swiss federal administrative elites

This article sets out to study the profile of Swiss administrative elites at federal level by showing how their profile has evolved in the light of what has come to be known as the wave of New Public Management (NPM), which has benefited from a very fertile ground in Switzerland. These elites correspond to a specific institutional order, in relation to specific organizational structures and workings, and have specific characteristics in terms of career paths and academic background. However, the administrative reforms that have been rolled out since the 1980s have transformed the institutional order within which executives of the federal administration evolve. This article analyses the extent to which these transformations have had an impact on the characteristics of these elites, through indicators such as academic capital, social capital, and career path within and outside the administration. The results show a slow but significant transformation in the profiles of these elites towards an increasing managerialization, reflecting that of the context in which they evolve.Points for practitioners The relationship between politics and the administration is naturally shaped by individuals but is closely dependent on the profiles of the players. They are currently undergoing a transformation in the wake of administrative reforms, and also of the changing profiles of both the political and administrative players. Gaining an insight into the slow transformation of the profiles of administrative elites therefore sheds light on the political-administrative nexus. The gradual managerialization of the administrative elite highlighted in this article also allows for a better understanding of which professional experiences, qualifications and skills are valued today within the senior civil service in Switzerland.