Evidências empírico-exploratórias de fatores críticos de sucesso em treinamentos corporativos a distância via web

The goal of this dissertation is to identify some of the relevant elements that are related to corporate in-house training programs via the worldwide web. An analysis of the way these factors act upon the success of these processes was conducted. To complete this assignment, one real case was studied using the methodology proposed and which in itself was actually used by an insurance company. The results obtained suggest that some components influence the accomplishment of this procedure. According to the results verified, they do bring a set of observations that must be considered by companies in their implementation strategies of this kind of training program.

Responsabilidade social empresarial no mercado de seguros brasileiro: influências culturais e implicações relacionais

The Brazilian insurance market is the ambience in which this research study takes place in search for a better understanding of how cultural characteristics are related with organizational signs, practices and expectations on social responsibility. The concepts of social responsibility as well as the concept of culture are presented and discussed from different points of view, in accordance with different authors and trough several methodological approaches, in order to establish a coherent theoretical basis for qualitative data analysis. The phenomenological attitude assumed by the researcher in especial dialogues situations during the field research phase added new possibilities of apprehension or emergence of each studied organization self orientation in terms of pre-occupation with social issues intimately related with their insurance activities in the market place. Final reflections show the complexity of the insurance cultural context in the studied Brazilian segment, in which cultural and subcultural national and organizational singularities appear. However leaving space for common values and coherent orientation toward the peculiar understanding of social responsibility as inherent to any insurance company activities, themselves. Last comments point out that future research studies may give additional contribution for the continuity of the discussions initiated in this dissertation, expecting that some changes in the organizational posture and practices may happen, especially those related with risk taking and broad processes of communication with clients and society as a whole.

Conflito de agência no consórcio DPVAT: uma análise à luz da nova economia institucional sob a perspectiva da teoria da agência

Diferentes arranjos institucionais resultam em diferentes incentivos para a realização de trocas econômicas. Com efeito, estruturas regulatórias implementadas em determinado contexto histórico-econômico podem resultar em consequências diversas daquelas originariamente pretendidas, impondo ao regulador a necessidade de constante monitoramento e de intervenções com vistas a diagnosticar e corrigir ou minimizar possíveis distorções nas relações entre os atores envolvidos. Assim, esta dissertação tem por objetivo analisar o funcionamento do Consórcio do Seguro DPVAT como mecanismo de conexão entre seus diversos stakeholders. Pretende-se analisar a existência de conflitos de interesses derivados das diversas relações entre as partes interligadas – geradas pelo arranjo institucional firmado para a gestão dos recursos arrecadados com os prêmios pagos pelos proprietários de veículo automotor para o Seguro de Danos Pessoais Causados por Veículos Automotores de Via Terrestre, ou por sua carga, a Pessoas Transportadas ou Não (DPVAT) – que possam suscitar intervenção regulatória no sentido de evitá-los, ou, ao menos, mitigá-los. A pesquisa é conduzida a partir da identificação dos comportamentos esperados de agentes econômicos autointeressados, tendo por referência os pressupostos da Nova Economia Institucional sob a perspectiva da Teoria da Agência, e do exame das principais mudanças legislativas havidas na estrutura do seguro obrigatório de trânsito no Brasil nos últimos 50 anos. Na sequência, com base em elementos teóricos e empíricos, foram identificados e analisados três conflitos de agência entre os stakeholders do Consórcio DPVAT: o primeiro seria aquele havido entre a entidade gestora do Consórcio DPVAT (agente) e as sociedades seguradoras consorciadas (principal); o segundo conflito observado refere-se à relação mantida entre a entidade gestora do Consórcio DPVAT (agente) e o órgão regulador (principal); e, por fim, o conflito de agência existente entre a seguradora que administra o referido consórcio (agente) e os proprietários de veículo automotor (principal).

Quantifying the Economics of Medical Malpractice - A View from a Civil Law Perspective

Life is full of uncertainties. Legal rules should have a clear intention, motivation and purpose in order to diminish daily uncertainties. However, practice shows that their consequences are complex and hard to predict. For instance, tort law has the general objectives of deterring future negligent behavior and compensating the victims of someone else's negligence. Achieving these goals are particularly difficult in medical malpractice cases. To start with, when patients search for medical care they are typically sick in the first place. In case harm materializes during the treatment, it might be very hard to assess if it was due to substandard medical care or to the patient's poor health conditions. Moreover, the practice of medicine has a positive externality on the society, meaning that the design of legal rules is crucial: for instance, it should not result in physicians avoiding practicing their activity just because they are afraid of being sued even when they acted according to the standard level of care. The empirical literature on medical malpractice has been developing substantially in the past two decades, with the American case being the most studied one. Evidence from civil law tradition countries is more difficult to find. The aim of this thesis is to contribute to the empirical literature on medical malpractice, using two civil law countries as a case-study: Spain and Italy. The goal of this thesis is to investigate, in the first place, some of the consequences of having two separate sub-systems (administrative and civil) coexisting within the same legal system, which is common in civil law tradition countries with a public national health system (such as Spain, France and Portugal). When this holds, different procedures might apply depending on the type of hospital where the injury took place (essentially whether it is a public hospital or a private hospital). Therefore, a patient injured in a public hospital should file a claim in administrative courts while a patient suffering an identical medical accident should file a claim in civil courts. A natural question that the reader might pose is why should both administrative and civil courts decide medical malpractice cases? Moreover, can this specialization of courts influence how judges decide medical malpractice cases? In the past few years, there was a general concern with patient safety, which is currently on the agenda of several national governments. Some initiatives have been taken at the international level, with the aim of preventing harm to patients during treatment and care. A negligently injured patient might present a claim against the health care provider with the aim of being compensated for the economic loss and for pain and suffering. In several European countries, health care is mainly provided by a public national health system, which means that if a patient harmed in a public hospital succeeds in a claim against the hospital, public expenditures increase because the State takes part in the litigation process. This poses a problem in a context of increasing national health expenditures and public debt. In Italy, with the aim of increasing patient safety, some regions implemented a monitoring system on medical malpractice claims. However, if properly implemented, this reform shall also allow for a reduction in medical malpractice insurance costs. This thesis is organized as follows. Chapter 1 provides a review of the empirical literature on medical malpractice, where studies on outcomes and merit of claims, costs and defensive medicine are presented. Chapter 2 presents an empirical analysis of medical malpractice claims arriving to the Spanish Supreme Court. The focus is on reversal rates for civil and administrative decisions. Administrative decisions appealed by the plaintiff have the highest reversal rates. The results show a bias in lower administrative courts, which tend to focus on the State side. We provide a detailed explanation for these results, which can rely on the organization of administrative judges career. Chapter 3 assesses predictors of compensation in medical malpractice cases appealed to the Spanish Supreme Court and investigates the amount of damages attributed to patients. The results show horizontal equity between administrative and civil decisions (controlling for observable case characteristics) and vertical inequity (patients suffering more severe injuries tend to receive higher payouts). In order to execute these analyses, a database of medical malpractice decisions appealed to the Administrative and Civil Chambers of the Spanish Supreme Court from 2006 until 2009 (designated by the Spanish Supreme Court Medical Malpractice Dataset (SSCMMD)) has been created. A description of how the SSCMMD was built and of the Spanish legal system is presented as well. Chapter 4 includes an empirical investigation of the effect of a monitoring system for medical malpractice claims on insurance premiums. In Italy, some regions adopted this policy in different years, while others did not. The study uses data on insurance premiums from Italian public hospitals for the years 2001-2008. This is a significant difference as most of the studies use the insurance company as unit of analysis. Although insurance premiums have risen from 2001 to 2008, the increase was lower for regions adopting a monitoring system for medical claims. Possible implications of this system are also provided. Finally, Chapter 5 discusses the main findings, describes possible future research and concludes.

Complementary and alternative medicine costs - a systematic literature review

Objective: The aim of this literature review, performed within the framework of the Swiss governmental Program of Evaluation of Complementary Medicine (PEK), was to investigate costs of complementary and alternative medicine (CAM). Materials and Methods: A systematic literature search was conducted in 11 electronic databases. All retrieved titles and reference lists were also hand-searched. Results: 38 publications were found: 23 on CAM of various definitions (medical and non-medical practitioners, over-the-counter products), 13 on homeopathy, 2 on phytotherapy. Studies investigated different kinds of costs (direct or indirect) and used different methods (prospective or retrospective questionnaires, data analyses, cost-effectiveness models). Most studies report 'out of pocket' costs, because CAM is usually not covered by health insurance. Costs per CAM-treatment / patient / month were AUD 7-66, CAD 250 and GBP 13.62 +/- 1.61. Costs per treatment were EUR 205 (range: 15-1,278), USD 414 +/- 269 and USD 1,127. In two analyses phytotherapy proved to be cost-effective. One study revealed a reduction of 1.5 days of absenteeism from work in the CAM group compared to conventionally treated patients. Another study, performed by a health insurance company reported a slight increase in direct costs for CAM. Costs for CAM covered by insurance companies amounted to approximately 0.2-0.5% of the total healthcare budget (Switzerland, 2003). Publications had several limitations, e.g. efficacy of therapies was rarely reported. As compared to conventional patients, CAM patients tend to cause lower costs. Conclusion: Results suggest lower costs for CAM than for conventional patients, but the limited methodological quality lowers the significance of the available data. Further well-designed studies and models are required.

The Amplifier - v. 7, no. 3

In this issue...Nuclear Reactor Testing Station, Arco, Idaho, Wesley club, Northern Pacific Railroad, Newman Club, geology, Russell Barthell, Main Hall, Thanksgiving, Montana Power

Three-year cost analysis of function-centred versus pain-centred inpatient rehabilitation in patients with chronic non-specific low back pain

OBJECTIVE: To compare costs of function- and pain-centred inpatient treatment in patients with chronic low back pain over 3 years of follow-up. DESIGN: Cost analysis of a randomized controlled trial. PATIENTS: A total of 174 patients with chronic low back pain were randomized to function- or pain-centred inpatient treatment. METHODS: Data on direct and indirect costs were gathered by questionnaires sent to patients, health insurance providers, employers, and the Swiss Disability Insurance Company. RESULTS: There was a non-significant difference in total medical costs after 3 years' follow-up. Total costs were 77,305 Euros in the function-centred inpatient treatment group and 83,085 Euros in the pain-centred inpatient treatment group. Likewise, indirect costs after 3 years from lost work days were non-significantly lower in the function-centred in-patient treatment group (6354 Euros; 95% confidence interval -20,892, 8392) and direct medical costs were non-significantly higher in the function-centred inpatient treatment group (574 Euros; 95% confidence interval -862, 2011). CONCLUSION: The total costs of function-centred and pain-centred inpatient treatment were similar over the whole 3-year follow-up.

A shift from oral to intravenous iron supplementation therapy is observed over time in a large swiss cohort of patients with inflammatory bowel disease

BACKGROUND In 2007, leading international experts in the field of inflammatory bowel disease (IBD) recommended intravenous (IV) iron supplements over oral (PO) ones because of superior effectiveness and better tolerance. We aimed to determine the percentage of patients with IBD undergoing iron therapy and to assess the dynamics of iron prescription habits (IV versus PO). METHODS We analyzed anonymized data on patients with Crohn's disease and ulcerative colitis extracted from the Helsana database. Helsana is a Swiss health insurance company providing coverage for 18% of the Swiss population (1.2 million individuals). RESULTS In total, 629 patients with Crohn's disease (61% female) and 398 patients with ulcerative colitis (57% female) were identified; mean observation time was 31.8 months for Crohn's disease and 31.0 months for ulcerative colitis patients. Of all patients with IBD, 27.1% were prescribed iron (21.1% in males; 31.1% in females). Patients treated with steroids, immunomodulators, and/or anti-tumor necrosis factor drugs were more frequently treated with iron supplements when compared with those not treated with any medications (35.0% versus 20.9%, odds ratio, 1.94; P < 0.001). The frequency of IV iron prescriptions increased significantly from 2006 to 2009 for both genders (males: from 2.6% to 10.1%, odds ratio = 3.84, P < 0.001; females: from 5.3% to 12.1%, odds ratio = 2.26, P = 0.002), whereas the percentage of PO iron prescriptions did not change. CONCLUSIONS Twenty-seven percent of patients with IBD were treated with iron supplements. Iron supplements administered IV were prescribed more frequently over time. These prescription habits are consistent with the implementation of guidelines on the management of iron deficiency in IBD.

Zu den Ergebnissen des Modellprojektes der Techniker-Krankenkasse zum Qualitätsmonitoring in der ambulanten Psychotherapie - eine Replik des wissenschaftlichen Beirats

Zur Versachlichung der Diskussion über die TK-Studie zum Effekt eines Qualitätsmonitorings in der ambulanten Psychotherapie hat der wissenschaftliche Beirat die Ergebnisse aus seiner Sichtweise dargestellt. Zur Hauptfragestellung wird der Abschlussbericht zitiert, der bestätigt, dass es sich um eine konfirmatorische Untersuchung handelte. Im Kern sollte sie die Hypothesen zur Überlegenheit des TK-Modells gegenüber dem Verfahren der Gutachterverfahren überprüfen. Beim TK-Modell handelt es sich um eine „Komplexintervention“, die aus mehreren Bausteinen bestand. Die Studienergebnisse lassen somit nur die Aussage zu, dass diese Komplexintervention in ihrer Kombination keine Überlegenheit gezeigt hat. Ob einzelne Bausteine Wirksamkeit hatten, bedarf weiterer Forschung. Schließlich werden das Repräsentativitäts- und das Selektivitätsproblem der Studie bzw. der verwertbaren Stichproben erläutert und mit Verweis auf die Literatur wird deren Relevanz dargelegt.

AN EMPIRICAL ESTIMATION OF MEDICAL AND NON-MEDICAL INPUTS IN THE PRODUCTION OF CARDIO-RESPIRATORY PHYSICAL HEALTH STATUS

The purpose of this study was to examine, in the context of an economic model of health production, the relationship between inputs (health influencing activities) and fitness.^ Primary data were collected from 204 employees of a large insurance company at the time of their enrollment in an industrially-based health promotion program. The inputs of production included medical care use, exercise, smoking, drinking, eating, coronary disease history, and obesity. The variables of age, gender and education known to affect the production process were also examined. Two estimates of fitness were used; self-report and a physiologic estimate based on exercise treadmill performance. Ordinary least squares and two-stage least squares regression analyses were used to estimate the fitness production functions.^ In the production of self-reported fitness status the coefficients for the exercise, smoking, eating, and drinking production inputs, and the control variable of gender were statistically significant and possessed theoretically correct signs. In the production of physiologic fitness exercise, smoking and gender were statistically significant. Exercise and gender were theoretically consistent while smoking was not. Results are compared with previous analyses of health production. ^

Entre a saúde e a repressão - políticas públicas na região da \'Cracolândia\' SP

Um território, uma substância e três Políticas Públicas atuando sobre uma mesma população. O trabalho tem como objetivo oferecer uma análise das Políticas Públicas para usuários de Crack instaladas no território da \"Cracolândia\" paulista, localizado no Bairro da Luz (São Paulo-SP). A criação do Programa Crack É Possível Vencer em 2010, articulada à emergência de discursos que especulavam sobre uma possível epidemia e crescente interesse dos meios de comunicação sobre a população usuária, abriu a possibilidade de criação de espaços institucionais para que o Estado intervisse sobre os usuários de crack. Dentro desse contexto, e articuladas a esse Programa do Governo Federal, surgem duas Políticas Públicas: Programa Recomeço de gestão Estadual e Programa De Braços Abertos de gestão Municipal. As ações dessas duas políticas durante os anos 2014 e 2015 constituem o foco do recorte empírico do presente trabalho. O esforço de pesquisa foi no sentido de investigar como as novas Políticas Públicas que se propunham a operar no campo da Saúde Pública e do cuidado iriam se materializar no território, como o discurso institucional iria se traduzir enquanto práticas. Em especial, interessava observar se as novas ações iriam inibir o movimento histórico de higienização do território e expulsão dos usuários. Visando contemplar na pesquisa ponto de vistas, experiências e discursos que não se limitassem ao relato institucional, foram utilizadas três fontes de dados: pesquisas realizadas na região, reportagens e documentos lançados pela mídia e pesquisa de campo. Foi realizada uma leitura e descrição detalhada de três etnografias feitas na região, com o objetivo de comparar as intervenções passadas com o contexto atual; através da análise de duas personagens midiáticas, que surgiram nos meios de comunicação em 2015, traçou-se a imagem do usuário de crack que é veiculada socialmente. E através de observação participante no território, foram descritos os eventos acontecidos durante o período de tempo delimitado, distribuídos em três eixos: Saúde, Repressão e Resistência. À partir desse itinerário de pesquisa, foi elaborada uma discussão que pontua as diferenças entre o discurso e a prática. Dentre as considerações finais, destaca-se a diferença dos modelos de tratamentos propostos pelas Políticas Públicas internação e Redução de Danos e a forma como essa disputa se materializa no cuidado aos usuários de crack. Embora tenha ocorrido um crescimento de ofertas de saúde, também ocorreu um aumento progressivo no número de agentes de segurança e equipamentos de vigilância na Cracolândia, instaurando aquilo que é chamado de Confinamento dos usuários, composto de práticas de limpeza das ruas, retirada de bens dos usuários e filmagem dos usuários. Uma estratégia de gentrificação foi detectada e descrita, ação cujo protagonista é uma empresa de seguros que, no período delimitado, se mostrou excessivamente atuante no território, mobilizando as ações estatais. E por fim, também foram descritas as ações de resistência dos usuários frente à criação das Políticas Públicas e das outras formas de intervenção estatal, ações tais como a construção das favelinhas e a atuação dos profissionais e militantes da região. Espera-se que esse trabalho contribua para uma maior compreensão da Cracolândia paulista e forneça subsídios para que melhores Políticas Públicas sejam criadas no território.

A ação direta da vítima contra a seguradora nos seguros facultativos de responsabilidade civil na dogmática brasileira

A investigação parte do surgimento histórico do contrato de seguro, abordando em sequencia sua teoria geral e a dogmática brasileira pertinente para, após, traçar os contornos específicos do contrato de seguro de responsabilidade civil, tanto pelo viés doutrinário quanto da legislação vigente no Brasil, dando ênfase maior ao seu conceito e finalidade social, às peculiaridades de seu sinistro, assim como à pluralidade de interesses nele albergado, afastando-se a ideia de se tratar de um seguro de reembolso, e adotando-se sua conceituação como de um seguro de garantia. Após, são fixados os conceitos básicos de processo civil aplicáveis ao objeto do estudo: jurisdição, processo, ação e seus elementos, para somente então expor o surgimento e desenvolvimento teórico da ação direta da vítima contra a seguradora na doutrina e jurisprudência francesas, passando pelas fases exegética, legalista e doutrinária de sua análise. Com base neste desenvolvimento histórico, adota-se concepção da ação direta da vítima contra a seguradora como instituto jurídico de conformação própria, oriundo dos princípios de equidade e justiça, e destinado ao afastamento dos princípios gerais de direito civil da relatividade contratual e da igualdade entre credores, constituindo meio de exercício do direito próprio da vítima contra a seguradora do causador do dano. Delimitados os conceitos em estudo, são expostas algumas experiências estrangeiras acerca do uso da ação direta e, partindo-se do embasamento teórico do seguro de responsabilidade civil e da ação direta da vítima por este protegida, ingressa-se na análise de seu desenvolvimento na dogmática brasileira. Para tanto, volta-se à ideia do seguro de responsabilidade civil como seguro de reembolso, e aos argumentos dela decorrentes para afastar o cabimento da ação direta, tais como o princípio da relatividade contratual, a ausência de previsão de solidariedade entre segurado e seguradora, e as dificuldades de exercício da ação e também de defesa por parte da seguradora e do segurado. Expostos e criticados os argumentos contrários ao cabimento da ação direta, passa-se ao estudo das tentativas doutrinárias e jurisprudenciais, no direito brasileiro, de se fornecer à vítima um meio de exercício de sua ação contra a seguradora, inicialmente por instrumentos de processo civil, e terminando por se reconhecer a possibilidade de acionamento conjunto de segurado e seguradora pelo Superior Tribunal de Justiça na sua Súmula 529. Por último, são tratados os argumentos doutrinários e legislativos favoráveis ao cabimento da ação direta da vítima contra a seguradora em qualquer seguro de responsabilidade civil, com e sem a participação inicial do segurado no processo, com destaque à função social do contrato de seguro de responsabilidade civil facultativo e ao direito próprio da vítima perante a seguradora. Conclui-se, assim, que a ação direta da vítima contra a seguradora, em qualquer seguro de responsabilidade civil, é instrumento apto e cabível na dogmática brasileira para dar vazão aos preceitos de equidade e justiça, despersonalizando a responsabilidade civil, ao levar seu foco da imputação para a indenidade, respeitando ao duplo interesse do moderno contrato de seguro de responsabilidade civil, e solucionando pela via mais apta e simples situação complexa.

Extending working life in Belgium. CEPS Working Document No. 386, 22 November 2013

This report aims at understanding how persons aged 50 years and older are and can be integrated into the working society in Belgium. We are interested in how people in this age group can be induced to engage in various forms of employment and lifelong learning. Based on secondary literature, descriptive databases as well as interviews with experts and focus groups, we find that the discussion on active ageing in Belgium is well advanced with numerous contributions by academics, stakeholders, social partners, the public administration and interest groups. The wish to retire at 60 is widely shared, but at the same time the majority of Belgium’s elderly are able and would be willing to work under specific conditions. Therefore, we recommend that Belgium should invest in more flexible systems including a revision of the tax scheme, such as the part-time retirement system proposed by the insurance company Delta Lloyd. An equally relevant recommendation would be to ensure that public employment agencies, employers and agencies that provide training encourage all workers to work and learn regardless of their age.

Financial statement.

Mode of access: Internet.

Field notes.

Latest issue consulted: Vol. 80, no. 6 (July-Aug. 1981).