韓国のソーシャル・セーフティネット

アジア通貨危機後、韓国はIMFの構造調整を受け入れた。不況とマクロ緊縮政策があいまって、失業率が急激に上昇した。その対策として、政府はソーシャル・セーフティネットの整備に力を入れた。雇用保険の適用者拡大などの政策は、IMFのコンディショナリティに従ったものである。しかし、実際に実施された政策はIMFの勧告を超え、広く社会保障の整備につながるものであった。

The Feasibility of Cuban Market Economy: A Comparison with Vietnam

In spite of the difficulties incurred by its people, Cuba has maintained a centrally planned economy with single party system. On the contrary, Vietnam has introduced a market economy under communist rule, and succeeded in generally improving living standards. The factors that contributed to the introduction of Vietnamese-style reforms are (1) severe economic crisis, (2) demonstration effects from neighboring countries, (3) poor social policy, (4) initiatives by ex-conservative leader/s, and (5) weak state capacity. The conditions to sustain high economic growth are (1) social sectors familiar with capitalist economics, (2) abundant labor forces with relatively low labor cost, and (3) investment by exiles. This paper analyzes to what extent Cuba meets these conditions.

Un nuevo sistema de gobernanza para afrontar los retos del siglo XXI en la educación universitaria en Perú basado en el modelo de análisis de políticas

Un nuevo sistema de gobernanza para afrontar los retos del siglo XXI en la educación universitaria en Perú basado en el modelo de análisis de políticas, surge de observar el efecto de la competencia en los mercados, de la distribución de los escasos recursos según productividad y rendimiento, y de la gestión ineficiente de las universidades ya que estos parámetros están cambiando los criterios de confianza y legitimidad del sistema universitario en Perú. Las universidades se perciben más como instituciones del sector público, mientras que los servicios que ofrecen deben más bien contribuir a la modernización de la sociedad emergente y a la economía del conocimiento. Las reformas universitarias- iniciadas en los años 80 - han estado inspiradas en las organizaciones universitarias exitosas que han logrado modificar su gobernanza y van dirigidas a transformar ciertas instituciones burocráticas en organizaciones capaces de desempeñar la función de actores en esta competición global por los recursos y los mejores talentos. En este contexto, la universidad peruana se enfrenta a dos grandes desafíos: el de adaptarse a las nuevas perspectivas mundiales, y el poder dar mejor respuesta a las demandas, necesidades y expectativas de la sociedad. Un cambio en el sistema de gobernanza para la educación superior universitaria dará una solución integral a estos desafíos permitiéndole enfrentar los problemas de la universidad para su desarrollo e inserción en las corrientes mundiales. La metodología planteada en la investigación es cualitativa parte del análisis de la realidad como un TODO, sin reducirlos a sus partes integrantes, con la interpretación de los hechos, buscando entender las variables que intervienen. Se propone una política para la educación universitaria en Perú que se permeabilice a la sociedad, cambiando el modelo de planificación de un modelo de reforma social a un modelo de análisis de políticas, donde el Estado Peruano actúe como único responsable de responder a la sociedad demandante como su representante legal, y con unos organismo externo e independiente que siente las bases de la práctica, como se está haciendo en muchos modelos universitarios del mundo. Esta investigación presenta una primera fase conceptual, que aborda la evolución histórica de las universidades en el Perú, analizando y clarificando las fuerzas impulsoras a través del tiempo y distinguir las principales líneas que le imprimen dirección y sentido a los cambios de una realidad educativa universitaria. Así mismo, en esta fase se hace un análisis de la situación actual de las universidades en el Perú para llegar a determinar en qué situación se encuentra y si está preparada para enfrentar los retos de la educación universitaria mundial, para esto se analizan los modelos universitarios de mayor prestigio en el mundo. El marco teórico anterior permite sentar, en una segunda fase de la investigación, las bases científicas del modelo que se propone: el modelo de planificación de análisis de políticas para el sistema universitario peruano. Este modelo de ámbito público propuesto para la educación universitaria peruana basa su estrategia en un modelo de planificación con un objetivo común: “Mejorar la calidad de la educación superior universitaria peruana con el fin de aumentar la empleabilidad y la movilidad de los ciudadanos así como la competitividad internacional de la educación universitaria en Perú”, y con unas líneas de acción concretadas en cuatro objetivos específicos: 1) competencias (genéricas y específicas de las áreas temáticas); 2) enfoques de enseñanza, aprendizaje y evaluación; 3) créditos académicos; 4) calidad de los programa. Así como los fundamentos metodológicos del modelo de análisis de políticas, utilizado como estructura política, teniendo en cuenta las características básicas del modelo: a) Planificación desde arriba; b) Se centra en la toma de decisiones; c) Separación entre conocimiento experto y decisión; d) El estudio de los resultados orienta el proceso decisor. Finalmente, se analiza una fase de validación del modelo propuesto para la educación superior universitaria peruana, con los avances ya realizados en Perú en temas de educación superior, como es, el actual contexto de la nueva Ley Universitaria N°30220 promulgada el 8 de julio de 2014, la creación del SUNEDU y la reorganización del SINEACE, que tienen como propósito atender la crisis universitaria centrada en tres ejes principales incluidos en la ley, considerados como bases para una reforma. Primero, el Estado asume la rectoría de las políticas educativas en todos los niveles educativos. El segundo aspecto consiste en instalar un mecanismo de regulación de la calidad que junto con la reestructuración de aquellos otros existentes debieran sentar las bases para que las familias y estudiantes tengan la garantía pública de que el servicio que se ofrece, sin importar sus características particulares, presenten un mínimo común de calidad y un tercer aspecto es que la ley se reafirma en que la universidad es un espacio de construcción de conocimiento basado en la investigación y la formación integral. Las finalidades, la estructura y organización, las formas de graduación, las características del cuerpo docente, la obligatoriedad por los estudios generales, etc., indican que la reflexión académica es el centro articulador de la vida universitaria. Esta validación también se ha confrontado con los resultados de las entrevistas cualitativas a juicio de experto que se han realizado a rectores de universidades públicas y privadas así como a rectores miembros de la ex ANR, miembros de organizaciones como CONCYTEC, IEP, CNE, CONEAU, ICACIT e investigadores en educación superior, con la finalidad de analizar la sostenibilidad del modelo propuesto en el tiempo. Los resultados evidencian, que en el sistema universitario peruano se puede implementar un cambio hacía un modelo de educación superior universitaria, con una política educativa que se base en un objetivo común claramente definido, un calendario para lograrlo y un conjunto objetivos específicos, con un cambio de estructura política de reforma social a un modelo de análisis de políticas. Así mismo se muestran los distintos aspectos que los interesados en la educación superior universitaria deben considerar, si se quiere ocupar un espacio en el futuro y si interesa que la universidad peruana pueda contribuir para que la sociedad se forje caminos posibles a través de una buena docencia que se refleje en su investigación, con alumnos internacionales, sobre todo, en los postgrados; con un investigación que se traduzca en publicaciones, patentes, etc., de impacto mundial, con relevancia en la sociedad porque contribuye a su desarrollo, concretándose en trabajos de muy diversos tipos, promovidos junto con empresas, gobiernos en sus diversos niveles, instituciones públicas o privadas, etc., para que aporten financiación a la universidad. ABSTRACT A new system of governance to meet the challenges of the twenty-first century university education in Peru based on the model of policy analysis, comes to observe the effect of market competition, distribution of scarce resources according to productivity and performance, and inefficient management of universities as these parameters are changing the criteria of trust and legitimacy of the university system in Peru. Universities are perceived more as public sector institutions, while the services provided should rather contribute to the modernization of society and the emerging knowledge economy. The-university reforms initiated in the 80s - have been inspired by successful university organizations that have succeeded in changing its governance and as attempting to transform certain bureaucratic institutions into organizations that act as actors in this global competition for resources and top talent. In this context, the Peruvian university faces two major challenges: to adapt to the new global outlook, and to better respond to the demands, needs and expectations of society. A change in the system of governance for university education give a comprehensive solution to address these challenges by allowing the problems of the university development and integration into global flows. The methodology proposed in this research is qualitative part of the analysis of reality as a whole, without reducing them to their constituent parts, with the interpretation of the facts, seeking to understand the variables involved. a policy for university education in Peru that permeabilizes society is proposed changing the planning model of a model of social reform a model of policy analysis, where the Peruvian State to act as the sole responsible for responding to the applicant as its legal representative, and with external and independent body that provides the basis of practice, as is being done in many university models in the world. This research presents an initial conceptual phase, which deals with the historical development of universities in Peru, analyzing and clarifying the driving forces over time and distinguish the main lines that give direction and meaning to changes in university educational reality. Also, at this stage an analysis of the current situation of universities in Peru is done to be able to determine what the situation is and whether it is prepared to meet the challenges of the global higher education, for this university models are analyzed most prestigious in the world. The above theoretical framework allows to lay in a second phase of research, the scientific basis of the model proposed: the planning model of policy analysis for the Peruvian university system. This proposed model of public sphere for the Peruvian college bases its strategy on a planning model with a common goal: "To improve the quality of the Peruvian university education in order to enhance the employability and mobility of citizens and the international competitiveness of higher education in Peru ", and lines of action materialized in four specific objectives: 1) competences (generic and specific subject areas); 2) approaches to teaching, learning and assessment; 3) credits; 4) quality of the program. As well as the methodological foundations of policy analysis model, used as political structure, taking into account the basic characteristics of the model: a) Planning from above; b) focuses on decision making; c) Separation between expertise and decision; d) The study of the results process guides the decision maker. Finally, a validation phase of the proposed Peruvian university higher education, with the progress already made in Peru on issues of higher education model is analyzed, as is the current context of the new University Law No. 30220 promulgated on July 8 2014, the creation of SUNEDU and reorganization of SINEACE, which are intended to serve the university crisis centered on three main areas included in the law, considered as the basis for reform. First, the State assumes the stewardship of education policies at all educational levels. The second aspect is to install a mechanism for regulating the quality along with the restructuring of those existing ones should lay the foundation for families and students to guarantee that public service is offered, regardless of their individual characteristics, are of common minimum quality and a third aspect is that the law reaffirms that the university is building a space of research-based knowledge and comprehensive training. The aims, structure and organization, forms of graduation, faculty characteristics, the requirement for the general studies, etc., indicate that the academic reflection is the coordinating center of university life. This validation has also been confronted with the results of qualitative interviews with expert judgment that has been made to directors of public and private universities as well as leading members of the former ANR members of organizations like CONCYTEC, IEP, CNE, CONEAU, ICACIT and researchers in higher education, in order to analyze the sustainability of the proposed model in time. The results show, that the Peruvian university system can implement a change to a model of university education, an educational policy based on clearly defined common goal, a timetable for achieving specific objectives set and, with a change social policy structure to a model of reform policy analysis. It also shows the various aspects that those interested in university education should consider, if you want to occupy a space in the future and if interested in the Peruvian university can contribute to society possible paths is forged through research good teaching, international students, especially in graduate programs; with research that results in publications, patents, etc., global impact, relevance to society because it contributes to their development taking shape in very different types of jobs, promoted with businesses, governments at various levels, public institutions or private, etc., to provide funding to the university.

Gender sensitivity in national health plans in Latin America and the European Union

Objectives: To evaluate the situation regarding gender sensitivity in national health plans in Latin America and the European Union for the decade 2000–2010. Methods: A systematic search and content analysis of national health plans were carried out within 37 countries. Gender sensitivity, defined as the extent to which a health plan considers gender as a central category and develops measures to reduce any gender-related inequalities, was analysed through an ad hoc checklist. Results: The description of health problems by sex was more frequent than intervention proposals aimed at reducing gender health disparities. The greatest number of specific intervention proposals targeted at overcoming gender-based health inequalities were associated with sexual and/or reproductive health, gender based violence, the working environment and human resources training. Compared to the European Union member states, Latin American health plans were found to be generally more gender sensitive. Conclusions: National health plans are still generally lacking in gender sensitivity. Disparities exist in health policy formulation in favour of men, whilst women's health continues to be identified mainly with reproductive health. If gender sensitivity is not taken into account, efforts to improve the quality of clinical care will be insufficient as gender inequalities will persist.

A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

Background: Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods: A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results: We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions: Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Validation of a mobility item bank for older patients in primary care

Background: To develop and validate an item bank to measure mobility in older people in primary care and to analyse differential item functioning (DIF) and differential bundle functioning (DBF) by sex. Methods: A pool of 48 mobility items was administered by interview to 593 older people attending primary health care practices. The pool contained four domains based on the International Classification of Functioning: changing and maintaining body position, carrying, lifting and pushing, walking and going up and down stairs. Results: The Late Life Mobility item bank consisted of 35 items, and measured with a reliability of 0.90 or more across the full spectrum of mobility, except at the higher end of better functioning. No evidence was found of non-uniform DIF but uniform DIF was observed, mainly for items in the changing and maintaining body position and carrying, lifting and pushing domains. The walking domain did not display DBF, but the other three domains did, principally the carrying, lifting and pushing items. Conclusions: During the design and validation of an item bank to measure mobility in older people, we found that strength (carrying, lifting and pushing) items formed a secondary dimension that produced DBF. More research is needed to determine how best to include strength items in a mobility measure, or whether it would be more appropriate to design separate measures for each construct.

What do older people understand by mobility-related difficulties?

Despite the centrality of the difficulty concept in the study of disability, there has been little research on its significance from the point of view of people with functional limitations. The main objective of this study was to describe what older people understand when asked about difficulty in undertaking mobility activities. As a secondary objective, we considered whether there are any differences depending on the type of activities, according to the International Classification of Functioning (ICF) mobility domains. Methods: Seventeen community-dwelling men and women aged 70 years old or over were interviewed by means of a questionnaire containing 55 items covering the ICF mobility domains. The participants responded to the items while thinking aloud, saying what led them to give a specific answer about their level of difficulty. Inductive content analysis was conducted and categories, subthemes and themes were identified. Results: Causes of difficulty (pathologies, impairments, symptoms) and accommodations (task modifications and use of aids) were the two themes identified; and their importance (and that of the subthemes included) varied across the types of activity. All the participants said that they had no difficulty in at least one task, despite mentioning changes in the way they performed them. Conclusions: Older people's opinions were consistent with theoretical models of disability and with the standard practice of measuring functional limitations by asking about the degree of difficulty; however, the design of these measures needs to be improved in order to detect perceptions of no difficulty in the presence of task modification.

Patients' and professionals' views on managing fibromyalgia

BACKGROUND: Managing fibromyalgia is a challenge for both health care systems and the professionals caring for these patients, due, in part, to the fact that the etiology of this disease is unknown, its symptoms are not specific and there is no standardized treatment. OBJECTIVE: The present study examines three aspects of fibromyalgia management, namely diagnostic approach, therapeutic management and the health professional-patient relationship, to explore specific areas of the health care process that professionals and patients may consider unsatisfactory. METHODS: A qualitative study involving semistructured interviews with 12 fibromyalgia patients and nine health professionals was performed. RESULTS: The most commonly recurring theme was the dissatisfaction of both patients and professionals with the management process as a whole. Both groups expressed dissatisfaction with the delay in reaching a diagnosis and obtaining effective treatment. Patients reported the need for greater moral support from professionals, whereas the latter often felt frustrated and of little help to patients. Patients and professionals agreed on one point: the uncertainty surrounding the management of fibromyalgia and, especially, its etiology. CONCLUSION: The present study contributes to a better understanding regarding why current management of fibromyalgia is neither effective nor satisfactory. It also provides insight into how health professionals can support fibromyalgia patients to achieve beneficial results. Health care services should offer greater support for these patients in the form of specific resources such as fibromyalgia clinics and health professionals with increased awareness of the disease.

Assessment of the Association of Health with the Liberalisation of Trade in Services under the World Trade Organisation

Background: The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators – life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established. Methods and Findings: This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995–2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995–2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: 20.358 p,0.001; MM: 20.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995–2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services. Conclusions: The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995–2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.