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Reassemblig Social Security: A Survey of Pension and Health Care Reforms in Latin America
Abstract
A description in a comparative manner of the social security pensions and health care reforms implemented in the 20 countries of Latin America. Evaluation of the reforms results and impact on conventional social security principles, as well as testing on whether the reforms presumed effects have materialized. Based on 44 statistical tables and more than 500 bibliographical sources.
... Another feature of health systems of the South is segmentation, which refers to the coexistence of different modalities of financing, service delivery and affiliation, each of them targeting different population groups according to income, social status and/or type of employment (Frenk and Londoño, 1997;Mesa-Lago, 2007;Pan American Health Organization, 2007). In organisational terms, in segmented systems, public, not-for-profit and for-profit financing agencies and providers coexist (Pan American Health Organization, 2007;WHO, 2019c). ...
... Furthermore, Mackintosh et al. (2016) classifies private sectors in 11 countries in Asia, Africa and Latin America. Our review also comprises typologies that are limited to specific regions of the Global South: Frenk and Londoño (1997) and Mesa-Lago (2007) target Latin America cases, and Borisova (2011) former communist countries in Central and Eastern Europe and Asia. Sam (2014) includes two upper-middle-income countries (Malaysia and Thailand) into the analysis together with OECD and Asian high-income nations. ...
... Qualitative classification Bambra et al., 2005Lee et al., 2008Wendt et al., 2009Kam, 2012Frenk & Donabedian, 1987Hurst, 1991Roemer, 1991Elling, 1994Moran, 2000Wendt et al., 2009Toth, 20162018Bazzoli et al., 1999Wendt, 2009Reibling, 2010Joumard et al., 2010Borisova, 2011Kam, 2012Sam, 2014Mackintosh et al., 2016Hagenaars et al., 2017Bertin & Pantalone, 2018Ferreira et al., 2018Roemer, 1960Anderson, 1963Field, 1973Maxwell, 1974Terris, 1978OECD, 1987Lassey et al., 1997Saltman & Figueras, 1997;Londoño and Frenk, 1997;Busse andJakubowski, 1998 Tuohy, 1999;Freeman, 2000Docteur and Oxley, 2003Mesa-Lago, 2007Freeman & Schmid, 2008;Thomson et al., 2009Toth, 2010Santerre and Neun, 2010 European Frenk and Donabedian (1987) produce a matrix, which differentiates between concentrated and dispersed state control and eligibility based on citizenship, contribution or poverty. Hurst (1991) arrives at six possible types distinguishing the public or private nature of health care coverage and three logics of provider remuneration in public or private systems. ...
Typologies are a useful and widely employed instrument in comparative research, including the study of health care systems. This study analyses the effectiveness of extant classifications in representing health care systems globally, examining whether existing literature adequately helps to understand health care systems of the Global South. To this end, the study highlights key elements of health care systems in the Global South, in particular limited resources, segmentation and the involvement of non-domestic/international actors. In a further step, we conduct a systematic literature review of typological scholarship on health care systems, in which 42 classifications are identified and analysed regarding regional coverage, methods, as well as the criteria and categories they include. The results point to major limitations: First, there is a general lack of representation and systematic classification of health care systems of the Global South. Second, there is a bias as criteria for classification are developed inductively based upon health care systems of the Global North. Consequently, existing typologies mostly fail to take into account the particularities of the countries beyond high-income economies. The study concludes by putting forth recommendations for developing a more comprehensive, globally applicable typological framework.
... Group 2 countries were located between the other two groups. As time elapsed and changes occurred in the countries, they were reordered within the same taxonomy (Mesa-Lago, 2008a). For this book, the taxonomy has been modified and updated, eliminating some variables and adding others, in order to take the crisis into account. ...
... In my analysis, I question policies implemented in previous decades that promoted a drastic cut in the state's role and regulation, together with an increase in the market and the private sector, neglecting social protection. My recommendations give 7 See C. Mesa-Lago, Las reformas de pensiones en América Latina y su impacto en los principios de la seguridad social (Santiago: ECLAC Serie de Financiamiento del Desarrollo 144, 2004); Las reformas de la salud en América Latina y el Caribe: su impacto en los principios de la seguridad social (Santiago: ECLAC/GTZ, Documentos de Proyectos, 2006); and Mesa-Lago 2008a. INTRODUCTION the state the crucial social role that it should play at the present juncture and in the future of the region. ...
... Before the 2001 crash in Argentina, the government pressured private pension administrators to increase investment in public debt (up to 77 per cent of their portfolio) and to convert dollarised instruments into 'guaranteed' pesos. Later the government devalued the peso to one third of its value and cut the interest rate thus provoking a 44 per cent fall in the value of the fund and negative capital returns (Mesa-Lago, 2008a ...
... Faced with long-term fiscal challenges, Latin America chose a fairly radical solution. Most Latin American nations have phased out their older social security systems and replaced them with various forms of mixed or fully defined-contribution arrangements (Flores-Castillo, 2013;Mesa-Lago, 2008). In addition to multiple problems that contribute to economic inefficiency, as we mentioned earlier, the dramatic aging of the labor force places limits on the type and amount of work that individuals can provide and the revenue that can be collected from them. ...
... As we have mentioned, the real problem for Mexico is the informality that makes any form of formal pension irrelevant. As a consequence, many Mexican workers have no choice but to continue to work after 65 (Mesa-Lago, 2008;Villagómez & Ramírez, 2013). ...
Projections of the solvency of Social Security paint a dire picture, with the Social Security Trust Fund reaching empty by 2033. Without additional infusion of funds, retiree benefits will have to decrease by 23% (Folley, 2023). Social Security, of course, was never intended to be one’s sole source of retirement income, and in reality, average payments are quite modest. Without legislative action, the consequences of cuts in payments could be drastic for many recipients. Other important pillars supporting economic security in old age are private retirement plans, personal savings or inherited wealth, home equity, and property income. Today, a major question has to do with the adequacy of those pillars of support. Clearly, the longer one can stay employed and the more sources of income one has the better off one will be in retirement. Yet many Americans have little, and in some cases nothing, saved for retirement, and many have no private pension or other sources of income in retirement. Moreover, employment opportunities for those with less education are narrower at older ages. Automation and age discrimination contribute to a lower labor demand for older low-skilled workers. As a consequence, older low-skilled workers who experience job loss are less likely to be reemployed (National Academies of Sciences, 2022).
... The Washington Consensus initially set this policy agenda to ease the recovery of Latin American countries after significant economic crises in the 1980s (Williamson, 1990). Technical advice combined with foreign lending triggered a wave of structural reforms in Latin America, such as social reforms (e.g., pensions and healthcare), economic reforms (e.g., liberalisation of financial and commercial markets), and tax reforms (Almeida, 2002;Haggard & Kaufman, 2008;Homedes & Ugalde, 2005;Mesa-Lago, 2008;Williamson, 1993). In healthcare, the neoliberal model, which centred on controlling healthcare costs, was used to intervene in the way services were financed and provided, emphasising decreased public spending and a larger role for the private sector (WB, 1993). ...
... However, they were restricted to specific social groups (i.e., formal employees), and approximately 75% of the population was not covered by any scheme (Giovanella & Faria, 2015). In theory, individuals without healthcare coverage were the responsibility of health ministries; however, these were underfunded, politically weak, and institutionally inefficient (Haggard & Kaufman, 2008;Mesa-Lago, 2008). Therefore, healthcare systems in the region were characterised by access inequalities, inadequate regulation, and insufficient financial, technical, and human resources. ...
Recent literature on comparative welfare states has recognised the central role international financial institutions (IFIs) play in shaping social policy. Particularly in low-and middle-income countries (LMICs), where constraints often lead to reliance on foreign resources, IFIs can act as agenda-setters, transferring their ideas to vulnerable governments. The neolib-eral model promoted by IFIs at the end of the 20th century reveals their influence on domestic policy in South America. This study analyses the impact of World Bank (WB) prescriptions on healthcare reform legislation in five South American countries: Argentina, Bolivia, Colombia, Paraguay, and Peru. In doing so, it attempts to answer the following questions: Are LMICs receptive to IFIs' healthcare system prescriptions? More precisely, have WB policy prescriptions been adopted in healthcare reform legislation in South American countries? If so, in what way? Through content analysis, this study examines domestic healthcare legislation vis-à-vis the WB's prescriptions. The main findings show that countries are receptive to IFIs prescriptions, making them a legitimate source of policy recommendations. Further, the results suggest a correlation between economic development and reliance on foreign resources and the degree to which countries adhere to IFIs prescriptions.
... As well as having experienced a rapid a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 demographic change in terms of fertility and mortality, it is further argued that the 'weakening of familial norms and values, and radical reforms of publicly funded safety nets, is rapidly eroding the foundation of traditional support for the elderly' [2]. As in other parts of the world, both parametric and paradigmatic reforms to pension and other social welfare systems [3][4][5][6] are being proposed in order to 'maintain fiscal balance and sustain economic prosperity' [7]. Elsewhere, extensive reforms to healthcare and insurance systems [4,8] have been implemented, as well as more proactive approaches such as 'active ageing' programs [9,10]. ...
... As in other parts of the world, both parametric and paradigmatic reforms to pension and other social welfare systems [3][4][5][6] are being proposed in order to 'maintain fiscal balance and sustain economic prosperity' [7]. Elsewhere, extensive reforms to healthcare and insurance systems [4,8] have been implemented, as well as more proactive approaches such as 'active ageing' programs [9,10]. In common with other aspects of social and economic change, inequalities also play an important role in shaping the lived experiences of older persons and, as a consequence, shape the necessary policy responses [11,12]. ...
By conventional measures, it is often remarked that Central and South America is one of the fastest aging geographic regions in the world. In recent years, however, scholars have sought to problematize the orthodox measures and concepts employed in the aging literature. By not taking dynamic changes in life expectancy into account, measures which hold chronological age constant (e.g. defining a boundary to old age at 60 or 65) represent a very narrow view of population aging. Furthermore, such constant measures may misrepresent differences between territories when performing a comparative analysis. Prospective measures based on the number of years until death present an alternative approach which can adapt to dynamic changes in life expectancy and differences over time and space. The objective of this paper, then, is to apply the new ‘prospective’ measures of aging to the territories of Central and South America. We calculate prospective median age; an alternative old-age threshold based on the age at which remaining life expectancy is 15 years, and calculate prospective old-age dependency ratio for 1950–2100 using estimated and projected life tables from the latest iteration of the UN’s World Population Prospects. These new measures present a very different view of aging in Central and South America. While there are significant differences across countries, the pace and scale of aging are considerably slower and diminished when compared to standard, orthodox measures based on fixed chronological ages. Applying these new measures can not only serve to present a more realistic view of aging which maps onto demographic reality but can also serve to reconceptualize and reframe the issue as something which is far more manageable (e.g. through institutional reform) than is often perceived to be.
... puede describirse como tripartita porque incluía tres peldaños distintos: el más alto donde era posible la afiliación voluntaria y privada para los sectores de mayores ingresos; el intermedio donde coexistían diferentes modelos de protección para distintos segmentos del sector asalariado formal -asegurado a través de esquemas contributivos-; y el más bajo que ofrecía asistencia social para los sectores vulnerables y pobres. Fuera de este trípode se ubicaba la población indígena situada al margen del sistema de salud (Barba 2012;Mesa-Lago 2007: Cuadro 7.1). ...
... Las reformas realizadas a los sistemas de pensiones del IMSS y el ISSSTE pusieron fin a los sistemas de reparto o de "pay as you go" e implicaron una mercantilización de este segmento de la protección social, a través de la creación de cuentas individuales y de instituciones financieras encargadas de administrarlas (Afores y Pensionissste). Estas reformas fueron realizadas para hacer frente a la crisis financiera por la que atravesaban esas instituciones como resultado del deterioro de la tasa de trabajadores activos respecto de los pasivos, de la mala administración de los recursos acumulados, de la evasión fiscal por parte de los empleadores y de los altos costos administrativos de la operación de los sistemas (Mesa- Lago 1994Lago 2007; además, el impacto de la coalición internacional pro-mercado en el campo de las pensiones fue notable en México (Madrid 2008), junto con la incorporación de pensiones no contributivas (como esquema de combate a la pobreza extrema). El resultado fue una nueva estructura aún más segmentada en el campo pensionario. ...
... La privatización eliminó esa participación en el nuevo sistema, a pesar de que los trabajadores eran los únicos cotizantes y propietarios de las cuentas individuales (en Chile, inicialmente, los fondos de pensiones más pequeños tenían esa representación, pero eventualmente se perdió). En Argentina, el Estado Plurinacional de Bolivia, Colombia, El Salvador, México, Panamá y Perú, los trabajadores quedaron excluidos de la administración de sus fondos de pensiones (Mesa-Lago, 2008). Asimismo, en Hungría, la administración tripartita del sistema público continuó inmediatamente después de la reforma, pero fue eliminada posteriormente por el gobierno conservador. ...
... Por ejemplo, en Argentina, a principios de siglo, el órgano supervisor de los fondos de pensiones privados (la superintendencia de afp) se coludió con el gobierno para permitir que los fondos de pensiones cambiaran los instrumentos en dólares estadunidenses por instrumentos en pesos en el momento en que el tipo de cambio estaba a la par; esto provocó que dichos instrumentos perdieran dos terceras partes de su valor cuando se produjo la devaluación del peso(Mesa-Lago, 2008). ...
Entre 1981 y 2014, treinta países privatizaron total o parcialmente sus sistemas de pensiones públicas obligatorias; en 2018, dieciocho países habían revertido las privatizaciones. Este informe analiza el fracaso de los sistemas de pensiones privadas obligatorias para mejorar la seguridad de ingresos en la vejez y su bajo desempeño en términos de cobertura, niveles de beneficios, costos administrativos, costos de transición, e impactos sociales y fiscales negativos, entre otros.
... La población con inserción formal en el mercado de trabajo obtiene cobertura a través de la seguridad social, con marcos de cobertura variable según categoría ocupacional. Los sectores de mayores ingresos tienden a estar atendidas por seguros privados de salud o entidades de medicina integral prepagas (Terris, 1980;Londoño & Frenk, 1997;Fleury, 2000;CEPAL, 2006;Mesa-Lago, 2007). ...
This article presents an analytical framework for the comparative study on the origin and development of one of the central components of Welfare State: the Health System. The work seeks to facilitate the understanding of the processes of construction of health systems with a universalistic orientation, identifying the milestones in its construction, as well as the challenges that are posed for its stability and development. The approach is built on the analysis of the experience of mature health protection systems in developed countries, seeking to provide clues to Latin American countries that seek to advance the path of implementing universal health systems. Building universal health systems is a fundamental task in affirming the statute of citizenship, an essential component of a substantive democracy.
... Estos dos aspectos se analizarán combinados en una sola condición causal ("ECONODEM") definida como el conjunto de países/casos en los que se observa alta intensidad de presiones económicas y/o demográficas. Según los análisis de las reformas neoliberales de los años noventa en la región (Castiglioni, 2005;Madrid 2003;Kay y Sinha 2007;Mesa-Lago 2008;Weyland 2006;Orestein 2008;, uno de los puntos de partida del Banco Mundial (BM), el Fondo Monetario Internacional (FMI) y otras IFI para impulsar la introducción de las cuentas de ahorro y capitalización individual, fue la enorme carga fiscal que representaba para el estado el financiamiento del sistema previsional público tipo seguro social (PAYG). Esta carga fiscal sería creciente debido a la estructura del proceso de envejecimiento. ...
En el contexto de las nuevas reformas a las políticas previsionales en América Latina, esta investigación se propone explorar específicamente dos aspectos: en primer lugar, indaga las causas explicativas de los nuevos casos de cambios de tercer orden y, en segundo lugar, se pregunta por la dirección u orientación de estos cambios. Como pregunta general esta investigación propone indagar ¿Cómo las ideas programáticas de los gobiernos latinoamericanos (2005-2015) han contribuido a causar cambios de tercer orden en las políticas previsionales?, es decir, ¿cuál es el mecanismo causal que conecta las ideas programáticas de los gobiernos latinoamericanos (2005-2015) con nuevos cambios de tercer orden en las políticas previsionales? Como hipótesis se argumenta que los cambios de tercer orden en las políticas previsionales en América Latina (2005-2015) han estado orientados por las perspectivas ideológicas de los respectivos gobiernos, evidenciadas en sus ideas programáticas, pero solamente se han hecho efectivos cuando se han superado los puntos de veto institucional. Esta hipótesis general supone otras complementarias: se ha producido una coyuntura de crisis social, relacionada con el mal desempeño de la política previsional previa, que ha posibilitado una puesta en agenda del tema previsional (que adopta la forma de ideas programáticas); y, en segundo lugar, para que estas ideas contribuyan a causar cambios de tercer orden, se requiere de las condiciones institucionales de relaciones ejecutivo-legislativo que permitan superar los puntos de veto en los regímenes políticos (interacciones políticas). Considerado de manera global, este proceso describe un mecanismo causal de cambio paradigmático de políticas públicas (Peter Hall), que refleja claramente la interacción entre ideas e instituciones en un tipo específico de cambio de políticas.
En términos metodológicos, se desarrolla un diseño de investigación de multimétodos basados en teoría de conjuntos. Se combina una primera fase de análisis comparado, mediante análisis combinatorio tipo fsQCA, sobre las reformas previsionales (cambios de primer, segundo y tercer orden) realizadas por 18 países de América Latina entre 2005-2015, con el objetivo de evaluar qué factores causales están asociados a la realización de reformas previsionales orientadas a fortalecer los instrumentos de solidaridad social (dirección de las reformas). Luego se desarrolla una segunda fase de análisis en profundidad de Argentina (2008) y Bolivia (2010) como nuevos cambios de tercer orden, mediante el seguimiento de procesos causales (process tracing) incluyendo el análisis bayesiano formal (cálculo de probabilidades), con el objetivo de evaluar el funcionamiento del mecanismo causal de cambio paradigmático de políticas públicas.
Los resultados confirman que durante la década analizada los cambios en las políticas previsionales estuvieron claramente orientados al fortalecimiento del principio de solidaridad social en los sistemas previsionales, desplazando de esta manera la hegemonía del ahorro individual como fundamento exclusivo/dominante de estas políticas públicas. Este resultado global está asociado a la presencia de gobiernos de izquierda en diferentes países de la región, pero incluso en donde no gobernó la izquierda también se puede observar que los sistemas previsionales fortalecieron instrumentos de solidaridad social. Los casos de Argentina y Bolivia muestran que los gobiernos kirchneristas y masistas, respectivamente, se embarcaron en un verdadero cambio paradigmático de sus políticas previsionales (re-reformas).
... Estos dos aspectos se analizarán combinados en una sola condición causal ("ECONODEM") definida como el conjunto de países/casos en los que se observa alta intensidad de presiones económicas y/o demográficas. Según los análisis de las reformas neoliberales de los noventa (Castiglioni, 2005;Madrid 2003;Kay y Sinha 2008;Mesa-Lago 2008;Weyland 2006;Orenstein 2008), un punto de partida del BM, el FMI y otras IFI para promover las cuentas de ahorro y capitalización individual, era la carga fiscal para el estado de los sistemas PAYG. Esta carga fiscal sería creciente debido a la estructura del proceso de envejecimiento. ...
Este trabajo analiza la orientación de las reformas previsionales en Latinoamérica (2005-2015) y los factores que influyen en que éstas fortalezcan la solidaridad o el ahorro individual como principio paradigmático sobre el cual se fundan estas políticas públicas. Metodológicamente se realiza una comparación con fsQCA que busca abordar relaciones de causalidad compleja entre factores tradicionalmente considerados “objetivos” (p.ej. resultados de la política previsional, estado de la economía, envejecimiento) y factores que podríamos denominar “políticos” (p.ej., orientación ideológica del gobierno, puntos de veto en el legislativo). Los resultados confirman teorías que han sido relativamente dejadas de lado, como la teoría de los recursos de poder y su relación con efectos institucionales. En general puede afirmarse que la dirección de estas nuevas reformas previsionales en América Latina (fortalecer la solidaridad o el ahorro individual como principio paradigmático) está en buena medida relacionada con la orientación ideológica del gobierno de turno, pero la realización efectiva de dichas reformas y su alcance (cambios de primer, segundo o tercer orden) dependen de la superación del punto de veto institucional en el legislativo. Estos resultados permiten volver a poner en discusión el carácter propiamente político de las políticas públicas en un campo altamente técnico como el previsional. Por otro lado, las características de las reformas vuelven a poner en discusión la importancia de fortalecer los elementos solidarios en los esquemas previsionales ante los reiterados fracasos de las reformas de los años noventa.
... Because of the level of vulnerability old-aged persons suffer (Atakro et al., 2021;Kpessa-Whyte, 2018;Tawiah, 2011;WHO, 2014), in most countries, government across the World have made pension scheme a compulsory savings scheme, which contributions are required from every worker and employer; failure of which might lead to legal action especially in the formal sector of employment. The fixed-rate periodic contributions plus returns are calculated and made available to the member of the pension scheme during the time of retirement to stop or reduce the income insecurity after retirement in order to improve their livelihood and wellbeing (UN, 2013;Mesa-Lago, 2008). ...
... In pioneering research, Mesa-Lago (1978) considered the role of interest groups in social security segmentation in five Latin American countries. In subsequent work, Mesa-Lago identifies country clusters and patterns of reform, separating health care and pensions (Mesa-Lago 2008). Yet he seldom framed his contribution in terms of welfare regimes, focusing on the description of policy results instead. ...
The literature on welfare and social policy regimes often assumes that countries perform consistently across policy sectors. Is this assumption correct, particularly in the global South? Do countries that do well in a given policy sector do also well in others? This article examines the matter by contrasting pensions with health care in Latin America, clustering countries based on their degree of segmentation in policy outputs. As a region, Latin America is an interesting case to study because of its comparatively high levels of social spending, long history of welfare systems, significant policy transformation in the first decade of the twenty-first century and extensive body of research. Findings show that while some countries do consistently well or poorly across sectors, others report an uneven performance. Questioning overarching generalizations based on the notion of the regime, the paper calls for further comparative analysis on the political economy behind the sectoral change.
... Una baja coordinación y alta fragmentación del sistema puede disminuir la calidad de la atención y empeorar los resultados en salud 6 . En América Latina es reconocido que los niveles de fragmentación del sistema de salud, han tenido como efecto la entrega de servicios de salud de baja calidad técnica, un uso ineficiente de los recursos y una pérdida en la continuidad de la atención 7,8 . ...
Resumen
Objetivo
Caracterizar la situación actual del médico gestor de la demanda (MGD) en la atención primaria de salud (APS), desde las percepciones de aquellos que cumplen ese rol, sus pares médicos y los directivos de los centros de salud familiar (CESFAM).
Diseño
Estudio transversal cualitativo con enfoque de teoría fundamentada.
Emplazamiento
Cuatro CESFAM del Servicio de Salud Metropolitano Sur Oriente en Santiago, Chile.
Participantes
Médico gestor de la demanda, médicos generales y directores de CESFAM.
Método
Se utilizó la entrevista semiestructurada y el grupo de discusión como técnica de recolección de datos. Se realizó codificación abierta, axial y selectiva con el apoyo del software NVivo v.12.
Resultados
El MGD realiza en la práctica más funciones que las definidas para el cargo por el Ministerio de Salud, generando una sensación de falta de tiempo para realizar su labor, lo que representa su principal barrera en el trabajo y refleja la falta de apoyo institucional que reciben de sus jefaturas. Entre estas funciones invisibles están: retroalimentar al equipo médico, liderar reuniones clínicas y generar protocolos de referencia. Para el buen desempeño del MGD es necesario contar con competencias técnicas y ser reconocido por sus pares. Se estimó que el médico de familia es el profesional más apto para el cargo. La labor del MGD está limitada por factores institucionales como las listas de espera, la falta de especialistas y la baja coordinación entre niveles asistenciales.
Conclusiones
Estandarizar las funciones del MGD es un elemento necesario para su consolidación y lograr cumplir los objetivos de mantener la continuidad del cuidado en la población.
... With an eye on the growing political incorporation of worker organizations, and pension fund reserves, governments engaged in the consolidation and expansion of pension schemes (2). Toward the end of the 20th century, structural adjustment policies sought to reduce public sector deficits by replacing pay-as-you-go occupational pension schemes with individual retirement plans modeled on the individual retirement accounts (IRAs) in the United States of America (3,4). They consist of mandatory savings accounts managed by financial providers. ...
This paper examines inequalities in income security in later age. Three dimensions of inequality are considered: (i) inequalities in access to income support across countries and types of schemes; (ii) inequalities in the level of support within countries; and (iii) trends in gender inequality. Scheme stratification reinforces inequalities across socioeconomic groups and gender. More egalitarian, and sustainable, outcomes in later age income security in Latin America require policy reforms aimed at the incorporation of excluded groups and the withdrawal of public subsidies supporting privileged retirees.
... Because of the level of vulnerability old-aged persons suffer (Atakro et al., 2021;Kpessa-Whyte, 2018;Tawiah, 2011;WHO, 2014), in most countries, government across the World have made pension scheme a compulsory savings scheme, which contributions are required from every worker and employer; failure of which might lead to legal action especially in the formal sector of employment. The fixed-rate periodic contributions plus returns are calculated and made available to the member of the pension scheme during the time of retirement to stop or reduce the income insecurity after retirement in order to improve their livelihood and wellbeing (UN, 2013;Mesa-Lago, 2008). ...
This paper assesses the effect of pension receipt on household and individual wellbeing in Ghana using a fuzzy regression discontinuity design. We used data obtained from 3,086 individuals of which retired workers constituted 33% of the final sample. Data was extracted from the current wave of the Ghana Living Standards Survey (GLSS 7). We find pension receipts is significantly and positively associated with expenditure for outpatient services and energy use but significantly reduces expenditure on alcohol and smoking and food consumption at the household level. However, at the individual level, we detected an increase in body mass index and acquisition of home appliances; along with a reduction in hospitalisation and consultation.
... As per Mesa-Lago (2008), pension systems have at least two mechanisms for bringing about income redistribution: i) a financing model comprising active workers' individual contributions, employer contributions and general taxation, and ii) the universal lump-sum components of pension benefits. In terms of the former, redistribution can be helped or hindered depending on whether upper and lower limits are set on taxable income subject to proportional employee and employer contributions and whether more or less progressive taxes are used to fund the system. ...
One mechanism for influencing income redistribution through a pension system is to incorporate non‐contributory financing. Using mathematic modelling tools, this study compares two arrangements for financing Argentina’s pension system that emerged from an optimization exercise. One arrangement permits financing through income tax and the other does not. The former is found to be preferable in terms of equality and proves robust to changes in the investment rate and the inequality aversion parameter. The use of mathematical modelling tools by decision‐makers with access to sufficient high‐quality data would allow for a credible assessment of the extent to which a particular parametric reform might (or might not) contribute to improved income distribution.
... Bolivia, Mexico, El Salvador, and the Dominican Republic followed the Chilean model and put a fully funded private pension system in place of the previous payas-you-go public pension system. Peru and Colombia established a private parallel to the public system, and Argentina, Uruguay, Costa Rica, and Panama established mixed sys tems, with a basic public tier and a supplementary private tier (ECLAC, 2018;Mesa-Lago, 2008). In Argentina, Uruguay, and Costa Rica, resistance to privatization was intense, re sulting in a mixed system. ...
Latin American welfare states have undergone major changes over the past half century. As of 1980, there were only a handful of countries (Argentina, Brazil, Chile, Costa Rica, and Uruguay) with social policy regimes that covered more than half of their population with some kind of safety net to insure adequate care during their old age and that provid ed adequate healthcare services. With few exceptions, access to social protection and to healthcare in these countries and others was based on formal employment and contribu tions from employees and employers. There were very few programs, and those few were poorly funded, for those without formal sector jobs and their dependents. The debt crisis and the ensuing neoliberal reforms then damaged the welfare state in all countries, in cluding these leading nations. Deindustrialization, shrinking of the public sector, and cuts in public expenditures reduced both coverage and quality of transfers and services. Poverty and inequality rose, and the welfare state did little to ameliorate these trends. With the turn of the century, the economic and political situation changed significantly. The commodity boom eased fiscal pressures and made resources available for an increase in public social expenditure. Democracy was more consolidated in the region and civil so ciety had recovered from repression. Left-wing parties began to win elections and take advantage of the fiscal room which allowed for the building of redistributive social pro grams. The most significant innovation has been expansion of coverage to people in the informal sector and to people with insufficient histories of contributions to social insur ance schemes. The overwhelming majority of Latin Americans now have the right to some kind of cash assistance at some point in their lives and to healthcare provided by their governments. In many cases, there have also been real improvements in the generosity of cash assistance, particularly in the case of non-contributory pensions, and in the quality of healthcare services. However, the least progress has been made toward equity. With very few exceptions, new non-contributory programs were added to the traditional con tributory ones; severe inequalities continue to exist in the quality of services provided through the new and the traditional programs.
... Besides, informal labour market are a crucial component of the challenges of the contributory pension schemes. In specific, high informality rates, under-employment and the temporality of workers, among other characteristics of Latin American labour markets, limit the capabilities of the individual capitalisation funds to accrue enough resources to provide a decent pension similar to the average wage of workers during their active period (Bertranou et al. 2019;Mesa-Lago 2008;Sojo 2017). ...
Families in Latin America have gone through a silent revolution affecting the role of women, leading to decreased marriage and increased divorce and separation, as well as out-of-wedlock births and more mono-maternal families. We argue that two problematic features of the region’s family regimes have deepened: an unbalanced patriarchal contract, and a divergence along class lines in how families adjust to confront a transformed socioeconomic landscape. The upper and upper middle classes exhibit a move towards a more gender egalitarian division of labour, informal yet childless first unions, less and later fertility, and relatively stable levels of mono-maternality. Lower-income groups see persistent early fertility with decreasing stable bi-parental families with a traditional sexual division of labour, while another increasing proportion witness the disappearance of men as providers. Despite some changes, the State has not kept pace with these transformations with adapting and expanding social protections to meet these forms of social vulnerabilities.
... Besides, informal labour market are a crucial component of the challenges of the contributory pension schemes. In specific, high informality rates, underemployment, and the temporality of workers, among other characteristics of Latin American labour markets, limit the capabilities of the individual capitalisation funds to accrue enough resources to provide a decent pension similar to the average wage of workers during their active period (Bertranou et al., 2019;Mesa-Lago, 2008;Sojo, 2017). ...
Pension programmes have occupied a central space in the long history of social policy in Latin America. Social policy took the shape of Bismarckian social insurance systems, which had at their core different types of pensions, like old age, survivors’, disability and work-risks pensions. The evolution of social insurance followed an incremental path with various degrees of fragmentation and stratification reflecting and reproducing labour market structures. Due to the persistent segmentation of labour markets that was never diluted, large sectors of the population remained excluded. Social security and pension systems have transformed the Latin American welfare systems into a comprehensive but dual and stratified one. This chapter delves into the Latin American pension systems focusing on the policy architectures, the typologies of the contributory and non-contributory pensions, and the trajectories of change and reform in the last 30 years. The chapter concludes discussing some of the challenges for the twenty-first-century.
... The 1980s and 1990s saw a radical shift towards pension privatisation (Müller 2003;Orenstein 2008Orenstein , 2011. The paradigm change failed to improve coverage, however, particularly among women and in the rural and informal sectors (Mesa-Lago 2008. Only a minority of Latin Americans are covered by contributory pension schemes, be they publicly or privately managed (OECD/IDB/World Bank 2014: 14-15). ...
Während nicht beitragsfinanzierte Renten eine weltweite Konjunktur erleben, ist Bolivien nach wie vor das einzige lateinamerikanische Land mit einer universellen Altersrente, obwohl diese bereits vor zwanzig Jahren entwickelt wurde. Zwischen-zeitlich wurde die Grundrente mehrmals infrage gestellt, überlebte aber den politi-schen Regimewechsel vom Neoliberalismus zum neuen Desarrollismus. Ein Blick auf die politische Ökonomie dieser Transferleistung ist lohnenswert, zumal sich der pro-gressive Neo-Extraktivismus – und damit auch Boliviens Grundrente – nach dem Ende des Ressourcenbooms neuen Herausforderungen gegenüber sieht.
... Therefore, we first looked at the relationship between the cumulative frequency of protests and the share of private health expenditure at the beginning of the period to see if social policy legacies influenced levels of contention. Out-of-pocket expenditures have traditionally been the most important source of financing healthcare, suggesting both insufficiency and inequity of provision (Mesa-Lago, 2008). Figure 3 provides some evidence that several countries with higher levels of private health expenditure have experienced more frequent protests (r=0.26). ...
Latin America witnessed a resurgence of protests during the 1990s and early 2000s. Citizens took to the streets to protest against the liberalization of public services and rising levels of inequalities and poverty. This situation partly changed in the decade of the 2000s when the region experienced a period of sustained social policy expansion intended to extend protections to formerly excluded groups. Did popular mobilization have an influence on the turn toward universalism in Latin American social policy? This paper explores this question by looking at the relationship between protest, the strength of the Left and the adoption of expansive reforms in healthcare, conditional cash transfers and noncontributory pensions. The findings bring support to the idea that protest is a relevant aspect of the politics of social policy reform, although its effects are both sensitive to other characteristics of the political environment and the particular policy dimension considered.
... In recent decades, many low and middleincome countries have implemented social protection programmes to provide income support for the elderly. [1][2][3] The financial costs of these programmes require a deeper understanding of how old-age pensions and conditional cash transfers impact individual well-being. Several studies have evaluated the effect of old-age pensions on myriad outcomes. ...
Introduction
As old-age pensions continue to expand around the world in response to population ageing, policymakers increasingly wish to understand their impact on healthcare demand. In this paper, we examine the effects of supplemental income to older adults on healthcare use patterns, expenditures and insurance uptake in Yucatan, Mexico.
Method
We use a longitudinal survey for individuals aged 70 or older and an individual fixed-effects difference-in-difference approach to understand the effect of an income supplement on healthcare use patterns, out-of-pocket expenditures and health insurance uptake patterns.
Results
The implementation of the old-age pension was associated with increased use of healthcare with nuanced effects on the type of care. Old-age pensions increase the use of formal healthcare by 15 percentage points (95% CI 6.1 to 23.9) for those with healthcare use at baseline and by 7.5 percentage points (95% CI 3.7 to 11.3) for those without healthcare use at baseline. We find no evidence of greater out-of-pocket expenditures, likely because old-age pensions were associated with a 4.2 percentage point (95% CI 1.5 to 6.9) increase in use of public health insurance.
Conclusion
Old-age pensions can shift healthcare demand towards formal services and eliminate financial barriers to basic care. Pension benefits can also increase the uptake of insurance programmes. These results demonstrate how social programmes can complement each other This highlights the potential role of old-age pensions in achieving universal health coverage for individuals at older ages.
... The inade quacies of privatized pension systems were widely known by the 2000s. Such programs had failed at both increasing pension coverage, particularly among women and informalsector workers (Arza, 2017;Mesa-Lago 2008), and at ensuring that all contributors re ceived a livable pension upon retirement (Arza, 2012, p. S53, Carnes & Mares, 2013Pribble 2013, p. 72 countries that had previously privatized their systems were more likely to adopt NCPs (Carnes & Mares, 2014). ...
The last two decades witnessed an unprecedented decline in poverty across the develop ing world, a decline partly explained by the adoption of social cash transfer programs. Ironically, Latin America, traditionally the world's most unequal region, has been a global trendsetter in this regard. Beginning in the late 1990s, governments across the region and across the ideological spectrum began adopting conditional cash transfer (CCT) pro grams, which award poor families regular stipends conditional on their children attend ing school and/or getting regular medical checkups , and non-contributory pension (NCP) schemes for low-income and/or uncovered seniors. There is robust evidence that CCT programs achieve their short-term goals of reducing poverty while increasing school attendance and usage of health services. However, they do not improve learning and appear to be failing at their long-term goal of breaking the intergenerational transmission of poverty. Likely as a result of low-quality education, long-term CCT beneficiaries do not have significantly better economic prospects than comparable non-beneficiaries. CCTs also have electoral effects-there is robust evidence from across the region that they increase support for incumbent presidential candidates. CCTs were a response to the two big transformations the region underwent during the 1980s: the debt crisis and subsequent lost decade and the transition of most countries to democracy. Increased economic insecurity following the crisis and subsequent neoliberal reforms represented both a threat to the survival of newly elected governments and an opportunity for politicians to win over voters through increased social assistance. Pio neered by Mexico and Brazil in the mid-1990s, CCTs were by far the most effective poli cies to emerge from that context. They quickly diffused across the region, often with sup port from international financial institutions. Counterintuitively, adoption appears to be unrelated to the ascendance of left-wing governments in the region during the 2000s. The politics of CCT design are less understood. The myriad ways in which design can be con ceptualized and measured, combined with the relative newness of this literature, have limited the accumulation of knowledge. It does appear that left-wing governments adopt more expansive CCTs and de-emphasize conditionality enforcement.
... La población con inserción formal en el mercado de trabajo obtiene cobertura a través de la seguridad social, con marcos de cobertura variable según categoría ocupacional. Los sectores de mayores ingresos tienden a estar atendidas por seguros privados de salud o entidades de medicina integral prepagas (Terris, 1980;Londoño & Frenk, 1997;Fleury, 2000;CEPAL, 2006;Mesa-Lago, 2007). ...
Este artículo presenta un marco analítico para el estudio comparativo sobre el origen y desarrollo de uno de los componentes centrales de los Estados de Bienestar: los sistemas de servicios de salud. El trabajo procura facilitar la comprensión de los procesos de construcción de sistemas de salud con orientación universalista, identificando los principales hitos en su construcción, así como los desafíos que se plantean para su estabilidad y desarrollo. El enfoque se construye a partir del análisis de la experiencia de los sistemas de protección en salud maduros de países desarrollados, procurando aportar pistas a los países latinoamericanos que buscan avanzar en la senda de implantar sistemas de salud universales. Construir sistemas de salud universales es una tarea fundamental en la afirmación del estatuto de ciudadanía, componente esencial para una Democracia sustantiva.
... Sin embargo, la cobertura descendió de 26 % de la PEA en 1998 -antes de la reforma-a 18 % en 2004, y a 19 % en 2007 -todavía siete puntos porcentuales por debajo del nivel de prereforma-(Mesa-Lago, 2012). Por otro lado, Guatemala y Honduras conservaron sistemas colectivos obligatorios para la población asalariada (Mesa-Lago, 2008). ...
... La mayoría de la literatura comparada explica el nivel, la composición o la capacidad redistributiva del gasto social (Haggard y Kaufman, 2008;Segura-Ubiergo, 2007) . Otra ha explicado las reformas de política social en las últimas décadas (Castiglioni, 2005;Madrid, 2003;Mesa-Lago, 2008;Rudra, 2008) . Ninguna de estas líneas de investigación ha abordado explícitamente la creación y expansión del universalismo . ...
... Sin embargo, la cobertura descendió de 26 % de la PEA en 1998 -antes de la reforma-a 18 % en 2004, y a 19 % en 2007 -todavía siete puntos porcentuales por debajo del nivel de prereforma-(Mesa-Lago, 2012). Por otro lado, Guatemala y Honduras conservaron sistemas colectivos obligatorios para la población asalariada (Mesa-Lago, 2008). ...
http://biblioteca.clacso.edu.ar/clacso/se/20181116071335/Politicas_sociales.pdf
... Inflation was the main, but not the exclusive, mechanism of forced savings. Having looted the social insurance funds (caixas) to finance the construction of the Volta Redonda iron and steel complex, regimes in Brazil and elsewhere learnt to milk -politically as well as economically-the social security system (Mesa-Lago 2008). As a growing proportion of the urban white-and blue-collar workforce was brought within the scope of the social insurance net and while the funds remained in surplus, they were an important source of forced saving (Mesa-Lago 1991, 186). ...
Reappraising cepalina import-substituting industrialisation (ISI) means exploring strategies associated with diagnoses and policy prescriptions, recognising that ideas and processes changed over time, that there was divergence between original diagnoses of development problems and policy interventions designed to resolve them, and that some strategies and outcomes attributed to ECLA were distant from original propositions. Section one locates the ECLA project within a stylised chronology. The second focusses on two sub-periods: (i) proto-cepalismo; (ii) the classic phase of cepalismo. The third re-evaluates the project, challenging contemporary and current opinions. The main findings emphasise continuities between the two sub-periods, arguing that current vilification of the project by the left and the right is/was myopic. Industrial growth was underway in some economies by/before the end of the nineteenth century; industrialisation may have occurred in some countries before 1940; and what had been achieved by the 1990s in parts of the continent was considerable.
La publicación recopila 13 de las principales reflexiones técnicas producidas por el equipo de la OIT para el Cono Sur de América Latina, junto a la contribución de expertos y académicos, que abordan diversas temáticas como las políticas de empleo durante la pandemia, sistemas de pensiones, regulación del teletrabajo, seguridad y salud en el trabajo, Big Data y la ciencia de datos en el mundo del trabajo, entre otros.
- Políticas de empleo durante el COVID-19 en América Latina
- Seguridad social, pensiones, solidaridad, sistemas mixtos, índice Mercer, seguridad económica para personas mayores
- Teletrabajo, jornada de laboral
- Seguridad y Salud en el Trabajo, Covid-19
- Trabajo Decente y Reforma Constitucional en Chile
- Big data y ciencia de datos: experiencias en el ámbito laboral
- Cambio climático, transición justa
- C169, pueblos indígenas, igualdad de derechos, derecho de participación
Latin America underwent two major transformations during the 2000s: the widespread election of left-leaning presidents (the so-called left turn) and the diffusion of conditional cash transfer programs (CCTs)—innovative social programs that award regular stipends to poor families on the condition that their children attend school. Combining cross-national quantitative research covering the entire region and in-depth case studies based on field research, Human Capital versus Basic Income: Ideology and Models for Anti-Poverty Programs in Latin America challenges the conventional wisdom that these two transformations were unrelated. In this book, author Fabián A. Borges demonstrates that this ideology greatly influenced both the adoption and design of CCTs.
Social protection is related to a whole range of the Sustainable Development Goals. Depending on how it is defined, social protection can help to reduce poverty temporarily or permanently, raise educational attainment, reduce inequality, promote gender equality and support inclusive growth. It is thus, as it were, a cross-cutting development task, potentially covering gaps that arise in the realization of the other goals (ILO, World Social Protection Report 2017–19, Geneva, 2017). Social protection or social security is defined as the ensemble of policy interventions designed to alleviate poverty and vulnerability across the life cycle of people. It covers nine areas: Support for children and their families in the early stages of life, maternity protection, assistance in the event of unemployment or reintegration into working life, cover for accidents at work, support or insurance in the event of illness, protection against health risks and their consequences, cover for disability and support for widows and orphans. One could also include education policy, insofar as it provides life chances and protects against lifelong poverty; however, this is not usually done (see Chap. 7).
The expansion of social pensions in Latin America was part of a larger process aimed at extending protections to informal workers and other individuals not covered by social insurance. These reforms were enacted by governments of different colours, and varied considerably with regard to the scope of the new programmes. While previous comparative studies have privileged economic factors and electoral dynamics to explain these differences, this article extends these frameworks to incorporate the interplay between contentious and institutional politics. It uses a two-step qualitative comparative analysis to investigate the long-term effect of protests on reforms extending the coverage of social pensions under different constellations of political, economic and institutional conditions in 18 Latin American countries (2000-2011). The results show that protest was present in almost all configurations of expansion, but that its effect was contingent on the ideology of governments, the levels of political competition and the strength of unions.
The thesis deals with the present theme of the welfare state, specifically in Latin America. In order to begin the analysis, it presents the evolution of welfare states in developed capitalist countries and discusses the theories stemming from such experiences. The study focuses on the importance of Citizenship Theory, considering the dimension of social citizenship, as the central idea of the welfare state. Nevertheless, what is social citizenship today? Bringing back the concept of social rights of citizenship/ social citizenship requires both overcoming a definition of equal citizenship, which is abstract and universal, and moving closer to a concept of equity through a perspective of integration, interdependence and the indivisibility of rights. This perspective allows us to understand more clearly the challenges nation states face, given the fact citizens are exposed to old and new risks, as well as hidden risks. In Latin America, these hidden risks are particularly important, since they refer to the urgency of confronting structural problems that were historically ignored in the region, creating situations that deeply affect social cohesion (p.e. intergenerational traps, the permanence of poverty and the lack of channels for social mobility). After presenting the process of how welfare states evolved in Latin America, until the first decade of the 21st century, the thesis analyzes some of its determinants according to a sample of 18 countries (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, El Salvador, Ecuador, Guatemala, Honduras, México, Nicaragua, Panamá, Paraguay, Peru, Dominican Republic, Uruguay and Venezuela). By analyzing the determinants of the emergence and development of the welfare states in the region, according to economic and political variables, the study identified eight countries with a greater effort of welfare/ effort of implementing welfare policies and their respective trajectories. These countries are the object of a more in-depth analysis, focusing on the respective welfare regimes, with the intent of understanding how such regimes promote social citizenship. Decomodification, comodification, the familiarization and handling of risks are used in this analysis, according to the general perspective of risks and invisible at-risk groups (women, indigenous population and blacks). Exploring these variables, which reflect the comodification and familiarization of invisible at- risk groups, allows one to identify the process of both the renewed visibility of these risks and how it relates to trajectories of emergence and development of Latin American welfare states. The study concludes that democracy and the strength of the left are key variables in this process. The empirical part of the study used Principal Component and Factorial Analysis in the construction of indicators and Qualitative Comparative Analyis (QCA) in the identification of determinants of development in welfare states in the region.
Using household surveys from 17 Latin American countries over 2009–2018, we analyze contributory pension coverage for the economically active population (EAP) and contributory/non‐contributory pension coverage for older persons. Nine countries have “private” and eight have “public” pension systems. Inequalities in gender, income, education, location and firm size affect both coverage of the EAP and the elderly. Rather than being affected by the type of pension system – private or public –, coverage depends on structural features of the labour market and public policy interventions. Our findings confirm current understanding that level of development is directly related with coverage whereas inequality and informality are inversely related with coverage. Based on these results, we recomend policy interventions.
The pandemic the world is currently undergoing has strained all the national health services. This situation allows us to compare their performance and resilience in different countries of the continent. It is clear that some have weathered the crisis better than others. This resulted, in part, from the condition of the health services themselves, but also from the approach that different governments took to deal with the epidemic: there were governments that initially denied the severity of the disease (Brazil, Mexico); some that continue to do so (Brazil); others reacted late (Ecuador, Bolivia), while still others did everything they could from the start (or even before, when the pandemic hit European countries) to face the crisis (Costa Rica, Uruguay and Argentina).
Soziale Sicherung hat einen Bezug zu einer ganzen Reihe der nachhaltigen Entwicklungsziele. Je nach Definition dieser Sicherung kann sie helfen, Armut zeitweilig oder dauerhaft zu verringern, den Bildungstand zu erhöhen, Ungleichheit zu mildern, Geschlechtergleichheit zu fördern und breitenwirksames Wachstum zu unterstützen. Sie ist damit gleichsam eine entwicklungspolitische Querschnittsaufgabe, deckt möglicherweise Lücken, die bei der Realisierung der anderen Ziele entstehen (ILO 2017). Soziale Sicherung oder sozialer Schutz wird definiert als das Ensemble von politischen Interventionen, das Armut und Verletzlichkeit über den ganzen Lebenszyklus der Menschen mindern soll. Es umfasst neun Bereiche: Die Unterstützung von Kindern und ihrer Familien in der ersten Lebensphase, Mutterschutz, Hilfe bei Arbeitslosigkeit bzw. der Wiedereingliederung in das Arbeitsleben, Absicherung bei Arbeitsunfällen, Unterstützung bzw. Versicherung im Krankheitsfalle, Schutz vor Krankheiten und gegen deren Folgen, Absicherung bei Invalidität und Unterstützung von Witwen und Waisen. Man könnte auch noch die Bildungspolitik dazu rechnen, soweit sie Lebenschancen vermittelt und vor lebenslanger Armut schützt; üblicherweise geschieht das aber nicht (siehe dazu Kap. 7).
The pension system for public servants referred to as "20530" or the "cedula viva" caused severe fiscal damage to the Peruvian state until its reform in 2004. The reform was particularly difficult to accomplish because a number of senior officials and former government authorities were elite beneficiaries of this pension regime. In this article, we explore the reform process led by a government agency, identifying this agency's capacity and the implementation of a strategy of visibilization as key factors.
During the last three decades, the social security and health systems of the dual welfare regimes of Latin America (LA) have undergone thorough reforms, they have also developed numerous conditional cash transfer (CCT) programmes and social pension schemes. The purpose of this work is to classify the reforms, showing which actors and paradigms were behind them, determining to what extent the reforms have had an effect on social well-being, and whether they have promoted or restricted the building up of rights and social citizenship. To accomplish such an objective, we analyze the impact of these reforms on five countries: Brazil, Colombia, Mexico, Panama, and Venezuela.
The exclusion of insurance for large portions of the population in many countries and a structure of access and financing of services supported by the direct out-of-pocket expenses of individuals, have historically characterized Latin American health care systems. Beyond these weaknesses, during last decades the countries have carried out transformations and reforms of the health systems in the region. This article aims to answer the following question: What were the effects of the waves of reforms on the structure of Latin American health systems? To address this question, results of reforms implemented in the region between 1990 and 2015 are discussed to assess their impact in terms of the financing structure and population coverage. The analysis reinforces the argument that these reforms have not had a significant impact on the structure of health systems and countries have a stable pattern of heath coverage explained by welfare and labour market past performance.
Esta nota presenta anotaciones preliminares sobre los principales temas que dominan el debate de las pensiones en América Latina, durante y después de la pandemia por la COVID-19. También examina la agenda de políticas para las pensiones que la pandemia ha acelerado junto a sus posibles efectos para el presente y futuro de la seguridad económica de las personas mayores.
Este estudio tiene como propósito analizar el proceso y los contenidos de la reforma del Sistema de Ahorro para Pensiones (SAP) desarrollada en 2017, e identificar los avances y desafíos pendientes luego de esta reforma, tomando como referencia las normas internacionales y los principios fundamentales de la seguridad social precisados por la Organización Internacional del Trabajo (OIT).
Low back pain is a global health problem. In Mexico it is one of the most common musculoskeletal conditions as well as the leading cause of disability. This review provides an overview of the challenges and complexities of managing low back pain in Mexico. It begins with an explanation of the Mexican healthcare system and an overview of the burden of low back pain. Usual care for low back pain in Mexico is then contrasted with recommended best practice care to highlight common evidence-practice gaps and drivers of poor care. Finally, solutions are proposed based on positive experiences from other countries. Delving into the Mexican health framework and the burden of low back pain will provide a better understanding of why it is important to pay attention to this musculoskeletal disorder. Potential steps required to reduce the burden are also outlined to benefit not only the people suffering from low back pain but also the Mexican economy and society.
Some comparative research on the growth of social assistance in low- and middle-income countries attributes this expansion to the influence of transnational actors, particularly multilaterals. This chapter challenges this widely held view, for which a review of available comparative literature fails to find strong support. Addressing this issue is important because it raises central questions about the focus, scope and methods of comparative research on emerging welfare institutions in low- and middle-income countries. The chapter argues that a focus on institutions as opposed to policies, better data and quantitative methods, as well as a clearer conceptualization of the role of transnational actors will take us further toward theorizing emerging welfare institutions in low- and middle-income countries.
In 1980–2005, 11 Latin American countries (out of a total of 20) implemented structural reforms (“privatization”) in their pension systems, totally or partially shifting them from defined benefit, PAYG, and public administration toward defined contribution, fully funded financing, and private management. Initial design flaws and later modifications have required re-reforms ranging from full reversion to PAYG (Argentina and Bolivia) to improve the private system infusing social solidarity (Chile). Several countries that privatized their pensions have introduced parametric reforms (Colombia, Costa Rica, Mexico, and Uruguay), whereas others are discussing re-reforms (Dominican Republic, El Salvador, Panama, and Peru). Such reforms include adopting or expanding non-contributory pillars, increasing coverage, improving competition, and strengthening financial equilibrium, albeit with substantial differences between the countries. In this chapter, we review the implemented re-reforms, as well as those under discussion, and extract useful lesson for the region and the world.
Este documento contiene un análisis detallado del estado actual del sistema de pensiones peruano. El documento enumera y describe los retos principales que el sistema de pensiones enfrentará en los siguientes años así como distintos elementos de análisis para avanzar en una nueva generación de ajustes que: (i) considere el sistema pensional en su conjunto; (ii) incremente cobertura; (iii) mantenga un equilibrio entre contribuciones y beneficios; (iv) reduzca la inequidad; (v) proporcione subsidios apropiados, progresivos y sostenibles; y (vi) proporcione cobertura efectiva de riesgos (muerte, longevidad, volatilidad en tasas).
We study the effects of different pricing schemes on the overall surplus in a privately managed retirement system with multiple service providers and switching costs. We develop a theoretical model based on the Chilean retirement system and consider a repeated auction for monopoly rights over new enrollees. We consider a dynamic model solved by pension fund administrators and by consumers. We compare three different pricing schemes: (a) fees on contributions, (b) fees on returns, and (c) a two‐part tariff including an auction over a guaranteed rate of return and allowing the firm to keep a portion of returns generated above this guaranteed rate. We also consider heterogeneity across individuals where agents earn high or low wages and high‐wage customers have proportionally lower switching costs due to more cost‐effective access to financial planning services. We find that auction participants subsidize consumers. We also treat savings as a durable good. In this case, pricing over returns worsens the switching related inefficiencies just described relative to pricing over contributions, despite the better incentives it provides. These inefficiencies can be resolved by allowing firms to price discriminate.
This chapter argues that extant insights into South American human resource management (HRM) derived from cross-cultural approaches could be enhanced by integrating comparative institutional perspectives. This insightful chapter lays out opportunities and challenges for integrating comparative institutional approaches into HRM research in South America. A primary contribution is an identification of five core issues common to comparative institutional approaches and that are particularly relevant to HRM research in the South American context.
This article analyses and compares President Bachelet’s successful efforts to reform the Chilean pension system in 2008 and her failure to achieve the same objective in 2017. The article addresses the impact of electoral promises, policy legacies, policy ideology, presidential power, the role of the private sector, and the role that the government coalitions had in the process of pension reform during the Bachelet administrations. We argue that the 2008 reform was possible because of Bachelet’s personal commitment to reform and the presence of a stable governing coalition that had the will and capacity to legislate. In the second administration, although the policy legacies and ideology had remained the same, the reform did not materialise due to intense conflict within the administration and within the government coalition, as well as conflict between the administration and the coalition. These conflicts, in turn, generated a vicious cycle responsible for Bachelet’s declining popularity, limited political capital, and reduced support for reform. A stagnant economy further undermined these efforts. In brief, this article argues that when assessing success and failure in pension policy reform it is important to analyse not only policy legacies and political ideology but also the strength of the executive, the cohesion of the governing coalition, and the country’s economic performance.
This paper provides a reflexive analysis about the design and implementation of social protection systems and anti-poverty programs in Latin America and the Caribbean, with emphasis on the expansion of Conditional Cash Transfer and non-contributory pension programs implemented over the past decades. The objective of this study is to distill policy lessons and foster a debate about the current challenges and opportunities that the Agenda 2030 for Sustainable Development bring upon the social protection systems. The paper argues that more of the same will not be enough to maintain progress trends and achieve higher levels of development in the future. Using examples, the discussion turns to the challenges lying ahead under the new Development Agenda paradigm. The main challenges highlighted are related to excluded groups, life cycle needs, better coordination between sectors and fiscal constraints. The paper ends with some questions to foster discussion and a conclusion with policy recommendations.
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