Quality Management in IMSS

The Mexican Social Security Institute has published the book “Quality Management in the Mexican Institute of Social Security”. It tells the story from the 1990s until today as well as the current policies. It is divided into two major sections: the first summarizes the models, plans and programs that have systematized knowledge, practices and efforts to improve administration, such as the new model of family medicine, and the improvement of childcare and customer service. The second section puts emphasis on systems and instruments to support quality, such as the system of information management with focus on users, and the training of institutional managers through the model of evaluation and strengthening of leadership skills. Members of the CISS interested in obtaining a copy can send an e-mail to secretaria.general@ciss.org.mx.

Managing regulations on patient admissions

With increasing regulations to contain cost of health insurance, hospitals face substantial pressure to comply with regulations to admit patients. "Over the last two decades, the demand for hospital services in the United States has been on the rise. Inpatient admissions have increased by 14 percent and emergency department (ED) visits by 40 percent, while the number of staffed hospital beds has dropped by 15 percent.". This has led to new forms of organization of hospitals, and an interesting application for a South-Side hospital in Chicagto can be found here.

Changes in the pension system in Colombia

Since last August 1, more than 100 special pension regimes that allowed an employee pension could be 25 years of work were removed. This change precludes the President from the Republic and members of the Armed Forces. No Colombian may retire with an allowance above 25 minimum wages (12 million pesos 975 000 today.)
The reform also provides that from 2014 the retirement age will increase by two years so that women will rise from 55 to 57 years, whereas men will pass from 60 to 62 years.

For more information click here.

Administrative reforms in the collection process

The Slovakia government is proposing a reform to the collection process aimed at consolidate the collection of taxes and social security contributions (see note here). This reform will take advantages of economies of scale and will improve the collection by managing more information. This reform is in line to other reforms in the world that are centerizing common processes. See our Annual Report 2008.

The Greece effect

The crisis that we are seeing in Greece is the result of a budget deficit and debt, these stem from all the welfare benefits (unemployment insurance, old-age assistance, health insurance) provided by the government. However, this is not Greece´s problem alone, but nearly all developed countries that face an increasingly aging population with huge health and retirement benefits, which have not been able to cover through taxes (see here). Greece's government is taking some measures, on Monday approved a bill aimed at reforming the social security system, which is expected to go bust in less than 15 years if left unrepaired. View details of the bill here.

Congratulations to SSA!

Congratulations to the SSA (U.S. Social Security Administration), our member, for their first three places in the American Customer Satisfaction Index (ACSI). See details here.

Improved disability claim management in the Social Security Administration

The Social Security Administration is speeding the claim process of disability for rare diseases. This new project is in reality an extensión and a continuation of the operating transformation launched some years ago that is based on statistical analysis of the agency previous records. To read more click here.

Performance in retirement funds is recovered in Latin America

The Administrators of Retirement Funds (Afores) in Mexico and Pension Fund Administrators (AFP) in Chile gave the worker a better real annual yield in 2009 than it was in 2008. Below is a table with data for 2009.

Regarding the CISS annual meeting in Guatemala (fourth report)

In her intervention, Diane Braustein from the Social Security Administration of the United States mentioned that besides the long term challenges the aging of the population is having in the social security system, the global recession is also imposing difficult conditions on the system. As a response, the government trought the ARRA has granted 13 billion dollars as a one time payment of 250 USD to all SSA beneficiaries, a new payment of 250 USD per beneficiary is expected to be granted again to cope to the increase in the consumer price index, and the SSA is implementing new fast track procedures to deal with the increase in the work load due to the fact that it is expected an increase of 15% in retirement claims and 17% in disability claims.

OECD on Mexico

Recently the international organization issued its 2009 Economic Survey: Mexico. In the document several topics are analyzed, but one very important and close to our sphere is the health system. The study main messages are:

 

1.     1. The vertical integration and horizontal segmentation of the system contributes to inefficiencies and increase cost

2.    2.  While the health reform of2004 and current policies, including the sharing of new facilities between insurers, address some of these issues, there is further scope for improving the efficiency of spending

3.    3.  A clear split between the functions of insurer and provider of care should be introduced throughout the system and any insurer should be allowed to contract with any provider.

4.     4. Administrative costs could be reduced by introducing a unified claims management system, as has been done in other OECD countries with multiple insurers

Health technology

We have talked in a previous note about how technology can reduce health cost and improve health care. See here this new electronic device to monitor outdoors patients behavior.

Health: management, service care and financing III

The last sessions of our conference focused on elderly. We had presentations that talk about global trends and country specific presentations. Among the most important messages of the presentations we had: i) with the increasing longevity, most people will be fragil (this occurs even if during the past years, the fragility have been compressed to the last years of the life of elders); ii) Even if most of people will be fragil, the important factor for well being is to maintain functionality; iii) elderly should be care at home or at the community level; institutionalized care should be only to specific cases; and iv) to maintain the functionality of elderly homes and cities should be adapted with facilities and service tailored to the elder population.

Health: management, service care and financing II

We continue with the summary of the presentations that talk about global issues at our conference that was celebrated this week in Panama. Roberto Yllescas mentioned that today the paradigm of medical care can change. The previous paradigm focused in intrawalls attention, i.e., in hospitals and health institutions. The new paradigm aims for an attention focused in the prevention and monitoring, especially in patients with chronic diseases, home based. The major facilitators of this new technology are the internet and the mobile phones.

Health: Management, service care and financing I

Today it was inaugurated the seminar organized by the CISS. Presentation will be posted in the CISS web page, nevertheless in this blog during the next few days we would like to highlight the most important lessons that apply for all countries (country´s experiences can be download from the page). In its presentation Dr. Freire from the Instituto de Salud Carlos III stressed that: i) the current situation, global economic crisis and a possible reform to the USA health care system, will have a significant impact on the future of health systems around the world; ii) nevertheless, it has been proved that public financing is the only way to reach universal coverage (private financing is ineffective for these purposes); iii) social security and public services should complement each other; the former has been in the history of the world the way health systems have developed.

New free web based tool to store family health data

The Mayo Clinic launched last Tuesday the Mayo Clinic Health Manager a free web based tool to store health data of families. While today the tool needs a lot of efforts from the families to load data, this open access electronic medical file goes in the direction of having medical records that can be shared by any provider worldwide, which in turn should be translated in better health care. For those interested, in our Annual Social Security Report 2008 we talked about the new administrative and technology trends in health.

Lessons from impact evaluations in LAC

In our seminar Lorenzo Moreno and Larissa Campuzano, researchers from Mathematica Policy Research, presented a paper where they try to identify barriers that prevent rigorous impact evaluations in Latin America and the Caribbean. They argue that there are different evaluation methods and that each of them has a different level of reliability, being the experimental evaluations the ones that are more rigorous. The presenters used the methodology of case study to analyze three social programs. First, Millenium Challenge Corporation Compact in El Salvador, that aims to improve the infrastructure of high schools, give scholarships to poor youth and adults, and provide guarantees and loans to micro and small producers, among other things. The second case analyzed was the Reform of the Social Safety Net in Jamaica, which provides cash transfers to participant households. And finally they analyzed the Habitat program in Mexico, where the intervention is carried out through founds allocated to municipalities to support urban, social and community development. The researchers mentioned the following barriers that prevent evaluations: lack of support for rigorous designs, little or no early planning nor interest to build on lessons learned and data limitations. Finally they presented the lessons learned when development and implementing the evaluations of the mentioned programs; these are: detailed knowledge of evaluation methodology, maintaining early communication with key decision makers, identify barriers and propose alternatives, confirming that the evaluation will answer key questions and limiting discussion of the design’s technical aspects to a group of experts.

Evaluations in rural electrification programs

Jörg Peters, research associated at the RWI Essen in Germany, presented a paper in our conference aimed to be a practical guide for the evaluation of rural electrification programs. Peters commented that although the ideal scheme for conducting evaluations are experimental projects, evaluations can be reliable if an appropriate control group is found. In the rural electrification projects in Africa in which he participated, they were able to evaluate the impact trough the analysis of the before and after conditions of the treatment population and its comparison to a control area that was electrified previously. He mentioned that this evaluation at the same time that could provide reliable results in assessing the impact on poverty could be done with a very limited budget. The speaker also noted that it is very helpful that evaluators stay in close contact with both project staff and the field research team. Finally, the author concluded that because the survey collected quantitative and qualitative data it was possible to analyze multiple variables.

PANES: Focus and Impact

The paper presented by Fernando Borraz (professor at The University of Montevideo) in our seminar, aims to quantify the efficiency in targeting the National Health Plan for the National Emergency (PANES) implemented in Uruguay between 2005 and 2007 and determine its impact on relevant issues, such as school attendance, child labor and labor supply.
Doctor Borraz stressed the findings: in 2007, 27% of households in Montevideo and other cities that met the requirements to be in PANES, failed to enter the program; while less than 2% of households that did not meet the eligibility criteria established, received benefits from the program. He concluded that in practice the program targeting was not high, but indicators show a marked improvement in targeting when compared to 2006.
In relation to the evaluation, he commented that the PANES has not had a significant effect on school attendance and child labor. However, he noted, that it is observed a reduction 1.4% in the work hours of men and 8% in the work hours of women in the urban interior.
Finally, Professor Borraz, concluded saying that the PANES had a partial resolution, because it was addressed in a short-term plan many aspects as employment, school attendance, health, among others; that are difficult to solver together.

Impact evaluation of labor programs

In the paper presented in our seminar, Ángel Calderón (professor of the Center of Economic Studies at El Colegio de México) identifies the challenges for the evaluation of labor programs in Mexico. He mentioned that in Mexico, as in many Latin America countries, most workers who lose their jobs do not have funding to search for a new job: they have no unemployment insurance, saving, or access to credits.
Professor Calderón analyzes two programs operated by the Ministry of Labor and Social Welfare in Mexico, PROBECAT-SICAT-BECATE, which aims to provide training for 3 months to unemployed workers; and SABE-FORMAL EMPLOYMENT, which gives a financial aid and information on vacancies available to job seekers who were displaced from the formal sector of the economy.
Calderón argues that even that the program has had millions of beneficiaries, it is not known whether the programs have been effective in improving the employability and income of the participants. The fundamental reason is that the databases that are used are not appropriate for a satisfactory evaluation.

Impact Evaluation

This week we will talk about the papers presented at the conference “Making Impact Evaluations of Social Programs Work”. A selection of the presented papers will be published in the journal edited by the CISS “Well-Being and Social Policy”.

Gonzalo Hernández, Director of CONEVAL (Consejo Nacional de Evaluación), through different cases of evaluations of social programs in Mexico, identifies the main lessons that this experience has left. First he defined that is fundamental to have well prepared evaluators and to secure financing for evaluation. In this regard, he emphasized the need to generate more human capital, which applies to almost all countries of the continent. Second, he mentioned that the best evaluations are those that are demanded by the operators of the programs, as administrators cooperate in a better way and the evaluations can be planned from the beginning, although he recognized that the disadvantage of making evaluations “on demand” is that only programs are evaluated when there is a ex ante suspicion that the program are delivering good results, rather than evaluating programs for which there is a ex ante suspicion that the program is not producing good results, but programs for which evaluations are more necessary. Third, he mentioned that the economic impact evaluation should be understood as a piece of an integral strategy of monitoring and evaluation and that to improve social programs is very important to generate all relevant information, from simple indicators to sophisticated evaluations. Finally, Dr. Hernández said that in the particular case of Mexico (although it applies to most countries) the public system of evaluation should evolve from evaluating specific programs to the evaluation of strategies or systems, such as health or pension systems.