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迈向21世纪的新型社会保障:没有筹资团结就没有全民覆盖

[Towards a new social security in the 21st century: without financing solidarity there will be no universality].

作者信息

Titelman D, Uthoff A, Jiménez L F

出版信息

Rev Panam Salud Publica. 2000 Jul-Aug;8(1-2):112-7. doi: 10.1590/s1020-49892000000700015.

Abstract

In the countries of Latin America and the Caribbean, social security systems have traditionally been almost exclusively the responsibility of the public sector. These systems have had major shortcomings, such as low coverage rates, unbalanced budgets, inadequate funding, and poor management of resources. In order to solve these problems and face the increased demands associated with demographic and epidemiological transitions, in the 1990s a number of countries began to reform their social security systems. These reforms have been characterized by three fundamental features: a) a search for a closer link between contributions and benefits, in order to better balance income and expenses, b) changes in the public-private composition of the systems that allow a greater private role in the financing and delivery of services, and c) an emphasis on market mechanisms as a way to promote efficiency in applying resources, and leaving to the State a role as a regulator and as a guarantor of basic benefits to groups that, because of their socioeconomic conditions, cannot make certain minimum contributions. This article looks at some of the problems raised by the reforms carried out so far, and the lessons that can be learned from them. The piece also analyzes the relationship between universal coverage and societal unity. In addition, the article suggests that the main challenge with social security reforms is that of moving toward universal systems that significantly expand coverage. In order to achieve that, it is necessary to strengthen the mechanisms of cohesion in financing and to improve efficiency by introducing market instruments that do not negatively affect the unitarian character of the financing. The piece concludes that it is necessary to increase coverage; improve management; be concerned about the design of the public-private makeup; identify the responsibilities of the private sector and of the government in financing, provision, and regulation of social security systems; and introduce and strengthen unity mechanisms in financing.

摘要

在拉丁美洲和加勒比地区国家,社会保障体系传统上几乎完全由公共部门负责。这些体系存在重大缺陷,如覆盖率低、预算失衡、资金不足以及资源管理不善。为了解决这些问题并应对与人口和流行病学转变相关的需求增加,20世纪90年代一些国家开始改革其社会保障体系。这些改革具有三个基本特征:a)寻求缴费与福利之间更紧密的联系,以更好地平衡收支;b)改变体系的公私构成,使私营部门在服务融资和提供方面发挥更大作用;c)强调市场机制是提高资源配置效率的一种方式,让国家作为监管者以及为因社会经济状况无法缴纳某些最低费用的群体提供基本福利的担保人。本文探讨了迄今为止改革引发的一些问题以及从中可以吸取的教训。文章还分析了全民覆盖与社会团结之间的关系。此外,文章指出社会保障改革的主要挑战是朝着大幅扩大覆盖范围的全民体系迈进。为了实现这一目标,有必要加强融资中的凝聚机制,并通过引入不会对融资的统一性质产生负面影响的市场手段来提高效率。文章得出结论,有必要增加覆盖范围;改善管理;关注公私构成的设计;明确私营部门和政府在社会保障体系融资、提供和监管方面的责任;并引入和加强融资中的统一机制。

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