哥伦比亚的职业病、工伤事故和缺乏社会保障。

School of Nursing, Pontificia Universidad Javeriana, Bogotá, Colombia.

Department of Anthropology and Human Rights Institute, University of Connecticut, United States.

Soc Sci Med. 2017 Aug;187:118-125. doi: 10.1016/j.socscimed.2017.06.030. Epub 2017 Jun 23.

The impacts of neoliberal or market-based social security reforms in health have been extensively studied. How such reforms transformed employment-related insurance and entitlements, however, has received significantly less attention. This study aims to understand how the employment insurance system operates in Colombia and to assess how the experience of workers seeking social security entitlements relates to the system's structure. We conducted an ethnographic study of the Colombian Occupational Risk System between May 2014 and March 2016, with two main components: 1) analysis of the system itself through in-depth interviews with 32 people working in leadership positions and a systematic review of the system's most important legislation, and 2) a study of people who experienced problems receiving entitlements and were challenging the assessment of their work-related illness or accident. We conducted in-depth interviews with 22 people, followed up with half of them, and reviewed their case files. We found that difficulties accessing health care services, payments for medical leave, job reassignments, severance packages, and filing for pension benefits were common to all cases and resulted from overwhelming bureaucratic and administrative demands. Regional and national evaluation bodies dictate whether a given illness or accident is work-related, and establish a percentage of Loss of Wage Earning Capacity (LWEC). People's disabled bodies rarely reached the threshold of 50% LWEC to qualify for disability pensions. The lengthy process that workers were forced to endure to obtain work-related entitlements always involved the judiciary. The three competing for-profit financial sectors (health insurance, pension funds, and Occupational Risk Administrators) actively challenged workers' demands in order to increase their profits. We conclude that these for-profit sectors work contrary to the principles that sustain social security. Indeed, they push sick and disabled workers to unemployment, informality, economic dependence, and ultimately dire poverty.

新自由主义或基于市场的社会保障改革对卫生的影响已得到广泛研究。然而，这种改革如何改变与就业有关的保险和权益，却受到了较少关注。本研究旨在了解哥伦比亚的就业保险制度如何运作，并评估寻求社会保障权益的工人的经验与该制度结构的关系。我们于 2014 年 5 月至 2016 年 3 月期间对哥伦比亚职业风险系统进行了民族志研究，主要有两个组成部分：1）通过对 32 名处于领导地位的人进行深入访谈以及对该系统最重要的立法进行系统审查，对该系统本身进行分析；2）研究经历领取权益困难并对其与工作相关的疾病或事故的评估提出质疑的人。我们对 22 人进行了深入访谈，其中一半人进行了跟进，并审查了他们的病例档案。我们发现，所有人都普遍面临着获得医疗服务、支付病假工资、工作调动、离职补偿和申请养老金等方面的困难，这是由于繁琐的官僚和行政要求所致。地区和国家评估机构决定某一疾病或事故是否与工作有关，并确定丧失劳动能力的百分比（Loss of Wage Earning Capacity，LWEC）。人们残疾的身体很少达到 50%的 LWEC 门槛，从而有资格领取残疾抚恤金。工人为获得与工作有关的权益而被迫忍受的漫长过程总是涉及司法机构。三个盈利性金融部门（健康保险、养老基金和职业风险管理者）积极挑战工人的要求，以增加其利润。我们的结论是，这些盈利性部门违背了维持社会保障的原则。实际上，它们迫使患病和残疾工人失业、从事非正规经济活动、经济上依赖他人，并最终陷入赤贫。