Social security through the prism of economic analysis of law: a comparative interdisciplinary study of the countries of the european south

It is well known that social security is one of the most important social rights in a welfare state. The main purpose of the institution of social security is to cover and protect employees from insurance risks, which lead to income reduction or an increase in costs. The Economic Analysis of Law (EAL), which is a dynamic collaboration between Economics and Law, plays an important role in the institution of social security. The EAL assesses the rules of law as to whether they have achieved the objective set by the legislator and to what extent, while it and can also propose improvements to the existing rules of law (by revising or repealing them), or suggest a new interpretation of the existing ones that leads to economic efficiency. The EAL´s contribution to social security is considered particularly useful and is divided into two main axes: economic efficiency and redistributive justice. These are two concepts that are opposite to one other and have different orientations. The Greek social security system, from the first years of its implementation, has been economically inefficient and at the same time socially unjust. In addition to the internal problematic factors, the social security system is called upon to also deal with external factors, such as unemployment and demographic aging, that threaten its viability. If the goal of social security is economic efficiency, the EAL can have a crucial contribution in investigating the incentives, benefits, costs, and consequences (willed or unwilled), which derive from the adoption of specific measures. In this dissertation, an attempt is made to evaluate the security laws during the last decade, specifically from the advent of the global financial crisis until today. Greece along with Italy, Spain, and Portugal, have been hit hard economically throughout this financial crisis, while they also had to deal with external factors such as unemployment and low birth rates, combined with rising life expectancy. Under these circumstances, a comparative approach to the pension systems of the countries of southern Europe is attempted, along with an evaluation of their effectiveness in light of the EAL. Have the adopted security arrangements in the aforementioned countries really been effective in achieving fiscal balance and reducing public debt? Considering the economic data of the four southern European countries, it was found that although the public expenditures were reduced -pensions in particular-, the coveted reduction of the public debt was not achieved; on the contrary, it increased, causing negative consequences both socially and economically. Finally, given that social security is influenced by many different factors, the configuration of sustainable social security system requires an interdisciplinary and multidisciplinary approach from a variety of scientific fields.Όπως είναι γνωστό, η κοινωνική ασφάλιση αποτελεί ένα από τα σημαντικότερα κοινωνικά δικαιώματα και αποτελεί έκφανση του κοινωνικού κράτους. Βασικός σκοπός του θεσμού της κοινωνικής ασφάλισης είναι η κάλυψη και η προστασία των εργαζομένων από την επέλευση των ασφαλιστικών κινδύνων, που επιφέρουν τη μείωση του εισοδήματος ή την αύξηση των δαπανών. Σημαντικό ρόλο στον εν λόγω θεσμό δύναται να παίξει η Οικονομική Ανάλυση του Δικαίου (ΟΑΔ), η οποία αποτελεί μια δυναμική συνεργασία μεταξύ των επιστημών της Οικονομίας και της Νομικής. Η ΟΑΔ αξιολογεί τους κανόνες δικαίου ως προς το εάν έχουν επιτύχει το στόχο που έχει θέσει ο νομοθέτης και σε ποιο βαθμό, ενώ επίσης δύναται να προτείνει βελτιώσεις στους υφιστάμενους κανόνες δικαίου (μέσω αναθεώρησης ή και κατάργησής τους) ή μια νέα ερμηνεία των υφιστάμενων με σκοπό την οικονομική αποτελεσματικότητα. Η συμβολή της ΟΑΔ στην κοινωνική ασφάλιση κρίνεται ιδιαίτερα χρήσιμη και διακλαδίζεται σε δύο βασικούς άξονες: την οικονομική αποτελεσματικότητα και την (ανα)διανεμητική δικαιοσύνη. Πρόκειται για δύο έννοιες αντίθετες μεταξύ τους και με διαφορετικό προσανατολισμό. Το ελληνικό ασφαλιστικό σύστημα ήδη από τα πρώτα χρόνια της εφαρμογής του υπήρξε οικονομικά αναποτελεσματικό και την ίδια στιγμή κοινωνικά άδικο. Πέρα όμως από τις εσωτερικές παθογένειες το κοινωνικοασφαλιστικό σύστημα καλείται να αντιμετωπίσει κι εξωγενείς παράγοντες που απειλούν τη βιωσιμότητά του, όπως η ανεργία και η δημογραφική γήρανση. Εφόσον στόχος της κοινωνικής ασφάλισης είναι η οικονομική αποτελεσματικότητα, η ΟΑΔ μπορεί να συμβάλει καταλυτικά ερευνώντας τα κίνητρα, τα οφέλη, τα κόστη και τις συνέπειες θελημένες/αθέλητες που προκύπτουν από την υιοθέτηση συγκεκριμένων μέτρων. Στην παρούσα διατριβή γίνεται μια προσπάθεια αξιολόγησης των ασφαλιστικών νόμων κατά την τελευταία δεκαετία και συγκεκριμένα από την έλευση της παγκόσμιας οικονομικής κρίσης μέχρι και σήμερα. Η Ελλάδα μαζί με τις χώρες της Ιταλίας, της Ισπανίας και της Πορτογαλίας δέχθηκαν ισχυρό πλήγμα στις οικονομίες τους καθ’ όλη τη διάρκεια της οικονομικής κρίσης έχοντας όμως επιπλέον να αντιμετωπίσουν τους εξωγενείς παράγοντες της ανεργίας και της υπογεννητικότητας συνδυαστικά με το αυξημένο προσδόκιμο ζωής. Κάτω από αυτές τις συνθήκες, επιδιώκεται μια συγκριτική προσέγγιση των συνταξιοδοτικών συστημάτων των χωρών του ευρωπαϊκού νότου κι επιχειρείται η αξιολόγηση της αποτελεσματικότητάς τους υπό το πρίσμα της ΟΑΔ. Οι ασφαλιστικές ρυθμίσεις που υιοθετήθηκαν στις εν λόγω χώρες υπήρξαν πράγματι αποτελεσματικές ως προς την επίτευξη της δημοσιονομικής ισορροπίας και τη μείωση του δημόσιου χρέους; Λαμβάνοντας υπόψη οικονομικά δεδομένα και στοιχεία των τεσσάρων νοτιοευρωπαϊκών κρατών διαπιστώθηκε ότι αν και μειώθηκαν οι δημόσιες δαπάνες και συγκεκριμένα οι συνταξιοδοτικές, δεν επιτεύχθηκε η πολυπόθητη μείωση του δημόσιου χρέους· αντίθετα, αυξήθηκε, προκαλώντας αρνητικές συνέπειες τόσο σε κοινωνικό όσο και σε οικονομικό επίπεδο. Τέλος, και δεδομένου ότι η κοινωνική ασφάλιση επηρεάζεται από πολλούς διαφορετικούς παράγοντες, η διαμόρφωση βιώσιμων συστημάτων κοινωνικής ασφάλισης απαιτεί μια διεπιστημονική και πολυεδρική προσέγγιση από ποικίλα επιστημονικά πεδία

Dietary patterns and survival of older Europeans: the EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition)

Objective: To investigate the association of a posteriori dietary patterns with overall survival of older Europeans. Design and setting: This is a multi-centre cohort study. Cox regression analysis was used to investigate the association of the prevailing, a posteriori-derived, plant-based dietary pattern with all-cause mortality in a population of subjects who were 60 years or older at recruitment to the European Prospective Investigation into Cancer and Nutrition (EPIC-Elderly cohort). Analyses controlled for all known potential risk factors. Subjects: in total, 74 607 men and women, 60 years or older at enrolment and without previous coronary heart disease, stroke or cancer, with complete information about dietary intakes and potentially confounding variables, and with known survival status as of December 2003, were included in the analysis. Results: An increase in the score which measures the adherence to the plant-based diet was associated with a lower overall mortality, a one standard deviation increment corresponding to a statistically significant reduction of 14% (95% confidence interval 5-23%). In country-specific analyses the apparent association was stronger in Greece, Spain, Denmark and The Netherlands, and absent in the UK and Germany. Conclusions: Greater adherence to the plant-based diet that was defined a posteriori in this population of European elders is associated with lower all-cause mortality. This dietary score is moderately positively correlated with the Modified Mediterranean Diet Score that has been constructed a priori and was also shown to be beneficial for the Survival of the same EPIC-Elderly cohort

Point-prevalence survey of healthcare facility-onset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study.

The correlation of Clostridium difficile infection (CDI) with in-hospital morbidity is important in hospital settings where broad-spectrum antimicrobial agents are routinely used, such as in Greece. The C. DEFINE study aimed to assess point-prevalence of CDI in Greece during two study periods in 2013.There were two study periods consisting of a single day in March and another in October 2013. Stool samples from all patients hospitalized outside the ICU aged ≥18 years old with diarrhea on each day in 21 and 25 hospitals, respectively, were tested for CDI. Samples were tested for the presence of glutamate dehydrogenase antigen (GDH) and toxins A/B of C. difficile; samples positive for GDH and negative for toxins were further tested by culture and PCR for the presence of toxin genes. An analysis was performed to identify potential risk factors for CDI among patients with diarrhea.5,536 and 6,523 patients were screened during the first and second study periods, respectively. The respective point-prevalence of CDI in all patients was 5.6 and 3.9 per 10,000 patient bed-days whereas the proportion of CDI among patients with diarrhea was 17% and 14.3%. Logistic regression analysis revealed that solid tumor malignancy [odds ratio (OR) 2.69, 95% confidence interval (CI): 1.18-6.15, p = 0.019] and antimicrobial administration (OR 3.61, 95% CI: 1.03-12.76, p = 0.045) were independent risk factors for CDI development. Charlson's Comorbidity Index (CCI) >6 was also found as a risk factor of marginal statistical significance (OR 2.24, 95% CI: 0.98-5.10). Median time to CDI from hospital admission was shorter with the presence of solid tumor malignancy (3 vs 5 days; p = 0.002) and of CCI >6 (4 vs 6 days, p = 0.009).The point-prevalence of CDI in Greek hospitals was consistent among cases of diarrhea over a 6-month period. Major risk factors were antimicrobial use, solid tumor malignancy and a CCI score >6

Point-prevalence survey of healthcare facility-onset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study.

The correlation of Clostridium difficile infection (CDI) with in-hospital morbidity is important in hospital settings where broad-spectrum antimicrobial agents are routinely used, such as in Greece. The C. DEFINE study aimed to assess point-prevalence of CDI in Greece during two study periods in 2013.There were two study periods consisting of a single day in March and another in October 2013. Stool samples from all patients hospitalized outside the ICU aged ≥18 years old with diarrhea on each day in 21 and 25 hospitals, respectively, were tested for CDI. Samples were tested for the presence of glutamate dehydrogenase antigen (GDH) and toxins A/B of C. difficile; samples positive for GDH and negative for toxins were further tested by culture and PCR for the presence of toxin genes. An analysis was performed to identify potential risk factors for CDI among patients with diarrhea.5,536 and 6,523 patients were screened during the first and second study periods, respectively. The respective point-prevalence of CDI in all patients was 5.6 and 3.9 per 10,000 patient bed-days whereas the proportion of CDI among patients with diarrhea was 17% and 14.3%. Logistic regression analysis revealed that solid tumor malignancy [odds ratio (OR) 2.69, 95% confidence interval (CI): 1.18-6.15, p = 0.019] and antimicrobial administration (OR 3.61, 95% CI: 1.03-12.76, p = 0.045) were independent risk factors for CDI development. Charlson's Comorbidity Index (CCI) >6 was also found as a risk factor of marginal statistical significance (OR 2.24, 95% CI: 0.98-5.10). Median time to CDI from hospital admission was shorter with the presence of solid tumor malignancy (3 vs 5 days; p = 0.002) and of CCI >6 (4 vs 6 days, p = 0.009).The point-prevalence of CDI in Greek hospitals was consistent among cases of diarrhea over a 6-month period. Major risk factors were antimicrobial use, solid tumor malignancy and a CCI score >6

Impact of solid tumor malignancy and Charlson’s Comorbidity Index score more than 6 on the time until development of CDI.

<p>Impact of solid tumor malignancy and Charlson’s Comorbidity Index score more than 6 on the time until development of CDI.</p

Cox regression analysis of variables associated with time until development of CDI.

<p>Cox regression analysis of variables associated with time until development of CDI.</p

Comparative characteristics of patients with diarrhea with and without <i>Clostridium difficile</i> infection (CDI).

<p>Comparative characteristics of patients with diarrhea with and without <i>Clostridium difficile</i> infection (CDI).</p

Logistic regression analysis of risk factors related to <i>Clostridium difficile</i> infection among patients with diarrhea.

<p>Logistic regression analysis of risk factors related to <i>Clostridium difficile</i> infection among patients with diarrhea.</p

Study flow chart for each study period.

<p>CDI: <i>Clostridium difficile</i> infection</p