Banking competition and welfare

We develop a simple general equilibrium model in which investment in a risky technology is subject to moral hazard and banks can extract market power rents. We show that more bank competition results in lower economy-wide risk, higher social welfare, lower bank capital ratios, more efficient production plans and Pareto-ranked real allocations. Perfect competition supports a second best allocation and optimal levels of bank risk and capitalization. These results are at variance with those obtained by a large literature that has studied a similar environment in partial equilibrium, they are empirically relevant, and carry significant implications for policy guidance

La sostenibilidad del Sistema Nacional de Salud en España The sustainability of the Spanish National Health System

El Sistema Nacional de Salud (SNS) español presenta problemas de sostenibilidad derivados de deficiencias en su diseño institucional y de gobierno, agravadas por la crisis económica que padece. La crisis económica mundial ha tenido una repercusión especialmente virulenta en España, caracterizada por altos niveles de desempleo y de deuda pública y privada. Las políticas de ajuste fiscal emprendidas pueden deteriorar el SNS significativamente. Junto a problemas de financiación general, la fuerte descentralización territorial de competencias sanitarias en las Comunidades Autónomas no ha sido acompañada de un marco eficaz de coordinación sanitaria a nivel de Estado. El SNS adolece de problemas en sus reglas de gobierno, su sistema de financiación autonómica, las políticas de recursos humanos y la diversidad de formas de gestión directa e indirecta que funcionan en las distintas Comunidades Autónomas. Una estrategia de reformas en el gobierno de la sanidad española debe articularse en el marco de una revisión más amplia de las políticas públicas que permita estabilizar las líneas de defensa del Estado del Bienestar. En el ámbito del sector sanitario se debe mejorar su sistema de financiación y desarrollar cambios institucionales para aumentar la eficiencia.<br>The Spanish National Health System (SNHS) has sustainability problems resulting from weaknesses in institutional design and governance compounded by the economic crisis it faces. The global economic crisis has had a particularly virulent impact in Spain, characterized by high levels of unemployment and public and private debt. Fiscal adjustment policies implemented may significantly compromise the SNHS. Along with general funding problems, the strong territorial decentralization of health jurisdictions in the Autonomous Communities has not been backed up by efficient State-level health coordination. The SNHS suffers from problems in its rules of governance, its autonomous financing system, human resource policies and diversity of direct and indirect management models in different Autonomous Communities. A reform strategy in Spanish healthcare governancemust be articulated within the context of a broader review of public policies to stabilize the lines of defense of the welfare state. Within the scope of the health sector, the financing system must be improved and institutional changes to increase efficiency must be implemented

La industria farmacéutica y la sostenibilidad de los sistemas de salud en países desarrollados y América Latina The pharmaceutical industry and the sustainability of healthcare systems in developed countries and in Latin America

La crisis económica y su impacto en las finanzas públicas en la mayoría de los países desarrollados, están originando políticas de contención del gasto en los servicios de salud. Las leyes actuales del medicamento exigen calidad, seguridad y eficacia de estos productos. Algunos países incluyen criterios de eficiencia para los nuevos medicamentos que desean ser incluidos en la financiación pública. El consumo apropiado de genéricos y "medicamentos biosimilares" es muy importante para mantener el equilibrio financiero de los servicios de salud. El problema en América Latina es que no todos los productos multifuentes son bioequivalentes y no todos los países tienen los recursos necesarios para realizar los estudios de bioequivalencia in vivo. La Agencia Europea del Medicamento en 2005 aprobó la directriz sobre "medicamentos biosimilares" y después se han autorizado trece de ellos para su comercialización. El referenciamiento de este modelo por otros países seria importante. La influencia de la industria farmacéutica sobre las áreas políticas y administrativas es necesario controlarla. Las compañías farmacéuticas afirman que actúan con responsabilidad social corporativa, por ello, se debería garantizar el cumplimiento de la misma con la sociedad.<br>The global economic crisis and its impact on public finances in most developed countries are giving rise to cost-containment policies in healthcare systems. Prevailing legislation on medication requires the safety, quality, and efficacy of these products. A few countries include efficiency criteria, primarily for new medication that they wish to include in public financing. The appropriate use of generic and "biosimilar medication" is very important for maintaining the financial equilibrium of the Health Services. The problem in Latin America is that not all multisource products are bioequivalent and not all countries have the resources to conduct bioequivalence studies in vivo. The European Medicines Agency in 2005 adopted guidelines on "biosimilar medicines" and thirteen of them were subsequently approved for general release. Benchmarking of this model by other countries would be important. The influence of the pharmaceutical industry on political and administrative areas is enormous and control is necessary. The pharmaceutical companies claim that they act with corporate social responsibility, therefore, they must ensure this responsibility toward society

Sistema de Informação em Saúde do Trabalhador: desafios e perspectivas para o SUS Occupational Health Information System: challenges and perspectives in the Brazilian Unified Health System (SUS)

O presente artigo identifica e discute alguns desafios e perspectivas relativos à implantação de um Sistema de Informações em Saúde do Trabalhador (SIST) no âmbito do Sistema Único de Saúde (SUS). Os desafios para a coleta, produção e a análise de dados e a disseminação continuada de informações sobre o estado de saúde dos trabalhadores e seus determinantes são revisados. Há destaque para a necessidade de investimentos em capacitação de recursos humanos, articulação e harmonização das bases de dados de interesse à saúde do trabalhador, implantação de infra-estrutura de informática nos níveis locais e da coleta das informações na rede de serviços do SUS, e integração e articulação interministerial. A realização da 3ª Conferência Nacional de Saúde do Trabalhador e a recém aprovada Política Nacional de Segurança e Saúde do Trabalhador representam reforços importantes para o debate sobre a implantação do SIST e sua prioridade na agenda do SUS. A relativa sintonia entre as agendas de técnicos, pesquisadores, trabalhadores e lideranças sindicais na defesa comum de um sistema de informações também é vista como um apoio à implantação do SIST e seu efetivo controle social.<br>This paper presents a review of challenges and perspectives regarding the development of an occupational health information system in the Brazilian Unified Health System (SUS). It stress the need to set up a process of continuous data collection, processing, analyzing and communication of information on worker’s health and its determinants, emphasizing occupational risks. The paper also address the need to support the training of health workers. It is also recommended to take into consideration the feasibility of database standardization that allows linkage and, improvement in the information technologies utilized in health services, especially in community health centers, following a coordinated state action. Both, the 3rd National Conference on the Worker’s Health, and the federal policy on worker’s safety and health have been promoting a debate on the occupational health information system and the need to give priority in the SUS national planning. The proximity of the academic and labor union agendas are pointed as a relevant support to an occupational health information system, that need to be able to strengthen health promotion and prevention and an effective social participation in the SUS management organization