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One of the biggest problems of Nepal has remained overwhelming poverty among the rural populace. At the moment, more than 25 percent of the population is compelled to live their life without basic necessities of life. As the predominant population lives in rural areas and depends on agriculture for their living, poverty in Nepal has been considered as rural phenomenon. In the past, the Nepalese government tried to address the poverty problem basically through supply-led credit interventions. However, they could not bring the desired result because of their limited focus on "credit alone" without emphasis on other support services. By considering past failure, with the support of donors, the Nepalese government started implementing Microenterprise Development Program (MEDEP) in 1998 in 10 districts(at the moment running in 36 districts) by focusing on women, economically and socially deprived communities, and hard core poor integrating components related to social mobilization for enterprise development, entrepreneurship training, technical skills development, access to finance, appropriate technology testing and transfer, and marketing linkages and business counseling . Because of meager economic base of the poor, microcredit is very important for them to start up a microenterprise. In that sense the microfinance component of MEDEP is the most important component while talking about reduction in poverty through microenterprise development in Nepal. Against this backdrop, we have assessed the effectiveness of microcredit provided to MEDEP entrepreneurs in the Sindhupalchowok district in eastern Nepal during 2005-2008 by various financial institutions by using propensity score matching methodology. Secondary data (2005-2008) that was made available to Seoul National University (SNU) by the Microenterprise Development Program (MEDEP) has been used for the purpose of this research. In addition, qualitative (exploratory) research methodology has also been used by interviewing 38 MEDEP microentrepreneurs in order to supplement information need to better explain the results received through PSM estimation. The major objective of the research is to assess the effect of microcredit support in enterprise development for poverty reduction among MEDEP microentrepreneurs. In this regard, efforts have been made to assess the effect of microcredit on sales, cost and profit of entrepreneurs in their entrepreneurial activities. Moreover, the effect of microcredit on the enterprise and the entrepreneur levels has also been assessed as per the research framework proposed. The effect has been measured in two time line scenarios "After one Year" and "After two years". In the first scenario, sales, costs and profit are statistically significant. However, the effect on profit is found to be negative implying that immediately after the establishment of any enterprise making profit is not that easy in the pretext that the entrepreneurs need more time to arrange raw materials, establish linkages with processors and traders, and to arrange necessary sales outlets. Even if the average effect of treatment on the treated (ATT) for profit is negative, the value of profit for the treated group is positive conveying the message that treated groups also had profit but it was less in comparison to untreated groups. In the next scenario, effect "after two years", the microcredit effect on sales and cost are statistically insignificant, whereas such effect on profit are statistically significant. Besides, there is a fluctuation in cost and sales values for treated group in two different scenarios. According to AsDB (1997) fluctuations in the performance of microenterprises in short span of time is possible in developing countries as a micro entrepreneur may have many part time or seasonal activities undertaken to support family income apart from the specific enterprise he is running at the moment. Net earnings in this kind of microenterprises are used for survival purposes meaning that they have short term impact on poverty thorough self-employment with larger number of direct beneficiaries. Livelihood microenterprises show lots of fluctuation in their schedule and volume of production (ibid). ATT derived is the average value of the estimated additional effects of each microcredit borrowing entrepreneur. All the microcredit borrowing entrepreneurs, however, have their own additional effects, which is the effect of microcredit after controlling for selection bias. In this context, we have performed econometrical analysis on the effect of different characteristics/explanatory variables with a data set of microcredit borrowing entrepreneurs using these additional effects as dependent variables. While doing so, rural dummy, savings, Hindu dummy, Dalit Dummy, PCI before MEDEP were found to be significant. However, the contribution of saving is significant and coefficients are positive in both scenarios showing the vital role saving was playing to make credit effective in the effort of poverty alleviation. Statistically significant but positive values of per capita income before MEDEP intervention in case of cost and profit have shown that the real poor were not contributing in microcredit effect on cost and profit. It raises a question whether MEDEP had really succeeded to bring hard core poor people in its ambit as lower level of profit might not encourage them to borrow microcredit and run microenterprise. Even though microentrepreneurs had not been able to generate employment to outsiders they had managed to create work for themselves. It is positive aspect while dealing with poverty because those who were making the agriculture sector overburdened, had been diverted away to the microenterprise sector. Among the major targeted beneficiaries of MEDEP, the women's contribution to generate positive effect of microcredit is not proved except in the case of sales and cost in the "after two years" and "after one year" scenarios. Dalits, however, were doing well in the long run contributing to generate profit. Indigenous microentrepreneurs, though a major focus of the program, are statistically insignificant showing that their role needed to be increased in the whole MEDEP process and basically in borrowing microcredit. On the whole, we have concluded in our research that microcredit had positive effect on the enterprise level in terms of income generation, employment creation and savings and positive but mixed results on the entrepreneur level in terms of enhanced self-esteem, control over resources and community participation. This conclusion has been supported by the findings of the qualitative research (interview) as well. However, the MEDEP has been suffering from number of problems for years, especially from the perspective of institutional development for the sustainability of the program and from the perspective of delivery of microcredit and other support services in rural areas. We believe that microcredit would have done much better, if those problems had been sorted out. Considering the scope of this research, we are not able to ascertain with conformity whether microcredit had contributed to poverty reduction among MEDEP entrepreneurs of Sindhupalchowok district. However, we expect that microcredit might have contributed to some extent in the effort of poverty reduction through MEDEP in the district. The extent, depth and magnitude of such reduction need to be confirmed through in-depth research with comprehensive data on economic and non-economic dimensions of the household, microentrepreneurs and microenterprises. Nevertheless, we recommend the Nepalese government (Ministry of Industry) and United Nations Development Program (UNDP) to expand the coverage of MEDEP nationwide by addressing challenges it has been facing. ; Doctor

�쓽�븰怨�/諛뺤궗 ; [�븳湲�] [�쁺臾�] Korea has suffered much during the past twenty-five years. The country was divided at the 38th parallel, then fighting with the army of the north broke out in 1950 and lasted 3 years. During this period about 80 per cent of industrial plants was destroyed. Several millions of refugees from north of the 38th parallel settled in South Korea. All these factors had an unfavourable effect upon the economic condition of the country which has always been poor. This is especially serious in rural area. One particular area, Kaejong Myon, suffered equally with the rest of the country but was fortunate on having a fairly large dispensary where 40 per cent of the poor received free medical care for ten years 1935-1945. In 1049, 150 beds hospital was added. As there are as yet no vital statistics in Korea-birth, infant and adult mortality rates can not be compared with other countries. Country people do not report births until the child has lived a few years and ultimate survival seems likely. Therefore neither the birth or death of those who die early is recorded. Also since "herb" doctors are permitted to sign death certificates, the cause of death reported is not likely to correspond to the WHO list of causes of death. The present investigation has been made to obtain more accurate data on the infant and child mortality in Kaejong Myon, Okku-Gun, Cholla-Pukdo, based on a house-to-house survey carried out at the end of December, 1953 and in January, 1958 in order to compare the data collected before with that after the public health work was completed. The content of this investigation include birth, death and infant mortality rates, also the cause of the infant and child deaths, the method of infant feeding, weaning period, and the kind of treatment before death. The results have been ananlized and discussed from the point of view of public health, rural economics, present customs, and the environment, then compared with that of other conturies. The failure to provide adequate care for the rural population is discussed and methods for improvement suggested. We believe that the result gives a true picture of the health problem of the whole Korean rural area even though based on the smallest administrative unit in Korea namely the Myon. The results are as follows : 1) Birth rate : During the war there was a slight fall and marked rise is noticed in the birth rate a few years after the war, when there was a big mobilization of young men ; the birth rate remained fairly high with no apparent change and was maintained at an above average 35. The birth rate of Kaejong-Myon in 1957 was 43.5. The birth rate remained same for both surveys. 2) Mortality rate : The mortality rate was fairly high and remained so without apparent change for the ten years preceding the first survey done in 1953 when it averaged about 16.1 per 1,000 live births. In contrast, it averaged 9.0 for the two years from 1956 to 1957, after the public health activities in Kaejong-Myon had been instituted. Since the birth rate remained high and the mortality rate was much reduced, we find an unusually high increase in population. 3) Fetal death rate : The fetal death rate, when it includes 12-40 weeks gestational period, was high and remained above 85 without showing any apparent difference preceding or after the public health work. However, it was 126.1 in 1944 and 113.1 in 1951, in which years there was a military conflict, and this gives us the impression that the fetal death rate may be increased during war time. The data death rate if it includes more than 28 weeks gestational period, was around 20 in the Myon, which is similar to that of advanced European countries. The majority of the fetal deaths occured at the fetal age of 3 to 4 months. 4) Infant mortality rate : When we observe the infant mortality rate for the five years from 1944 to 1948 was 171.4, from 1949 to 1953 was 98.6, and 61.4 for the two years from 1956 to 1957 after the public health services were provided. 5) Neonatal deaths : The neonatal deaths accounted for 39.9 per cent of the total infant deaths for the 30 years from 1924 to 1953 ; in contrast, neonatal deaths were 62.7 per cent of the total infant deaths for the two years from 1956 to 1957. This would indicate that neonatal deaths which can be attributed principally to biological factors has not been materially reduced, but that mortality during the latter part of infancy (1-11 months), which can be attributed mainly to environmental and social factors, is remarkably reduced. 6) Cause of infant death : Premature birth is still first in order, and neonatal tetanus is still an important cause of infant death even after the institution of a public health service. In contrast, smallpox, measles and whooping cough, which caused a high mortality before the first survey, has not been remarkably reduced following this public health activity. 7) Child mortality : there was an average child death every year of 32 for the 30 years from 1924 to 1953. In contrast, the number of child deaths every year was reduced to an average of 13 in 1956 and 1957 ; particularly, the number of deaths among the one-year-olds is markedly reduced. 8) Cause of death in childhood : The majority of deaths in children 1 to 4 years of age in the Myon can most commonly be attributed to contagious disease or to diseases caused by microorganisms, diseases which could be largely prevented or controlled by timely adequate measures. The main causes of death in childhood are still pneumonia, measles and gastroenteritis. Measles which ranked first before the first survey, bacame third afterwards and smallpox, which previously ranked as an important cause of childhood death has completely disappeared. 9) In Kaejong-Myon 96.1 per cent of infants are breast fed. There is no definite weaning period in Korean rural areas. The infant usually remains on breast milk until the mother again becomes pregnant and the milk ceases to flow. The average weaning age found in the first study was 2 years and 3 months. 10)In an analyses the results according the type of treatment in Kaejong-Myon in 3 ten year periods 1924-1953 we find that death without treatment was given remain fairly constant at 50 per cent. The number of deaths of those receiving hospital treatment during the ten years from 1944 to 1953 was 21.6 per cent ; the number of those receiving "herb" treatment in the same period was 16.2 per cent. It would appear that expensive hospital care did less to reduce the overall infant mortality than less expensive simple public health measures. Similar public health activities carried out on a nation wide scale would do much to decrease the infant mortality so that it would approximate that in countries when the public health standards are much higher. ; restriction

This Systematic Country Diagnostic (SCD) aims to identify the major constraints on and opportunities for sustaining poverty reduction and shared prosperity in Serbia. The SCD serves as the analytic foundation on which the World Bank Group and the Government of Serbia will define a new Country Partnership Framework for FY2016 to FY2020. It is based on the best possible analysis, drawing on available evidence, and not limited to areas where the World Bank Group is currently engaged. The SCD is structured as follows: Chapter 2 presents the political and economic context. The economic context describes recent trends in growth, shared prosperity, and poverty reduction and briefly discusses factors behind them. Chapter 3 discusses pre-crisis patterns of growth and opportunities for future growth and inclusion in Serbia. Chapter 4 presents drivers of economic growth in Serbia and the principal constraints on growth and competitiveness. Chapter 5 discusses drivers of and constraints to economic inclusion. Chapter 6 outlines risks to sustainable shared prosperity and poverty reduction. Chapter 7 presents priorities for action.

This paper estimates slum residents willingness to pay for formalized land tenure in Pune, India. In so doing, it offers evidence that the legal assurance of slum residents occupancy of their lands could benefit them. Previous studies have discussed legal and non-legal factors that substantially influence the tenure security of residents in informal settlements. However, it remains unclear to what extent, and how, the assignment of legal property rights through the formalization of land tenure improves the tenure security of residents in informal settlements and living conditions, even in the presence of other legal and non-legal factors that also contribute to their tenure security. To address the question, this study focuses on the city of Pune, India, where government agencies have formalized slums by legally ensuring the occupancy of the residents under slum declaration. Applying a hedonic price model to an original household survey, this paper investigates how slum residents evaluate formalized land tenure. A spatial econometrics method is also applied to account for spatially autocorrelated unobserved errors. The spatial hedonic analysis finds that the premium of slum declaration is worth 19 percent of the average housing rent in slums. The associated marginal willingness to pay is equivalent to 6 percent of the average household expenditure, although it is heterogeneous depending on a households caste and other legal conditions. This finding suggests that the assurance of occupancy rights is a vital component of land-tenure formalization policy even if it does not directly provide full property rights.

La mondialisation, considérée comme un processus d'intégration internationale des ressources nationales sur les plans économique, culturel et démographique, exacerbe la concurrence entre les pays (OECD, 2005; Sahlberg, 2016). Cette concurrence amène d'ailleurs plusieurs d'entre elles à nouer des alliances stratégiques et à coopérer pour conserver ou améliorer leur positionnement dans ce marché globalisé (OECD, 2005). Pour faire face à cette concurrence mondialisée, un discours réclamant des réformes en profondeur en éducation s'est propagé à l'internationale par les représentants des organisations internationales durant les dernières décennies (Maroy, 2021). Ce discours s'inscrit dans ce que Sahlberg (2016) désigne de mouvement mondial de réforme de l'éducation (Global Education Reform Movement) influencé par ce que d'autres auteurs identifieront comme étant l'idéologie de la nouvelle gestion publique (Chappoz, 2012; Lane, 2000). La qualité des systèmes éducatifs représente pour ainsi dire le socle sur lequel repose l'avenir des pays. La formation continue des citoyens tout au long de la vie permet donc aux pays de s'adapter aux contingences de l'évolution permanente des connaissances et des compétences sur un marché du travail de plus en plus intégré (Brian, 2007). L'appel incessant des gouvernants et des organisations supranationales, comme l'Organisation de coopération et de développement économique (OCDE), à réformer les systèmes éducatifs de nombreux pays démocratiques est éloquent à cet égard (Charbonnier & Gouëdard, 2020; Maroy, 2021). La régulation des systèmes éducatifs par les résultats s'inscrit dans cette marche ascensionnelle de la mondialisation et des réformes en éducation. Cette régulation est marquée par une utilisation systématique des données chiffrées à des fins d'amélioration continue de la performance des systèmes éducatifs qui implique une amélioration du fonctionnement des centres de services scolaires (CSS) et des établissements scolaires (ÉS), notamment en matière de pratiques professionnelles, de taux de diplomation et de réduction des inégalités sociales (Maroy, 2013). Spécifiquement, on parle ici d'amélioration continue de l'enseignement et de l'apprentissage dont l'actualisation se réalise en définitive dans les ÉS. Aussi, l'on associe la régulation par les résultats à la promotion de l'autonomie des ÉS. Cette autonomie va de pair avec une augmentation de la responsabilisation des acteurs tels que les gestionnaires des CSS, les directions d'établissement (DÉ) et les enseignants. Cette autonomie va également de pair avec l'obligation de rendre des comptes typiquement aux parents, aux CSS et au ministère de l'Éducation quant aux résultats obtenus par rapport aux objectifs établis, aux indicateurs de performance fixés et aux moyens retenus pour les atteindre (Maroy, 2021). Dans ce contexte, la prise de décision appuyée sur les données en éducation représente dès lors un champ de recherche pertinent pour répondre au besoin d'amélioration continue de l'enseignement et de l'apprentissage à l'échelle des ÉS, des CSS et du système éducatif. Cette recherche doctorale s'inscrit dans cette quête d'amélioration continue de l'enseignement et de l'apprentissage dans le cadre du fonctionnement des équipes-écoles en communautés d'apprentissage professionnelles. La difficulté pour celles-ci d'utiliser les données accessibles ou produites dans les établissements scolaires (ÉS), particulièrement en ce qui concerne leur analyse (Bouchamma et al., 2019), dissimule en réalité des limites quant aux compétences professionnelles des acteurs locaux et à la capacité des outils technologiques existant à valoriser les données de sources et de types multiples (données quantitatives et qualitatives). Une communauté d'apprentissage professionnelle (CAP) d'une école secondaire de la région de la Chaudière-Appalaches s'est engagée à répondre à cette difficulté en implantant et en expérimentant un processus de la prise de décision pédagogique appuyé sur les données locales de sources multiples (PDPADLSM), à savoir sur les données qui sont accessibles ou produites dans les ÉS. Quatre enseignants¹ et un praticien-chercheur ont participé à cette recherche sur une base volontaire. Cette recherche appliquée repose sur un devis de type qualitatif qui se présente sous la forme d'une recherche-action suivant une perspective pragmatique et fonctionnaliste (Van der Maren, 2014). Dans la pratique, cette recherche vise l'amélioration du fonctionnement des ÉS et plus spécifiquement des CAP. Le corpus rassemble des données qualitatives provenant d'un questionnaire, d'entrevues semi-structurées, de comptes-rendus analytiques, d'extraits du journal de bord du praticien-chercheur et de la correspondance électronique entretenue entre les enseignants et le praticien-chercheur. L'analyse en mode écriture (Paillé & Mucchielli, 2016a) et thématique (Paillé & Mucchielli, 2016b) ainsi que la modélisation systémique (Buckley & Waring, 2013; Gendron & Richard, 2015) constituent les dispositifs de traitement des données. En guise d'amorce, le praticien-chercheur a effectué une analyse de sa pratique professionnelle relative à la PDPADLSM qui s'inscrit dans un enjeu ontogénique, soit le perfectionnement du praticien-chercheur à titre d'acteur central de la pratique (Van der Maren, 2014). Cette recherche se base sur les concepts de PDPADLSM et de CAP. Nous convoquons en sus la théorie C-K de la conception (Concept-Knowledge Theory) de Le Masson et al. (2018) et le modèle du changement social en milieu organisationnel de Lewin (1947). Les résultats de cette recherche révèlent que sept éléments participent à l'implantation du processus de la PDPADLSM : a) la mobilisation des acteurs autour d'un objectif commun ; b) l'acquisition d'un langage commun ; c) les compétences en relations interpersonnelles ; d) l'autoformation des participants ; e) la mise en œuvre différenciée ; f) le retour réflexif des acteurs ; g) le rapport paradoxal entretenu par les participants avec les outils technologiques. La démarche de conception innovante d'un outil d'aide à la décision pédagogique nous a permis de mettre au jour cinq catégories de connaissances associées à sa conception : a) le public cible ; b) les contextes dans lesquels il doit fonctionner ; c) la lourdeur de la tâche relative à la collecte et l'analyse des données ; d) les compétences requises pour concevoir et développer l'outil ; e) les ressources humaines nécessaires pour le réaliser. Le concept d'outil d'aide à la décision pédagogique renvoie à un outil qui collecte et analyse des données de sources et de types multiples (données quantitatives et qualitatives), offrant aux utilisateurs la possibilité d'interagir avec celui-ci pour répondre aux questions d'ordre descriptif (décrire une situation), diagnostique (expliquer la situation), prédictif (anticiper la situation) et prescriptif (recommander des actions). Enfin, dans sa dimension expérientielle, la recherche brosse un panorama d'un changement organisationnel planifié relatif à l'implantation du processus de la PDPADLSM et qui révèle que le gain en temps et en précision, en matière de collecte et d'analyse des données locales de sources multiples, améliore le fonctionnement des CAP et, ultimement, renforce la responsabilisation de leurs membres à l'égard de la réussite éducative de tous les élèves. ; Globalization, considered as a process of international integration of national resources on the economic, cultural and demographic levels, exacerbates competition between countries. This competition is leading many countries to form strategic alliances and cooperate to maintain or improve their position in this globalized market (OECD, 2005). In order to face this globalized competition, a discourse calling for in-depth reforms in education has been propagated internationally by representatives of international organizations over the last few decades (Maroy, 2021). This discourse is part of what (Sahlberg, 2016) refers to as the Global Education Reform Movement, influenced by what other authors have identified as the ideology of the New Public Management (Chappoz, 2012; Lane, 2000). The quality of education systems is, so to speak, the foundation on which the future of countries rests. Continuous lifelong learning of citizens thus allows countries to adapt to the contingencies of ever-changing knowledge and skills in an increasingly integrated labor market (Brian, 2007). The incessant call by governments and supranational organizations, such as the Organization for Economic Cooperation and Development (OECD), to reform the education systems of many democratic countries speaks volumes in this regard (Charbonnier & Gouëdard, 2020; Maroy, 2021). The regulation of education systems by results is part of this upward march of globalization and educational reforms. This regulation is marked by a systematic use of numerical data for the purpose of continuous improvement of the performance of education systems, which implies an improvement in the functioning of school service centres (SSCs) and schools, particularly in terms of professional practices, graduation rates and the reduction of social inequalities (Maroy, 2013). Specifically, we are talking about the continuous improvement of teaching and learning, which is ultimately achieved in the schools. Thus, regulation by results is associated with the promotion of autonomy in the schools. This autonomy goes hand in hand with an increase in the accountability of actors such as the CSS managers, the school principals (SP) and the teachers. This autonomy also goes hand in hand with the obligation to be accountable, typically to parents, CSSs and the Ministry of Education, for the results obtained in relation to the objectives set, the performance indicators set and the means used to achieve them (Maroy, 2021). In this context, data-based decision-making in education therefore represents a relevant field of research to address the need for continuous improvement of teaching and learning at the level of the schools, the SSCs and the education system. This doctoral research is part of this quest for continuous improvement of teaching and learning in the context of the operation of school teams in professional learning communities (PLCs). The difficulty for these teams to use the data accessible or produced in the schools, particularly with regard to their analysis (Bouchamma et al., 2019), actually conceals limitations with regard to the professional skills of local actors and the capacity of existing technological tools to make use of data from multi-source and types (quantitative and qualitative data). A PLC in a high school in the Chaudière-Appalaches region has committed to addressing this challenge by implementing and testing a pedagogical decision-making process using local multi-source data (PDMULMSD), i.e., on data that are accessible or produced in the schools. Four teachers and one practitioner-researcher participated in this research on a voluntary basis. This applied research is based on a qualitative design that takes the form of action research following a pragmatic and functionalist perspective (Van der Maren, 2014). In practice, this research aims to improve the functioning of schools and more specifically of PLCs. The corpus gathers qualitative data from a questionnaire, semi structured interviews, analytical accounts, excerpts from the practitioner-researcher's logbook, and electronic correspondence maintained between teachers and the practitioner researcher. Writing (Paillé & Mucchielli, 2016a) and thematic analysis (Paillé & Mucchielli, 2016b) as well as systemic modeling (Buckley & Waring, 2013; Gendron & Richard, 2015) constitute the data processing devices. As a primer, the practitioner-researcher conducted an analysis of his professional practice related to the PDMULMSD that is part of an ontogenic issue, the development of the practitioner-researcher as a central actor in practice (Van der Maren, 2014). This research is based on the concepts of PDMULMSD and PLC. We additionally convene Le Masson et al. (2018) Concept-Knowledge Theory (C-K) and Lewin's (1947) model of social change in organizational settings. The results of this research reveal that seven elements participate in the implementation of the PDMULMSD process: a) the mobilization of actors around a common objective; b) the acquisition of a common language; c) interpersonal skills; d) members' self training; e) differentiated implementation; f) the reflexive feedback of the actors; g) members' paradoxical relationship with technological tools. The innovative design process of a pedagogical decision support tool allowed us to identify five categories of knowledge associated with its design: a) the target audience; b) the contexts in which it must operate; c) the heaviness of the task related to data collection and analysis; d) the skills required to design and develop the tool; e) the human resources needed to implement it. The concept of an educational decision support tool refers to a tool that collects and analyzes data from multi-source and types (quantitative and qualitative data), offering users the possibility of interacting with it to answer questions of a descriptive (describing a situation), diagnostic (explaining the situation), predictive (anticipating the situation) and prescriptive (recommending actions) nature. Finally, in its experiential dimension, the research provides an overview of a planned organizational change related to the implementation of the PDMULMSD process and reveals that the gain in time and accuracy in collecting and analyzing local multi-source data improves the functioning of PLCs and ultimately strengthens the accountability of their members towards the educational success of all students.

Este trabajo examina las tendencias a largo plazo observadas en el nivel de vida de la población colombiana durante los últimos cien años, con especial atención en la salud. Construimos un índice histórico de desarrollo humano para Colombia (IHDHC) para los siglos XIX y XX por género. Encontramos que no hubo avances importantes en los niveles de vida durante el siglo XIX debido principalmente al estancamiento del PIB per cápita de Colombia. Por el contrario, se observaron avances significativos en todos los componentes del IHDHC en el siglo XX, especialmente los de las mujeres. Durante la primera mitad del siglo, las mejoras en la calidad de vida se debieron principalmente a un mayor ingreso per cápita, mientras que las mejoras posteriores a la década de 1950 se debieron a una mayor inversión pública, por ejemplo, en educación y salud. A continuación, analizamos los logros de salud, considerando que la salud es uno de los componentes del IHDHC que ha sido menos estudiado en la literatura de historia económica colombiana. Construimos un nuevo conjunto de datos utilizando estadísticas reportadas por el gobierno colombiano, que incluyeron información anual sobre las principales enfermedades y causas de mortalidad durante el período de 1916-2014 desagregadas por departamentos. Los datos muestran que el porcentaje de muertes por tuberculosis, neumonía y enfermedades gastrointestinales disminuyó significativamente a lo largo del siglo. Por el contrario, las muertes causadas por cáncer y enfermedades del corazón han aumentado considerablemente en las últimas décadas. Los resultados de los modelos de diferencia en diferencias muestran que la disminución en la tasa de mortalidad total y en la tasa de mortalidad por enfermedades transmitidas por el agua estuvo relacionada en gran medida con la expansión en la provisión de servicios de acueductos y alcantarillado. ; This paper examines the long-term trends observed in the standard of living of the Colombian population during the past one hundred years, with special attention on health. We construct a historical index of human development for Colombia (HIHDC) for the 19th and 20th centuries by gender. We find that there were no major advances in living standards during the nineteenth century due to the stagnation of Colombia's GDP per capita as a result of the lack of dynamism in exports. On the contrary, significant advances in all components of the HIHDC were seen in the twentieth century, especially those for women. During the first half of the century, improvements in the quality of life were mainly driven by a higher per capita income, while improvements after the 1950s were driven by greater public investment, for example, in education and health. Next, we analyze health achievements, considering health is one of the components of the HIHDC that has been less studied in the Colombian economic history literature. We construct a new dataset using statistics reported by the Colombian government, which included annual information on the main diseases and causes of mortality during the period of 1916-2014 disaggregated by territorial units. The data show that the percentage of deaths from tuberculosis, pneumonia, and gastrointestinal diseases decreased significantly throughout the century. On the contrary, deaths caused by cancer and heart diseases have increased considerably in recent decades. Results from difference-in-difference models show that the decline in the total mortality rate and in the mortality rate for waterborne diseases was largely related with the expansion in the provision of public goods, namely aqueducts and sewerage services.

학위논문 (박사) -- 서울대학교 대학원 : 사회과학대학 사회복지학과, 2020. 8. 홍백의. ; This study characterizes 15 countries' pension reform trajectories and statistically examines how these pension reform trajectories affect pension effort during the CRP (Compound Reform Period 1990-2015). This study defines pension reform are either contractionary and expansionary reforms; pension effort refers to both pension expenditure and pension generosity. Conventionally, studies have often examined how socio-influential factors (e.g. socio-economic, institutional, and political factors) affect pension effort. However, these discourses have heavily emphasized contractionary pension reforms and pension expenditure, but have overlooked expansionary pension reforms and pension generosity. This study argues that the traditional retrenchment-focused approach to pension policy research is rooted largely in inherited theories of the 'Welfare State Crisis' and macro-socio-economics, that are not reflective of the recent post-industrial policy shifts occurring in the world. In particular to pension policy, in response to the 20th century old and new social risks, traditional Bismarckian and Beveridgean countries have implemented a mix of contractionary and expansionary reforms. These reforms were designed to deal with pension financial sustainability and adequacy against old-age poverty. Consequently, two primary limitations of previous studies have become apparent. The austerity-oriented and macro view of pension effort using socio-influential factors overlooks an important building block within the dynamic pension reform process. In addition, existing quantitative and qualitative studies have centered around institutions that examine pension policies from a static perspective - overlooking pension policy dynamic changes. During the CRP, pension systems have experienced two interconnected components - retrenchment and expansionary reforms - that ultimately define pension effort. Accordingly, it is necessary to comprehensively investigate how these components of dynamic pension reform affect pension effort in the context of both pension expenditure and pension generosity. This study organized expansionary and retrenchment pension reforms using ten pension reform variables based on the work Häusermann (2010): insurance (e.g. parametric pension reforms), capitalization (e.g. DB to DC shifts), targeting (e.g. means-tested), and recalibration (e.g. pension credits). In order to evaluate how these pension reforms affected pension effort, this study utilized two analytical methods: unsupervised clustering characterizes pension reform trajectories, and an LMM (Mixed Effect Model) statistically evaluates their effectiveness with respect to pension expenditure and pension generosity. Pension reforms were categorized into four pension reform clusters: labor-activated pension (LAP) reforms, extended privatization pension (EPP) reforms, latecomer structural pension (LSP) reforms, and extensive retrenchment pension (ERP) reforms. The labor-activated pension reform (LAP) cluster is generally composed of advanced welfare states that experienced the highest unemployment rates and most pressing demographic changes prior to the CRP. However, their transition into the CRP has been met with significant GDP growth and high employment rates. At the same time, this cluster is facing the highest level of new social risks in regions like women's labor participation, employment in services, and economic openness. In response to both old and new social risks, most of the countries in this cluster made significant reforms meant to mitigate their effects. Various parametric pension reforms (e.g. increasing the retirement age, penalizing early retirement, etc.) encourage individuals near retirement to continue working or re-enter the workforce, thus increasing labor supply. In addition, targeting and recalibration reforms incentivize participation in the labor market by lowering pension eligibility requirements. The extended privatization pension reform (EPP) cluster is very similar in its Marco-socio-economic structure to the labor-activated pension reform (LAP) cluster, in that it is defined by developed nations that experienced drastic macro-socio-economic changes before the CRP. However, in the CRP this cluster has the highest levels of aged 65 years and older individuals, coupled with a moderately high economic growth. Growth compared to the labor activated pension reform cluster may be lower due to this aging. When a higher proportion of a total population is elderly, a larger proportion of economic expenses must be spent on retirement care. However, another additional feature of this cluster's socio-economics is lower birth rates. Some new social risks of interest that have had a particular effect on this cluster are increasing service sector employment rates and higher economic openness. However, pension reform strategies are vastly different from the labor-activated pension reform (LAP) reform strategies. This reform cluster shifts enrollment in occupational or individual pension programs from voluntary to mandatory and these programs then work in conjunction with existing public pension systems. However, in order to compensate disadvantaged groups and unpaid workers, various expansionary pension reforms were also implemented in tandem; for example, means-tested pension benefits, tax reductions or earnings-related subsidies to employers, employees or individuals. The latecomer structural pension reform cluster (LSP) is uniquely composed of countries that had transitioned from centrally planned economies to widespread market-based economies at the inception of their original pension programs. Their transition to market based-economies was not smooth and this was reflected in their relatively slow economic growth. Structural changes are not the only facet that describes the struggles these countries have had during the CRP; demographic issues have also played an outsized role in their economies. Not only had their relative population aged, but at the same time, there was a dramatic drop in their fertility rates. New social risks have been reflected in their rising proportion of service sector employment and the swift opening of their economies. This cluster turned to structural-based reforms as a countermeasure to the ballooning pension expenditures that ensued, because of these different macro-socio-economic hardships. In order to compensate disadvantaged groups and unpaid workers, various expansionary pension reforms were also implemented in tandem with contractionary reforms (ex. targeting reform), but recalibration reforms were not implemented. The extensive retrenchment pension reform cluster (ERP), is composed of countries that demographically aged the most, and experienced the greatest long-term economic hardships because of economic crises during the CRP. Another critical issue was the decline of birth rates in these countries. New social risks have also added stress to their economic hardships with increases in atypical workers, women's labor participation rates, and serious issues with low employment rates. Under these increasing new social risks and problematic pension structures, the extensive retrenchment pension (ERP) reform cluster retrenched inherited asymmetric pension systems through radical parametric reforms, then means-tested programs were additionally added to compensate low-income groups and impoverished elderly. Each pension reform clusters' socio-economic backgrounds provide insight into the underlying indicators that are correlated with their adoption of different pension reform policies. Using these pension reform clusters as independent variables, this study demonstrates that different pension reforms have diversified the existing architecture of pension effort. According to the Linear Mixed Effect Model (LMM) results, the labor-activated pension reform (LAP) cluster statistically reduced pension expenditure relative to the reference pension reform cluster (extensive retrenchment pension reform cluster). The extended privatization pension (EPP) reform cluster significantly reduced pension generosity relative to the reference pension reform cluster (extensive retrenchment pension reform cluster). While the labor-activated pension (LAP) reform cluster maintained the highest standard pension retirement age and most restrictions on early retirement, the extended privatization pension (EPP) reform cluster created a more direct link between pension benefits and an individual's pension contributions, by shifting to mandatory enrollment in occupational or individual pension programs. This study asserts that pension reforms are the key to understanding pension effort (pension expenditure and pension generosity), and that contractionary and expansionary pension reform policies should be studied together. In addition, existing comparative studies have often excluded East-Asian countries, in particular, China, Japan, and Korea. They should be included in comparative policy analysis that will allow researchers to determine if they are empirically different, and thus compensate or address those differences more effectively in future research. In comparative social policy research, from the new institutionalism perspective, policy classifications should consider the process of policy change, from a dynamic perspective rather than static characteristics. This study suggests that policymakers may need to be concerned about each pension reform's pros and cons in the context of pension expenditure and generosity when adopting a pension reform. In future pension reforms, policymakers need to explicitly design their policies around increasing new profiles who, if not considered more carefully, are at higher risk of poverty in this post-industrialized global economy. The most sensible means of doing this is if policymakers avoid reducing benefits for these groups when legislating future pension reforms. Take Korean pension reforms as an example. Korea adopted an extensive parametric pension (ERP) reforms that may prove to be an effective way of curbing costs, while means-tested incentives provide more generous benefits to the growing population of at-risk individuals. However, extensive retrenchment pension (ERP) reforms have a high risk of providing inadequate pension benefits to at-risk groups without seriously resolving issues with program expenditure. Since extensive retrenchment pension (ERP) reforms do not sufficiently meet the needs of the Korean pension system, the next step is to look at alternative clusters to resolve these issues. Extended privatization pension reforms (EPP) generally supplement pension benefits by adopting a market-based pension component. However, adopting a reform from this cluster will also likely result in stagnated pension coverage, deteriorated pension benefits, and increased gender and income inequality. Adoption of a latecomer structural pension reform (LSP) (e.g. NDC) is also not realistic, because there are a large number of atypical workers in Korea (e.g. self-employed, part-time workers) who are unable to shoulder considerable financial burdens (double payment issues). This study suggests that adopting a labor-activated pension reform (LAP) may be the most effective pension strategy to strengthen Korean public pension system security. This strategy takes into account new career profiles that were previously overlooked by the system; the goal of including these workers to the system would be to reduce the occurrence of old-age poverty. ; 本论文定量比较分析了15个国家在1990-2015 (compound reform period, CRP:1990-2015)综合改革期间的养老金改革轨迹,及其对养老金努力(pension effort)的影响。本文定义了养老金改革包括消减性改革(contractionary pension reform)和扩张性改革(expansionary pension reform),养老金努力(pension effort)包括养老金支出(pension expenditure)和养老金慷慨度(pension generosity)。受"福利国家危机论"的影响,现存的大部分相关学术主要分析了宏观社会・经济因素(包括经济,政治和制度因素)对养老金政策的影响。这些研究集中在研究养老金支出而忽视了对养老金慷慨度的分析. 宏观社会经济背景及制度的遗产(institutional legacy)或历史轨迹等对养老金努力(pension effort)影响效应息息相关,但是本研究认为基于宏观理论并限定于养老金支出的传统文献没有充分的的分析到后工业社会下(post-industrialization)的养老金改革轨迹和特征。尤其是从20世纪末,为了应对新旧社会风险(old and new social risks)的压力,综合型养老金改革(compound pension reform),即消减性改革(contractionary pension reform)和扩张性改革(expansionary pension reform)被纷纷采纳去同时解决养老金财政可持续性和抵御老年贫困的两个问题。本文认为传统文献在研究养老金政策的影响因素中存在两个主要局限性问题:第一,忽视了核心变量-养老金改革对老金支出(pension expenditure)和养老金慷慨度(pension generosity)的影响。第二,现有的定量和定性社会政策比较或聚类研究只从围绕静态角度(static perspective)的政策特征却忽视了政策的动态变化(policy dynamic change)。 本文以Häusermann (2010)的养老金改革理论为基础,分析了包括消减性改革(contractionary pension reform)和扩张性改革(expansionary pension reform)养老金改革的十个变量:保险参数(parametric reform参数改革),市场化(例如: 从DB 改革成 DC),目标化(targeting) (例如: 经济能力审查:means-tested), 再调整(recalibration) (例如:养老金补贴: pension credits)。为了从统计学上评估分析这些养老金改革对养老金努力(pension effort)对影响效应,本文采用了两种分析方法:K均值无监督聚类分析(clustering analysis)和线性混合效应模型(linear mixed effect model, LMM)。根据聚类分析(clustering analysis)结果,15国家在1990-2015期间的养老金改革可分为四个改革类型:劳动激励改革型(labor-activated pension reform, LAP), 扩展私有化改革型(extended privatization pension reform, EPP), 后发结构改革型(latecomer structural pension reform, LSP),和激进消减改革型(extensive retrenchment pension reform, ERP). 基于定量统计数据比较分析,线性混合效应模型(linear mixed effect model, LMM)分析结果发现不同的改革轨迹对养老金支出和养老金慷慨度影响不同。 劳动激励改革型(labor-activated pension reform, LAP)是由发达福利国家组成,这些国家在CRP(1990-2015)之前遭遇过经济衰退和前所未有的失业率增加和人口转变问题,但是在CRP(1990-2015)的过度期间实现了GDP和就业率的总体水平回升。相比于其他的改革类型,这些国家面临着最高水平的社会新风险(new social risks): 女性劳动就业和服务性就业者不断增加。为了应对新旧社会风险(old and new social risks)和减轻养老金财政压力,这些国家采取了大力度的养老金参数改革。主要包括参数改革(例如: 延后退休, 处罚提前退休等),鼓励接近退休等人继续工作或重新加入劳动市场。此外利用扩张性的目标化(targeting)和再调整(recalibration)改革鼓励人们参与劳动市场并通过养老金水平等。 扩展私有化改革型(extended privatization pension reform, EPP)的宏观社会经济结构背景和劳动激励改革型(labor-activated pension reform, LAP)比较相似,但是他们的养老金改革决策却大相径庭。在CRP前期,这些国家也是经历过宏观经济巨变的发达福利国家.低生育率和最高的老年人口比例,这个改革类型的国家面临养老金支出巨大失衡的压力。另外不规则就业者(atypical worker)和服务性就业者的比例不断上升也威胁着养老金政策的长期可持续性。扩展私有化改革型(extended privatization pension reform, EPP)的主要决策是通过强制性策略提高参加职业和商业养老保险并且采取相对应的公共养老金参数改革方案。扩张型改革(expansionary pension reform)主要是为了弥补弱势和底薪群体,例如,对雇主,雇员或个人就行减税并且给以适当的补贴,经济能力审查的(means-tested)养老金补贴改革也是尤为突出。 后发结构改革型(latecomer structural pension reform cluster, LSP)的国家在养老金改革初期经历了市场经济转型独特社会变化。特别是在市场经济转型初期经济增长还没有真正的崛起,养老金制度不仅面临经济转型的挑战,人口转变包括人口老龄化和生育率下降问题更是加剧了养老金制度的财政失衡。另外新社会风险(new social risks)和全球化更激化了服务性劳动者的增加。为了扩大政府财政来源和弥补养老金缺口,这些社会背景推动了这些国家以结构改革(structural pension reform)为主线。为弱势群体也提供一定的社会补助,例如,经济能力审查的(means-tested)养老金补贴,但是后发结构改革型(latecomer structural pension reform cluster, LSP)目前缺乏再调整(recalibration)的扩张型改革(expansionary pension reform)。 激进消减改革型(extensive retrenchment pension reform, ERP)在CRP初期临最严重的老龄化增长和经济危机带来的长期经济困难。人口转变(生育率急剧下降,老龄化进程加速)更是加剧了养老金的经济持续性问题。同时,这些国家更面临着由迅速的现代化进程所带来的挑战:服务性劳动者,女性劳动市场的参与与日俱增,就业率急剧下降等新社会风险(new social risks)。在这种社会背景下,激进消减改革型 (extensive retrenchment pension reform, ERP)采用了大幅度的参数改革(parametric pension reform)为消减现存的养老金财政问题。资格审核(means-tested)的社会救助被采用去补助低收入人群和老人的养老金收入。 本文把以上的四个改革类型作为自变量研究分析了各个改革类型对养老金努力(pension effort: pension expenditure, pension generosity)的影响效果。根据线性混合效应模型(linear mixed effect model, LMM)的分析结果,相对于激进消减改革型 (extensive retrenchment pension reform, ERP), 劳动激励改革型(labor-activated pension reform, LAP)有效的消减了养老金支出; 扩展私有化改革型(extended privatization pension reform, EPP)有效的得降低了养老金的慷慨度。相比之下,劳动激励改革型(labor-activated pension reform, LAP)维持了最高标准的养老金退休年龄和提前退休的最大限制,而扩展私有化改革型(extended privatization pension reform, EPP)则是通过强制参与职业和商业退休金制度加大紧缩养老金和缴费之间的直接关系。 理论层面,第一,本研究强调养老金改革变量是理解养老金努力(pension effort)的关键。第二,1990年以来的养老金改革应该同时考虑消减性改革(contractionary pension reform)和扩张性改革(expansionary pension reform)。第三,从新制度主义的理论角度来看,社会政策比较更应该考虑动态政策变化(pension dynamic change),不应该只限于静态视角(static perspective)的政策特征。第四,传统的社会政策比较研究文献经常忽略了东亚国家,比如,中国,日本和韩国。本文认为,尤其是比较研究更应该把这些国家包括在内因为通过比较可以更有效的分析这些制度改革决策的差异性。 政策层面,在制定养老金改革方案时需要同时考虑改革对养老金支出和养老金慷慨度影响的利弊。考虑到后工业化所带来的新风险和现存的旧社会风险,在未来的养老金改革方案中养老金长期可持续性需要要均衡养老金支出可持续性和慷慨度。以韩国养老金改革为例,激进消减改革型(extensive retrenchment pension reform, ERP)可能有助于控制养老金支出,另外经济审查性的社会补助(means-tested)是可以填充贫穷老人的养老金水平;但是其改革方案很可能让高风险群体(ex. atypical workers, lower-income)面临养老金严重不足的问题。由于激进消减改革型(extensive retrenchment pension reform, ERP)不能充分满足韩国养老金制度的需求,本文总结分析了其他三个改革方案的可取性。扩展私有化改革型(extended privatization pension reform, EPP)方案主要是通过市场养老金组成部分来补充养老金福利慷慨水平,但是此改革方案可能导致韩国养老金覆盖率停滞,并恶化高风险群体(ex. atypical workers, lower-income group)的养老金慷慨度并且加剧性别福利水平不平等等问题。后发结构改革型(latecomer structural pension reform cluster, LSP) (ex. NDC) 方案对于韩国的现状更不现实。由于韩国的独特的工业及劳动市场结构,绝大部分的非典型就业者 (atypical workers) 会很难负担双重付费 (double payment issue) 问题。采用劳动激励改革型 (labor-activated pension reform, LAP) 方案可以加固韩国的公共养老金体系并有效的提高新型职业 (new career profiles) 人员的养老金覆盖率且减少老年贫困。 ; 본 연구는 15개 국가를 대상으로 1990-2015년 사이 발생한 다양한 연금개혁의 궤적을 군집화하고 이러한 연금개혁궤적 군집이 연금노력(Pension Effort)에 미치는 영향에 대해 분석하고자 한다. 본 연구에서 연금개혁은 축소개혁(Contractionary Reform) 과 확장개혁(Expansionary Reform)을 동시에 고려하며 연금노력(Pension Effort)은 연금지출(Pension Expenditure)과 연금관대성 (Pension Generosity)을 나타낸다. "복지국가의 위기론"의 영향으로 기존 대부분의 연구들은 연금노력(Pension Effort)과 관련하여 주로 거시적 관점에서사회・경제・정치 영향 요인이 연금지출에 미치는 영향에 대해서만 분석이 이뤄졌다. 특히 핵심적 연금정책수단인 연금개혁에 대한 연구가 부족했으며 연금노력(Pension Effort)에 연금관대성을 살펴본 연구는 많지 않았다. 또한 실질적으로 전통적인 "복지국가 축소론"을 기반으로 분석한 연구들은 脫산업화로 인해 복지정책의 다양한 변화 및 특징을 충분히 포착하지 못했다. 지난 20세기말부터 舊사회위험(Old Social Risk) 및 新사회위험(New Social Risk)을 동시에 대응하기 위해 많은 국가들은 연금제도의 지속가능성 개선을 위해 축소개혁(Contractionary Reform)뿐만 아니라 확장개혁(Expansionary Reform)도 같이 도입했다. 다시 말해, 기존의 연구들은 크게 두 가지 한계점을 뚜렷하게 나타내고 있었다. 첫째, 거시적 관점에서 분석한 기존연구들은 사회・경제・제도적 영향 요인이 연금노력(Pension Effort)에 미치는 영향과 연금관대성에 대해 연구가 부족하다. 또한 가장 중요한 영향요인 변수인 연금개혁에 대해 분석하지 못했다. 둘째, 기존의 질적 및 양적 비교정책연구들은 주로 연금제도의 정태적(靜態的) 특성만 포착했으며 동태적(動態的) 개혁과정에 대한 연구가 부족했다. 따라서, 동태적(動態的)인 연금개혁이 연금지출과 연금관대성에 대해 어떤 영향을 미치는가에 대한 연구가 시급하고 중요하다. 본 연구는 Häusermann (2010)의 연금개혁을 이론적 기반으로10가지 연금개혁 변수를 포함하며 15개 국가를 대상으로 26년 동안 연금개혁궤적에 대해 분석하고자 한다. 구체적으로 연금개혁 변수는 주로 보험(Insurance), 적립화(Capitalization) (예: DB에서 DC로 전환), 표적화(Targeting) (예: Means-Tested)과 再조준화(Recalibration) (예: 연금크레딧 혹은 교육크레딧)를 포함한다. 우선, 군집분석(Cluster Analysis)을 통해서 다양한 축소 및 확장 연금개혁을 연금개혁궤적으로 규명하였고, 선형혼합효과모형 (Linear Mixed Effect Model, LMM)을 통해 각 연금개혁궤적이 연금노력(Pension Effort), 즉 연금지출(Pension Expenditure)과 연금관대성(Pension Generosity)에 대한 영향을 분석하였다. 분석결과에 따라, 4가지 연금개혁 궤적 유형으로 구분할 수 있다: 노동활성화개혁(Labor-Activated Pension, LAP), 민영화확장개혁(Extended Privatization Pension, EPP)개혁, 후발구조적개혁(Latecomer Structural Pension, LSP) 그리고 긴축연금개혁(Extensive Retrenchment Pension, ERP). 노동활성화개혁(LAP)은CRP(1990-2015) 기간 이전의 매우 높은 실업률과 급진적인 인구학적 변화를 겪은 선진 복지국가로 구성되어 있다. CRP(1990-2015)기간에 진입하여 GDP 성장과 고용률 증가세를 점차적으로 확인할 수 있지만 新사회위험(New Social risk)에 가장 심각한 국면을 직면하고 있었다. 예를 들어, 높은 여성의 노동시장 참가율, 높은 세계화 지수 및 서비스업의 증가 등 있다. 이러한 舊사회위험(Old Social Risk) 및 新사회위험(New Social Risk)을 대응하기 위해 대부분 국가들은 다양한 모수적연금개혁을 실시했다. 특히 은퇴에 근접한 연령인 개인들은 계속 노동시장에 남을 수 있도록 많은 연금개혁을 노력해왔다. 예를 들어, 은퇴연령을 높이고 조기은퇴 연령 축소 및 조기은퇴의 감액을 강화하여 노동시장 참여를 유발하기 위한 많은 연금개혁을 했다. 동시에 표적화(Targeting)와 再조준화(Recalibration)등 확장개혁(Expansionary Reform)을 통해 연금 수급여건을 낮춤으로써 서비스업을 비롯한 저임금 노동자들의 노동시장 참여를 장려하기 위한 개혁을 실시하였다. 민영화확장개혁(EPP)은 거시적 사회경제 변화를 경험한 선진국으로 노동활성화개혁(LAP) 클러스터와 비슷한 거시적 사회변화 구조를 경험하였다. 이 클러스터는 CRP(1990-2015) 기간에 높은 서비스업 취업률과 더 높은 경제적 개방성을 나타낸다. 또한 65세 이상 인구 비율이 가장 높고 저출산 문제를 함께 경험하고 있다. 연금개혁 전략은 노동활성화개혁(LAP)의 채택 전략과 뚜렷한 차이가 존재하고 있다. 민영화확장개혁(EPP)은 직업 또는 개인연금의 가입을 자발적 가입에서 강제가입으로 확정하며 기존 공적연금시스템에 대한 축소개혁을 함께 진행해왔다. 저임금 노동자를 보상화기 위하여 자산조사 (Means-Test)를 통해 연금 혜택이나 연금 크레딧 (Pension Credit)과 같은 다양한 확장연금개혁(Expansionary Reform)도 이뤄졌다. 후발구조적개혁(LSP)은 기존의 연금제도는 중앙계획경제에서 광범위한 시장경제로의 이행을 경험한 국가들로 이루어졌다는 독특한 성격을 지닌다. 이러한 국가가 시장경제로 전환한 초기에는 비교적 느리게 경제가 성장하였으며 거시 경제적 전환뿐만 아니라 인구 구조적인 변화도 같이 직면하고 있었다. 또한 빠른 시장경제개방과 脫산업화로 인해 산업구조도 급격한 변화를 겪고 있기 때문에 기존의 연금제도의 골격을 유지하기 힘든 조건에 직면하고 있다. 후발구조적개혁(LSP)은 이처럼 다양한 거시 사회경제적 구조변화로 인해 급등한 연금비용 지출에 대한 대책으로 구조적개혁을 선택하였다. 취약한 집단을 보상하기 위해 여러 표적화(Targeting)와 같은 확장 연금개혁(Expansionary Reform)을 했지만 再조준화(Recalibration) 개혁은 아직 도입되지 않았다. 긴축형연금개혁(ERP)은 가장 빠른 고령화를 겪었으며 출산율이 급격히 하락한 것을 경험하고 있는 국가로 구성되었다. 新사회위험(New Social Risk) 역시 비정규직 노동자, 여성 노동시장 참여율 그리고 낮은 취업률을 포함하는 심각한 사회 및 경제적 어려움을 겪고 있다. 긴축형연금개혁(ERP)은 이처럼 점차 늘어나는 新사회위험 (New Social Risk)과 전통적인 '고급여, 저분담' 연금구조의 어려움에 직면하기 때문에 포괄적인 모수개혁을 통해 기존의 관대한 연금시스템을 축소하려고 한다. 저소득 집단과 고령 빈곤층에 대한 자산조사 (Means-test) 와 같은 표적화 (Targeting) 개혁을 통해 노후소득보장의 보조적 역할을 추가하였다. 본 연구는 위에 도출한 4가지 연금개혁 클러스터를 독립변수로 혼합효과모형(Linear Mixed Effect Model, LMM)에 투입하여 각 연금개혁이 연금노력 (Pension Effort)에 대해 통계적으로 분석하였다. 분석결과, 긴축형연금개혁(ERP)에 비해 노동활성화개혁(LAP)은 통계적으로 연금지출(Pension Expenditure)을 감소시켰으며, 반면에 민영화확장개혁(EPP)은 연금관대성(Pension Generosity)을 통계적으로 감소시켰다. 노동활성화개혁(LAP)의 연금개혁 특징을 보면 은퇴연령과 조기은퇴에 대해 가장 많이 강화했고, 한편 긴축형연금개혁(ERP)은 직업 또는 개인연금 가입을 강제가입으로 확장하여 연금 기여와 혜택 간의 더 직접적인 연결고리를 강조했다. 본 연구의 이론적 함의는 다음과 같다. 첫째, 본 연구는 연금개혁이 연금노력 (연금 지출 및 연금 관대성)에 대한 영향의 가장 핵심적인 변수라고 강조하며 또한 연금개혁은 축소형과 확장형 연금개혁을 함께 연구해야 한다고 주장한다. 둘째, 대부분 기존의 비교연구는 중국, 일본과 한국 등 동아시아 국가들을 제외해왔다. 하지만 비교정책에서 이러한 국가들을 실증적분석을 통해 차이점을 도출하여 미래 연구에서 더 효과적으로 다룰 수 있도록 해야 한다. 셋째, 이 연구는 비교사회정책 연구의 복지정책 및 제도를 분류에 대한 정태적(靜態的)인 관점이 아닌 정책변화를 반영할 수 있는 동태적(動態的)인 관점으로 보는 것을 더 타당하며 심층적으로 분석할 수 있다고 주장한다. 정책적 함의는 다음과 같이 제시하였다. 개혁 클러스터마다 각 장단점이 존재하며 정책 입안가들은 연금개혁 정책을 도입할 때 연금지출과 연금관대성을 모두 고려해야 한다. 특히 脫산업화로 인해 일시적・장기적 실업의 증가, 비정규직고용과 여성고용의 증가 등 新사회위험 및 舊사회위험을 고려해서 미래 연금개혁에서 연금지출과 연금 관대성을 동시에 고려해야한다. 이를 신중하게 고려하지 않으면 脫산업화 이후의 저소득 및 취약계층은 더 높은 노인 빈곤에 직면할 수 있다. 한국 연금개혁의 예를 들면, 긴축형연금개혁(ERP)은 장기적으로 연금지출을 낮추고 또한 자산조사(Means-Test)와 같은 표적화(Targeting)개혁을 통해 사회부조형 연금으로 노인빈곤을 해소할 수 있지만 이러한 포괄적인 축소 개혁은 특히 미래 세대의 저소득층의 심각한 연금부족의 문제를 초래할 수 있다. 또 다른 세 가지 한국의 연금개혁에 대한 시사점을 다음과 같이 제시한다. 민영화확장개혁(EPP)은 주로 개인연금 및 직업연금의 강제가입을 통해 연금의 관대성을 제고하기 때문에 이와 같은 개혁전략을 채택하면 한국의 연금의 보장성을 악화시킬 가능성이 매우 크다. 특히 비전형 노동자와 저소득층의 연금수준을 악화시킬 가능성이 매우 크다. 또한 후발구조적개혁(LSP)은 한국의 연금제도의 현황에 현실적이지 않다고 본다. 한국의 독특한 산업구조 및 脫산업사회적 요구와 수요로 인해 비정규직 노동자의 증가로 많은 가입자가 이중부담(Double Payment)을 직면해야 하는 실정이다. 노동활성화개혁(LAP)은 한국의 공적연금제도를 강화하며 한국의 노인 빈곤 및 新사회위험(New Social Risk) 등 문제를 완화하는데 있어 도움이 될 수 있다고 판단한다. ; Chapter One: Introduction 1 1.1 The Purpose of this Study 1 1.2 Limitations of Contemporary Literature 7 1.3 Identifying Dynamic Pension Reform and Pension Effort 13 1.4 Research Scope and Research Questions 15 Chapter Two: Theoretical Framework and Literature Review 18 1.1 Pension Reform Background 19 1.1.1 Demographic Pressures 19 1.1.2 Macro-economic Pressures 24 2.1 Pension Reforms Trends and Pension Structures 27 2.1.1 Trend 1: Convergence between Bismarckian and Beveridgean Structures 28 2.1.2 Trend 2: Retrenchment of Inherited Pension Systems 41 2.1.3 Summary 43 3.1 What Influences Changes in Pension Effort? Existing Arguments 45 3.1.1 Socio-economic Factors 46 3.1.2 Institutional Factors 50 3.1.3 Political Factors 52 4.1 Pension Reform Implementation - The Linchpin of Pension Effort 59 5.1 Characterizing Pension Reform – Four Pension Reform Dimensions 63 5.1.1 Insurance 69 5.1.2 Capitalization 70 5.1.3 Targeting 71 5.1.4 Recalibration 72 6.1 Empirical Research Overview 73 7.1 Analytical Framework 79 Chapter Three: Research Methodology 81 1.1 Data and Scope 81 2.1 Operational Definition of Variables 82 2.1.1 Dependent Variables 84 2.1.2 Independent Variables 87 2.1.3 Control Variables 98 3.1 Methodology 107 3.1.1 Part One: Pension Reform Classification 110 3.1.2 Part Two: Evaluation for Pension Effort - Linear Mixed-effect Model (LMM) 114 Chapter Four: Empirical Analysis 119 1.1 Descriptive Analysis 120 1.1.1 Data 120 1.1.2 Macro-socio-economic Changes 122 1.1.3 Tendencies of Pension Expenditure and Pension Generosity 127 1.1.4 Pension Reform across Countries from 1990 to 2015 132 1.1.5 Summary 151 2.2 Cluster Analysis Results 152 2.1.1 Identifying Pension Reform Clusters 152 2.1.2 Pension Reform Cluster Descriptive Statistics 156 2.1.3 Pension Expenditure and Pension Generosity 164 3.1 Pension Reform Characteristics in Four Pension Reform Clusters 166 3.1.1 Labor-activated pension (LAP) Reforms 166 3.1.2 Extended Privatization Pension (EPP) Reforms 175 3.1.3 Latecomer Structural Pension (LSP) Reforms 190 3.1.4 Extensive Retrenchment Pension (ERP) Reforms 198 3.1.5 Summary 207 4.1 Mixed Effect Model Analytical Results 211 4.1.1 Pension Expenditure 218 4.1.2 Pension Generosity 226 Chapter Five: Conclusion 232 1.1 Research Summary of Findings 232 1.2 Theoretical Implications 235 1.3 Policy Implications 239 1.4 Research Limitations 244 References 248 Appendix A. 267 Abstract (Korean) 272 Abstract (Chinese) 278 ; Doctor

학위논문 (박사) -- 서울대학교 대학원 : 사회과학대학 사회복지학과, 2020. 8. 홍백의. ; This study characterizes 15 countries' pension reform trajectories and statistically examines how these pension reform trajectories affect pension effort during the CRP (Compound Reform Period 1990-2015). This study defines pension reform are either contractionary and expansionary reforms; pension effort refers to both pension expenditure and pension generosity. Conventionally, studies have often examined how socio-influential factors (e.g. socio-economic, institutional, and political factors) affect pension effort. However, these discourses have heavily emphasized contractionary pension reforms and pension expenditure, but have overlooked expansionary pension reforms and pension generosity. This study argues that the traditional retrenchment-focused approach to pension policy research is rooted largely in inherited theories of the 'Welfare State Crisis' and macro-socio-economics, that are not reflective of the recent post-industrial policy shifts occurring in the world. In particular to pension policy, in response to the 20th century old and new social risks, traditional Bismarckian and Beveridgean countries have implemented a mix of contractionary and expansionary reforms. These reforms were designed to deal with pension financial sustainability and adequacy against old-age poverty. Consequently, two primary limitations of previous studies have become apparent. The austerity-oriented and macro view of pension effort using socio-influential factors overlooks an important building block within the dynamic pension reform process. In addition, existing quantitative and qualitative studies have centered around institutions that examine pension policies from a static perspective - overlooking pension policy dynamic changes. During the CRP, pension systems have experienced two interconnected components - retrenchment and expansionary reforms - that ultimately define pension effort. Accordingly, it is necessary to comprehensively investigate how these components of dynamic pension reform affect pension effort in the context of both pension expenditure and pension generosity. This study organized expansionary and retrenchment pension reforms using ten pension reform variables based on the work Häusermann (2010): insurance (e.g. parametric pension reforms), capitalization (e.g. DB to DC shifts), targeting (e.g. means-tested), and recalibration (e.g. pension credits). In order to evaluate how these pension reforms affected pension effort, this study utilized two analytical methods: unsupervised clustering characterizes pension reform trajectories, and an LMM (Mixed Effect Model) statistically evaluates their effectiveness with respect to pension expenditure and pension generosity. Pension reforms were categorized into four pension reform clusters: labor-activated pension (LAP) reforms, extended privatization pension (EPP) reforms, latecomer structural pension (LSP) reforms, and extensive retrenchment pension (ERP) reforms. The labor-activated pension reform (LAP) cluster is generally composed of advanced welfare states that experienced the highest unemployment rates and most pressing demographic changes prior to the CRP. However, their transition into the CRP has been met with significant GDP growth and high employment rates. At the same time, this cluster is facing the highest level of new social risks in regions like women's labor participation, employment in services, and economic openness. In response to both old and new social risks, most of the countries in this cluster made significant reforms meant to mitigate their effects. Various parametric pension reforms (e.g. increasing the retirement age, penalizing early retirement, etc.) encourage individuals near retirement to continue working or re-enter the workforce, thus increasing labor supply. In addition, targeting and recalibration reforms incentivize participation in the labor market by lowering pension eligibility requirements. The extended privatization pension reform (EPP) cluster is very similar in its Marco-socio-economic structure to the labor-activated pension reform (LAP) cluster, in that it is defined by developed nations that experienced drastic macro-socio-economic changes before the CRP. However, in the CRP this cluster has the highest levels of aged 65 years and older individuals, coupled with a moderately high economic growth. Growth compared to the labor activated pension reform cluster may be lower due to this aging. When a higher proportion of a total population is elderly, a larger proportion of economic expenses must be spent on retirement care. However, another additional feature of this cluster's socio-economics is lower birth rates. Some new social risks of interest that have had a particular effect on this cluster are increasing service sector employment rates and higher economic openness. However, pension reform strategies are vastly different from the labor-activated pension reform (LAP) reform strategies. This reform cluster shifts enrollment in occupational or individual pension programs from voluntary to mandatory and these programs then work in conjunction with existing public pension systems. However, in order to compensate disadvantaged groups and unpaid workers, various expansionary pension reforms were also implemented in tandem; for example, means-tested pension benefits, tax reductions or earnings-related subsidies to employers, employees or individuals. The latecomer structural pension reform cluster (LSP) is uniquely composed of countries that had transitioned from centrally planned economies to widespread market-based economies at the inception of their original pension programs. Their transition to market based-economies was not smooth and this was reflected in their relatively slow economic growth. Structural changes are not the only facet that describes the struggles these countries have had during the CRP; demographic issues have also played an outsized role in their economies. Not only had their relative population aged, but at the same time, there was a dramatic drop in their fertility rates. New social risks have been reflected in their rising proportion of service sector employment and the swift opening of their economies. This cluster turned to structural-based reforms as a countermeasure to the ballooning pension expenditures that ensued, because of these different macro-socio-economic hardships. In order to compensate disadvantaged groups and unpaid workers, various expansionary pension reforms were also implemented in tandem with contractionary reforms (ex. targeting reform), but recalibration reforms were not implemented. The extensive retrenchment pension reform cluster (ERP), is composed of countries that demographically aged the most, and experienced the greatest long-term economic hardships because of economic crises during the CRP. Another critical issue was the decline of birth rates in these countries. New social risks have also added stress to their economic hardships with increases in atypical workers, women's labor participation rates, and serious issues with low employment rates. Under these increasing new social risks and problematic pension structures, the extensive retrenchment pension (ERP) reform cluster retrenched inherited asymmetric pension systems through radical parametric reforms, then means-tested programs were additionally added to compensate low-income groups and impoverished elderly. Each pension reform clusters' socio-economic backgrounds provide insight into the underlying indicators that are correlated with their adoption of different pension reform policies. Using these pension reform clusters as independent variables, this study demonstrates that different pension reforms have diversified the existing architecture of pension effort. According to the Linear Mixed Effect Model (LMM) results, the labor-activated pension reform (LAP) cluster statistically reduced pension expenditure relative to the reference pension reform cluster (extensive retrenchment pension reform cluster). The extended privatization pension (EPP) reform cluster significantly reduced pension generosity relative to the reference pension reform cluster (extensive retrenchment pension reform cluster). While the labor-activated pension (LAP) reform cluster maintained the highest standard pension retirement age and most restrictions on early retirement, the extended privatization pension (EPP) reform cluster created a more direct link between pension benefits and an individual's pension contributions, by shifting to mandatory enrollment in occupational or individual pension programs. This study asserts that pension reforms are the key to understanding pension effort (pension expenditure and pension generosity), and that contractionary and expansionary pension reform policies should be studied together. In addition, existing comparative studies have often excluded East-Asian countries, in particular, China, Japan, and Korea. They should be included in comparative policy analysis that will allow researchers to determine if they are empirically different, and thus compensate or address those differences more effectively in future research. In comparative social policy research, from the new institutionalism perspective, policy classifications should consider the process of policy change, from a dynamic perspective rather than static characteristics. This study suggests that policymakers may need to be concerned about each pension reform's pros and cons in the context of pension expenditure and generosity when adopting a pension reform. In future pension reforms, policymakers need to explicitly design their policies around increasing new profiles who, if not considered more carefully, are at higher risk of poverty in this post-industrialized global economy. The most sensible means of doing this is if policymakers avoid reducing benefits for these groups when legislating future pension reforms. Take Korean pension reforms as an example. Korea adopted an extensive parametric pension (ERP) reforms that may prove to be an effective way of curbing costs, while means-tested incentives provide more generous benefits to the growing population of at-risk individuals. However, extensive retrenchment pension (ERP) reforms have a high risk of providing inadequate pension benefits to at-risk groups without seriously resolving issues with program expenditure. Since extensive retrenchment pension (ERP) reforms do not sufficiently meet the needs of the Korean pension system, the next step is to look at alternative clusters to resolve these issues. Extended privatization pension reforms (EPP) generally supplement pension benefits by adopting a market-based pension component. However, adopting a reform from this cluster will also likely result in stagnated pension coverage, deteriorated pension benefits, and increased gender and income inequality. Adoption of a latecomer structural pension reform (LSP) (e.g. NDC) is also not realistic, because there are a large number of atypical workers in Korea (e.g. self-employed, part-time workers) who are unable to shoulder considerable financial burdens (double payment issues). This study suggests that adopting a labor-activated pension reform (LAP) may be the most effective pension strategy to strengthen Korean public pension system security. This strategy takes into account new career profiles that were previously overlooked by the system; the goal of including these workers to the system would be to reduce the occurrence of old-age poverty. ; 本论文定量比较分析了15个国家在1990-2015 (compound reform period, CRP:1990-2015)综合改革期间的养老金改革轨迹,及其对养老金努力(pension effort)的影响。本文定义了养老金改革包括消减性改革(contractionary pension reform)和扩张性改革(expansionary pension reform),养老金努力(pension effort)包括养老金支出(pension expenditure)和养老金慷慨度(pension generosity)。受"福利国家危机论"的影响,现存的大部分相关学术主要分析了宏观社会・经济因素(包括经济,政治和制度因素)对养老金政策的影响。这些研究集中在研究养老金支出而忽视了对养老金慷慨度的分析. 宏观社会经济背景及制度的遗产(institutional legacy)或历史轨迹等对养老金努力(pension effort)影响效应息息相关,但是本研究认为基于宏观理论并限定于养老金支出的传统文献没有充分的的分析到后工业社会下(post-industrialization)的养老金改革轨迹和特征。尤其是从20世纪末,为了应对新旧社会风险(old and new social risks)的压力,综合型养老金改革(compound pension reform),即消减性改革(contractionary pension reform)和扩张性改革(expansionary pension reform)被纷纷采纳去同时解决养老金财政可持续性和抵御老年贫困的两个问题。本文认为传统文献在研究养老金政策的影响因素中存在两个主要局限性问题:第一,忽视了核心变量-养老金改革对老金支出(pension expenditure)和养老金慷慨度(pension generosity)的影响。第二,现有的定量和定性社会政策比较或聚类研究只从围绕静态角度(static perspective)的政策特征却忽视了政策的动态变化(policy dynamic change)。 本文以Häusermann (2010)的养老金改革理论为基础,分析了包括消减性改革(contractionary pension reform)和扩张性改革(expansionary pension reform)养老金改革的十个变量:保险参数(parametric reform参数改革),市场化(例如: 从DB 改革成 DC),目标化(targeting) (例如: 经济能力审查:means-tested), 再调整(recalibration) (例如:养老金补贴: pension credits)。为了从统计学上评估分析这些养老金改革对养老金努力(pension effort)对影响效应,本文采用了两种分析方法:K均值无监督聚类分析(clustering analysis)和线性混合效应模型(linear mixed effect model, LMM)。根据聚类分析(clustering analysis)结果,15国家在1990-2015期间的养老金改革可分为四个改革类型:劳动激励改革型(labor-activated pension reform, LAP), 扩展私有化改革型(extended privatization pension reform, EPP), 后发结构改革型(latecomer structural pension reform, LSP),和激进消减改革型(extensive retrenchment pension reform, ERP). 基于定量统计数据比较分析,线性混合效应模型(linear mixed effect model, LMM)分析结果发现不同的改革轨迹对养老金支出和养老金慷慨度影响不同。 劳动激励改革型(labor-activated pension reform, LAP)是由发达福利国家组成,这些国家在CRP(1990-2015)之前遭遇过经济衰退和前所未有的失业率增加和人口转变问题,但是在CRP(1990-2015)的过度期间实现了GDP和就业率的总体水平回升。相比于其他的改革类型,这些国家面临着最高水平的社会新风险(new social risks): 女性劳动就业和服务性就业者不断增加。为了应对新旧社会风险(old and new social risks)和减轻养老金财政压力,这些国家采取了大力度的养老金参数改革。主要包括参数改革(例如: 延后退休, 处罚提前退休等),鼓励接近退休等人继续工作或重新加入劳动市场。此外利用扩张性的目标化(targeting)和再调整(recalibration)改革鼓励人们参与劳动市场并通过养老金水平等。 扩展私有化改革型(extended privatization pension reform, EPP)的宏观社会经济结构背景和劳动激励改革型(labor-activated pension reform, LAP)比较相似,但是他们的养老金改革决策却大相径庭。在CRP前期,这些国家也是经历过宏观经济巨变的发达福利国家.低生育率和最高的老年人口比例,这个改革类型的国家面临养老金支出巨大失衡的压力。另外不规则就业者(atypical worker)和服务性就业者的比例不断上升也威胁着养老金政策的长期可持续性。扩展私有化改革型(extended privatization pension reform, EPP)的主要决策是通过强制性策略提高参加职业和商业养老保险并且采取相对应的公共养老金参数改革方案。扩张型改革(expansionary pension reform)主要是为了弥补弱势和底薪群体,例如,对雇主,雇员或个人就行减税并且给以适当的补贴,经济能力审查的(means-tested)养老金补贴改革也是尤为突出。 后发结构改革型(latecomer structural pension reform cluster, LSP)的国家在养老金改革初期经历了市场经济转型独特社会变化。特别是在市场经济转型初期经济增长还没有真正的崛起,养老金制度不仅面临经济转型的挑战,人口转变包括人口老龄化和生育率下降问题更是加剧了养老金制度的财政失衡。另外新社会风险(new social risks)和全球化更激化了服务性劳动者的增加。为了扩大政府财政来源和弥补养老金缺口,这些社会背景推动了这些国家以结构改革(structural pension reform)为主线。为弱势群体也提供一定的社会补助,例如,经济能力审查的(means-tested)养老金补贴,但是后发结构改革型(latecomer structural pension reform cluster, LSP)目前缺乏再调整(recalibration)的扩张型改革(expansionary pension reform)。 激进消减改革型(extensive retrenchment pension reform, ERP)在CRP初期临最严重的老龄化增长和经济危机带来的长期经济困难。人口转变(生育率急剧下降,老龄化进程加速)更是加剧了养老金的经济持续性问题。同时,这些国家更面临着由迅速的现代化进程所带来的挑战:服务性劳动者,女性劳动市场的参与与日俱增,就业率急剧下降等新社会风险(new social risks)。在这种社会背景下,激进消减改革型 (extensive retrenchment pension reform, ERP)采用了大幅度的参数改革(parametric pension reform)为消减现存的养老金财政问题。资格审核(means-tested)的社会救助被采用去补助低收入人群和老人的养老金收入。 本文把以上的四个改革类型作为自变量研究分析了各个改革类型对养老金努力(pension effort: pension expenditure, pension generosity)的影响效果。根据线性混合效应模型(linear mixed effect model, LMM)的分析结果,相对于激进消减改革型 (extensive retrenchment pension reform, ERP), 劳动激励改革型(labor-activated pension reform, LAP)有效的消减了养老金支出; 扩展私有化改革型(extended privatization pension reform, EPP)有效的得降低了养老金的慷慨度。相比之下,劳动激励改革型(labor-activated pension reform, LAP)维持了最高标准的养老金退休年龄和提前退休的最大限制,而扩展私有化改革型(extended privatization pension reform, EPP)则是通过强制参与职业和商业退休金制度加大紧缩养老金和缴费之间的直接关系。 理论层面,第一,本研究强调养老金改革变量是理解养老金努力(pension effort)的关键。第二,1990年以来的养老金改革应该同时考虑消减性改革(contractionary pension reform)和扩张性改革(expansionary pension reform)。第三,从新制度主义的理论角度来看,社会政策比较更应该考虑动态政策变化(pension dynamic change),不应该只限于静态视角(static perspective)的政策特征。第四,传统的社会政策比较研究文献经常忽略了东亚国家,比如,中国,日本和韩国。本文认为,尤其是比较研究更应该把这些国家包括在内因为通过比较可以更有效的分析这些制度改革决策的差异性。 政策层面,在制定养老金改革方案时需要同时考虑改革对养老金支出和养老金慷慨度影响的利弊。考虑到后工业化所带来的新风险和现存的旧社会风险,在未来的养老金改革方案中养老金长期可持续性需要要均衡养老金支出可持续性和慷慨度。以韩国养老金改革为例,激进消减改革型(extensive retrenchment pension reform, ERP)可能有助于控制养老金支出,另外经济审查性的社会补助(means-tested)是可以填充贫穷老人的养老金水平;但是其改革方案很可能让高风险群体(ex. atypical workers, lower-income)面临养老金严重不足的问题。由于激进消减改革型(extensive retrenchment pension reform, ERP)不能充分满足韩国养老金制度的需求,本文总结分析了其他三个改革方案的可取性。扩展私有化改革型(extended privatization pension reform, EPP)方案主要是通过市场养老金组成部分来补充养老金福利慷慨水平,但是此改革方案可能导致韩国养老金覆盖率停滞,并恶化高风险群体(ex. atypical workers, lower-income group)的养老金慷慨度并且加剧性别福利水平不平等等问题。后发结构改革型(latecomer structural pension reform cluster, LSP) (ex. NDC) 方案对于韩国的现状更不现实。由于韩国的独特的工业及劳动市场结构,绝大部分的非典型就业者 (atypical workers) 会很难负担双重付费 (double payment issue) 问题。采用劳动激励改革型 (labor-activated pension reform, LAP) 方案可以加固韩国的公共养老金体系并有效的提高新型职业 (new career profiles) 人员的养老金覆盖率且减少老年贫困。 ; 본 연구는 15개 국가를 대상으로 1990-2015년 사이 발생한 다양한 연금개혁의 궤적을 군집화하고 이러한 연금개혁궤적 군집이 연금노력(Pension Effort)에 미치는 영향에 대해 분석하고자 한다. 본 연구에서 연금개혁은 축소개혁(Contractionary Reform) 과 확장개혁(Expansionary Reform)을 동시에 고려하며 연금노력(Pension Effort)은 연금지출(Pension Expenditure)과 연금관대성 (Pension Generosity)을 나타낸다. "복지국가의 위기론"의 영향으로 기존 대부분의 연구들은 연금노력(Pension Effort)과 관련하여 주로 거시적 관점에서사회・경제・정치 영향 요인이 연금지출에 미치는 영향에 대해서만 분석이 이뤄졌다. 특히 핵심적 연금정책수단인 연금개혁에 대한 연구가 부족했으며 연금노력(Pension Effort)에 연금관대성을 살펴본 연구는 많지 않았다. 또한 실질적으로 전통적인 "복지국가 축소론"을 기반으로 분석한 연구들은 脫산업화로 인해 복지정책의 다양한 변화 및 특징을 충분히 포착하지 못했다. 지난 20세기말부터 舊사회위험(Old Social Risk) 및 新사회위험(New Social Risk)을 동시에 대응하기 위해 많은 국가들은 연금제도의 지속가능성 개선을 위해 축소개혁(Contractionary Reform)뿐만 아니라 확장개혁(Expansionary Reform)도 같이 도입했다. 다시 말해, 기존의 연구들은 크게 두 가지 한계점을 뚜렷하게 나타내고 있었다. 첫째, 거시적 관점에서 분석한 기존연구들은 사회・경제・제도적 영향 요인이 연금노력(Pension Effort)에 미치는 영향과 연금관대성에 대해 연구가 부족하다. 또한 가장 중요한 영향요인 변수인 연금개혁에 대해 분석하지 못했다. 둘째, 기존의 질적 및 양적 비교정책연구들은 주로 연금제도의 정태적(靜態的) 특성만 포착했으며 동태적(動態的) 개혁과정에 대한 연구가 부족했다. 따라서, 동태적(動態的)인 연금개혁이 연금지출과 연금관대성에 대해 어떤 영향을 미치는가에 대한 연구가 시급하고 중요하다. 본 연구는 Häusermann (2010)의 연금개혁을 이론적 기반으로10가지 연금개혁 변수를 포함하며 15개 국가를 대상으로 26년 동안 연금개혁궤적에 대해 분석하고자 한다. 구체적으로 연금개혁 변수는 주로 보험(Insurance), 적립화(Capitalization) (예: DB에서 DC로 전환), 표적화(Targeting) (예: Means-Tested)과 再조준화(Recalibration) (예: 연금크레딧 혹은 교육크레딧)를 포함한다. 우선, 군집분석(Cluster Analysis)을 통해서 다양한 축소 및 확장 연금개혁을 연금개혁궤적으로 규명하였고, 선형혼합효과모형 (Linear Mixed Effect Model, LMM)을 통해 각 연금개혁궤적이 연금노력(Pension Effort), 즉 연금지출(Pension Expenditure)과 연금관대성(Pension Generosity)에 대한 영향을 분석하였다. 분석결과에 따라, 4가지 연금개혁 궤적 유형으로 구분할 수 있다: 노동활성화개혁(Labor-Activated Pension, LAP), 민영화확장개혁(Extended Privatization Pension, EPP)개혁, 후발구조적개혁(Latecomer Structural Pension, LSP) 그리고 긴축연금개혁(Extensive Retrenchment Pension, ERP). 노동활성화개혁(LAP)은CRP(1990-2015) 기간 이전의 매우 높은 실업률과 급진적인 인구학적 변화를 겪은 선진 복지국가로 구성되어 있다. CRP(1990-2015)기간에 진입하여 GDP 성장과 고용률 증가세를 점차적으로 확인할 수 있지만 新사회위험(New Social risk)에 가장 심각한 국면을 직면하고 있었다. 예를 들어, 높은 여성의 노동시장 참가율, 높은 세계화 지수 및 서비스업의 증가 등 있다. 이러한 舊사회위험(Old Social Risk) 및 新사회위험(New Social Risk)을 대응하기 위해 대부분 국가들은 다양한 모수적연금개혁을 실시했다. 특히 은퇴에 근접한 연령인 개인들은 계속 노동시장에 남을 수 있도록 많은 연금개혁을 노력해왔다. 예를 들어, 은퇴연령을 높이고 조기은퇴 연령 축소 및 조기은퇴의 감액을 강화하여 노동시장 참여를 유발하기 위한 많은 연금개혁을 했다. 동시에 표적화(Targeting)와 再조준화(Recalibration)등 확장개혁(Expansionary Reform)을 통해 연금 수급여건을 낮춤으로써 서비스업을 비롯한 저임금 노동자들의 노동시장 참여를 장려하기 위한 개혁을 실시하였다. 민영화확장개혁(EPP)은 거시적 사회경제 변화를 경험한 선진국으로 노동활성화개혁(LAP) 클러스터와 비슷한 거시적 사회변화 구조를 경험하였다. 이 클러스터는 CRP(1990-2015) 기간에 높은 서비스업 취업률과 더 높은 경제적 개방성을 나타낸다. 또한 65세 이상 인구 비율이 가장 높고 저출산 문제를 함께 경험하고 있다. 연금개혁 전략은 노동활성화개혁(LAP)의 채택 전략과 뚜렷한 차이가 존재하고 있다. 민영화확장개혁(EPP)은 직업 또는 개인연금의 가입을 자발적 가입에서 강제가입으로 확정하며 기존 공적연금시스템에 대한 축소개혁을 함께 진행해왔다. 저임금 노동자를 보상화기 위하여 자산조사 (Means-Test)를 통해 연금 혜택이나 연금 크레딧 (Pension Credit)과 같은 다양한 확장연금개혁(Expansionary Reform)도 이뤄졌다. 후발구조적개혁(LSP)은 기존의 연금제도는 중앙계획경제에서 광범위한 시장경제로의 이행을 경험한 국가들로 이루어졌다는 독특한 성격을 지닌다. 이러한 국가가 시장경제로 전환한 초기에는 비교적 느리게 경제가 성장하였으며 거시 경제적 전환뿐만 아니라 인구 구조적인 변화도 같이 직면하고 있었다. 또한 빠른 시장경제개방과 脫산업화로 인해 산업구조도 급격한 변화를 겪고 있기 때문에 기존의 연금제도의 골격을 유지하기 힘든 조건에 직면하고 있다. 후발구조적개혁(LSP)은 이처럼 다양한 거시 사회경제적 구조변화로 인해 급등한 연금비용 지출에 대한 대책으로 구조적개혁을 선택하였다. 취약한 집단을 보상하기 위해 여러 표적화(Targeting)와 같은 확장 연금개혁(Expansionary Reform)을 했지만 再조준화(Recalibration) 개혁은 아직 도입되지 않았다. 긴축형연금개혁(ERP)은 가장 빠른 고령화를 겪었으며 출산율이 급격히 하락한 것을 경험하고 있는 국가로 구성되었다. 新사회위험(New Social Risk) 역시 비정규직 노동자, 여성 노동시장 참여율 그리고 낮은 취업률을 포함하는 심각한 사회 및 경제적 어려움을 겪고 있다. 긴축형연금개혁(ERP)은 이처럼 점차 늘어나는 新사회위험 (New Social Risk)과 전통적인 '고급여, 저분담' 연금구조의 어려움에 직면하기 때문에 포괄적인 모수개혁을 통해 기존의 관대한 연금시스템을 축소하려고 한다. 저소득 집단과 고령 빈곤층에 대한 자산조사 (Means-test) 와 같은 표적화 (Targeting) 개혁을 통해 노후소득보장의 보조적 역할을 추가하였다. 본 연구는 위에 도출한 4가지 연금개혁 클러스터를 독립변수로 혼합효과모형(Linear Mixed Effect Model, LMM)에 투입하여 각 연금개혁이 연금노력 (Pension Effort)에 대해 통계적으로 분석하였다. 분석결과, 긴축형연금개혁(ERP)에 비해 노동활성화개혁(LAP)은 통계적으로 연금지출(Pension Expenditure)을 감소시켰으며, 반면에 민영화확장개혁(EPP)은 연금관대성(Pension Generosity)을 통계적으로 감소시켰다. 노동활성화개혁(LAP)의 연금개혁 특징을 보면 은퇴연령과 조기은퇴에 대해 가장 많이 강화했고, 한편 긴축형연금개혁(ERP)은 직업 또는 개인연금 가입을 강제가입으로 확장하여 연금 기여와 혜택 간의 더 직접적인 연결고리를 강조했다. 본 연구의 이론적 함의는 다음과 같다. 첫째, 본 연구는 연금개혁이 연금노력 (연금 지출 및 연금 관대성)에 대한 영향의 가장 핵심적인 변수라고 강조하며 또한 연금개혁은 축소형과 확장형 연금개혁을 함께 연구해야 한다고 주장한다. 둘째, 대부분 기존의 비교연구는 중국, 일본과 한국 등 동아시아 국가들을 제외해왔다. 하지만 비교정책에서 이러한 국가들을 실증적분석을 통해 차이점을 도출하여 미래 연구에서 더 효과적으로 다룰 수 있도록 해야 한다. 셋째, 이 연구는 비교사회정책 연구의 복지정책 및 제도를 분류에 대한 정태적(靜態的)인 관점이 아닌 정책변화를 반영할 수 있는 동태적(動態的)인 관점으로 보는 것을 더 타당하며 심층적으로 분석할 수 있다고 주장한다. 정책적 함의는 다음과 같이 제시하였다. 개혁 클러스터마다 각 장단점이 존재하며 정책 입안가들은 연금개혁 정책을 도입할 때 연금지출과 연금관대성을 모두 고려해야 한다. 특히 脫산업화로 인해 일시적・장기적 실업의 증가, 비정규직고용과 여성고용의 증가 등 新사회위험 및 舊사회위험을 고려해서 미래 연금개혁에서 연금지출과 연금 관대성을 동시에 고려해야한다. 이를 신중하게 고려하지 않으면 脫산업화 이후의 저소득 및 취약계층은 더 높은 노인 빈곤에 직면할 수 있다. 한국 연금개혁의 예를 들면, 긴축형연금개혁(ERP)은 장기적으로 연금지출을 낮추고 또한 자산조사(Means-Test)와 같은 표적화(Targeting)개혁을 통해 사회부조형 연금으로 노인빈곤을 해소할 수 있지만 이러한 포괄적인 축소 개혁은 특히 미래 세대의 저소득층의 심각한 연금부족의 문제를 초래할 수 있다. 또 다른 세 가지 한국의 연금개혁에 대한 시사점을 다음과 같이 제시한다. 민영화확장개혁(EPP)은 주로 개인연금 및 직업연금의 강제가입을 통해 연금의 관대성을 제고하기 때문에 이와 같은 개혁전략을 채택하면 한국의 연금의 보장성을 악화시킬 가능성이 매우 크다. 특히 비전형 노동자와 저소득층의 연금수준을 악화시킬 가능성이 매우 크다. 또한 후발구조적개혁(LSP)은 한국의 연금제도의 현황에 현실적이지 않다고 본다. 한국의 독특한 산업구조 및 脫산업사회적 요구와 수요로 인해 비정규직 노동자의 증가로 많은 가입자가 이중부담(Double Payment)을 직면해야 하는 실정이다. 노동활성화개혁(LAP)은 한국의 공적연금제도를 강화하며 한국의 노인 빈곤 및 新사회위험(New Social Risk) 등 문제를 완화하는데 있어 도움이 될 수 있다고 판단한다. ; Chapter One: Introduction 1 1.1 The Purpose of this Study 1 1.2 Limitations of Contemporary Literature 7 1.3 Identifying Dynamic Pension Reform and Pension Effort 13 1.4 Research Scope and Research Questions 15 Chapter Two: Theoretical Framework and Literature Review 18 1.1 Pension Reform Background 19 1.1.1 Demographic Pressures 19 1.1.2 Macro-economic Pressures 24 2.1 Pension Reforms Trends and Pension Structures 27 2.1.1 Trend 1: Convergence between Bismarckian and Beveridgean Structures 28 2.1.2 Trend 2: Retrenchment of Inherited Pension Systems 41 2.1.3 Summary 43 3.1 What Influences Changes in Pension Effort? Existing Arguments 45 3.1.1 Socio-economic Factors 46 3.1.2 Institutional Factors 50 3.1.3 Political Factors 52 4.1 Pension Reform Implementation - The Linchpin of Pension Effort 59 5.1 Characterizing Pension Reform – Four Pension Reform Dimensions 63 5.1.1 Insurance 69 5.1.2 Capitalization 70 5.1.3 Targeting 71 5.1.4 Recalibration 72 6.1 Empirical Research Overview 73 7.1 Analytical Framework 79 Chapter Three: Research Methodology 81 1.1 Data and Scope 81 2.1 Operational Definition of Variables 82 2.1.1 Dependent Variables 84 2.1.2 Independent Variables 87 2.1.3 Control Variables 98 3.1 Methodology 107 3.1.1 Part One: Pension Reform Classification 110 3.1.2 Part Two: Evaluation for Pension Effort - Linear Mixed-effect Model (LMM) 114 Chapter Four: Empirical Analysis 119 1.1 Descriptive Analysis 120 1.1.1 Data 120 1.1.2 Macro-socio-economic Changes 122 1.1.3 Tendencies of Pension Expenditure and Pension Generosity 127 1.1.4 Pension Reform across Countries from 1990 to 2015 132 1.1.5 Summary 151 2.2 Cluster Analysis Results 152 2.1.1 Identifying Pension Reform Clusters 152 2.1.2 Pension Reform Cluster Descriptive Statistics 156 2.1.3 Pension Expenditure and Pension Generosity 164 3.1 Pension Reform Characteristics in Four Pension Reform Clusters 166 3.1.1 Labor-activated pension (LAP) Reforms 166 3.1.2 Extended Privatization Pension (EPP) Reforms 175 3.1.3 Latecomer Structural Pension (LSP) Reforms 190 3.1.4 Extensive Retrenchment Pension (ERP) Reforms 198 3.1.5 Summary 207 4.1 Mixed Effect Model Analytical Results 211 4.1.1 Pension Expenditure 218 4.1.2 Pension Generosity 226 Chapter Five: Conclusion 232 1.1 Research Summary of Findings 232 1.2 Theoretical Implications 235 1.3 Policy Implications 239 1.4 Research Limitations 244 References 248 Appendix A. 267 Abstract (Korean) 272 Abstract (Chinese) 278 ; Doctor

"The subject matter of international economics, then, consists of issues raised by the special problems of economic interaction between sovereign states." (Krugman et al., 2011)Institutional innovation fosters the development of these interactions. Thus, European states, on a social background, try to benefit from the cooperation leverage effect, to turn centuries of conflicts, into an economic asset. Such a construction and its pantagruelian twists and turns, as a fusion of history and empires, not far from Victor Hugo's utopia "the United-State of Europe", demonstrates the incredible ingenuity, national heterogeneities develop to refine the paradigm "Europe".In this thesis, we propose to shed some light on some of these challenges, with regard to the countries which, not half a century ago, marked the fracture of the continent, CEECs. These economies, from transition to developed economy, are an unprecedented case study, to understand international economic challenges. After explaining the general framework, in which this work takes place (Chapter 1), we investigate the impact of the ECB's monetary policy, on the peripheral countries of the euro zone, i.e., EU non-Euro members. In chapter 2, we construct two groups of countries, depending on their exchange rate regime (fixed or flexible). Drawn upon this construction, using monetary, price and output data, we measure the impact of a monetary shock, impulsed by the ECB, on the CEECs. We find that economic integration induces spillover effects, that influence domestic monetary decisions. As expected, pegged economies are more strongly affected, by the monetary policy of the ECB. However, in both groups of countries, we find that spillovers tend to have less impact, on the volatility of our variables (GDP and prices), over the last decade. We explain this, via a more efficient exchange rate channel, to absorb shocks (in flexible exchange) and an increased credibility of domestic monetary institutions.We highlighted that spillovers effects significantly influence the CEECs, with direct impact upon domestic monetary challenges. The first phase of the transition, during the 90's, has been hit by high level of both inflation and unemployment. Over the last years, inflation seems to be under control, and we observe relatively low unemployment rate, closed to its natural level. This could suggest that monetary credibility has been restored. However, in the process of accession to the Euro zone, monetary leeway is becoming increasingly restricted.Throughout Chapter 3, we use the well-known Phillips curve, to understand the relationship between the unemployment rate and price developments, as a proxy for the effectiveness of monetary policy. The Baltic States, Slovenia and Slovakia are perfect candidates to measure the impact of changes in exchange rate regimes, during accession to the EA. During the ERM-II, the relationship is negative and significant. However, the EA entry is prima facie evidence of a flattened Phillips curve. We explain this result by the fact that in a monetary union, "small" economies do not have sufficient power, to significantly influence monetary policy decisions.To be fully effective, the single policy of the ECB must confront, relatively homogeneous economies. This homogeneity transcends the monetary dimension and directly affects the real economy (evidenced by the Phillips curve). The impacts of asymmetric shocks are smoothed through the adjustment mechanisms in an optimal union. Among these mechanisms, we highlight the role of the labour market, which requires flexibility (of wages) and increased factor mobility. Chapter 4 analyses regional adjustment mechanisms, after an exogenous employment shock. Using regional NUTS-II data, we build a VAR panel, to understand these mechanisms. (.) ; "Le sujet de l'économie internationale consiste, donc, en des questions soulevées, par les problèmes particuliers, de l'interaction économique, entre États souverains." (Krugman et al., 2011)L'innovation institutionnelle se met au service de ces interactions. Ainsi les pays européens, sur fond social, tentent d'utiliser le levier de la coopération économique, pour permettre à des siècles de conflits, de se transformer en atout économique. Une telle construction, aux pantagruéliques rebondissements, fusion d'Histoire et d'empires, non loin de l'utopie États-Unis d'Europe de Victor Hugo, démontre l'incroyable ingéniosité, avec laquelle les hétérogénéités nationales semblent parfaire le paradigme Europe. Nous proposons, dans cette thèse, d'éclairer certains de ces défis, au regard des pays qui, il n'y a pas un demi-siècle, marquaient la fracture du continent, les PECO. Ces économies, passées du stade en transition à économie développée, sont un cas d'étude sans précédent pour la compréhension des challenges économiques internationaux. Après avoir explicité le cadre général, dans lequel s'inscrivent ces travaux (chapitre 1), nous tâchons d'éclairer l'impact, de la politique monétaire de la BCE, sur les pays périphériques de la zone Euro, cependant membre de l'UE. Dans ce chapitre 2, nous construisons deux groupes de pays, selon leur régime de change envers l'Euro (fixe ou flexible). A partir de là, en utilisant des données monétaires, de prix et de production, nous mesurons l'impact d'un choc monétaire, par la BCE, sur les PECO. Nous trouvons que l'intégration économique induit des effets de débordement qui viennent influencer les décisions monétaires domestiques. De manière cohérente, les pays en change fixe, subissent plus fortement la politique monétaire de la BCE. Cependant, dans les deux groupes de pays, nous trouvons que les débordements ont tendance, à avoir moins d'impact, sur la volatilité de nos variables, au cours de la dernière décennie. Nous l'expliquons, par un canal du taux de change, plus efficace, pour absorber les chocs (en change flexible) et une crédibilité accrue des institutions monétaires domestiques.Alors que nous venons de voir que des effets de débordement agissent dans les PECO, nous ne pouvons, nous empêcher, de relier cela, aux enjeux monétaires domestiques. La première phase de la transition, au cours des 90's, a été marquée par une forte inflation et par un taux de chômage très élevé. Ces dernières années sont sous le signe d'une inflation, qui semble maitrisée et d'un chômage relativement faible. Cela laisse à penser, que la crédibilité monétaire et que l'efficacité des banques centrales domestiques, ont été restaurées.Pourtant dans le processus d'accession à la zone Euro, les marges de manœuvre monétaires deviennent toujours plus restreintes. Tout au long du chapitre 3, nous utilisons la célèbre courbe de Phillips pour appréhender la relation, entre le taux de chômage et l'évolution des prix, comme proxy de l'efficacité de la politique monétaire. Les pays Baltes, la Slovénie et la Slovaquie nous permettent de mesurer l'impact des changements, de régimes de change, au cours de l'accession à la zone Euro. Dans le MCE-II, la relation est négative et significative. Néanmoins celle-ci disparait, au moment d'entrer dans l'union monétaire. Nous expliquons ce résultat par le fait que dans une union monétaire, les "petites" économies n'ont pas un poids suffisant pour influencer significativement les décisions de politiques monétaires.Si pour être pleinement efficace, la politique unique de la BCE doit se confronter, à des économies relativement homogènes, cette homogénéité transcende la sphère monétaire et touche directement l'économie réelle (en témoigne la courbe de Phillips). Les mécanismes d'ajustements, dans une union optimale, permettent de lisser l'impact des chocs asymétriques. Pour cela, le marché du travail nécessite une flexibilité (des salaires) et une mobilité des facteurs accrue. (.)

Moldova's recent Association Agreement with the European Union (EU), which includes a Deep and Comprehensive Free Trade Agreement (DCFTA), represents an important opportunity, as well as challenges. This analytical document has been commissioned by the World Bank Group to provide insights into potential outcomes of the DCFTA and of other trade options that Moldova has, using a Dynamic Computable General Equilibrium (DCGE) model calibrated to its economy. This paper begins by describing the general trends in economic relations between Moldova and the EU over the past 10 years, with an emphasis on trade, as well as Foreign direct investment (FDI) and labor migration. This section includes some additional facts and details that complement the Trade Competitiveness Diagnostic. In the second section, the paper presents the main elements of the DCFTA and highlights the trade commitments and concessions that the EU and Moldova undertook. It also includes a short review of available literature on the ex-ante or ex post impact assessments of other Association Agreements between the EU and third countries that have been done using CGE models. The third section presents key features of the DCGE and discusses the data used for assembling the Social Accounting Matrix (SAM). Then, the main features of the simulated trade scenarios are presented. Finally, this paper discusses the DCGE simulation results, including the effects of the various scenarios on welfare, trade, and economic activity level. Some distributional impacts are also brought into discussion. The final section concludes and makes several recommendations.

Romina Boccia and Dominik Lett


Congress is in the midst of debating the annual defense spending bill and chances for completion before the August recess look bleak. The multitrillion‐​dollar increase in the debt limit, which Congress passed in early June following months of negotiations, established budget levels for defense and nondefense appropriations for the next two years. The parties remain divided on the details.
Spending debates that are contentious now will likely get worse in future years, as the current fiscal trajectory will place inevitable constraints on America's military. Without reforms to health care and retirement benefits, other domestic and defense priorities will be increasingly squeezed. As debt levels and associated interest costs rise, economic growth will suffer. And as the share of the budget dedicated to autopilot entitlement spending expands, reduced fiscal capacity will further increase budgetary conflict over the shrinking portion of discretionary spending that Congress allocates each year.
Congress only debates 28 cents of every dollar it spends; the vast majority of federal spending goes out without congressional deliberation, primarily funding programs like Medicare, Medicaid, and Social Security, among other entitlements. A new mechanism is needed to reform entitlement spending and avoid a future fiscal crisis before it's too late.
Erosion of economic power
According to the Congressional Budget Office's (CBO's) latest long‐​term budget outlook, publicly held debt will grow from 98 percent of gross domestic product (GDP) to 181 percent of GDP by 2053. Most economic research finds that excessive public debt reduces economic growth, with dampening effects kicking in around debt reaching 78 percent of GDP.
There are many benefits of a robust economy including a higher standard of living. A strong domestic economy is also critical for supporting national security. Prominent national security leaders, including former Secretaries of State, Defense, Treasury, and Homeland Security across eight Republican and Democratic administrations, were recently gathered by the Peterson Foundation's Coalition for Fiscal and National Security. They argue that:
"[L]ong-term debt is the single greatest threat to our national security…This debt burden would slow economic growth, reduce income levels, and harm our national security posture. It would inevitably constrain funding for a strong military and effective diplomacy, and draw resources away from the investments that are essential for our economic strength and leading role among nations."

Delaying responsible fiscal reforms in the face of growing federal debt invites economic and national decline. High and rising U.S. federal debt leads to suppressed private investment, reduced incomes, and increased risk of a sudden fiscal crisis. A weaker economy and growing concerns by international bondholders of U.S. treasuries about the government's ability and willingness to service its debt—without resorting to high inflation—will drive up interest costs and eventually impact America's international standing negatively.
While investors continue to gobble up U.S. debt, which now exceeds $25 trillion, the $114 trillion in additional deficits CBO projects over the next 30 years pose serious questions about whether there will be enough appetite for markets to absorb such high levels of government debt. Troubling too is how much productivity‐​enhancing private investments will suffer because of crowding out. The prudent choice is to restore fiscal sustainability during times of peace and economic strength, reversing America's unsustainable debt crisis while it's still possible.
National defense is a core responsibility of the federal government. To maximize Americans' safety and prosperity, prudence should guide both strategy and the budget. A dire fiscal crisis would erode the economic foundation of America's strength, limiting U.S. capacity to defend its vital interests at home and abroad.
Crowding out of defense spending as a budget priority
Entitlements are increasingly dominating the federal budget. Since 1962, Social Security, Medicare, Medicaid, and other income security programs such as food stamps have grown four times larger as a share of GDP and consume more than half of the federal budget. By comparison, defense spending declined by a factor of three as a share of GDP, from 9 percent of GDP in 1962 to 3 percent of GDP by 2022. Defense spending makes up less than one‐​fifth of the budget, despite growing in real, inflation‐​adjusted terms as entitlement spending has claimed an increasing share of the taxpayer burden. In real terms, annual defense spending has increased by nearly $200 billion between 1962 and 2022. Meanwhile, annual entitlement spending has grown by $3.3 trillion over the same timeframe. The graphic below shows how entitlements have grown to consume a greater share of total non‐​interest spending over time.











As entitlements consume a larger share of the budget, this exerts downward pressure on other budget priorities. Former Principal Research Scientist for Massachusetts Institute of Technology's Security Studies Program Cindy Williams explains,
"Absent significant reform or a major expansion of the total federal budget, the rising costs of Social Security, Medicare, and Medicaid will continue to crowd out defense spending. In the extreme, if federal budgets are held near today's levels as a share of GDP, nondefense discretionary spending is not reduced significantly, and mandatory spending is not brought under control, there will soon be no money left for defense."
Defense has also been a prime target for cuts across several congressional efforts to reduce government spending. The Manhattan Institute's Brian Riedl examined 14 major deficit‐​reduction negotiations since 1980. More than any other category, legislators tend to reduce defense spending during fiscal consolidation periods. Cuts to defense discretionary spending produced the largest savings in four of six deficit‐​reduction deals. Despite entitlements primarily driving rising deficits, mandatory spending reforms in these deals were modest at best. It seems politically easier to keep targeting discretionary spending for cuts than to tackle the key driver of rising spending: entitlements.
For those in favor of restraining the scope of U.S. military engagement, a fiscally restrained government may have some upside. Cato's Justin Logan and former Cato research fellow Ben Friedman argue that depressed economic growth and rising interest rates driven by high debt could make the defense budget an increasingly likely target for cuts. Logan and Friedman write,
"The U.S. military of the 2010s and 2020s will likely have a moderately less ambitious strategy and smaller budget than that of last decade. But the ambitions will still be hegemonic and the budget massive, hardly those of a normal country concerned chiefly with its own affairs. Unfortunately, the old Bolshevik saying, ''the worse, the better'' may apply for those seeking to rein in American military ambition. Ironically, we are left to push for military restraint while rooting against the conditions liable to produce it."

In this way, a smaller U.S. defense budget would put real limits on unnecessary and self‐​defeating American military activities overseas by, constraining American legislators. Paradoxically, some level of defense budget constraints could improve U.S. national security by reducing our involvement in military conflicts that are not in America's national interest.
Apply a defense savings mechanism to the broader budget
The United States' unsustainable fiscal trajectory is almost entirely driven by rising interest expenses and entitlement spending. Legislators must work together to reform the major entitlement programs to avoid a potential debt crisis, massive tax increases, and lagging economic growth. One idea gaining traction is a debt commission to assist legislators with adopting budget reforms to stabilize the growth in the debt.
The 1988 Base Realignment and Closure Act (BRAC) successfully addressed the politically thorny issue of closing military bases and can serve as a model for Congress's debt commission. BRAC established an independent commission to select military bases for closures, with recommendations that were approved by the President being adopted by default in Congress unless legislators successfully passed a resolution of disapproval. BRAC successfully bypassed special interest politics and congressional gridlock to free up funding for more essential defense priorities. Congress should consider establishing a BRAC‐​like, independent fiscal commission to recommend changes to stabilize the debt at no more than 100 percent of GDP over the next 10 years.
A well‐​designed commission will be composed of a diverse group of experts, guided by clear goals established by Congress, and whose recommendations will be self‐​executing after Presidential approval; benefitting from so‐​called fast‐​track authority. Asking members of Congress to affirmatively vote for entitlement reforms recommended by such a commission will most likely undermine the debt commission's recommendations from becoming law. Few legislators are willing to stick their necks out in support of necessary and yet unpopular changes to Medicare and Social Security.
Unsustainable fiscal policy imperils American economic and military strength. By reforming entitlement programs and reducing spending, legislators can prevent high debt from undermining America's prosperity and security. A well‐​designed debt commission can help Congress to see this through.

Doutoramento em Economia ; A política orçamental, através da gestão das receitas e despesas públicas, é usualmente utilizada pelos decisores políticos para influenciar a atividade económica, nomeadamente através do controlo do rendimento disponível, de uma reafectação eficiente dos recursos existentes, do fornecimento de bens e serviços, bem como da correção de falhas de mercado. De acordo com o disposto na teoria Keynesiana, elaborada durante a Grande Recessão (década de 1930), os efeitos da política orçamental deverão variar de acordo com a fase do ciclo económico e dos instrumentos utilizados, sendo estes mais necessários e eficazes durante recessões. Contudo, em alguns episódios históricos, a evidência empírica parece contrariar as previsões teóricas efetuadas à luz da teoria Keynesiana, originando os comumente chamados efeitos não-Keynesianos da política orçamental. Por sua vez, a última Grande Recessão trouxe, uma vez mais, o debate relativo à eficácia da política orçamental para a literatura económica. Os elevados montantes de dívida pública acumulados na generalidade das economias europeias ocidentais comprometeram a sua sustentabilidade e restringiram decisões políticas, o que gerou repercussões tanto nos custos de financiamento soberano como no bem-estar social. Assim, diversos Estados Membros da Zona Euro foram forçados a implementar medidas mais restritivas de forma a conseguirem reduzir os seus desequilíbrios orçamentais, num cenário em que a política cambial se encontrava inacessível, e em que a taxa de inflação se apresentou especialmente baixa. Neste contexto, a presente tese debruça-se sobre o impacto macroeconómico da política orçamental nos Estados Membros da UEM, averiguando como este poderá variar de acordo com os instrumentos utilizados e com fatores intrínsecos de cada país, tendo em atenção tópicos relevantes que ainda não estão suficientemente explorados na literatura. É ainda analisado se, e como, a política orçamental poderá ser manipulada de acordo com motivações eleitoralistas, nomeadamente se as evidências empíricas dão suporte às previsões do modelo de "despesa visível" de Rogoff, ou ao modelo de despesa pública direcionada. Por outras palavras, se um hipotético aumento de despesa estará associado a mais despesas correntes, ou se existirão investimentos direcionados para satisfazer as pretensões de grupos ou regiões específicas. Num primeiro momento, foram calculados os valores dos multiplicadores orçamentais desde a criação da União Monetária. De acordo com os resultados obtidos, a despesa pública nos Estados Membros tem um impacto positivo sobre a atividade económica (multiplicador de 0,44), sendo o impacto maior perante menores níveis de endividamento soberano, recessões económicas e fases negativas do ciclo económico (hiato do produto negativo). Por sua vez, a receita fiscal apresenta valores negativos, compreendidos entre -0,11 e -0,55, podendo, no entanto, revelar um impacto expansionista em países com menores níveis de dívida pública. Porém, nem sempre as políticas resultam nos resultados expectáveis. Foram estimadas elasticidades do consumo privado, face aos instrumentos orçamentais, durante o período de 1960-2017, de forma a aferir como as elasticidades variam perante episódios orçamentais (claras ações políticas, como expansões ou consolidações orçamentais). As evidências indicam que as transferências sociais poderão estar na origem dos efeitos não-Keynesianos da política orçamental, uma vez o consumo privado apresenta elasticidades negativas face às suas variações, durante períodos de consolidação. Ainda, os episódios não-Keynesianos tornaram-se menos prováveis de serem observados após os países integrarem a Zona Euro, dado que os gastos em investimentos e as outras despesas deixaram de apresentar uma relação negativa com o consumo privado. Foi também observado que as transferências sociais aparentam ter um impacto mais recessivo durante consolidações, que aquele observado perante expansões ou na ausência de episódios orçamentais. Utilizando uma abordagem alternativa para identificar consolidações orçamentais (abordagem narrativa), foi constatado que o consumo privado continua a exibir uma resposta não-Keynesiana a choques fiscais. Por último, a política orçamental aparenta ainda ser sensível a fatores políticos. Durante anos eleitorais, os decisores políticos tendem a aumentar as despesas correntes e a diminuir o peso dos impostos diretos. Porém, a estratégia orçamental tem sofrido algumas alterações ao longo dos anos. Desde a Grande Recessão, os Estados Membros aparentam ter perdido a sua capacidade para manipular a despesa pública com objetivos eleitoralistas, e começaram a diminuir os impostos indiretos. Também, após os Estados Membros aderirem à UEM, os decisores políticos começaram a aumentar a carga fiscal dos seus países face a choques na taxa de juro, uma vez que perderam a capacidade de recorrer à política monetária. ; The fiscal policy, through the management of public revenue and expenditure, is usually used by policy makers to influence economic activity, namely through the control of available income, the reallocation of resources, the supply of goods and services or the correction of market failures. Following the Keynesian perspective, designed during the Great Depression (1930's), the effects of fiscal policy should vary over the stages of the business cycle and over fiscal instruments used, being more needed and effective during recessions. However, in some historical cases, the empirical evidence seems to contradict the theoretical predictions in the spirit of the Keynesian theory, giving rise to the so-called non-Keynesian effects of fiscal policy. Therefore, the last Great Recession brought the effectiveness of fiscal policy back into debate in the economic literature. The high amounts of sovereign debt accumulated in the majority of the western European economies have been jeopardizing the sustainability of public debts, restricting political decisions, with repercussions on sovereign financing costs and on people's welfare. Thus, several Eurozone's Member States were forced to implement more restrictive policies in order to reduce their budgetary imbalances, in a scenario where the exchange rate policies are unavailable, and the inflation rate has been especially low. In this context, this thesis focuses on the macroeconomic impact of fiscal policy on the Member States, assessing how it may vary according to the fiscal instruments used, and to country specific characteristics, taking into account some relevant topics not very explored yet in the literature. It is also analysed whether, and how, the fiscal policy can be manipulated according to electoral motivations, namely if evidence supports the predictions of the Rogoff's "visibility expenditure" model or the Public expenditure targeting model, i.e., if the hypothetical expenditure increase will be associated with current expenditure, or if the capital expenditure will be used as a target to specific groups and locations. Firstly, it was computed the value of fiscal multipliers since the creation of the currency union. According to the results, public expenditure in Member States has a positive impact on economic growth (multiplier of 0.44), with a bigger impact on the less indebted countries, facing economic recessions and negative output gaps. In turn, tax revenue has negative values, between -0.11 and -0.55, but it can reveal an expansionary impact in countries with lower levels of public debt. However, policies do not always result in the expected results. Elasticities of private consumption to fiscal instruments were estimated during the period 1960-2017, to access how fiscal elasticities vary during fiscal episodes (clear policy actions, such as fiscal expansions or consolidations). Evidence indicates that social benefits may be a root of the non-Keynesian effects of fiscal policy, since private consumption shows negative elasticities facing social benefits' shocks, during periods of fiscal consolidation. In addition, non-Keynesian episodes became less likely to be observed after countries joined the Eurozone, given that investment spending and other expenditures have lost their non-Keynesian role. It was also perceived that social transfers seem to be more contractionary in consolidations than in both expansions and in the absence of fiscal episodes. Using an alternative approach to identify fiscal consolidations (narrative approach), it is seen that private consumption continues to exhibit a non-Keynesian response to tax increases. Lastly, fiscal policy in the Eurozone countries appears to be sensitive to political factors. During election years, the incumbent Governments seem to increase current spending and to decrease the direct tax burden. However, the fiscal strategy has changed over the years. Since the Great Recession, Member States have lost their ability to manipulate the Government spending for electoral purposes and began to decrease the indirect tax burden. Furthermore, after countries joined the EMU, policy makers began to increase tax burden facing interest rate shocks, since they have lost the ability to use monetary policy. ; info:eu-repo/semantics/publishedVersion

Background. Today, an incidence and a mortality of incurable chronic diseases is increasing in the world, growing the relevance of Palliative and Hospice Care (PHC) systems and services creating and developing. The unfavorable medical and demographic situation in Ukraine requires a substantiation and implementation of an affordable, high-quality and effective PHC System that requires of health care providers of all levels involving, interagency and intersectoral coordination and cooperation in the PHC delivery. The purpose was to substantiate the optimal functional and organizational model of specialized PHC providing to the population in Ukraine. Materials and methods. Medical statistics, national and international scientific literature, results of sociological research were used in the work; methods of systematic and structural-functional analysis, medical cartography, biblio-semantic, statistical and sociological methods of research were applied in the work. Results. The optimum functional and organizational model of specialized PHC providing to the population in Ukraine is substantiated, in particular the health care providers involved in specialized PHC providing and their tasks were defined. Conclusions. 1. A medical and social analysis of morbidity and mortality rates and medical and demographic data shows high mortality rate from malignant neoplasms and severe complications of chronic noncommunicable diseases, rapid aging of the population in Ukraine, which determine the high need of the population in PHC. This requires the substantiation and development of an accessible, high-quality and efficient PHC System based on innovative multidisciplinary, interagency and intersectoral approaches, which requires the coordination of the work of institutions that subordinated to different ministries and departments, involvement in PHC providing and social care for palliative patients of health care providers of all levels and social care institutions. 2. A systematic analysis of the PHC worldwide experience in many countries around the world, the recommendations of WHO, the European Association for Palliative Care (EAPC) and other reputable international professional organizations, allows us to propose a three-levels model of PHC System in Ukraine: 1) Palliative care approach or primary PHC; 2) General palliative care; 3) Specialized PHC (hospice or end-of-life care). This was the basis of the developed of the PHC System delivery to the population in Ukraine concept. 3. It is grounded, developed and tested at the level of the innovative components of the functional and organizational model of specialized PHC that based on a patient-family-oriented paradigm, a multidisciplinary, interagency and intersectoral approach at all levels of health care delivery that meets current international standards and norms, to integrate PHC into the Health Care System, the continuity of its delivery, and feedback through the involvement and cooperation of health care providers and social care institutions, public and charitable organizations, patients and their families. 4. The functional and organizational model of specialized PHC providing to the population in Ukraine is a high-tech, highly professional component of the Healthcare System, which requires modern high-tech equipment and effective medicines, special professional training and continuous professional development and motivation of the staff, appropriate legal framework and, of course, proper financial and political support of the Government of Ukraine, regional and local authorities and the interest and support of the whole society. ; Актуальность. Сегодня в мире растет распространенность и смертность населения от инкурабельные хронических заболеваний, что увеличивает актуальность создания и развития систем и служб оказания паллиативной и хосписной помощи (ПХП) населению. Неблагоприятная медико-демографическая ситуация в Украине требует обоснования и внедрения системы доступной, качественной и эффективной ПХП, что требует привлечения к оказанию ПХП медицинских работников учреждений здравоохранения (УЗ) всех уровней медицинской помощи, межведомственной и межсекторальной координации и сотрудничества. Цель работы: обосновать оптимальную функционально-организационная модель оказания специализированной ПХП населению в Украине. Материалы и методы. В работе были использованы данные медицинской статистики, национальная и международная научная литература, результаты социологического исследования; применены методы системного и структурно-функционального анализа, медицинской картографии, библиосемантический, статистический и социологический методы исследования. Результаты. Обоснована оптимальная функционально-организационная модель оказания специализированной ПХП населению в Украине, в частности определены учреждения, которые привлекаются к оказанию специализированной ПХП, и их задачи. Выводы. 1. Медико-социальный анализ показателей заболеваемости, смертности и медико-демографических данных свидетельствует о высоком уровне смертности от злокачественных новообразований (ЗН) и тяжелых осложнений хронических неинфекционных заболеваний (ХНИЗ), быстрое постарение населения в Украине, определяющих высокую потребность населения в ПХП. Указанное требует создания и развития системы доступной, качественной и эффективной ПХП, основанной на инновационных мультидисциплинарных, межведомственных и межсекторальных подходах, что требует координации работы учреждений, подчиненных различным министерствам и ведомствам, привлечения к оказанию ПХП и социальной услуги по паллиативному уходу (СУПУ) медицинских работников УЗ всех уровней медицинской помощи и работников учреждений социальной защиты населения. 2. Системный анализ мирового опыта внедрения ПХП во многих странах мира, рекомендаций ВОЗ, Европейской Ассоциации паллиативной помощи (ЕАРС) и других авторитетных международных профессиональных организаций позволяет предложить внедрить в Украине трехуровневую модель системы оказания ПХП: 1) Паллиативный подход или первичная ПХП; 2) Общая паллиативная помощь; 3) Специализированная ПХП (хосписная помощь или «помощь в конце жизни» - «end of life care». Отмеченное выше было положено в основу разработанной концепции системы оказания ПХП населению в Украине. 3. Обоснована, разработана и апробирована на уровне отдельных инновационных составляющих функционально-организационная модель специализированной ПХП, основой которой является пациент-семья-ориентированная парадигма, мультидисциплинарный, межведомственный и межсекторальный подход на всех уровнях оказания медицинской помощи, которая соответствует современным международным стандартам и нормам. Это обеспечит интеграцию ПХП в систему здравоохранения, непрерывность и преемственность ее оказания и обратная связь путем привлечения и сотрудничества учреждений здравоохранения и учреждений социальной защиты населения, общественных и благотворительных организаций, пациентов и их семей. 4. Предложенная функционально-организационная модель специализированной ПХП представляет собой наукоемкую высокопрофессиональную составляющую здравоохранения, требует современного высокотехнологичного оборудования и эффективных лекарственных средств, специальной профессиональной подготовки, безпрерывого профессионального развития и мотивации кадров, соответствующей нормативно-правовой базы и, безусловно, надлежащего финансового обеспечения и политической поддержки Правительства Украины, региональных и местных органов власти, заинтересованности и поддержки всего общества. ; Актуальність. Сьогодні у світі зростає поширеність і смертність населення від інкурабельних хронічних захворювань, що збільшує актуальність створення і розвитку систем і служб надання паліативної і хоспісної допомоги (ПХД) населенню. Несприятлива медико-демографічна ситуація в Україні вимагає обґрунтування і впровадження системи доступної, якісної і ефективної ПХД, що потребує залучення до надання ПХД медичних працівників закладів охорони здоров'я (ЗОЗ) усіх рівнів медичної допомоги, міжвідомчої та міжсекторальної координації і співпраці. Мета роботи: обґрунтувати оптимальну функціонально-організаційну модель надання спеціалізованої ПХД населенню в Україні. Матеріали та методи. У роботі були використані дані медичної статистики, національна та міжнародна наукова література, результати соціологічного дослідження; застосовані методи системного та структурно-функціонального аналізу, медичної картографії, бібліосемантичний, статистичний і соціологічний методи дослідження. Результати. Обґрунтована оптимальна функціонально-організаційна модель надання спеціалізованої ПХД населенню в Україні, зокрема визначені заклади, що залучаються до надання спеціалізованої ПХД, та їх завдання. Висновки. 1. Медико-соціальний аналіз показників захворюваності і смертності та медико-демографічних даних свідчить про високий рівень смертності від злоякісних новоутворень (ЗН) і тяжких ускладнень хронічних неінфекційних захворювань (ХНІЗ), швидке постаріння населення в Україні, що визначають високу потребу населення у ПХД. Зазначене вимагає створення і розвитку системи доступної, якісної і ефективної ПХД, заснованої на інноваційних мультидисциплінарних, міжвідомчих та міжсекторальних підходах, що потребує координації роботи закладів, підпорядкованих різним міністерствам і відомствам, залучення до надання ПХД та соціальної послуги з паліативного догляду (СППД) медичних працівників ЗОЗ усіх рівнів медичної допомоги та працівників закладів соціального захисту населення. 2. Системний аналіз світового досвіду впровадження ПХД у багатьох країнах світу, рекомендацій ВООЗ, Європейської Асоціації паліативної допомоги (ЕАРС) та інших авторитетних міжнародних фахових організацій дозволяє пропонувати впроваджувати в Україні трирівневу модель системи надання ПХД: 1) Паліативний підхід або первинна ПХД; 2) Загальна паліативна допомога; 3) Спеціалізована ПХД (хоспісна допомога або «допомога наприкiнцi життя» – «end of life care». Зазначене було покладено в основу розробленої концепції системи надання ПХД населенню в Україні. 3. Обґрунтовано, розроблено та апробовано на рівні окремих інноваційних складових функціонально-організаційну модель спеціалізованої ПХД, основою якої є пацієнт-сім'я-орієнтована парадигма, мультидисциплінарний, міжвідомчий і міжсекторальний підхід на усіх рівнях надання медичної допомоги, що відповідає сучасним міжнародним стандартам і нормам. Це забезпечить інтеграцію ПХД в систему охорони здоров'я, безперервність та наступність її надання і зворотний зв'язок шляхом залучення і співпраці закладів охорони здоров'я і установ соціального захисту населення, громадських і благодійних організацій, пацієнтів і їх родин. 4. Запропонована функціонально-організаційна модель спеціалізованої ПХД являє собою наукоємну високопрофесійну складову охорони здоров'я, що потребує сучасного високотехнологічного обладнання та ефективних лікарських засобів, спеціальної професійної підготовки, безперервного професійного розвитку і мотивації кадрів, відповідної нормативно-правової бази і, безумовно, належного фінансового забезпечення і політичної підтримки Уряду України, регіональних і місцевих органів влади та зацікавленості і підтримки усього суспільства.

Sustainable human development is a theory of development that has been built since the middle of the last century, due to the need of the world to explain and seek alternatives to the deep levels of poverty produced by the conditions of inequality and exclusion of large populations of the globe . The great world conflicts caused the need for the installation of a system that would ensure that the world was not going to be involved again in such conflicts, so humanity should initiate a process of change in its structures and aim to give it participation to all development actors, raising the theory of First People with its importance of citizen participation. At the same time the generation of knowledge has had a great momentum trying to face the new challenges of humanity. In confronting the different problems that human beings have encountered in their future, they have used techniques and sciences to discover a solution to them. In the production of knowledge and based on the complexity of the problem, three schemes of relationship between the sciences were conceptualized: Disciplinarity, Interdisciplinarity and Transdisciplinarity, conceptualizing Morin the complex thought by recognizing the complexity of the human being, of the living, of the earth , of the cosmos, giving way to the construction of a new anthropocosmological culture. Faced with this horizon, there are two problematic fields that demand attention: the modes of production of knowledge, in what refers to scientific and academic knowledge, and the link between knowledge and strategic relationship for the establishment of policies that respond to the needs of reality through higher education.In the challenges of the university of the 21st century it is proposed that both from the social, political, cultural and economic point of view and from the perspective of the growing complexity of today's world, the mission of knowledge is key in terms of transformation and in terms of citizenship and social responsibility, which must be strengthened to contribute to the creation of sustainable human development, a fundamental task of Higher Education. There have been many jobs that have been on higher education produced and has been UNESCO with its Regional and World Conferences that have agreed which they are the challenges, challenges and trends as well as the Plan for Action that the countries of the world must face and promote so that higher education can achieve a lifelong education by promoting four general basic competences (Delors, 1996) as way to achieve a better world. UNESCO concludes that it is a priority to promote interaction and links between the various scientific disciplines and to promote training and research services that are oriented to the cultivation of recognition of the integration of the different sciences. As historical background and constructors of the current UNAH, writings by Tünnerman, Rama and others on the movements of University reform that occurred from the middle of the previous century in Latin America, aimed at strengthening the priority role of the Universities to consolidate were reviewed their autonomy from the dominant power groups and merge their actions with the demands of freedom of the peoples through the democratic participation of the studious youth in the conformation of the new nations. This work is based on the theoretical intellectual analysis of contextualizing the position of UNAH as a reference for higher education, within the framework of sustainable human development, through the trilogy of science, politics and citizenship, which entails the production of relevant scientific knowledge and Useful to the demands of the moment that the Honduran National lives. Based on this, the object of study of this Thesis is to assess whether UNAH, in its transformative process has reached the levels of quality, relevance and equity, transparency and accountability, making use of its resources and potential to provide the Honduran population benefits of knowledge management to contribute to the sustainable human development of the country. The research process concludes in the critical study of the products and results of UNAH as its raison d'être, in the period of transformation that it currently lives, to achieve the fulfillment of its responsibilities vis-à-vis the Honduran nation. ; El desarrollo humano sostenible es una teoría del desarrollo que se ha venido construyendo desde mediados del último siglo, por la necesidad del mundo de explicar y buscar alternativas a los profundos niveles de pobreza producida por las condiciones de inequidad y exclusión de grandes poblaciones del globo terráqueo. Los grandes confl ictos mundiales provocaron la necesidad de la instalación de un sistema que asegurara que el mundo no se iba a volver a ver envuelto en tales confl agraciones, por lo que la humanidad debería iniciar un proceso de cambio en sus estructuras y orientarse a darle participación a todos los actores del desarrollo, planteando la teoría de Primero la Gente con su importancia de la participación ciudadana. Al mismo tiempo la generación del conocimiento ha tenido un gran impulso tratando de enfrentar los nuevos retos de la humanidad. En el enfrentamiento a los distintos problemas que el ser humano ha encontrado en su devenir, ha utilizado las técnicas y las ciencias para descubrir solución a los mismos. En la producción del conocimiento y en base a la complejidad del problema, se conceptualizaron tres esquemas de relación entre las ciencias: Disciplinariedad, Interdisciplinariedad y Transdisciplinariedad, conceptualizando Morín el pensamiento complejo al reconocer la complejidad del ser humano, de lo viviente, de la tierra, del cosmos, dando paso a la construcción de una nueva cultura antropocosmológica. Frente a este horizonte, se presentan dos campos problemáticos que demandan atención: los modos de producción del conocimiento, en lo que se refi ere al saber científi co y académico, y la vinculación entre conocimiento y relación estratégica para el establecimiento de políticas que respondan a las necesidades de la realidad mediante la educación superior.En los retos de la universidad del Siglo XXI se plantea que tanto desde el punto de vista social, político, cultural y económico como desde la perspectiva de la creciente complejidad del mundo actual, la misión del conocimiento es clave en lo relativo a transformación y en términos de ciudadanía y responsabilidad social, lo que debe fortalecerse para contribuir a la creación de un desarrollo humano sostenible, tarea fundamental de la Educación Superior.Han sido muchos los trabajos que sobre educación superior se han producido y ha sido la UNESCO con sus Conferencias Regionales y Mundiales que han consensuado cuáles son los retos, desafíos y tendencias así como el Plan para la Acción que los países del mundo deben enfrentar y propiciar para que la educación superior pueda alcanzar una educación para toda la vida mediante el fomento de cuatro competencias básicas generales (Delors, 1996) como forma de lograr un mundo mejor. Concluye la UNESCO que es prioritario que se promueva la interacción y los vínculos entre las diversas disciplinas científicas y propiciar servicios de capacitación e investigación que se orienten al cultivo de reconocimiento de la integración de las distintas ciencias. Como antecedentes históricos y constructores de la actual UNAH se revisaron escritos de Tünnerman, Rama y otros sobre los movimientos de reforma Universitaria que se dieron a partir de la mitad del siglo anterior en América Latina, orientados a fortalecer el papel prioritario de las Universidades de consolidar su autonomía de los grupos de poder dominantes y fundir su accionar con las demandas de libertad de los pueblos mediante la participación democrática de la juventud estudiosa en la conformación de las nuevas naciones. Este trabajo se sustenta en el análisis intelectual teórico de contextualizar la posición de la UNAH como referente de la educación superior, en el marco del desarrollo humano sostenible, mediante la trilogía de ciencia, política y ciudadanía, que conlleve la producción de conocimiento científico pertinente y útil a las demandas del momento que vive la Nacional hondureña. En base a ello el objeto de estudio de esta Tesis es valorar si la UNAH, en su proceso transformador ha alcanzado los niveles de calidad, pertinencia y equidad, transparencia y rendición de cuentas, haciendo uso de sus recursos y potencialidades para poder brindar a la población hondureña los beneficios de la gestión del conocimiento para contribuir al desarrollo humano sostenible del país. Concluye el proceso de investigación en el estudio crítico de los productos y resultados de la UNAH como su razón de ser, en el periodo de trasformación que actualmente vive, para alcanzar el cumplimiento de sus responsabilidades frente a la nación hondureña.

Background. Today, an incidence and a mortality of incurable chronic diseases is increasing in the world, growing the relevance of Palliative and Hospice Care (PHC) systems and services creating and developing. The unfavorable medical and demographic situation in Ukraine requires a substantiation and implementation of an affordable, high-quality and effective PHC System that requires of health care providers of all levels involving, interagency and intersectoral coordination and cooperation in the PHC delivery. The purpose was to substantiate the optimal functional and organizational model of specialized PHC providing to the population in Ukraine. Materials and methods. Medical statistics, national and international scientific literature, results of sociological research were used in the work; methods of systematic and structural-functional analysis, medical cartography, biblio-semantic, statistical and sociological methods of research were applied in the work. Results. The optimum functional and organizational model of specialized PHC providing to the population in Ukraine is substantiated, in particular the health care providers involved in specialized PHC providing and their tasks were defined. Conclusions. 1. A medical and social analysis of morbidity and mortality rates and medical and demographic data shows high mortality rate from malignant neoplasms and severe complications of chronic noncommunicable diseases, rapid aging of the population in Ukraine, which determine the high need of the population in PHC. This requires the substantiation and development of an accessible, high-quality and efficient PHC System based on innovative multidisciplinary, interagency and intersectoral approaches, which requires the coordination of the work of institutions that subordinated to different ministries and departments, involvement in PHC providing and social care for palliative patients of health care providers of all levels and social care institutions. 2. A systematic analysis of the PHC worldwide experience in many countries around the world, the recommendations of WHO, the European Association for Palliative Care (EAPC) and other reputable international professional organizations, allows us to propose a three-levels model of PHC System in Ukraine: 1) Palliative care approach or primary PHC; 2) General palliative care; 3) Specialized PHC (hospice or end-of-life care). This was the basis of the developed of the PHC System delivery to the population in Ukraine concept. 3. It is grounded, developed and tested at the level of the innovative components of the functional and organizational model of specialized PHC that based on a patient-family-oriented paradigm, a multidisciplinary, interagency and intersectoral approach at all levels of health care delivery that meets current international standards and norms, to integrate PHC into the Health Care System, the continuity of its delivery, and feedback through the involvement and cooperation of health care providers and social care institutions, public and charitable organizations, patients and their families. 4. The functional and organizational model of specialized PHC providing to the population in Ukraine is a high-tech, highly professional component of the Healthcare System, which requires modern high-tech equipment and effective medicines, special professional training and continuous professional development and motivation of the staff, appropriate legal framework and, of course, proper financial and political support of the Government of Ukraine, regional and local authorities and the interest and support of the whole society. ; Актуальность. Сегодня в мире растет распространенность и смертность населения от инкурабельные хронических заболеваний, что увеличивает актуальность создания и развития систем и служб оказания паллиативной и хосписной помощи (ПХП) населению. Неблагоприятная медико-демографическая ситуация в Украине требует обоснования и внедрения системы доступной, качественной и эффективной ПХП, что требует привлечения к оказанию ПХП медицинских работников учреждений здравоохранения (УЗ) всех уровней медицинской помощи, межведомственной и межсекторальной координации и сотрудничества. Цель работы: обосновать оптимальную функционально-организационная модель оказания специализированной ПХП населению в Украине. Материалы и методы. В работе были использованы данные медицинской статистики, национальная и международная научная литература, результаты социологического исследования; применены методы системного и структурно-функционального анализа, медицинской картографии, библиосемантический, статистический и социологический методы исследования. Результаты. Обоснована оптимальная функционально-организационная модель оказания специализированной ПХП населению в Украине, в частности определены учреждения, которые привлекаются к оказанию специализированной ПХП, и их задачи. Выводы. 1. Медико-социальный анализ показателей заболеваемости, смертности и медико-демографических данных свидетельствует о высоком уровне смертности от злокачественных новообразований (ЗН) и тяжелых осложнений хронических неинфекционных заболеваний (ХНИЗ), быстрое постарение населения в Украине, определяющих высокую потребность населения в ПХП. Указанное требует создания и развития системы доступной, качественной и эффективной ПХП, основанной на инновационных мультидисциплинарных, межведомственных и межсекторальных подходах, что требует координации работы учреждений, подчиненных различным министерствам и ведомствам, привлечения к оказанию ПХП и социальной услуги по паллиативному уходу (СУПУ) медицинских работников УЗ всех уровней медицинской помощи и работников учреждений социальной защиты населения. 2. Системный анализ мирового опыта внедрения ПХП во многих странах мира, рекомендаций ВОЗ, Европейской Ассоциации паллиативной помощи (ЕАРС) и других авторитетных международных профессиональных организаций позволяет предложить внедрить в Украине трехуровневую модель системы оказания ПХП: 1) Паллиативный подход или первичная ПХП; 2) Общая паллиативная помощь; 3) Специализированная ПХП (хосписная помощь или «помощь в конце жизни» - «end of life care». Отмеченное выше было положено в основу разработанной концепции системы оказания ПХП населению в Украине. 3. Обоснована, разработана и апробирована на уровне отдельных инновационных составляющих функционально-организационная модель специализированной ПХП, основой которой является пациент-семья-ориентированная парадигма, мультидисциплинарный, межведомственный и межсекторальный подход на всех уровнях оказания медицинской помощи, которая соответствует современным международным стандартам и нормам. Это обеспечит интеграцию ПХП в систему здравоохранения, непрерывность и преемственность ее оказания и обратная связь путем привлечения и сотрудничества учреждений здравоохранения и учреждений социальной защиты населения, общественных и благотворительных организаций, пациентов и их семей. 4. Предложенная функционально-организационная модель специализированной ПХП представляет собой наукоемкую высокопрофессиональную составляющую здравоохранения, требует современного высокотехнологичного оборудования и эффективных лекарственных средств, специальной профессиональной подготовки, безпрерывого профессионального развития и мотивации кадров, соответствующей нормативно-правовой базы и, безусловно, надлежащего финансового обеспечения и политической поддержки Правительства Украины, региональных и местных органов власти, заинтересованности и поддержки всего общества. ; Актуальність. Сьогодні у світі зростає поширеність і смертність населення від інкурабельних хронічних захворювань, що збільшує актуальність створення і розвитку систем і служб надання паліативної і хоспісної допомоги (ПХД) населенню. Несприятлива медико-демографічна ситуація в Україні вимагає обґрунтування і впровадження системи доступної, якісної і ефективної ПХД, що потребує залучення до надання ПХД медичних працівників закладів охорони здоров'я (ЗОЗ) усіх рівнів медичної допомоги, міжвідомчої та міжсекторальної координації і співпраці. Мета роботи: обґрунтувати оптимальну функціонально-організаційну модель надання спеціалізованої ПХД населенню в Україні. Матеріали та методи. У роботі були використані дані медичної статистики, національна та міжнародна наукова література, результати соціологічного дослідження; застосовані методи системного та структурно-функціонального аналізу, медичної картографії, бібліосемантичний, статистичний і соціологічний методи дослідження. Результати. Обґрунтована оптимальна функціонально-організаційна модель надання спеціалізованої ПХД населенню в Україні, зокрема визначені заклади, що залучаються до надання спеціалізованої ПХД, та їх завдання. Висновки. 1. Медико-соціальний аналіз показників захворюваності і смертності та медико-демографічних даних свідчить про високий рівень смертності від злоякісних новоутворень (ЗН) і тяжких ускладнень хронічних неінфекційних захворювань (ХНІЗ), швидке постаріння населення в Україні, що визначають високу потребу населення у ПХД. Зазначене вимагає створення і розвитку системи доступної, якісної і ефективної ПХД, заснованої на інноваційних мультидисциплінарних, міжвідомчих та міжсекторальних підходах, що потребує координації роботи закладів, підпорядкованих різним міністерствам і відомствам, залучення до надання ПХД та соціальної послуги з паліативного догляду (СППД) медичних працівників ЗОЗ усіх рівнів медичної допомоги та працівників закладів соціального захисту населення. 2. Системний аналіз світового досвіду впровадження ПХД у багатьох країнах світу, рекомендацій ВООЗ, Європейської Асоціації паліативної допомоги (ЕАРС) та інших авторитетних міжнародних фахових організацій дозволяє пропонувати впроваджувати в Україні трирівневу модель системи надання ПХД: 1) Паліативний підхід або первинна ПХД; 2) Загальна паліативна допомога; 3) Спеціалізована ПХД (хоспісна допомога або «допомога наприкiнцi життя» – «end of life care». Зазначене було покладено в основу розробленої концепції системи надання ПХД населенню в Україні. 3. Обґрунтовано, розроблено та апробовано на рівні окремих інноваційних складових функціонально-організаційну модель спеціалізованої ПХД, основою якої є пацієнт-сім'я-орієнтована парадигма, мультидисциплінарний, міжвідомчий і міжсекторальний підхід на усіх рівнях надання медичної допомоги, що відповідає сучасним міжнародним стандартам і нормам. Це забезпечить інтеграцію ПХД в систему охорони здоров'я, безперервність та наступність її надання і зворотний зв'язок шляхом залучення і співпраці закладів охорони здоров'я і установ соціального захисту населення, громадських і благодійних організацій, пацієнтів і їх родин. 4. Запропонована функціонально-організаційна модель спеціалізованої ПХД являє собою наукоємну високопрофесійну складову охорони здоров'я, що потребує сучасного високотехнологічного обладнання та ефективних лікарських засобів, спеціальної професійної підготовки, безперервного професійного розвитку і мотивації кадрів, відповідної нормативно-правової бази і, безумовно, належного фінансового забезпечення і політичної підтримки Уряду України, регіональних і місцевих органів влади та зацікавленості і підтримки усього суспільства.