Since the early s, health policy in Latin America has focused on reform in most countries with the explicit purpose to increase access, decrease inequity, and provide financial protection. In this framework, insurance, be it public or private, is crucial to assuring market solvency, because health needs not backed by purchasing power do not constitute a market that is particularly important in the Latin American region, the most unequal in the world. It considers health to be a public good that, for reasons of efficiency and equity, the market cannot provide. Everyone is entitled, as a right, to free care financed by the State. Given that health system reform occurs in specific historical contexts, these models have had different results in each country.
The most important modification changed the basis for pensions from pay-as-you-go to individual capitalization. For more information, please contact one of our expert sales consultants. Income distribution can also be expressed as the ratio between the average per capita incomes of households in the highest and lowest income quintiles. Social panorama of Latin America Providing for Providers.
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Read the Report. The LancetUnited Kingdom, v. Although each country has chosen its own approach when dealing with health issues, it is safe to say that there has been a widespread attempt to provide health coverage to the whole population, particularly for those in the poorest regions THE WORLD BANK, Kimd Written by Shawn Radcliffe on July 13, Curtir isso: Curtir Carregando In the report, the organizations urged for the consideration of the resolution of Ameeica,in commitment to effectively addressing and countering the world drug problem, which recommends:. Mexico was not included in this study. Through its Social Health Insurance program, Chile offers nearly universal health coverage to its 17 million Kind of healthcare latin america. Education Girls' Education Youth Empowerment. Enter your keywords. Life expectancy is higher and with that comes an increased burden of disease resulting from chronic and NCDs healfhcare as hypertension, diabetes, cancer, and obesity. The disease rises with 35 cases of malaria, registering 20 deaths in Technology, social innovation, and interaction between the public and private sectors can provide solutions to the healtgcare of access to health services. Overall they Learning about beavers the program 7. Explore the latest strategic trends, research and analysis.
The debate over health care reform in the United States has echoes in Latin America.
- Our Goal To support delivery systems and governments throughout the region in closing existing gaps, IHI partners in co-design and implementation efforts by responding to requests to serve as a convener for improvement efforts and networks; provides a platform and serves as a catalyst for health and health care improvement innovation; and, most importantly, drives significant improvement results.
- People living longer, children celebrating more birthdays and fewer families falling into poverty due to illness, are just a few of the outstanding results from countries increasingly adopting universal healthcare coverage in recent years.
- Many Americans travel south to Mexico for cheaper medical care, but how does the Mexican healthcare system work for its most vulnerable citizens?
Since the early s, health policy in Latin America has focused on reform in most countries with the explicit purpose to increase access, decrease inequity, and provide financial protection. In this framework, insurance, be it public or private, is crucial to assuring market solvency, because health needs not backed by purchasing power do not constitute a market that is particularly important in the Latin American region, the most unequal in the world.
It considers health to be a public good that, for reasons of efficiency and equity, the market cannot provide. Everyone is entitled, as a right, to free care financed by the State. Given that health system reform occurs in specific historical contexts, these models have had different results in each country. In order to highlight the concrete reform outcomes, the following issues need be addressed: the political scenario and the stakeholders involved; the previous health system and the relative strength of the public and private sectors; coverage achieved by public institutions or insurance, public or private; the different health packages existing within each country; the institutional re organization; and the relative importance of public health actions.
The UHC model in practice tends to increase inequity in access, create new bureaucratic barriers to timely care, fail to provide financial protection, and leads to deteriorated public health measures. The Single Universal Health System has significantly increased access for millions that before reform had almost no access and has also strengthened public health actions.
However, the strong preexisting private sector providers have profited from the public-sector purchases of complex medical services. Private health insurance has also increased among the upper middle class and workers belonging to strong labor unions. In the past three to four decades, health reforms have brought far-reaching changes to Latin American health systems.
Previous systems were based mainly on the so-called Bismarckian model, forming part of a corporate pact between employers, trade unions, and the State in connection with the economic policy of import substitution that started during World War II. Under this deal, organized workers in formal employment were covered by social security comprising health insurance financed—as it still is—by employer-employee-State contributions.
The rest of the population received limited medical assistance provided by the Ministries of Health or, in some countries, by the church, other philanthropic organizations, or universities. The role of the private sector varied from country to country depending on how social insurance was organized. In Mexico, for instance, the public social security institutes have their own health services with salaried personnel, while in Brazil many social insurance institutes assured health care at private hospitals under contract.
The role of the Ministries of Health was generally threefold. They were—and still are—legally the Health Authority that regulates the whole health system, both public and private. They were also responsible for public health actions and provided limited free or low-cost medical assistance to those excluded from social security. In many cases, however, ministries developed highly specialized hospitals that both provided care for the uninsured and engaged in research and training.
The public services provided by the Ministries of Health have steadily diversified, and their territorial and population coverage has expanded. The importance of private service providers in each country depended on the social insurance arrangement, but doctors with private practices were—and are—quite common in most countries. Private medical insurance and large private hospitals developed later on, particularly where population coverage by public social security was low and where stable, lucrative markets had developed.
This three-tier system tends to persist, with national specificities, despite the fact that its multiple problems were precisely the strongest arguments for reform. However, there are considerable differences from one country to another, depending on what reform model has been implemented.
Segmentation of coverage and organizational fragmentation are still important. Inequality in service coverage and access to required services persist and is strongly determined by socioeconomic characteristics and geographical barriers. Although Primary Health Care PHC is strongly promoted all over the region, segmentation whatever its causes poses problems for efforts to establish integrated health service nets.
For instance, norms for what is public and private vary. Not unexpectedly, inequality in health status is still a major concern. The UHC model as applied in Latin America can be considered to inform the second-generation neoclassic health reforms in the context of the so-called modernization of the State Ozslak, In this framework, insurance, be it public or private, is crucial to assuring market solvency, because health needs not backed by purchasing power do not constitute a market.
This question is particularly important, given that the Latin American region is the most unequal in the world. UHC is an ambiguous term and after a long debate, the regional office of the WHO, the Pan American Health Organization , defined universal health coverage more comprehensively, but the terms of the debate remained the same. However, UHC is not implemented in the same manner everywhere. There are significant differences between countries, as will be exemplified with the reforms in Chile, Colombia, and Mexico, which belong to the UHC model, but have diverse characteristics mainly due to their historical and political settings.
The idea that health and health services are a responsibility of the State and a universal social right can be traced historically to the British National Health Service NHS , the Beveridge model of health system. The NHS was founded on the shared value that good health care should be available to all, regardless of wealth. The NHS is a tax-funded service that provides comprehensive, universal health care to all, free at point of delivery and based on clinical needs, not ability to pay.
In the SUS model of health system, the State generally provides health services directly. The hospital and outpatient service network, or the larger part of it, is State owned, and its health personnel are largely civil servants. As the main provider, the State is better able to regulate services, define procedures, and control costs. In the SUS, uniform rules are established for most health actions and services in order to guarantee similar services and more equitable conditions of access countrywide.
Guaranteeing comprehensive care means offering integrated promotion, prevention, cure, and rehabilitation. Personal care and public health measures are integrated into a single system organized to meet the health needs of both individuals and populations. For these characteristics, Single Universal Health Systems are regarded as more efficient they do more with fewer resources , more equitable, and as having greater impact on health conditions. Nonetheless, the nature and reach of the reform processes undertaken to build these systems have differed greatly between countries, as will be exemplified here by the cases of Brazil, Venezuela, and Cuba.
The underlying issues that will be addressed here in order to highlight differences and similarities among the selected cases are the following: the political scenario and the stakeholders involved; the previous health system and the relative strength of the public and private sectors; coverage achieved by public and private insurance; the different health packages existing within each country; the institutional re organization; and the relative importance of public health actions.
This scheme tends to obey the logic of private health insurance. In order for it to operate, priced health benefit packages have to be established and provision must be centered on the individual. This implies that health education, promotion, and prevention are focused, at best, on the person. The reason for examining Chile, Colombia, and Mexico is that these countries have implemented this model differently, and it has been in place for long enough to allow us to analyze changes, vicissitudes in its application, and results.
In Chile the —81 reform was part of the sweeping social security reform devised by pupils of Milton Friedman. The Colombian reform was also part of a broader social security reform strongly influenced by the World Bank. The Chilean case is interesting for several reasons. A second is that political ideology and values were much more important than evidence-based or technical concerns. A third is that the reform interrupted a sustained effort to bring the right to health and access to all through a public health system.
Fourthly, it radically changed the whole health system and gave rise to powerful new stakeholders. The rest of the population received services either through the social security institute for public employees, which used primarily private providers, or by paying directly for private services.
When Salvador Allende, a doctor, became president in , he set out to turn the NHS into a single unified public system financed by taxes. The NHS thus became a symbol of his government. These became the basis for a new constitution in that included health and social security. The NHS was formally ended in , but the most important reform was put in place in Significantly, however, the armed forces maintained their own social security institutes.
The ISAPREs can be seen to have profited legally from all the advantages, while public services shouldered the burden of caring for the poor, the ill, and the elderly. Reorganization of the health sector gave birth to two parallel systems, one private and the other public. It also introduced financial capital, in the form of the ISAPREs, as a new and dominant stakeholder in the health sector. Large private hospitals grew rapidly and so did their power.
The Medical Association, which had played an active role in support of the military coup, initially had more power, but lost its place to the new ISAPREs and private hospitals.
The previously strong public system was systematically weakened by State measures, but it continued to offer services to the vast majority of the population. This explains why it retained strong public acceptance despite its increasing operating difficulties Tetelboin, This two-tier system remained after the end of the dictatorship, but several reforms have been implemented under Socialist Party presidencies to restrict the worst abuses of the ISAPREs and to grant more equal access to services.
However, it is recognized to have favored the private sector indirectly and increased private provision Tetelboin, The public sector has also been strengthened by investment in infrastructure, a substantial increase in personnel, and a higher budget.
The Ministry of Health was restructured and now has two under-secretariats: one for public health and another for health services. This enables the ministry to fulfill its tasks as health authority and as service provider. A major effort has thus been made to restore the historical tradition and grant the right to health for all. However, the two-tier structure remains, as do copayments and unequal access. The reason is that the private system—particularly the for-profit ISAPREs—has become a powerful stakeholder and is backed by the political right.
The new Columbian constitution of apparently established a Social State based on human rights principles and intended to pacify the country after decades of violence.
At the same time, however, the government introduced a structural adjustment plan that contradicted the new constitution Franco, Enacted in , Law ushered in a comprehensive social security reform that included a health system reform modeled on structured pluralism Restrepo-Zea, , that is, a market-based reform whose method was to commodify health care and subsidize markets.
Contributions to the system are mandatory. Regulatory functions and public health activities are the responsibility of both the national and local governments. Equality was understood as health insurance for all. None of these promises was fulfilled, however, and the new system suffered from mounting tensions.
Universal insurance coverage was not achieved as planned, mainly because an important part of the population is occupied in informal activities and insufficiently poor to classify for the subsidized regime, entry to which depends on a poverty census conducted by the municipalities.
This led to a new stratification between those included and excluded. Furthermore, the discourse made no clear distinction between insurance coverage and access to needed services.
Differences in access are inherent to the model and depend on the benefit package, POS-C or POS-S, but also on other barriers, such as place of residence. The scheme soon got into financial trouble and showed a rising deficit. Last, but not least, there was little room for public health activities in a scheme oriented to providing medical care for individuals or families.
As a result, tuberculosis and malaria, for instance, increased rapidly Arbelaez et al. These results led to a series of adjustments. The legal framework was also changed and new legislation was put in place Giovanella et al. In a new law defined the functions of the central, provincial, and municipal levels of government, which added to the complexity of the system.
Basically the new legislation organized a system of public health to address what Law had disregarded. Although it has some important differences, the model is like that of the United States, with two parallel structures, one for public health and another, predominantly private one, for medical care.
This proposal caused widespread social mobilization and debate, which also revealed very serious corruption Morelli, and arbitrary refusals to treat patients, particularly by IPSs.
Overall they rated the program 7. Ensuring coverage for the region's poorest and most excluded populations a shared focus across the region. The disease rises with 35 cases of malaria, registering 20 deaths in This site is best viewed with Internet Explorer version 8 or greater. What was the purpose of your visit to worldbank.
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But one project, known as Adios Bacteriemias, has made remarkable progress using QI: intensive care units ICUs in 40 participating hospitals in seven countries have reduced central line-associated bloodstream infections by 43 percent, improving patient safety in ICUs across Latin America. Please wait while you are being redirected This site is best viewed with Internet Explorer version 8 or greater.
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Health and Equity in Latin America | Americas Quarterly
Access to healthcare in Latin America is a report by The Economist Intelligence Unit, commissioned by Gilead, which examines the challenges and opportunities to improving health systems in the region. In the past few decades Latin American countries have made significant strides in improving the health of their citizens. Political will and economic development have driven much of these improvements.
Still, progress has been uneven in the region, and significant disparities exist both within and between countries. Corruption and vested interests have also undermined efforts to extend access in some countries. Nevertheless, Latin America has developed several best practices in primary care and a number of innovative healthcare experiments that employ a free-market approach. Better public funding and greater use of technology, such as mobile healthcare for rural communities, could improve health-system equity in the region.
Download the report below to learn more. Download report. Back to the top. The metrics evaluated in this domain include: access to child and maternal health services; access to infectious diseases care; access to non-communicable diseases care; access to medicines; and equity of access to healthcare.
The metrics evaluated in this sub-domain include: measles immunisation coverage; births attended by skilled health personnel; and demand for family planning employing modern methods. The metrics evaluated in this sub-domain include: smoking prevalence five-year trend male ; level of taxes on tobacco; radiotherapy coverage; availability of cervical cytology; availability of coloncancer screening; availability of oral morphine; existence of a mental-health plan; and expenditure on mental health.
The metrics evaluated in this domain include: population coverage of the healthcare system; political will for increased access to healthcare; reach of healthcare infrastructure; and efficiency and innovation of the healthcare system. The metrics evaluated in this sub-domain include: sustainable financial protection and prevention, and public health services as a percentage of total health expenditure. The metrics evaluated in this sub-domain include: out-of-pocket expenditure as a percentage of total expenditure on health ten-year growth , and general government expenditure on health as a percentage of total government expenditure ten-year growth.
The metrics evaluated in this sub-domain include: density of physicians; density of nursing and midwifery personnel; and quality of vital statistics cancer mortality data. Each country is represented by a dot. The closer the dots align along the line, the stronger the correlation between the two indicators.