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Over the past three decades, many countries of Latin America and the Caribbean have recognized health as a human right. Since the early 2000s, 46 million more people in the countries studied are covered by health programs with explicit guarantees of affordable care. Reforms have been accompanied by a rise in public spending for health, financed largely from general revenues that prioritized or explicitly target the population without capacity to pay. Political commitment has generally translated into larger budgets as well as passage of legislation that ring-fenced funding for health. Most countries have prioritized cost-effective primary care and adopted purchasing methods that incentivize efficiency and accountability for results, and that give stewards of the health sector greater leverage to steer providers to deliver on public health priorities. Evidence from the analysis of 54 household surveys corroborates that investments in extending coverage are yielding results. Though the poor still have worse health outcomes than the rich, disparities have narrowed considerably - particularly in the early stage of the life course. Countries have reached high levels of coverage and equity in utilization of maternal and child health services; coverage of noncommunicable disease interventions is not as high and service utilization is still skewed toward the better off. Catastrophic health expenditures have declined in most countries; the picture regarding equity, however, is mixed. While the rate of impoverishment owing to health-care expenditures is low and generally declining, 2-4 million people in the countries studied still fall below the poverty line after health spending. Efforts to systematically monitor quality of care in the region are still in their infancy. Nonetheless, a review of the literature reveals important shortcomings in quality of care, as well as substantial differences across subsystems. Improving quality of care and ensuring sustainability of investments in health remain an unfinished agenda.
Reshaping Health Care in Latin America: A Comparative Analysis of Health Care Reform in Argentina, Brazil, and Mexico
This book critically analyses the influence of international policies and guidelines on the performance of interventions aimed at reducing health inequities in Latin America, with special emphasis on health promotion and health in all policies strategies. While the implementation of these interventions plays a key role in strengthening these countries’ capacity to respond to current and future challenges, the urgency and pressures of cooperation and funding agencies to show results consistent with their own agendas not only hampers this goal, but also makes the territory invisible, hiding the real problems faced by most Latin American countries, diminishing the richness of local knowledge production, and hindering the development of relevant proposals that consider the territory’s conditions and cultural identity. Departing from this general analysis, the authors search for answers to the following questions: Why, despite the importance of the theoretical advances r egarding actions to address social and health inequities, haven’t Latin American countries been able to produce the expected results? Why do successful initiatives only take place within the framework of pilot projects? Why does the ideology of health promotion and health in all policies mainly permeate structures of the health sector, but not other sectors? Why are intersectoral actions conjunctural initiatives, which often fail to evolve into permanent practices? Based on an extensive literature review, case studies, personal experiences, and interviews with key informants in the region, Globalization and Health Inequities in Latin America presents a strategy that uses monitoring and evaluation practices for enhancing the capacity of Latin American and other low and middle-income countries to implement sustainable processes to foster inclusiveness, equity, social justice and human rights. p/pp
This book examines issues concerning how developing countries will have to prepare for demographic and epidemiologic change. Much of the current literature focuses on the prevalence of specific diseases and their economic consequences, but a need exists to consider the consequences of the epidemiological transition: the change in mortality patterns from infectious and parasitic diseases to chronic and degenerative ones. Among the topics covered are the association between the health of children and adults, the strong orientation of many international health organizations toward infant and child health, and how the public and private sectors will need to address and confront the large-scale shifts in disease and demographic characteristics of populations in developing countries.
Beyond Survival: Protecting Households from Health Shocks in Latin America breaks new ground in the ongoing debate about health finance and financial protection from the costs of health care. The evidence and discussion support the need to consider financial protection, in addition to health status, as a policy objective when setting priorities for health systems. This book reviews the Latin American experience with health reform in the last 20 years and the fundamentals of health system financing, using new evidence to show the magnitude and mechanisms that determine the impoverishing effects of health events (diseases, accidents, and those of the life cycle). It provides options for policy makers on how to protect, and help households to protect themselves, against this impoverishment. The authors use empirical evidence from six case studies commissioned for this report, on Argentina, Chile, Columbia, Ecuador, Honduras, and Mexico. This book provides policy makers with a solid conceptual basis for decisions on the contents of mandatory health insurance benefit packages, choices of financing mechanisms, and the roles of public policy in this field. Beyond Survival provides an in-depth analysis of, and organizational alternatives for, risk pooling and health insurance for financial protection. It analyzes the urgent need to extend risk pooling to the informal sector, the challenges for current social insurance arrangements, and options for policy makers to effectively extend risk pooling to the informal sector.
Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC) are the most promising solution for health systems to satisfy the health needs of the population and to address access, efficiency, quality and equity challenges faced by health systems of the world. PHCs essential attributes (people and family centered care, comprehensiveness, continuity, longitudinality) position this approach as one of the key strategies for countries to meet the aspiration of achieving universal health coverage. Creating care networks has been a common thread running through Latin America and the Caribbeans health policy agendas. In terms of actually putting the IHSDN model in action, there is a wide range of interpretations and experiences, with designs, scales, organizational methods, and maturity levels that vary within and between countries. This book shares evidence of the progress made in forming and launching IHSDN in Latin America based on four case studies conducted in Argentina, Brazil, Colombia, and Mexico. The results were found by systematically applying an instrument that collects regional information on the context and features of the IHSDNs governance, funding, care models, and IHSDN management models. The books chapters describe the characteristics of IHSDN in the four studied countries, lessons are drawn from how these IHSDN have been designed and implemented, challenges for the future are identified and recommendations are provided on what will it take to consolidate the IHSDN model in Latin America. The hypothetical story of Dioselina, illustrates throughout the book the obstacles and difficulties that arise for a diabetic patient when using health services that are not people-centered. The results shed light on how prepared IHSDN in this region are to provide patient-centered care and where to focus efforts for improvement. The evidence found in this study will help develop and advance PHC in Latin America.
Argentina, Brazil, Chile, and Colombia have reformed the ways health insurance and health care are organized and delivered, have extended formal coverage to previously marginalized groups, and have tried to finance this extension fairly. Each has reformed health insurance differently.