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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.
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.
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.Jack examines public economics rationales for public intervention in health insurance markets, draws on the literature of organizational design to examine alternative intervention strategies, and considers health insurance reforms in four Latin American countries - Argentina, Brazil, Chile, and Colombia - in light of the theoretical literature.Equity has been the main reason for large-scale public intervention in the health insurance sector, despite the well-known failures of insurance and health care markets associated with imperfect information.Recent reforms have sought less to make private markets more efficient than to make public provision more efficient, sometimes by altering the focus and function of existing institutions (such as the obras sociales in Argentina) or by encouraging the growth of new ones (such as Chile's ISAPREs).Generally, these four Latin American countries have reformed the ways insurance and care are organized and delivered, have tried to extend formal coverage to previously marginalized groups, and have tried to finance this extension fairly.Colombia instituted an implicit two-tiered voucher scheme financed through a proportional wage tax.Chile's financing mechanism is similar but the distribution of benefits is less progressive, so the net effect is less redistributive.Argentina's remodeled obras system went halfway: the financing base is similar and there is some implicit redistribution from richer to poorer obras, but the quality of insurance increases with income.On the face of it, Brazil's health insurance system is less redistributive than those of the other three countries, as no tax is earmarked for financing health insurance. But taxes paid by higher-income taxpayers are not reduced when they choose private insurance, highlighting the problem of examining the health sector independent of the general tax and transfer system.This paper - a product of Public Economics, Development Research Group - was prepared as part of a regional analysis of social risk management in Latin America and the Caribbean. The author may be contacted at [email protected].
Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.
'Beyond Survival' 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 household to protect themselves,against this impoverishment. The authors use empirical evidence from six case studies commissioned for this report, on Argentina, Chile, Colombia, 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.
Latin America suffered a profound state crisis in the 1980s, which prompted not only the wave of macroeconomic and deregulation reforms known as the Washington Consensus, but also a wide variety of institutional or 'second generation' reforms. 'The State of State Reform in Latin America' reviews and assesses the outcomes of these less studied institutional reforms. This book examines four major areas of institutional reform: a. political institutions and the state organization; b. fiscal institutions, such as budget, tax and decentralization institutions; c. public institutions in charge of sectoral economic policies (financial, industrial, and infrastructure); and d. social sector institutions (pensions, social protection, and education). In each of these areas, the authors summarize the reform objectives, describe and measure their scope, assess the main outcomes, and identify the obstacles for implementation, especially those of an institutional nature.
Throughout the twentieth century, much of the population in Latin America lacked access to social protection. Since the 1990s, however, social policy for millions of outsiders - rural, informal, and unemployed workers and dependents - has been expanded dramatically. Social Policy Expansion in Latin America shows that the critical factors driving expansion are electoral competition for the vote of outsiders and social mobilization for policy change. The balance of partisan power and the involvement of social movements in policy design explain cross-national variation in policy models, in terms of benefit levels, coverage, and civil society participation in implementation. The book draws on in-depth case studies of policy making in Argentina, Brazil, Chile, and Mexico over several administrations and across three policy areas: health care, pensions, and income support. Secondary case studies illustrate how the theory applies to other developing countries.
Reshaping Health Care in Latin America: A Comparative Analysis of Health Care Reform in Argentina, Brazil, and Mexico
"This World Health Report was produced under the overall direction of Carissa Etienne ... and Anarfi Asamoa Baah ... The principal writers were David B. Evans ... [et al] -- t.p. verso.
Explores the variation in welfare and other social assistance policies in Latin America.