On either side of the globe, poor people often do not have access to the health services they need. Improvements in health care systems in Asia have lagged behind economic development, and progress in expanding health coverage in Latin America has been skewed across income levels. Health Services in Latin America and Asia takes a close look at how countries in both regions provide health care services, including the strategies that work and the problems that persist. The book documents encouraging progress in Bolivia, Brazil, China and Vietnam, and important preventive care programs in Central America and Thailand. It also examines health services in Chile, Colombia, the Philippines and Malaysia, as well as the health system and insurance model in Japan.Even though public and preventive health require specific and sustained allocations, both regions continue to use health insurance and other supply mechanisms to expand health service coverage. The book recommends broadening the supply of services through family doctors and community health workers, an alternative approach that would likely improve the equity, efficiency and sustainability of services.
This book explores the scope of reforms and changes in the social protection systems in Latin America that have started at the beginning of the 21st century. It describes how and to what extent changes in social protection systems and social policies have occurred in the region in recent decades. Taking a comparative approach, the volume identifies the triggers for the transformations and how such pressures are received by the welfare regime, or a specific policy sector, to finally yield a given type of reform. The analysis is characterized by the presence of certain factors that explain the development of social protection systems in Latin America, such as economic growth, the consolidation of democratic political regimes, and the region’s Left Turns. The book also examines to what extent common challenges and processes induced by international institutions have led to convergence among countries or welfare regimes, or whether each maintains its own identity.
From Few to Many is the first comprehensive look at Colombia's 1993 health system reforms. It describes the implementation of universal health insurance, including a subsidized system for the poor, and examines the impact of this and other reforms during a time when Colombia experienced crushing recession and internal conflict that displaced half a million people. Prior to the reforms, a quarter of the Colombian population had health insurance. Subsidies failed to reach the poor, who were vulnerable to catastrophic financial consequences of illness. Yet by 2008, 85 percent of the population benefited from health insurance. From Few to Many describes the challenges and benefits of implementing social health reforms in a developing country, exploring health care financing, institutional reform, the effects of political will on health care, and more. The reforms have provided important lessons not only for continued reform in Colombia, but also for other nations facing similar challenges.
En las ultimas tres decadas, muchos pafses en America Latina y el Caribe han reconocido el tema de la salud como un derecho humano. Desde inicios de la decada del 2000, 46 millones de personas adicionales, de los pafses estudiados, gozan de la protecci6n de programas de salud con explfcitos derechos a recibir atenci6n. Las reformas han venido acompafiadas por un incremento en el gasto publico del sector salud, financiado en gran pa rte por los ingresos fiscales generales que priorizan o estan dirigidos explfcitamente hacia las poblaciones sin capacidad de pago. Los compromisos polfticos se han traducido en general en presupuestos mas elevados yen leyes aprobadas que circunscriben los fondos destinados al sector salud. En la mayorfa de los pafses se ha priorizado la atenci6n primaria en salud por su costo efectividad y han adoptado metodos de adquisici6n que incentivan la eficiencia y la transparencia en los resultados y que les dan a los administradores del sector salud un mayor apalancamiento para dirigir a los proveedores hacia la . consecuci6n de las prioridades de salud publica. Sin embargo, a pesar de los avances. aun subsisten las disparidades en el financiamiento y calidad de los servicios de los subsistemas de salud. Cumplir con el compromiso de la cobertura universal de salud exigira esfuerzos concertados para mejorar la generaci6n de los ingresos fiscales de manera sostenible y de elevar la productividad y efectividad del gasto. En el re po rte Hacia la cobertura universal en salud v la equidad en America Latina v el Caribe: Evidencia de poises seleccionados. los autores sefialan que la evidencia tomada de un analisis de 54 encuestas de hogares corrobora que las inversiones en la ampliaci6n de la cobertura estan generando resultados. A pesar que los pobres aun presentan los peores fndices de salud en comparaci6n con los ricos, las disparidades se han reducido en gran medida, especialmente durante las primeras etapas de vida. Los pafses han alcanzado elevados niveles de cobertura y equidad en la utilizaci6n de los servicios de salud maternoinfantil. El panorama se torna mas lleno de matices y no tan positivo cuando se trata de la salud en adultos y de la prevalencia de condiciones y enfermedades cr6nicas. La cobertura de las intervenciones de enfermedades no transmisibles no es muy alta y la utilizaci6n de los servicios se inclina hacia aquellos que gozan de una mejor posici6n. La prevalencia de las enfermedades no transmisibles no ha mostrado el comportamiento esperado en vista de la cafda en las tasas de mortalidad: un mayor acceso a los servicios de diagn6stico por pa rte de los segmentos mas ricos podrfa encubrir cambios en la prevalencia real. Los gastos de salud provocados por situaciones catastr6ficas han ido en descenso en la mayorfa de los pafses. El panorama en torno a la equidad, sin embargo es mixto, apuntando hacia limitaciones en la medida. Si bien la tasa de empobrecimiento a causa de gastos de salud es baja, con tendencia decreciente en terminos generales, entre dos y cuatro millones de personas en los pafses estudiados aun caen por debajo de la lfnea de la pobreza despues de haber incurrido en gastos de salud. Los esfuerzos para darle un seguimiento sistematico a la calidad de la atenci6n en la region, apenas dan sus primeros pasos. Sin embargo, un repaso a la literatura revela graves deficiencias en la calidad de la atenci6n de salud, asi como sustanciales diferencias entre los diversos subsistemas. Elevar la calidad de la atenci6n y asegurar la sostenibilidad de las inversiones en salud siguen siendo una agenda inconclusa.
Starting with more general issues of healthcare policy and governance in a global perspective and using the lens of national case studies of healthcare reform, this handbook addresses key themes in the debates over changing healthcare policy.
Based on analysis of the evidence for climate change and the vulnerability of poor people, develops a framework for action and examines the link between consumer and political choices in the North, and impacts in the South on the most vulnerable people on the planet.
The social sciences have made fundamental contributions to the understanding of the economic, political and social life of nations in the past century. Social science libraries now have an important role to play in the context of the information society as significant sources of academic and social knowledge. This work provides information on the development and use of digital resources in the social sciences emphasizing best practices; an articulation of some of the problems presented to providing these resources; and a view to the use of these resources to support sustainable development.
This publication is the product of a joint initiative between PAHO/WHO, USAID, SIDA (Swedish International Development Agency) and AECI, initiated in 2004/05 to identify options for extending social protection in health to mothers, newborns, and children in Latin American Countries. It relies strongly on concepts and methodologies developed since 2000 by PAHO and SIDA and on the conceptual developments of the ILO (International Labour Organization) - PAHO Joint Initiative on Extension of Social Protection in Health.
