The newest issue of the Revista Panamericana de Salud Publica/Pan American Journal of Public Health is devoted entirely to the subject of health sector reform in North, Central, and South America and the Caribbean. The special, 150-page double issue of Ju

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.

International health and aid policies of the past two decades have had a major impact on the delivery of care in low and middle-income countries. This book argues that these policies have often failed to achieve their main aims, and have in fact contributed to restricted access to family medicine and hospital care. Presenting detailed evidence, and illustrated by case studies, this book describes how international health policies to date have largely resulted in expensive health care for the rich, and disjointed and ineffective services for the poor. As a result, large segments of the population world-wide continue to suffer from unnecessary casualties, pain and impoverishment. International Health and Aid Policies arms health professionals, researchers and policy makers with strategies that will enable them to bridge the gaps between public health, medicine and health policy in order to support robust, comprehensive and accessible health care systems in any political environment.

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.

The reform of social security pensions and healthcare is a key issue for the modern world, and in many ways Latin America has acted as a social laboratory for the reform of these systems. From the reforms that took place in Chile in 1981, most pension and health care systems in the region have seen reform, and been fully or partially privatized. Many other countries considering reform of their own systems have been influenced by the policies implemented in Latin America. Yet despite the importance and influence of these reforms, until now there has not been an integrated and comprehensive analysis of the changes and their effects. This book is the result of four years of painstaking work, data collection, field research and international collaboration, and so fills the vacuum in the literature with a systematic comparison of pension and healthcare reforms in the 20 Latin American countries. It identifies reform models, and elaborates taxonomies to facilitate their understanding and comparison. Some key features of the reforms to emerge are: labour force and population coverage, equity and solidarity, sufficiency and quality of benefits, state regulation, competition and degree of privatization, efficiency and administrative costs, social participation in management, financing sources and long-term sustainability. Effects of the reforms on social security principles are measured based on recent standardized statistics and other information. Goals or assumptions of the reforms are contrasted with actual outcomes, and the pros and cons of private versus private provision assessed. Detailed policy recommendations are offered to correct current problems and improve pension and healthcare systems. This is the first book to comprehensively study these influential reforms in Latin America's pension and health care systems, and as such will be of importance to academics and researchers interested in social security and welfare policy, pensions, health care, and public policy; Social security, pension, and health care policy-makers; And social security, pension, and health care consultants and practitioners. Published in association with PAHO

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.

This book explores recent social policy reforms and innovations in Chile. Focusing on four major reform episodes — health, pensions, childcare, and maternity leave — Silke Staab unveils the complex interplay of factors that have shaped the successes and failures of actors pursuing positive gender change in social policy. She shows that even in highly constrained settings positive gender change is possible, but that its scope and quality are bound to vary in response to sector-specific institutional constraints and opportunities.