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Analysis of the Health Systems in Latin America

Analysis of the Health Systems in Latin America : 작성자, 카테고리, 작성일, 조회수, 원문,출처, 정보 제공
작성자	임이슬	카테고리	전문가 인사이트
작성일	2017-08-10	조회수	2,286
원문
출처

글 Esteban Ortiz-Prado: 에콰도르 GPKOL위원

세부 전문분야 및 컨설팅 내용

R&D 기획(R&D Planning/Clinical Trial/GMP, GCP and Regulatory Affairs/Project management)
OneResearch Group, Faculty of Medicine, Universidad de las Americas, Quito, Ecuador; Department of Medicine and Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, NY, USA, Global Pharma Key Opinion Leader) position at the KHIDI (Korea Health Industry Development Institute).

ABSTRACT

The importance of understanding the health care systems in South America it’s very important for external investors, especially for those located in other continents. Understanding that several million people receive free health care and another important part of the population pays for services is important. In this manuscript we tried to summarize the normal functioning of the health systems in Latin America. This region since the last decades has been carrying out reforms of law that protects the population on the health access, especially that related to medications.

INTRODUCTION

Countries worldwide have had a significant development in issues such as health, population growth has led first-world countries to develop programs for improving health. Latin America since the last decades has been carrying out reforms of law that protects the population on the health issue by distributing resources to the neediest population; So that public and private institutions have intervened with the budgets dedicated to eradicate and solve the most serious problems in diseases that affect the population(Maceira, 2012).
There are excellent models developed by some countries in Latin America, such as Brazil, creating taxes that are aimed at health care, with the primary objective of improving quality, prompt attention and thus reducing death rates that are the most worrying in Latin America. For this reason, the so-called universal health service is a very significant advantage for the inhabitants of low economic resources or people who are not affiliated with systems or insurance of the State. However, the quality of care has not improved, and the dissatisfaction of the population in most of Latin America is evident, since most of them are not adequately equipped(Atun et al., 2015). Data analysis of Public Opinion Research in Latin America in nine of the ten countries of the study suggest that in 2007 about 25 to 50% of the population accessing services was not satisfied with her health services(Atun et al., 2015).

HEALTH SYSTEM ANALYSIS

A health system is the sum of all organizations, institutions and resources whose main objective is to improve health. A health system requires personnel, funding, information, supplies, transportation and communications, as well as general guidance and direction. It also has to provide good treatments and services that meet the needs of the population and are financially fair.
A good health system improves the daily lives of people in a tangible way. A woman who receives a letter reminding her that her child should be vaccinated against a life-threatening illness is getting a benefit from the health system. The same is true of a family that can finally access drinking water through the installation in their village of a water pump financed by a government sanitation project or with a person with HIV / AIDS who obtains antiretroviral drugs, nutritional advice and Periodic exams in an affordable outpatient clinic.

CENTRAL AMERICA

We will be reviwing all the Health systems in the most importst countries of central america in order to obtain information of how every health system works.

Health System in Mexico

In 1996, through the introduction of the National Decentralization Agreement, responsibility for Health was granted to the Mexican states. This decentralization helped people in rural communities to have more access to health services. In 2000, the OPPORTUNITIES plan was implemented, whose mission was to increase the use and demand of health services, focusing on poor populations and women. In 2003, it was approved revisions to the General Health Law to establish the Social Protection System in Health, through Popular Insurance coverage of around 52 million citizens until 2012(Atun et al., 2015).
The health system is divided into 2 sectors, one private sector that provides services to the population with good economic status, their financing is given by medical insurance and the remuneration to hospitals, clinics and private clinics and a public that has 2 sub sectors, the Which depends on the Ministry of Health (MS) and which is financed by fiscal resources and other social security system formed by institutes related to formal employment where their resources arise from salary and employer contributions(Maceira, 2012). So, we have 3 identified populations; The first one which benefits from social security institutions with 48.3 million users, the Mexican Social Security Institute (IMSS) is responsible for 80% of citizens, the Institute of Security and Social Services of State Workers (ISSSTE) covers 18% of the citizens and 1% are from Petróleos Mexicanos (PEMEX), Secretariat of National Defense (SEDEÑA) and Secretaría de Marina (SEMAR), this population includes active workers, retirees, and their families(Dantés et al., 2011). A second population are the non-salaried and unemployed along with their families, resort to the Social Protection System in Health (SPSS) along with Popular Health Insurance (SPS) covering about half of the Mexican population with around 27 Millions of users up to 2008. Finally, there is the population that makes use of private health services through insurance or cash payment(Frenk, González-Pier, Gómez-Dantés, Lezana, & Knaul, 2006; Frenk, Sepúlveda, Gómez-Dantés, & Knaul, 2003).

Health System in Guatemala

The health system in Guatemala is characterized by two types of coverage: public and private; In the Public Sector about 70% of the care is provided by the Ministry of Public Health and Social Assistance (MSPAS); While less than 17% provides the Guatemalan Social Security Institute (IGSS) with formal employers; The armed forces and police have an institution called Military Health that covers less than 0.5% of the population. Civil society organizations (CSOs) and / or religious organizations are involved in the private sector; it is estimated that 18% of the population goes to this sector. Private insurance occupy a minimal percentage as only the high-income population is accessed(Becerril-Montekio & López-Dávila, 2011a).
As for the resources that the MSPAS has, it has a network of 43 second and third level hospitals that are distributed nationwide, providing care to about 6.6 million users, as well as within this network encompasses primary and other medical services(Becerril-Montekio & López-Dávila, 2011b).
For formal employers there is a network of 104 medical units that are responsible for providing primary care through health centers and second level and third level services. It is necessary to consider that many people are of Mayan descent, reason why a third of the Guatemalans go to the traditional medicine native, nevertheless also works of private form for profit(Maceira, 2012).
In terms of allocation of funds for public health is managed by the General Government, in 2012 and 2013 the budget had an increase from 3.589 million quetzales in 2011 to 4.410 million in 2013 and by 2017 is expected to Investment of 6,819 million quetzales. (Molina-Salazar, González-Marín, & Carbajal-de Nova, 2008)

Health System in Panama

The National Coverage estimates allocate 60% of the population to Social security institute (CSS) and 40% to Ministry of Public Health (MINSA). Besides being a major service provider, it is also the Rector of the National Health System and, as such, formulates policies, regulates Activity and performs the function of sanitary authority. The two entities that provide public health and medical care in the country are MINSA and CSS, which contribute about 70% of the resources used, leaving 30% of citizens' out-of-pocket expenses(Conte, Gómez, & Barahona, 2015; de Salud, 2008; Organization & others, 2016).
The Republic of Panama is divided into 10 provinces, 77 municipalities, 648 villages. In turn, the Republic of Panama within the health sector has 16 developed and two in development Health Regions
Among the main national hospitals are: Long Stay Hospital, Child Hospital, Director of Santo Tomas Hospital and National Cancer Institute. Within the Specialized Centers: National Institute of Mental Health and National Institute of Physical Medicine and Rehabilitation.

Health System in Cuba

The National Health System of Cuba is under the caution of the Ministry of Public Health, the governing body, which is responsible for directing, executing and controlling the implementation of health policies that govern the State(Atun et al., 2015; Baly Gil, Toledo, & Rodríguez Jústiz, 2001; Campion & Morrissey, 2013). Health in this country is public, free and universal and funded by the Cuban National Government(Collazo Ramos, Ricardo, Luis, & Rodríguez Cabrera, 2010). The National Health System is made up of units that provide preventive-curative medical care, which include medical and family nursing clinics, specialized centers for maternal and child care, polyclinics, second and third level care hospitals, Blood banks and stomatologic clinics.
Hygienic-epidemiological units which are confined to environmental health and disease control. And also this country has medical-scientific research institutes. In addition, social programs aimed at the elderly and people with disabilities(Rodríguez Cabrera & Álvarez Vázquez, 2006; Torres Vidal & Gran Álvarez, 2005). Health care is supported by 219 hospitals, 13 research institutes, 498 polyclinics and groups of family physicians in communities, workplaces and educational institutes. There are also 127 medical posts and 26 blood banks. In addition to 158 stomatological clinics, 156 nursing homes, 338 maternal homes and 35 shelter homes for vulnerable people(Domínguez-Alonso & Zacea, 2011).

Health System in Dominican Republic

In the past, the health system of the Dominican Republic was financed by general state taxes. Voluntary reimbursement insurance and voluntary prepaid plans were used during this period. However, since 2001, was created the General Health Law and System Dominican Republic of Social Security (USAID.P.8). Forming the national health system, which is under the supervision of the National Health Insurance (SENASA) and the health risk administrator (ARS)(Rathe & Moliné, 2011). At present, the financing is based on a contribution scheme financed by the contributions of workers and employers, which includes the state and a subsidized regime that is clearly financed with state resources. Allowing access to the private health providers established in the network to users of the contribution scheme that are governed by (ARS) and access to public hospitals and private non-profit hospitals to the contributors to the subsidized regime. Which are supported by the (SENASA)(Rathe & Moliné, 2011).

Health System in Costa Rica

Costa Rica have favorable health conditions with respect to other countries in the world where their system provides their population with full access to their services regardless of their ability to pay or their condition of insurance(Herrero & Durán Valverde, 2001). Total health expenditure as a percentage of GDP amounted to 8.2%; 76.9% of this total corresponds to public spending and 23.1% to private spending(Sáenz, Acosta, Muiser, & Bermúdez, 2011). The Costa Rican health system consists of a public sector and a private sector (Maceira, 2014). The public sector is organized around national health insurance with the Costa Rican Social Security Fund (CCSS), which is the institution responsible for administering it in all its dimensions as a provider of health services and the Ministry of Health (MS) as the national manager of the system(Sáenz et al., 2011). The CCSS administers three regimes: sickness and maternity insurance (SEM), disability, old-age and death insurance (SIVM), and a non-contributory scheme that provides coverage to those who are unable to pay because of their poverty or disability(Maceira, 2012). Also, in the second level of care the CCSS is made up of 11 major clinics, 13 peripheral hospitals and seven regional hospitals and the third level of care has three national concentration hospitals and four specialized hospitals (Maceira, 2014; Sáenz et al., 2011). In the private sector are private medical services, five insurance companies, clinics and private hospitals where their services are concentrated mainly in outpatient care and in the marketing of pharmaceuticals(Herrero & Durán Valverde, 2001). At least once a year 31% of the population purchases health services in the private sector and only 2% of households have private insurance(Maceira, 2012).

SOUTH AMERICA

Most of the countries in South America have information about the Health Care System and what is the rol of the goberment in every single country

Health System in Venezuela

The Venezuelan health system is divided into public and private sectors. The public sector involves: entities of the Ministry of Health and Social Development (MSDS), State Departments of Health and Social Development (decentralized instances of MS), Venezuelan Institute of Social Security (IVSS), Institute of Social Security of the Armed Forces ) and the Social Welfare Institute of the Ministry of Education, Culture and Sports (IPASME). It should be noted that there are other entities such as Petróleos de Venezuela (PDVSA), which offer health insurance to their workers(Bonvecchio, Becerril-Montekio, Carriedo-Lutzenkirchen, & Landaeta-Jiménez, 2011; Llanos, Oyarzún, Bonvecchio, Rivera, & Uauy, 2008). In 2003 “Mision Barrio Adentro” was created with the objective of implanting a different perspective, involving an integral approach, proposing the organization and community participation based on integral health(Guédez, 2004). It is necessary to emphasize that the population covered by the different institutes of social security (IVSS, IPSFA, IPASME), are salaried workers, pensioners and retirees of the formal sector of the economy and their relatives. The IVSS covers 17.5% of the population (Maceira, 2014), which includes workers in the informal sector of the economy with a defined employment relationship, such as home, domestic, seasonal and occasional workers. We also have workers from the informal sector, unemployed population and people who do not have any type of insurance, receive attention from the decentralized instances of the Ministry of Health, population that receives care mainly through the “Mision Barrio Adentro” (Bonvecchio, et al. 2011). The private sector involves health insurance companies, which offer basic and specialized care, in exchange for direct payments. However the vast majority of Venezuelans present precarious conditions unable to access this sector. According to the Venezuelan Household Survey for 2005, private insurance covers 11.7% of the country (Maceira, 2014).

Health System in Colombia

Health policy in Colombia is integrated to guarantee the health of the population, through actions that are collectively directed to obtain results that contribute as indicators of the quality of life, development and well-being of the country through the state regent promoting Citizen participation(Guerrero, Gallego, Becerril-Montekio, & Vásquez, 2011). It has been observed that spending in Colombia for health is 74.8% with GDP $ US 7752; A health system has not been effective enough so this was an impetus to carry out a reform in health, allowing to expand the rights, equity and protection in health (Atun, R. Monteiro, L. Almeida.2015).
According to the WHO in data obtained between 2010 - 2012 in Colombia the coverage in health to the public was limiting being this one of 29%; In social insurance is 39.7% and with the contributory plan of 51.4%; In the private sector no data were found but in services for army personnel is 6.7% and without insurance of 3.5% (Atun, R. Monteiro, L. Almeida, 2015).
Another study carried out by UNICEF found that in 2012 GDP is 6.83%; In the area of health it is important to emphasize that in the regime it is requested to categorize the people to be able to position them according to their socioeconomic level and it is for that reason that they must be registered to the system of beneficiaries to access the service, that is why it is necessary (Maceira, D. 2014).

Health System in Ecuador

This national health system is made up of a chain of posts, health centers and public and private hospitals that provide medical care to all citizens. The public sector consolidated its efforts and vision through the signing of an interinstitutional agreement in April 2012. Following the signing of this Agreement, the Public Health Integral Network (RPIS), a network formed by the Ministry of Public Health (MSP), the Social Security Institute (IESS), the Police (ISSPOL) and the Armed Forces (ISSFA) (MSP 2012a). The function of this network is to articulate, coordinate, coordinate and ensure the exercise of the rectory over the institutions of the Public Health and Complementary Network(Lucio, Villacrés, & Henríquez, 2011). The objective of this study is to evaluate the performance of the sector in order to ensure that it operates in an integrated manner, within the framework of the laws, public policies and strategic guidelines of the sector.
The global organization of the Comprehensive Public Health Network and the Complementary Health Network includes medical offices and health posts as the most basic units to reach centers of great complexity such as specialty hospitals (Figure 1).

Figure 1 Number of health units according to provider. Source: MoH

The financing of the Ecuadorian Health System depends on the fiscal expenditure of the current year. In each of the years, from which there are data can be observed a progressive increase year by year.
According to data from the World Bank, the Ecuadorian State has increased health expenditure from 1996 to 2014 significantly. When we compare public expenditure on health in Ecuador, it can be observed that, in 2014, there was an increase of more than 24% in relation to 2006. This figure assumes that public spending on health in 2014 reached 4.51% of GDP , An increase of 0.65 points compared to 2013, which was 3.86% of GDP(Ortiz-Prado et al., 2015; Ortiz-Prado, Galarza-Maldonado, Cornejo, L, & Ponce, 2014).
This State investment has been able to increase the Per Capita Health Expenditure, being this a strong indicator of social security that the Ecuadorian State provides to its inhabitants. According to the World Health Organization (WHO), In 2014, health expenditure amounted to US $ 1,040 per inhabitant (WHO 2014), which is much lower than that reported by the United States of America or 5 Times higher than that of Cuba, without there being a direct relationship between spending and life expectancy.

Health System in Peru

In recent times the health system in Peru has undergone an impressive improvement and this is mainly due to the increase in the level of education, changes in the life style, urbanization, improvements in basic sanitation services, but above all to the extension of basic health services of the first level. At present, the health system of Peru has two sectors: the public and the private. The public system is divided into indirect subsidized or contributory regime and direct contributory scheme which is the one that belongs to social security(Alcalde-Rabanal, Lazo-González, & Nigenda, 2011; Cueto, 2000). The government of Peru also provides health services to the population that is not insured this is given in exchange for payment of a fee through Comprehensive Health Insurance (SIS). The social health insurance system has two subsystems: social insurance with traditional provision and private provision (Atun, R. Monteiro, L. Almeida.2015). The military, police and their families have their own health system composed of the Armed Forces (FFAA) and the National Police of Peru (PNP). In the private sector, private and non-profit private are distinguished (Maceira, D. 2014).The lucrative sector is represented by private insurers, specialized private clinics, medical and dental offices, etc. The non-profit private sector is represented by non-profit civil associations.

Health System in Bolivia

Bolivia is a country that is part of South America and has the caravan of lacking an entrance to the sea, constituting itself in the Andes mountain range. Bolivia presents the present and population of 11'1'7'770 inhabitants and presents a lower investment in health in Latin America (4% of GDP). The health system of Bolivia presents the segmentation of the expenses of 40% of social insurance, 30% of the public sector and 30% of the private sector. However, in 2015 the health system of the Universal Health System has been used to return the expenditure of the state of health services, reducing private health care companies(Ledo & Soria, 2011).

Health System in Brazil

Brazil is a large country located in the South American continent, which had a population in 2016 of 206'440'850 inhabitants in total.
When it comes to the health system in Brazil, we need to understand that this massive country has some contradictions about ensuring equal access to health services. Initially, any person in need of some type of medical treatment is entitled to a wide variety of services that are fully funded by the government, however this massive affluence of patients decreases the quality of medical attention and its gratuity. On the other hand, people who can afford private health care coverage in Brazil will have access to more modern services for a fee in a for-profit center.
This country has a very special health system because 75% of health services come from the United States of Health (U.S.) while the remaining 25% is services provided by community institutions or non-profit organizations. For this reason there is a 100% financing of health services in Brazil by the government, however, about 27% of the population has access to private insurance, which is optional and voluntary(Atkinson & Haran, 2004; Paim, Travassos, Almeida, Bahia, & Macinko, 2011).

Health System in Paraguay

In Paraguay, the health system is composed of 3 subsectors, the public system is composed by: the Ministry of Public Health and Social Welfare that provides health care until third level to citizens and within this subsystem is also the Police and Military Subsystem, which provides care to its active, retired and family employees; this system is fed by general taxes, credits and tariffs; despite this, it has been determined that only half of the population that required attention, had access to it (Maceira, 2014). Another component is the Social Security that operates through Social Security Institute that offers coverage to the private sector workers, teachers, retirees and domestic employees that represent 17% of the general population; this affiliation is mandatory for employers and employees, and this subgroup has its own facilities(Alum & de Bejarano, 2013; Mancuello & Cabral, 2011). The third subgroup is private, comprising non-profit institutions such as the Paraguayan Red Cross and for-profit institutions such as prepaid medicine, hospitals, insurers, clinics, pharmacies; this subgroup covers 10% of the population and these have their own establishments (Maceira, 2014).

Health System in Chile

In 1952, under the presidency of Gabriel González Videla the National Health system (Sistema Nacional de Servicios de Salud - SNSS) was created in Chile, four years after the National Health Service of Great Britain(Goic, 2015; Goic & Armas, 2003). It achieved many health programs and activities that reduced the mortality, increased the birth rate, augmented the access to purified water and allowed general population to access to a correct delivery care trough a regional healthcare coverage (Secretarías Regionales Ministeriales- SEREMI) that it’s under the control of the ministry of health, and that obtains its funds thanks to the FONASA (Fondo Nacional de Salud). In the eighty’s, under military influence, the private health system (Instituciones de Salud Previsonial- ISAPRES) was created, that caused that 7% of your salary went to insured private health care coverage (Goic, A. 2015). Although, this change wasn’t that significant (Nowadays 80% of the population general is cover by the SNSS and 17,5 % by the ISAPRES), it also allowed the creation of institutions that only covers work accidents. In 2003, there were 2177 working health care establishments which 1998 were part of the public sector and 179 from the private sector. Which caused in 2017, an increase in the number of aged hospitals that require an increment in their fund to allow a better health coverage(Becerril-Montekio, Reyes, & Manuel, 2011).

Health System in Argentina

The country of Argentina located in the continent of South America, has a population of 39'671'131 inhabitants and census of 2010, in 2016 obtained an increase to 43.85 million. However, since 2010 there has been a decrease in health investment in relation to GDP, in 2014 health investment was 4.8% according to the World Bank. In the case of Argentina, a survey was conducted of 3128 people of all ages, providing a 66.6% of the study population has a private health service(Belló & Becerril-Montekio, 2011; Moscoso & Larrosa, n.d.).

Conclusions:

The studies based the structure in four quadrants, this it allows social efficiency in the use of resources, and this is conditioned by the organization of health systems.
The health systems in latin american countries is divided into two, public and private, these systems are regularized and controlled with national health system governing, the most common are Ministry of Public Health and Social Security Institute.
The state is the principal in charge of providing access to public health to the largest number of citizens of a country, by means of the construction of houses of health, contracting of health professionals, free administration of medication, and prevention of controllable diseases.
Many of the countries maintain their public health system with the voluntary and obligatory affiliation of workers, to the Social Security Institute, which ensure the medical attention of the contributors and also in the long term of an economic remuneration in the retirement of the same ones.
The private health system is also regularized by the Ministry of Public Health, but the difference to the public system, is that are monopoly groups that own a hospital and see health as an economic business.

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Analysis of the Health Systems in Latin America

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