Neoliberalism in Latin America: effects on health system reforms

Abstract

OBJECTIVE: To analyze the recommendations of international organizations based on the Washington Consensus on health system reforms of selected countries in Latin America and the Caribbean in the 1980s and 1990s and to investigate the effects of the competitive market logic on public action in the health system. METHODS: Comparative analysis of the characteristics of health system reforms conducted in the 1980s and 1990s, still seen in Brazil, Argentina, Chile, Colombia, Mexico and Peru. Data were collected by documental analysis and literature review. The systems were described based on the characteristics of: co-payment, privatization mechanisms, decentralization, fragmentation of the system, integration of funding sources and coverage of the population (universal or segmented). RESULTS: The reforms were implemented differently, worsening inequalities in health service delivery systems. Changes related to the neoliberal idea of transforming public action in the direction of private logic point to the predominance of competition rules and the reduction in economic costs in all countries analyzed, contrary to the logic of universal health systems. CONCLUSION: The reduction in economic costs, the fragmentation of systems and inequalities in the provision of health services, among others, may mean other future costs resulting from low protection to the population’s health. A striking and multidimensional counter-reform is essential to make health a right of all again, in a solidarity system that can lead to the reduction in inequalities and a more democratic society.

National and subnational coverage and inequalities in reproductive, maternal, newborn, child, and sanitary health interventions in Ecuador: a comparative study between 1994 and 2012

“…Inequality is a major global challenge, including in Latin America, which has experienced periods of dramatic decline in levels of social spending accompanied by economic crises and political instability [1]. The widespread adoption of neo-liberal economic growth strategies has increased poverty and widened income inequalities in the provision of health services [2,3]. In countries such as Ecuador, Bolivia, Argentina and Brazil, periods of greatest economic and political crisis coincide with marked increases in inequality, as measured by the Gini Index [4,5].…”

What does COVID-19 tell us about the Peruvian health system?

“…In common with regional trends, the Peruvian health system remains highly fragmented and segmented, severely constraining state capacity to deliver quality healthcare for all (Homedes and Ugalde 2005;Göttems and Mollo 2020). This fragmentation affects different components of the system, generating dynamics among the various actors involved at different levels, and with implications for stewardship and the provision of healthcare.…”

“…Regarding accountability and planning, following the decentralisation process initiated in early 2000s, budgets are no longer under MINSA administration. Decentralisation sought to strength health service accountability to users, by decreasing the distance between the population and immediate managers (Göttems and Mollo 2020). One means of achieving this was through providing regional authorities with greater financial and administrative autonomy.…”

“…Moreover, following decentralisation, the administration of public health facilities (the largest network of health facilities in the country), as well as the capacity to implement health programmes and plan public investment, were transferred from MINSA to the regional governments. This has been described as a mechanism to decrease the responsibility of national governments (Göttems and Mollo 2020).…”

Preferences based interventions to address the use of antibiotics without prescription: a discrete choice experiment

“…Depending on the working status and socioeconomic conditions of a person or a family, health service extent and quality may differ. 17 , 18 Commonly, the low-income population also has poorer access to quality health services. This has undermined the general population’s trust in health services.…”