Nuevos cambios, viejos esquemas: las políticas de salud en México y Colombia en los años 2000

Abstract

Resumen: En años recientes se viene discutiendo la necesidad de incorporar modificaciones a los sistemas de salud en América Latina. Esta iniciativa, promovida nuevamente por el Banco Mundial como Universal Health Coverage (Cobertura Universal en Salud), se enfoca en las estrategias de protección contra riesgos financieros y en el acceso unificado a servicios y medicinas esenciales. A pesar de que las tendencias del Banco Mundial han sido incorporadas de diferentes formas en los países de la región, desde finales de los ochenta, también se han producido rupturas importantes en casos como los de Argentina, Brasil, Uruguay y Ecuador, quienes en momentos distintos han buscado implementar políticas y programas que enfatizan valores diferentes a los del mercado. Sin embargo, los cambios políticos, acaecidos recientemente con la crisis de los llamados gobiernos progresistas, han incidido para que la visión economicista de la salud vuelva con fuerza a las agendas públicas. Países de ingresos medios como México y Colombia se han caracterizado por implementar cambios inspirados en este modelo, en ambos casos distintos actores afines a este enfoque vienen impulsando la re-adecuación de los sistemas de salud a la perspectiva de los organismos financieros internacionales. Este trabajo plantea que estos cambios, promovidos como una alternativa “renovada” para responder a los problemas derivados de las transformaciones realizadas desde hace poco más de dos décadas, mantienen las bases del modelo neoliberal para la salud.

Strengthening health systems to achieve Universal Health Coverage: Lessons from four Latin American countries.

“…In 2012, Mexico also claimed to have achieved UHC, standing as another example of "nominal" UHC. [22] UHC initiatives in these four LAC have been faced with challenges surrounding the lack of strong nancial protection measures and inadequate governance mechanisms which continue to put many people at risk of catastrophic health expenditures. There is still debate surrounding the ideal nancing mechanisms for UHC in low to middle-income countries (LMICs).…”

“…POS has two components: the subsidized component for those not formally employed, and the contributive component for all others. [22] As enrollment in the subsidized component grew by 24% between 2000 and 2011, access to health services expanded to more people living at the poverty level. [23,24,36] In 2015, both components were uni ed under the Ley Estatutaria de Salud [Statutory Health Law], which standardized health bene ts, controlled resources, and limited the number of Tutelas [lawsuits] pursuing coverage for technologies not included in the insurer's bene t packages.…”

“…[23,24,36] In 2015, both components were uni ed under the Ley Estatutaria de Salud [Statutory Health Law], which standardized health bene ts, controlled resources, and limited the number of Tutelas [lawsuits] pursuing coverage for technologies not included in the insurer's bene t packages. [22] Mexico Mexico's healthcare is provided through the social security system, the public health sector, and private health plans. These sectors function in parallel with little coordination between them.…”

“…These sectors function in parallel with little coordination between them. The public health sector is composed of the social security institutions, which cover those formally employed, and Seguro Popular [Popular Insurance], which provides coverage to those under the informal sector or at the poverty level (self-employed, unemployed, informal sector workers, those working outside the labor market, and their families), thereby achieving the main goal of UHC [14,22,23,36,37]. Established in 2004, Seguro Popular expanded its breadth of coverage when, under the 2007-2012 health reform, introduced Seguro Medico para la Nueva Generation [Health Insurance for the New Generation], providing UHC to all children born after December 2006 and those under-ve-year-old who lack formal health coverage.…”

“…It is worth to remark that health expenditures vary across the four LAC as do their nancing mechanisms, according to the type of scal policies with most using a mix of federal and state taxes. [14,18,21,22,25,36,37,44,45] As other elements like Public-Private Partnerships (PPP), governance and HIS also do. .…”