Propuestas de reforma en salud y equidad en Uruguay: ¿redefinición del Welfare State?

Abstract

This article reviews and analyzes health sector reform proposals in Uruguay and the possible effects of such reforms in terms of equity, the health sector's institutional structure, and the power relationship between the various actors in the process. The authors contend that a highly structured yet simultaneously fragmented system has conspired against any attempt to introduce major reforms into the system. Thus the only possibility for reform resides neither in the consolidation of the so-called Institutions for Collective Medical Care (IAMCs) nor in the move towards a residual model. Rather, Uruguay is witnessing the system's passive restructuring (i.e., reform by default). In this context and given the system's built-in inequities, the current trend is towards an even more regressive distribution of goods and services. The authors use qualitative and quantitative techniques to show that inequities in expenditure, access, and quality have resulted from long-term developments and adaptive movements of an IAMC system in fiscal stress and the public system's declining quality. Thus, in the absence of changes in state policy that redefine the actors' power or in the absence of system collapse, the country should expect this same regressive trend to deepen.

Critical care practice – Latin American perspective

“…One striking feature of the Latin America concerns living standards and the provision of health care standards for the population of each country. Reports from Uruguay identify that better educated people in employment and with higher salaries have increased access to medical services (Mitjavila et al , 2002). By contrast, in Colombia, poorer people suffer the results of increased inequity in welfare provision because of recent health policies and reforms (Álvarez Castaño 2005).…”

Desafios para a saúde coletiva no século XXI

“…As reformas setoriais 5 empreendidas na América Latina e no Caribe ao longo da década de 1990 (PEGO & ALMEIDA, 2002;HERNANDEZ, 2002;LABRA, 2002;BELMARTINO, 2002;MITJAVILA et al, 2002), sob o patrocínio e direção de organismos internacionais a exemplo do Banco Mundial e Banco Interamericano de Desenvolvimento, vinculadas aos pacotes de ajuste macroeconômico, apresentam alguns elementos comuns: modificação de regras de financiamento, participação de agentes públicos e privados, embora com maior presença dos últimos, e separação das funções de financiamento, provisão e regulação (ALMEIDA, 2002). No Brasil, todavia, a agenda de reformas desses organismos internacionais encontrou certa resistência ou oposição aberta, por contrariar o caráter universal das políticas de saúde projetadas pelo movimento da Reforma Sanitária desde a década de 1970, além de ameaçar os preceitos constitucionais e a legislação sanitária.…”

La política de financiación de los sistemas de salud y la equidad de género en el estado de salud

“…La estructura de los datos mas comunes puede ser de corte transversal, series de tiempo, combinación de cortes transversales, y de panel o longitudinales 63 . El enfoque de género en el desarrollo (GED) 69 ha sido muy importante, toda vez que asocia el proceso de desarrollo de un país y su redefinición de prioridades, con la igualdad de oportunidades de todas las personas (hombres y mujeres), en términos de expansión de sus capacidades y posibilidades para ejercer los derechos, satisfacer sus necesidades, maximizar sus potencialidades 70 , para escoger la forma de vivir entre diferentes alternativas, "para aumentar las opciones 64 OPS. Glosario sobre género.…”

“…69 Término creado oficialmente en la segunda mitad de los años ochenta. 70 Se fundamenta en el enfoque de escala humana de Max Neef y el enfoque de desarrollo de extensión de capacidades de Sen.…”