Competing health policies: insurance against universal public systems

Abstract

Objectives: This article analyzes the content and outcome of ongoing health reforms in Latin America: Universal Health Coverage with Health Insurance, and the Universal and Public Health Systems. It aims to compare and contrast the conceptual framework and practice of each and verify their concrete results regarding the guarantee of the right to health and access to required services. It identifies a direct relationship between the development model and the type of reform. The neoclassical-neoliberal model has succeeded in converting health into a field of privatized profits, but has failed to guarantee the right to health and access to services, which has discredited the governments. The reform of the progressive governments has succeeded in expanding access to services and ensuring the right to health, but faces difficulties and tensions related to the permanence of a powerful, private, industrial-insurance medical complex and persistence of the ideologies about medicalized 'good medicine'. Based on these findings, some strategies to strengthen unique and supportive public health systems are proposed.

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

“…[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. [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. 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.…”

“…[36] The Fondo de Solidaridad y Garantia [Solidarity and Guarantee Fund] or FOSYGA, uses a similar form of cross-subsidy, receiving funds from the insurance companies and uses it to subsidize the noncontributory system. [23] Healthcare provision is run by EPS, private insurance organizations contracted under managed competition rules to manage both POS components. However, in a country where health is considered an "economic asset", this strategy of managed competition would be considered as an "open market initiative" rather than a PPP.…”

Programa Cegonha Carioca: contratualização do serviço por organização social

“…2019;13:e239431 https://doi.org/10.5205/1981-8963.2019.239431 8,142/90 that regulates and establishes the community's participation in the management of the Unified Health System, seen as essential in the formulation of public policies and accomplishment of the UHS, in order to meet the real needs of the population, also favoring the reduction of social inequalities and the construction of citizenship and democracy. 9 The management model adopted in the Programa Cegonha Carioca is based on liberalism, taking the path to the health commodification 10 . The analysis of the implementation of a program of public health in Finland, in association with the private sector, showed a reduction of control by national authorities on the work of health promotion in the municipalities, resulting in losses for the activities of health promotion 11 .…”

“Todo Mundo Quer Ter um Filho Perfeito”: Vivências de Mães de Crianças com Autismo

“…Diante das situações vivenciadas, dos encargos decorrentes das demandas dessas crianças, os níveis de depressão são elevados entre mães de crianças com autismo (Sanini, Brum, & Bosa, 2010;Piovesan, Scortegagna, & Marchi, 2015), e estudos apontam a importância de redes de suporte social entre ações promotoras e preventivas em relação à saúde mental dessa mãe (Fávero-Nunes & Santos, 2010;Najarsmeha & Cezar, 2011;Zanatta, Guimarães, Ferraz, & Motta, 2014), além da importância do apoio do profissional de saúde para que elas possam lidar de uma maneira mais adequada com as situações geradoras de estresse . Dessa forma, segundo Meimes, Saldanha, & Bosa (2015), o impacto do autismo pode ser amenizado quando mediado por uma rede de apoio social, familiar, por estratégias efetivas de enfrentamento e pela qualidade do sistema de saúde.…”