Why neoliberal health reforms have failed in Latin America

Homedes, Núria; Ugalde, Antonio

doi:10.1016/j.healthpol.2004.01.011

Cited by 238 publications

(214 citation statements)

References 22 publications

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“…During the 1990s, many Latin American countries began reforming their health systems according to a neoliberal development model that emphasizes free markets (Homedes and Ugalde 2005 ;Stocker et al 1999 ). Approved in 1993, health reform in Colombia was supposed to overcome problems such as low coverage, inequality in access and use of health care services, and ineffi ciency in the allocation and distribution of resources.…”

Section: Introductionmentioning

confidence: 99%

Resource Allocation and Priority Setting

Daniels

2016

Public Health Ethics Analysis

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Section: Introductionmentioning

confidence: 99%

Resource Allocation and Priority Setting

Daniels

2016

Public Health Ethics Analysis

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“…[5][6][7] Several contributions argue that decentralization neither increased local government healthcare finances, nor improved equity, quality or efficiency of publicly run health services. 5,8 In many cases it had the opposite effect, as performance deteriorated due to financial constraints, poor managerial skills at the local level, and supply failures. 6 However, studies acknowledge some positive effects mainly in areas where community participation became more active and in some regions that traditionally devoted more resources to healthcare and were eager to get local autonomy to administer these resources better.…”

Section: Introductionmentioning

confidence: 99%

“…Several decentralization experiments occurred in periods of deep economic crisis. 5,8 Consequently, most empirical studies overestimate the negative impacts of decentralization policies and cannot disentangle the impact of decentralization by itself. Very few studies have been able to use natural experiments to isolate the impact of economic adjustment from healthcare decentralization.…”

Section: Introductionmentioning

confidence: 99%

U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization? Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis"

Bustamante

2016

Int J Health Policy Manag

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For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization.

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“…Increasing privatisation together with rising out-of-pocket (OOP) health expenditures by households (Travis et al, 2004;Vega, 2013;Whitehead et al, 2001;WHO, 2010b) and cost-recovery measures, specifically user fees, contributed to the medical poverty trap (Whitehead et al, 2001), leaving millions of people burdened by catastrophic health care costs (Balarajan, Selvaraj, & Subramanian, 2011;Leive, 2008). The damaging effects of this on equity in health care access, and on absolute and relative health outcomes, has led to considerable experimentation in the name of health systems reform, with mixed results (Homedes & Ugalde, 2005;Jacobs & El-Sadr, 2012;Schrecker et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Sexual and reproductive health and rights in changing health systems

2015

Reproductive Health Matters

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Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities).Keywords: sexual and reproductive health and rights; universal health coverage/care; quality of care; accountability; equity Introduction Sexual and reproductive health and rights (SRHR) are centrally important to health outcomes in all countries. Sex and reproduction define unique and specific health needs for girls and women over the entire life course. Whether, how and to what extent these health needs are met by the health system depends on the extent to which girls' and women's human rights are respected, protected and fulfilled. Throughout the life course, the sexual and reproductive rights (SRR) of girls and women -to bodily autonomy and integrity, to choice in relation to sexuality and reproduction, to freedom from coercion, discrimination and violence or fear of violence, to safety, satisfaction and pleasureprofoundly shape their physical and mental health and well-being.

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Why neoliberal health reforms have failed in Latin America

Cited by 238 publications

References 22 publications

Resource Allocation and Priority Setting

Resource Allocation and Priority Setting

U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization? Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis"

Sexual and reproductive health and rights in changing health systems

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