Health care for all : toward universal health coverage and equity in Latin America and the Caribbean : evidence from selected countries

Over the past three decades, many countries of Latin America and the Caribbean have recognized health as a human right. Since the early 2000s, 46 million more people in the countries studied are covered by health programs with explicit guarantees of affordable care. Reforms have been accompanied by a rise in public spending for health, financed largely from general revenues that prioritized or explicitly target the population without capacity to pay. Political commitment has generally translated into larger budgets as well as passage of legislation that ring-fenced funding for health. Most countries have prioritized cost-effective primary care and adopted purchasing methods that incentivize efficiency and accountability for results, and that give stewards of the health sector greater leverage to steer providers to deliver on public health priorities. Evidence from the analysis of 54 household surveys corroborates that investments in extending coverage are yielding results. Though the poor still have worse health outcomes than the rich, disparities have narrowed considerably - particularly in the early stage of the life course. Countries have reached high levels of coverage and equity in utilization of maternal and child health services; coverage of noncommunicable disease interventions is not as high and service utilization is still skewed toward the better off. Catastrophic health expenditures have declined in most countries; the picture regarding equity, however, is mixed. While the rate of impoverishment owing to health-care expenditures is low and generally declining, 2-4 million people in the countries studied still fall below the poverty line after health spending. Efforts to systematically monitor quality of care in the region are still in their infancy. Nonetheless, a review of the literature reveals important shortcomings in quality of care, as well as substantial differences across subsystems. Improving quality of care and ensuring sustainability of investments in health remain an unfinished agenda. Over the past three decades, many countries in Latin America and the Caribbean have recognized health as a human right. Since the early 2000s, 46 million more people in the countries studied are covered by health programs with explicit entitlements to care. Reforms have been accompanied by a rise in public spending for health, financed largely by general revenues that prioritize or explicitly target the population without capacity to pay. Political commitment has generally translated into larger budgets as well as passage of legislation that ring-fenced funding for health. Most countries have prioritized cost-effective primary care and have adopted purchasing methods that incentivize efficiency and accountability for results and that give stewards of the health sector greater leverage to steer providers to deliver on public health priorities. Despite progress, disparities remain in financing and quality of services provision across health subsystems. Delivering on the commitment to universal health coverage will require concerted efforts to improve revenue generation in a fiscally sustainable manner and to increase the productivity of expenditures. In Toward Universal Health Coverage and Equity in Latin America and the Caribbean: Evidence from Select Countries, the authors show that evidence from an analysis of 54 household surveys corroborates that investments in extending coverage are yielding results. Although the poor still have worse health outcomes than do the rich, disparities have narrowed considerably — particularly in the early stages of life. Countries have reached high levels of coverage and equity in utilization of maternal and child health services. The picture is more nuanced, and not nearly as positive, regarding adult health status and prevalence of chronic conditions and illnesses. Coverage of noncommunicable disease interventions is not as high, and service utilization is still skewed toward those who are better off. Prevalence of noncommunicable diseases has not behaved as expected given the drop in mortality; better access to diagnosis among wealthier individuals may be masking changes in actual prevalence. Catastrophic health expenditures have declined in most countries. The picture regarding equity, however, is mixed, pointing to limitations in the measure. Although the rate of impoverishment owing to health expenditures is low and generally declining, 2†“4 million people in the countries studied still fall below the poverty line after health spending. Efforts to systematically monitor quality of care in the region are still in their infancy. Nonetheless, a review of the literature reveals important shortcomings in quality of care, as well as substantial differences across subsystems. Improving quality of care and ensuring sustainability of investments in health remain an unfinished agenda. Portraits of Labor Market Exclusion presents profiles or portraits of individuals who have limited labor-market attachment. It is widely accepted that those with limited attachment to the labor market are a highly heterogeneous group (including, for instance, recent job losers, long-term unemployed, school leavers with no labor-market experience, those close to retirement age, or people with caring responsibilities), and that understanding their circumstances and potential barriers is an essential prerequisite for designing and implementing a tailored and effective mix of policy support and incentives. The report takes a comprehensive view, focusing on both the labor market attachment of a country's out-of-work population and the social assistance package and poverty profile of the same segment of the population. In essence, the report looks at individuals through the lenses of both poverty/welfare status and labor market indicators, and, in doing so, the portraits helps move the dialogue from a purely labor market-centric view to a broader dialogue that includes social policy as a whole. This is an important shift; for instance, social protection programs, such as family benefits and maternity benefits, and broader social policy issues such as retirement ages, often have a great impact on who remains inactive. Specifically, the report presents portraits of the out-of-work population of six countries (Bulgaria, Estonia, Greece, Hungary, Lithuania and Romania) in terms of distance from the labor market, human capital, and labor supply conditions, as well as demographic conditions. The analysis relies on the European Union Statistics of Income and Living Conditions (EU-SILC) surveys for the years 2007 to 2011. Latent class analysis methodology allows multidimensional profiling of the out-of-work population, and identifies classes or groups of out-of-work individuals that are as homogeneous as possible within each class according to a set of observable characteristics, and as distant as possible between classes. Consequently, this analysis provide a much richer glimpse of the very different barriers to labor market integration that these various groups experience, considerably augmenting the limited amount of information contained in traditional descriptive statistics Over The Past Three Decades, Many Countries Of Latin America And The Caribbean Have Recognized Health As A Human Right. Since The Early 2000s, 46 Million More People In The Countries Studied Are Covered By Health Programs With Explicit Guarantees Of Affordable Care. Reforms Have Been Accompanied By A Rise In Public Spending For Health, Financed Largely From General Revenues That Prioritized Or Explicitly Target The Population Without Capacity To Pay. Political Commitment Has Generally Translated Into Larger Budgets As Well As Passage Of Legislation That Ring-fenced Funding For Health. Most Cou. Setting The Context For Universal Health Coverage Reforms In Lac -- Universal Health Coverage Policies In Lac -- Progress Toward Universal Coverage In Lac : Outcomes, Utilization, And Financial Protection -- Assessing Progress Toward Universal Coverage : Beyond Utilization And Financial Protection. Tania Dmytraczenko And Gisele Almeida, Editors. Includes Bibliographical References. After nearly a quarter century of implementing universal coverage reforms, it is apt to take stock of how well the region has fared. This volume reviews progress in reducing inequalities in health outcomes, service utilization, and financial protection, and assesses the common trends emerging from these reforms.

This volume reviews progress in reducing inequalities in health outcomes, service utilization, and financial protection, and assesses the common trends emerging from these reforms.