Universal health systems for Latin America: recent and old innovations in health services

Abstract

Objective: The paper discusses the need to balance “old and recent” innovations in the construction of health systems. Data synthesis: Description of the trajectory of contemporary systems with analysis of the reforms conducted in Brazil, Chile, Colombia, Spain and Portugal. Five moments were identified: expansion of services, "democratic-rationalizing" reforms, neoliberal adjustments, pro-coordination reforms, further adjustments and the proposal of universal coverage for low- and middle-income countries. In Chile and Colombia there was the explicit introduction of private insurance and, in Brazil, the implementation of an integrated public system under fiscal financing. In these three countries, segmentation and fragmentation of services still predominate, with a complex composition of public and private services. Portugal and Spain have implemented national systems integrating "old and recent innovations", whose macro-efficiency has been demonstrated. Conclusion: In Latin America, proposals to universalize coverage without changes in the health care model pose risks of a deregulated increase in consumption, not corresponding to the health needs of the population. Knowledge and debate based on the experiences accumulated in Brazil and in the Iberian countries can contribute to coping with these challenges.