Overcoming social segregation in health care in Latin America
Overcoming social segregation in health care in Latin America
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DOI：
10.1016/s0140-6736(14)61647-0
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发表时间：
2015-03-28
期刊：
影响因子：
168.9
通讯作者：
Saenz, Rocio
中科院分区：
文献类型：
--
作者：
Cotlear, Daniel;Gomez-Dantes, Octavio;Saenz, Rocio
拉丁美洲继续将不同的社会群体划分为单独的卫生系统部分，包括两个单独的公共部门板块：为受薪工人及其家庭提供资源充足的社会保障，以及卫生部为质量标准低且在服务点经常需要贫困支付的贫困和弱势人群提供服务。这种隔离表明了拉丁美洲长期存在的经济和社会不平等，这种不平等被一种经济框架所巩固，这种经济框架预测经济增长将导致经济迅速正规化。今天，人们认为，尽管预期寿命有所提高和其他进步，但在保健方面组织社会隔离的体制设置是实现健康权的障碍，这体现在许多拉丁美洲国家的立法中。本系列文件概述了拉丁美洲国家历史上的四个阶段，这些阶段解释了医疗保健分割的根源，并描述了各国寻求克服这一问题所采取的三条途径：统一用于资助社会保障和卫生部服务的资金（一个公共付款人）；自由选择供应商或保险公司；通过明确所有公民都有权享受的医疗保健福利，扩大对穷人和非工薪人口的服务。
Latin America continues to segregate different social groups into separate health-system segments, including two separate public sector blocks: a well resourced social security for salaried workers and their families and a Ministry of Health serving poor and vulnerable people with low standards of quality and needing a frequently impoverishing payment at point of service. This segregation shows Latin America's longstanding economic and social inequality, cemented by an economic framework that predicted that economic growth would lead to rapid formalisation of the economy. Today, the institutional setup that organises the social segregation in health care is perceived, despite improved life expectancy and other advances, as a barrier to fulfilling the right to health, embodied in the legislation of many Latin American countries. This Series paper outlines four phases in the history of Latin American countries that explain the roots of segmentation in health care and describe three paths taken by countries seeking to overcome it: unification of the funds used to finance both social security and Ministry of Health services (one public payer); free choice of provider or insurer; and expansion of services to poor people and the non-salaried population by making explicit the health-care benefits to which all citizens are entitled.