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Title: Overcoming social segregation in health care in Latin America
Authors: Cotlear, Daniel
Gómez-Dantés, Octavio
Knaul, Felicia
Atun, Rifat
Barreto, Ivana C. H. C.
Cetrángolo, Oscar
Cueto, Marcos
Francke, Pedro
Frenz, Patricia
Guerrero, Ramiro
Lozano, Rafael
Marten, Robert
Sáenz, Rocío
Affilliation: World Bank. Health, Nutrition and Population Global Practice. Washington, DC, Estados Unidos da América
National Institute of Public Health of Mexico. Cuernavaca, Morelos, México
Harvard University. Harvard Global Equity Initiative. Boston, MA, Estados Unidos da América
Harvard University. Harvard School of Public Health. Boston, MA, Estados Unidos da América
Harvard University. Boston, MA, Estados Unidos da América
Universidade Federal do Ceará. Escola de Saúde Pública. Fortaleza, CE, Brasil
Universidad de Buenos Aires. Buenos Aires, Argentina
Fundação Oswaldo Cruz. Casa de Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
Pontificia Universidad Católica del Peru. Lima, Peru
University of Chile. School of Public Health. Santiago, Chile
Rockefeller Foundation. New York, N, Estados Unidos da América
Universidad Icesi. Centro de Estudios en Protección Social y Economía de la Salud (PROESA). Cali, Colombia
Instituto Nacional de Salud Pública. Cuernavaca, México
University of Washington. Institute for Health Metrics and Evaluation. Seattle, WA, Estados Unidos da América
Universidad de Costa Rica. Escuela de Salud Pública. San Pedro de Montes de Oca, Costa Rica
Abstract: 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.
keywords: Saúde Pública
Assistência à Saúde
América Latina
DeCS: Assistência à Saúde
Segregação Social
Saúde Pública
América Latina
Issue Date: 2014
Citation: COTLEAR, Daniel et al. Overcoming social segregation in health care in Latin America. The Lancet, v. 385, n. 9974, p. 1248-1259, 2015.
Copyright: restricted access
Appears in Collections:COC - Artigos de Periódicos

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