Assuntos

RESUMO

Despite what is written in the constitutions and other basic document mandates of the countries of the Region, exclusion from societal protection in health (SPH) affects an important proportion of the population (at least 20 percent, which represents, in absolute figures, between 80 and 200 million people). These estimates are obtained through a series of theoretical (social security coverage) and practical indicators that encompass structural indicators (poverty, ethnicity, and geographical barriers) as well as process indicators (non-institutional births, compliance with vaccination schedules, and access to basic sanitation). Exclusion levels in a society are affected by the degree of segmentation of the health system. Traditionally, most countries of the Region have had a public, a social security and a private subsystem in health. Lack of attention to the problem has resulted in the formation of a community-based subsystem. The coexistence of many subsystems, along with poor regulation on the part of health authorities, has resulted in high levels of exclusion and inefficient resource allocation within the sector. The organization of social dialogue processes focusing on SPH within the context of health sector reform initiatives in each country is recommended. The process, which should be participatory, should include a full diagnosis of the situation (how many are excluded, who are they, and why, and what mechanisms are the most appropriate for tackling the issue in each country). It should also provide a political and technical feasibility analysis of the most suitable options for each society, and a determination of whether or not conventional subsystems have exhausted their potential. The process should culminate in a program for implementing the specific proposals made in each society, in an effort to maximize SPH (AU)

Assuntos

RESUMO

A pesar de lo que senalan las Constituciones y otras normas basicas de los paises de la Region de las Americas, la exclusion de la proteccion social en salud es un problema que afecta a una proporcion importante de la poblacion (al menos 20 por cien y, en numeros absolutos, entre 80 y 200 millones de personas). A esta cifra se llega a traves de una serie de indicadores teoricos (cobertura de la seguridad social) y practicos, tanto de estructura (pobreza, etnia y barreras geograficas) como de proceso de salud (partos que tienen lugar fuera de instituciones de salud, cumplimiento del calendario vacunal y acceso a saneamiento basico). La exclusion se ve afectada por el nivel de segmentacion de los distintos subsistemas de salud de una sociedad. Tradicionalmente existian en la Region de las Americas los subsistemas publico, privado y de seguridad social. La falta de respuesta a este problema ha motivado el surgimiento de un subsistema comunitario. La coexistencia de distintos sistemas combinada con la falta de regulacion por las autoridades sanitarias ha ocasionado altos niveles de exclusion y una alta ineficiencia en el uso de los recursos del sector. En el contexto de la reforma del sector de la salud de cada pais, se recomienda un proceso de dialogo social en el que se discuta explicitamente el tema de la proteccion social en salud. Este proceso, que debe ser organizado de forma participativa, deberia incluir un diagnostico completo de la situacion (cuantos son los excluidos, quienes y por que, y cuales son los mecanismos mas adecuados en el contexto nacional para combatir el problema) y una evaluacion tecnico-politica de las opciones mas convenientes para cada sociedad, en la que se determine si se han agotado o no las posibilidades de los subsistemas tradicionales. El proceso deberia culminar con un programa de implementacion de las propuestas en el que tengan cabida las distintas modalidades mas adecuadas para cada caso, de forma que se logre la maxima proteccion social en salud

Despite what is written in the constitutions and other basic document mandates of the countries of the Region, exclusion from social protection in health (SPH) affects an important proportion of the population (at least 20%, which represents, in absolute figures, between 80 and 200 million people). These estimates are obtained through a series of theoretical (social security coverage) and practical indicators that encompass structural indicators (poverty, ethnicity, and geographical barriers) as well as process indicators (non-institutional births, compliance with vaccination schedules, and access to basic sanitation). Exclusion levels in a society are affected by the degree of segmentation of the health system. Traditionally, most countries of the Region have had a public, a social security and a private subsystem in health. Lack of attention to the problem has resulted in the formation of a community-based subsystem. The coexistence of many subsystems, along with poor regulation on the part of health authorities, has resulted in high levels of exclusion and inefficient resource allocation within the sector. The organization of social dialogue processes focusing on SPH within the context of health sector reform initiatives in each country is recommended. The process, which should be participatory, should include a full diagnosis of the situation (how many are excluded, who are they, and why, and what mechanisms are the most appropriate for tackling the issue in each country). It should also provide a political and technical feasibility analysis of the most suitable options for each society, and a determination of whether or not conventional subsystems have exhausted their potential. The process should culminate in a program for implementing the specific proposals made in each society, in an effort to maximize SPH.

Assuntos

Assuntos