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[Proposals for health reform and equity in Uruguay: a redefinition of the Welfare State?]. / Propuestas de reforma en salud y equidad en Uruguay: ¿redefinición del Welfare State?
Mitjavila, Myriam; Fernandez, José; Moreira, Constanza.
Afiliação
  • Mitjavila M; Centro de Informaciones y Estudios del Uruguay, Montevideo, Uruguay.
Cad Saude Publica ; 18(4): 1103-20, 2002.
Article em Es | MEDLINE | ID: mdl-12118314
This article reviews and analyzes health sector reform proposals in Uruguay and the possible effects of such reforms in terms of equity, the health sector's institutional structure, and the power relationship between the various actors in the process. The authors contend that a highly structured yet simultaneously fragmented system has conspired against any attempt to introduce major reforms into the system. Thus the only possibility for reform resides neither in the consolidation of the so-called Institutions for Collective Medical Care (IAMCs) nor in the move towards a residual model. Rather, Uruguay is witnessing the system's passive restructuring (i.e., reform by default). In this context and given the system's built-in inequities, the current trend is towards an even more regressive distribution of goods and services. The authors use qualitative and quantitative techniques to show that inequities in expenditure, access, and quality have resulted from long-term developments and adaptive movements of an IAMC system in fiscal stress and the public system's declining quality. Thus, in the absence of changes in state policy that redefine the actors' power or in the absence of system collapse, the country should expect this same regressive trend to deepen.
Assuntos
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Justiça Social / Seguridade Social / Reforma dos Serviços de Saúde / Centros Comunitários de Saúde Tipo de estudo: Qualitative_research Aspecto: Determinantes_sociais_saude / Equity_inequality Limite: Humans País/Região como assunto: America do sul / Uruguay Idioma: Es Revista: Cad Saude Publica Assunto da revista: SAUDE PUBLICA Ano de publicação: 2002 Tipo de documento: Article País de afiliação: Uruguai País de publicação: Brasil
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Justiça Social / Seguridade Social / Reforma dos Serviços de Saúde / Centros Comunitários de Saúde Tipo de estudo: Qualitative_research Aspecto: Determinantes_sociais_saude / Equity_inequality Limite: Humans País/Região como assunto: America do sul / Uruguay Idioma: Es Revista: Cad Saude Publica Assunto da revista: SAUDE PUBLICA Ano de publicação: 2002 Tipo de documento: Article País de afiliação: Uruguai País de publicação: Brasil