Las reformas sanitarias y los modelos de gestión / Health sector reform and management models

ABSTRACT

This article tries to indicate the direction of progress in management being taken in health sector reforms in Latin America. The piece first discusses the tensions between local forces and international neoliberal trends being manifested in the reform in various countries. The article next looks at the distinction between the tools and the management models that are being applied, presenting a taxonomy of three management levels macromanagement (national health systems), midlevel management (hospitals, insurers, and other such institutions), and micromanagement (clinics). The piece concludes by reflecting on the future of management in the health sector in Latin America, where health systems are overadministered and undermanaged. Their future depends on multiple factors, most of which are outside the health care field itself. Better management of policies, institutions, and patients would be a tremendous tool in directing the future. Management is here to stay, with greater emphasis on either supply -hospitals and physicians- or demand -citizens or clients. For both the public and private sectors, health management is central to health sector reforms in Latin America