Aseguramiento y cobertura: dos temas criticos en las reformas del sector de la salud / Health insurance and health coverage: two critical issues within the context of health sector reform

RESUMEN

La meta de salud para todos en el ano 2000, que se establecio en Alma Ata hace mas de 20 anos, ha llevado a la adopcion de reformas sectoriales en los paises de America Latina y el Caribe encaminadas a ofrecer aseguramiento de salud a todos y cada uno de sus habitantes. Si bien las politicas adoptadas han llevado a adelantos importantes de caracter teorico y normativo, en la practica las metas establecidas estan lejos de haberse alcanzado y en muchos paises existen grandes disparidades entre la cobertura real de la poblacion y su cobertura teorica. Ello se debe, en gran medida, a la organizacion y otras caracteristicas "endogenas" de los sistemas de salud vigentes en cada pais, y a factores "exogenos" de caracter politico, macroeconomico, social, epidemiologico y cultural. En este documento se examinan detenidamente los diferentes tipos de sistemas de salud que existen actualmente en la Region y el efecto que ejercen sobre las fuentes de aseguramiento y cobertura de salud de los habitantes. Al final se presentan los distintos tipos de estrategias adoptadas por los paises para extender la cobertura de salud, algunas veces mediante la focalizacion de las politicas en los grupos sociales mas vulnerables

ABSTRACT

The goal of health for all in the year 2000, which was established at Alma Ata more than two decades ago, has led countries in Latin America and the Caribbean to adopt health sector reforms aimed at extending health coverage to each and every individual citizen. Whereas much has come about as a result of reform policies in the way of theory and legislation, in practice the goals that were established are far from attained, and many countries show large gaps in theoretical coverage on the one hand, and true coverage on the other. This is largely due to organizational features and other "endogenous" characteristics of the various countries' health systems, as well as to "exogenous" factors in the political, macroeconomic, social, epidemiologic, and cultural spheres. This documents takes a close look at the different types of health systems that are currently operating in countries of the Region and their impact on sources of health insurance and health coverage for individuals living in those countries. The end of the article focuses on the different strategies adopted by the countries in an effort to extend health coverage, which in some cases involve policies targeting the most vulnerable social groups.