Sistemas de proteccion social para el adulto mayor en America Latina y el Caribe / Social protection systems for older adults in Latin America and the Caribbean

Only one half (50.1 percent) of all older adults in Latin America currently receive benefits under some form of social protection system for the elderly, either through social assistance or social security programs, or have access to a savings plan for old age in the form of individual capitalization accounts (ICA) based on mandatory or voluntary contributions. The other half enjoys no social protection at all; its consumer and health needs are covered through accrued assets, voluntary family transfers, or charitable deeds. Social security pension plan reforms and the creation of social-security-based savings plans for old age in the form of ICA have failed to yield the expected results in terms of coverage and benefits. Over-all, reforms have led to the dismantling of social-security-based social protection systems for the elderly without creating alternative mechanisms for social protection. This document describes the various social protection systems and savings plans for old age that are in place in countries of the Region and looks at current challenges in terms of correcting "government failures" and applying policies that will redress "market failures", so that the working population can count on having enough resources to satisfy its consumer and health needs after retirement (AU)

Equity and systems of intergenerational transfers in Latin America and the Caribbean

Intrafamilial intergenerational transfers involve direct transfers from one generation to another via family connections. Family ties secure the claims of one group of individuals on the goods or services produced and delivered by other family members. When the family is unable to produce sufficient godds or services to meet the demands of all family members, then family assets have to be augmented. In addition to the transfer of goods and services, these intrafamilial transfers include emotional and moral support, personal companionship, and other intangibles. The mechanisms for these intrafamilial transfers are not always stated explicitly. Instead, the mechanisms are frequently worked out according to the availability of kin and the expectations of how limited resources are to be distributed among generations within a family. In the case of poor families, the balance is often tilted in favor of the younger generation, and the burden of old age care becomes a major stress if there is not additional support from the broader society (AU)

Hacia una nueva seguridad social en el siglo XXI: sin solidaridad en el financiamiento no habra universalidad / Towards new social security systems in the 21st century: universal coverage is impossible without cohesion in financing

In the countries of Latin America and the Caribbean, social security systems have traditionally been almost exclusively the responsibility of the public sector. These systems have had major shortcomings, such as low coverage rates, unbalanced budgets, inadequate funding, and poor management of resources. In order to solve these problems and face the increased demands associated with demographic and epidemiological transitions, in the 1990s a number of countries began to reform their social security systems. These reforms have been characterized by three fundamental features: a) a search for a closer link between contributions and benefits, in order to better balance income and expenses, b) changes in the public-private composition of the systems that allow a greater private role in the financing and delivery of services, and c) an emphasis on market mechanisms as a way to promote efficiency in applying resources, and leaving to the State a role as a regulator and as a guarantor of basic benefits to groups that, because of their socioeconomic conditions, cannot make certain minimum contributions. This article looks at some of the problems raised by the reforms carried out so far, and the lessons that can be learned from them. The piece also analyzes the relationship between universal coverage and societal unity. In addition, the article suggests that the main challenge with social security reforms is that of moving toward universal systems that sinificantly expand coverage. In order to achieve that, it is necessary to strengthen the mechanisms of cohesion in financing and to improve efficiency by introducing market instruments that do not negatively affect the unitarian character of the financing. The piece concludes that it is necessary to increase coverage; improve management; be concerned about the design of the public-private makeup; identify the responsibilities of the private sector and of the government in financing, provision, and regulation of social security systems; and introduce and strengthen unity mechanisms in financing (AU)

Health care financing in Grenada: how to share the responsibility of paying for better services

Presents details of a study of the health services sector and the current and prospective means of financing its operation. Findings show that the public health system accounted for nearly 14.6 percent of the government's recurrent budget or about EC$23.5 million in 1990/91, whilst Grenadian spent EC$3 million on private consultations and medicine. The combined total amounts to EC$265 per capita, which is significantly more than in Dominica and St. Lucia. Details on how the public and private sectors share the responsibility of paying for health services are given. Concludes that public health system is well organized in terms of structure and distribution of physical facilities, but inefficient in the management of personnel and material resources. Recommendations and suggestions as to ways non-tax sources can share the responsibility of paying for better health services are given

Comparative health care financing in St. Lucia, Grenada and Dominica

Presents the findings of a study of health care financing in the English-speaking Caribbean. The initial objective of the study was to explore whether increased support for maternal and child health might be provided through an expansion of social insurance coverage to include health benefits for workers and their dependents and also to find out how countries can adapt the organization, financing and delivery of health services so as to continue to provide primary health care equitably and efficiently, while at the same time providing essential secondary and tertiary level services. Details of the comparative study of the health systems in the three countries in terms of the adequacy of the health care provided at different levels and the real resources with which it is provided. Findings show that the level of health care spending both from public and private sources vary considerably among the islands. Includes statistical data on expenditure on health as well as the findings of a survey of consumers' view on the organization and quality of health care in the islands

The role of social security in the provision of medical care in the English-speaking Caribbean

This paper reviews the current role of social security institutions in financing health care and explores possible alternative avenues for their participation

Problems of venereal infections in Latin America and the Caribbean and means of fighting them

Campaigns against sexually transmitted diseases (STD) in Latin America and the Caribbean encounter a number of special conditions. This article describes some of those conditions and points out the rising interest that PAHO's Member Governments have recently shown in STD control (AU)

Poor relief and aspects of public health in Bagnolds District of St. Mary - period 1st April, 1968 to 31st March, 1978

The system as it is appears to be sound from an administrative point of view. Recommendations have been made as to 1) improvement in methods of investigating personnel, 2) minimum weekly dole, 3) housing, 4) women with 3 or more children 5) welfare of inmates in infirmaries 6) rehabilitation of recipients (AU)

Medical aspects of national insurance and social security scheme, Guyana

A National Insurance and Social Scheme was introduced in Guyana on the 29th September, 1969. On 1st January, 1970, injury benefit was payable to all insurable workers which virtually meant that even if a worker was not registered under the Scheme and he sustained an industrial injury, so long as he was in insurable employment he was eligible to receive injury benefit and also disablement benefit if he suffered any degree of disablement resulting from the injury. This paper will confine itself to the provisions for medical examination, certification and treatment of persons suffering industrial injuries. The programme for medical care is conceived as a vertical one, and so an industrially injured worker is not permitted to change the medical practitioner and proceed horizontally with his treatment without the permission of the general manager. From the very inception of the scheme every registered medical practioner was accepted as an examining officer and was empowered to examine, treat and issue certificates in keeping with the relevant regulations. If a claimant for injury benefit is not satisfied with the handling of his case, he could lodge an appeal, and then he would be allowed to go upwards in the organizational structure and be examined by a medical referee in order to resolve the issue. A panel of Medical referees has been appointed by the National Insurance Board. If a claimant is dissatified with the medical referee's determination, he can lodge a further appeal and his case would then be placed before a Medical Board comprised of two or more members. A panel of Medical Board members has been appointed by the National Insurance Board. A Medical Board's determination is final unless there is a disagreement between two members, when another Board will be arranged comprised of least 3 members. The decision of a Medical Board consisting of more than 2 members, if not unanimous, will be that the majority of the members. So far, no separate facility for medical care of industrially injured workers has been established. The country's existing resources in medical man-power and institution (public and private) are being fully utilized to provide all aspects of diagnosis and treatment of cases. Medical Care includes - General Medical Practitioners care, specialist care and treatment at hospitals the supply of prescribed essential pharmaceutical products and dressing, the provision, repair and renewal within limits laid down by the National Insurance Board, of orthopaedic and prosthetic appliances necessary for the rehabilitation or the reduction of incapacity for work of the injured person, arising as a direct consequences of employment injury. The main pre-occupation of the Medical Division and of physicians and surgeons, appointed under the Scheme is with refereeing and boarding of workers suffering from industrial injuries. Thus in 1972, 403 claimants appealed against determinations of Medical Referees and to date some 395 have been medically boarded. The main questions for determination by Medical Referees and Board Members are reviewed (AU)

The economics of pharmaceuticals and health sector reform in the Americas

Increasing pressures on health systems and significant economic changes in many Latin American and Caribbean countries make reforms to the health and pharmaceutical sectors imperative. While health and pharmaceutical needs continue to mount, trade and price liberalization policies implemented to revitalize economies are frequently associated with higher pharmaceutical expenses. Such conditions affect the poor disproportionately, further aggravating existing imbalances in society. The fundamental principle of optimal health sector reform is that access to quality health services is a right of all individuals. From this principle, three objectives are identified: universality and equity in access, quality, and efficiency. Each country must shape health sector reform in accordance with its priorities and social and economic conditions, but pharmaceutical reform must be incoporated within health sector reform and should seek to ensure that all individuals have access to essential drugs and to quality health services. The essential drugs concept, advocated by WHO through its Action Programme on Essential Drugs and PAHO, stresses availability, affordability, quality, and rational use of drugs. Five areas are central to reform strategy: the roles of the public and private sectors, drug financing alternatives, pricing policies, generic strategies, and rational drug use (AU)