From instinct to evidence: the role of data in country decision-making in Chile.

BACKGROUND: The Chilean health system has undergone profound reforms since 1990, while going through political upheaval and facing demographic, health, and economic transformations. The full information requirements to develop an evidence-informed process implied the best possible use of the available data, as well as efforts to improve information systems. OBJECTIVE: To examine, from a historical perspective, the use of evidence during the health sector reforms undertaken in Chile from 1990 to date, and to identify the factors that have both determined improvements in the data and facilitated their use. METHODS: A qualitative methodological approach was followed to review the Chilean experience with data on decision-making. We use as the primary source our first-hand experience as officials of the Ministry of Health (MOH) and the Ministry of Finance before and during the reform period considered. A literature review was also conducted, using documents from official sources, historical accounts, books, policy reports, and articles published in indexed journals reviewing and discussing the reform process, looking for the use of data. RESULTS: The Chilean health-care reform process was intensive in its use and production of information. The MOH conducted several studies on the burden of disease, efficacy of interventions, cost-effectiveness, out-of-pocket payments, fiscal impact, social preferences, and other factors. Policy and prioritization frameworks developed by international agencies strongly influenced the use of data and the study's agenda. CONCLUSIONS: The Chilean example provides evidence that tradition, receptiveness to foreign ideas, and benchmarking with international data determined the use of data, facilitated by the political influence of physicians and, later, other technocrats. Internationally comparable statistics are also shown to play a significant role in the policy debate.

The role of international remittances in health outcomes in Ecuador: prevention and response to shocks.

This article evaluates the impact of remittances on health outcomes in Ecuador using an instrumental-variables approach. Although we do not find significant impacts on long-term child health variables, we find that remittances do have an impact on health expenditures, and on some preventive issues such as de-worming and vaccination. In addition, we find significant effects of remittances on medicine expenditures when illness occurs. In this regard, remittances are used for both preventive and emergency situations. Interestingly, we also find a significant and positive effect of remittances on health knowledge.

Three worlds of relief: race, immigration, and public and private social welfare spending in American cities, 1929.

Using a data set of public and private relief spending for 295 cities, this article examines the racial and ethnic patterning of social welfare provision in the United States in 1929. On the eve of the Depression, cities with more blacks or Mexicans spent the least on social assistance and relied more heavily on private money to fund their programs. Cities with more European immigrants spent the most on relief and relied more heavily on public funding. Distinct political systems, labor market relations, and racial ideologies about each group's proclivity to use relief best explain relief spending differences across cities.

Sístoles e diástoles no financiamento da saúde no estado de Minas Gerais: o período pós-constituição de 1989 / Systoles and diástoles public in health on the state of Minas Gerais, Brazil the period after Minas Gerais constitution 1989

Esta tese tem como objeto o estudo do financiamento da saúde pública no Estado de Minas Gerais, no período compreendido entre a promulgação da Constituição mineira, em 21 de setembro de 1989, e o ano de 2005.Seu texto analisa também o financiamento da saúde pública no federalismo trino, em Minas Gerais, em diferentes momentos de vinculação constitucional: na vigência do ordenamento constitucional determinado pelo § 1° do art. 158 da Constituição estadual de 1989 e na vigência da Emenda n° 29, de 13 de setembro de 2000, da Constituição da República. A presente tese constrói a série histórica de 1989 a 2005, com os valores do gasto em saúde pelo Estado de Minas Gerais, a partir dos Balanços Gerais do Estado. Através desses dados, comprova-se que a aplicação de recursos em ações e serviços públicos de saúde não se elevou com a vigência da EC-29, ao contrário, constatamos uma diminuição do aporte realizado em 2005 quando comparado ao valor aplicado em 1995 (15,62 por cento). A construção da série histórica de gastos municipais em saúde – total dispendido pelo conjunto dos 853 municípios mineiros – no período 1996-2005, demonstra que em Minas Gerais no período analisado o aporte dos governos locais é na média anual expressa em real de 2005, 13,22 por cento, menor no qüinqüênio 2000-2005 do que no quadriênio 1996-1999 que antecede a vigência da EC-29. Este estudo pioneiro, já que o Siops disponibiliza dados municipais até o primeiro semestre de 2003, recomenda a necessidade de verificação em outros estados, pois em Minas Gerais a EC-29 se revela ferramenta incapaz de garantir maiores aportes ao financiamento das ações e serviços públicos de saúde. Verificamos, também que, nos últimos quatro anos, há coerência entre as quatro leis que formam o arcabouço do planejamento orçamentário (PMDI, PPAG, LDOs, LOAs) e os respectivos Balanços Gerais do Estado, mas o Fundo Estadual de Saúde – FES – não é a unidade orçamentária que realiza a maior parte dos gastos na função saúd...

[Desperately seeking decentralisation: Mexican health policies in two periods of reform: the 1920s-30s and the 1980s]. / Buscando desesperadamente la descentralización: las políticas de salud mexicanas en dos épocas de reforma (los años 20 y 30 y la década de los 80).

This article compares public health policy reforms in Mexico during the 1920s and 1930s with subsequent reforms initiated in the 1980s. The attempts at decentralization in the 1920s-30s were supported by the Rockefeller Foundation, which was interested in the formation of local cooperative health units. In the 1980s, the aim of the Mexican government and international financial agencies, such as the Inter-American Development Bank, was to reduce public spending (as part of "structural adjustment" policies). One of the hypotheses of this article is that, in the end, the public health reforms were unable to overcome the limitations imposed by Mexico's political centralization and longstanding inequities in public spending. At the same time, one of the unforeseen achievements of these reforms was an increase in local capabilities to demand a better distribution of social services.