RESUMEN
Corruption has been described as a disease. When corruption infiltrates global health, it can be particularly devastating, threatening hard gained improvements in human and economic development, international security, and population health. Yet, the multifaceted and complex nature of global health corruption makes it extremely difficult to tackle, despite its enormous costs, which have been estimated in the billions of dollars. In this forum article, we asked anti-corruption experts to identify key priority areas that urgently need global attention in order to advance the fight against global health corruption. The views shared by this multidisciplinary group of contributors reveal several fundamental challenges and allow us to explore potential solutions to address the unique risks posed by health-related corruption. Collectively, these perspectives also provide a roadmap that can be used in support of global health anti-corruption efforts in the post-2015 development agenda.
RESUMEN
Countries have reached universal health coverage by different paths and with varying health systems. Nonetheless, the trajectory toward universal health coverage regularly has three common features. The first is a political process driven by a variety of social forces to create public programmes or regulations that expand access to care, improve equity, and pool financial risks. The second is a growth in incomes and a concomitant rise in health spending, which buys more health services for more people. The third is an increase in the share of health spending that is pooled rather than paid out-of-pocket by households. This pooled share is sometimes mobilised as taxes and channelled through governments that provide or subsidise care--in other cases it is mobilised in the form of contributions to mandatory insurance schemes. The predominance of pooled spending is a necessary condition (but not sufficient) for achieving universal health coverage. This paper describes common patterns in countries that have successfully provided universal access to health care and considers how economic growth, demographics, technology, politics, and health spending have intersected to bring about this major development in public health.
Asunto(s)
Desarrollo Económico/tendencias , Política , Cobertura Universal del Seguro de Salud/tendencias , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/organización & administración , Reforma de la Atención de Salud/tendencias , Gastos en Salud/tendencias , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Cobertura Universal del Seguro de Salud/economía , Cobertura Universal del Seguro de Salud/organización & administraciónRESUMEN
COVID-19 had severe direct and indirect effects on health and well-being in Latin America. To understand the extent to which disruptions among non-COVID-19-related health services affected population health, we used administrative data from the period 2015-21 to examine public hospital discharges and mortality for conditions amenable to health care in four Latin American countries: Brazil, Ecuador, Mexico, and Peru. Between March 2020 and December 2021, hospitalization rates for these conditions declined by 28 percent and mortality rates increased by 15 percent relative to prepandemic years. Noncommunicable diseases accounted for 89 percent of this rise in mortality. The poorest states in each country experienced relatively larger increases in mortality. Our results, which focus on the health effects of service disruption, suggest that maintaining health care services in this region during the pandemic could have avoided at least 96,000 deaths. Policies should focus on maintaining essential health care services during emergencies, particularly for patients with noncommunicable diseases, and on minimizing negative consequences by ensuring coordinated and continuous care; leveraging alternative modalities of care, such as telemedicine; broadening the role of nonphysician health care workers; and expanding options for medication delivery.
Asunto(s)
Enfermedades no Transmisibles , Pandemias , Humanos , América Latina/epidemiología , Pandemias/prevención & control , Enfermedades no Transmisibles/epidemiología , Atención a la Salud , PolíticasRESUMEN
An increasing interest in initiating and expanding social health insurance through labor taxes in low- and low-middle-income countries goes against available empirical evidence. This article builds on existing recommendations by leading health financing experts and summarizes recent research that makes the case against labor-tax financing of health care in low- and low-middle-income countries. We found very little evidence to justify the pursuit of labor-tax financing for health care in these countries and persistent evidence that such policies could lead to increased inequality and fragmentation of the health system. We recommend that countries considering such policies heed the evidence on labor-tax financing and seek alternative approaches to health financing: primarily using general taxes or, depending on the context, general taxes combined with adequately regulated insurance premiums.
Asunto(s)
Países en Desarrollo , Cobertura Universal del Seguro de Salud , Financiación de la Atención de la Salud , Humanos , Seguro de Salud , ImpuestosRESUMEN
Almost every country exhibits two important health financing trends: health spending per person rises and the share of out-of-pocket spending on health services declines. We describe these trends as a "health financing transition" to provide a conceptual framework for understanding health markets and public policy. Using data over 1995-2009 from 126 countries, we examine the various explanations for changes in health spending and its composition with regressions in levels and first differences. We estimate that the income elasticity of health spending is about 0.7, consistent with recent comparable studies. Our analysis also shows a significant trend in health spending - rising about 1 per cent annually - which is associated with a combination of changing technology and medical practices, cost pressures and institutions that finance and manage healthcare. The out-of-pocket share of total health spending is not related to income, but is influenced by a country's capacity to raise general revenues. These results support the existence of a health financing transition and characterize how public policy influences these trends.
Asunto(s)
Financiación Personal/tendencias , Gastos en Salud/tendencias , Países Desarrollados/economía , Países en Desarrollo/economía , Investigación Empírica , Sector de Atención de Salud , Humanos , Política PúblicaRESUMEN
Per capita health spending across countries ranges by more than 100 to 1, leading many people to ask, "What should a country spend on health care?" This paper discusses four approaches to this question and demonstrates how each approach, in effect, answers a slightly different question, all of which are important to public policy decisions regarding health care spending. The paper also addresses a commonly cited World Health Organization statement that countries should spend 5 percent of national income on health care services.
Asunto(s)
Atención a la Salud/economía , Organización de la Financiación/normas , Gastos en Salud/estadística & datos numéricos , Política de Salud/economía , Salud Pública/economía , Presupuestos/normas , Presupuestos/estadística & datos numéricos , Niño , Mortalidad del Niño , Análisis Costo-Beneficio , Comparación Transcultural , Países Desarrollados/economía , Países en Desarrollo/economía , Organización de la Financiación/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Salud Pública/normas , Organización Mundial de la SaludAsunto(s)
Países en Desarrollo , Fuerza Laboral en Salud , Emigración e Inmigración , Humanos , MotivaciónRESUMEN
This study analyzes health and economic aspects of occupational safety in Latin America and the Caribbean. Work-related injuries and illnesses represent a primary health risk in the region. Specific factors negatively affect work safety in the region: the structure of the labour market, the lack of adequate resources for enforcement, prevention and research, the hazard profile, as well as the presence of vulnerable groups in the workforce. This study estimates that between 27,270 and 73,500 occupational fatal accidents occur in the region each year. It also calculates that the economic costs of these hazards represent between 2 and 4% of regional Gross Domestic Product. The paper concludes by discussing public policies that could address this problem and improve compliance with appropriate safety standards in the region.
Asunto(s)
Accidentes de Trabajo/economía , Accidentes de Trabajo/estadística & datos numéricos , Costo de Enfermedad , Enfermedades Profesionales/economía , Enfermedades Profesionales/epidemiología , Salud Laboral/estadística & datos numéricos , Accidentes de Trabajo/prevención & control , Adulto , Región del Caribe/epidemiología , Países en Desarrollo/economía , Empleo , Humanos , Sindicatos , América Latina/epidemiología , Persona de Mediana Edad , Enfermedades Profesionales/prevención & control , Factores de Riesgo , Control Social FormalAsunto(s)
Países en Desarrollo , Seguridad Social , Política de Salud , Humanos , Formulación de PolíticasRESUMEN
América Latina gasta grandes cantidades de recursos en servicios sociales. No obstante, su esperanza de vida y tasas de escolaridad son deficientes cuando se comparan con las de otras regiones con niveles de ingreso similares. Una razón fundamental es la inherente dificultad de conseguir que los servicios sociales respondan de manera eficiente a las demandas y necesidades existentes. En esta obra se ilustra cómo una mejor organización de estos servicios puede redundar en grandes diferencias en las condiciones de salud y en los niveles de educación de la población. En la introducción se presenta un esquema general en que se aplican las lecciones aportadas por la economía institucional a las particularidades de los servicios sociales. A continuación se presentan estudios de casos que evalúan el impacto de la organización sobre el rendimiento del sistema educativo en Brasil, Venezuela y Chile, y sobre la salud en Uruguay, Chile y la República Dominicana. Los autores demuestran que las relaciones y reglamentos observados por los gobiernos, proveedores de servicios y consumidores pueden determinar la diferencia entre el éxito y el fracaso. Asimismo, presentan una enorme variedad de enfoques, algunos con antecedentes muy antiguos, que apuntan hacia formas más idóneas de mejorar la organización de los servicios sociales, la salud y la educación en la región