Health systems in Latin America are “highly fragmented” and maintain “significant coverage gaps” between contributory social security affiliates and the rest of the population, the International Labor Organization (ILO) said in a report presented this Tuesday. .
The organization, which has its regional headquarters in Lima, analyzed the short-term health responses that Latin American countries have put in place to address the health emergency generated by the covid-19 pandemic, as well as the “persistent challenges” facing the region.
In this sense, he warned that achieving “universal and equitable access” to quality health services will require “very careful management of fiscal policy” in the context of the current economic crisis that is also hitting the continent.
“The gaps in coverage and quality of services between contributory social security affiliates and the rest of the population are still very important in these countries”said Pablo Casalí, one of the authors of the report, Social Protection specialist of the ILO Office for the Andean Countries.
Added to this is the low priority of public spending on health and efficiency problems, which generate “significant out-of-pocket costs” to access health services or medicines.
Health systems in the region also have a low endowment of human and physical resources, it was noted.
Brazil and Costa Rica
The report mentioned Brazil as “the most relevant case” in terms of systems without mandatory contributory health insurance, while Costa Rica is the “clearest and most traditional case of coordination between contributory and general income sources of financing for a system of homogeneous universal coverage ”.
The ILO added that countries such as Uruguay and Colombia “had already made progress, before the pandemic, in important reforms” to eliminate fragmentation and coverage gaps between contributory social security affiliates and the rest of the population.
In the case of Peru, Bolivia, Ecuador and Mexico, they had announced reforms in the same sense, but the agency considered that “the progress is not as relevant as in the previous case.”
Chile and Argentina
The report mentioned that in the case of Chile the reforms “tend to consolidate the gap or fragmentation between contributory and non-contributory insurance.”
In Argentina, he added, the coverage of the entire population was determined, but “the changes led to a greater degree of divergence and the system today presents serious equity problems.”
“The irruption of the pandemic by COVID-19 it has made countries rethink the priority that health systems had within each country “, said Casalí.
Measures during the emergency
The ILO stressed that the measures implemented during the health emergency have been “quite similar” in the region and included the predominance of health policy in government agendas and public budgets, and the strengthening of the leadership of the Ministries of Health.
In addition, incentives for health personnel and centralized management of hospital infrastructure, the accelerated incorporation of information and communication technologies (ICT) in services, financial support for social security, transfers in kind to vulnerable groups and financing plans and vaccine procurement.
Casalí said that “now it is time to think beyond the current crisis and define what long-term reform routes will allow achieving universal and equitable access to quality health services,” with “supportive and sustainable” financing mechanisms.
The specialist considered, in that sense, that when the health emergency passes “some” of these measures will disappear little by little, but he believed that “some of the elements … should remain and constitute the basis for more permanent changes.”
Between these changes, The ILO mentioned the “revaluation” of public policy, especially the leadership of the Ministries of Health, and the incorporation of ICT in health services.
“There is no ideal reform route. Each country must take the appropriate path, considering the fiscal space that the crisis allows and making the most efficient use of scarce resources, to advance towards social protection policies that guarantee universal coverage and access to health services ”, the agency concluded. EFE