International Health Care Systems

Healthcare for all in Latin America?

The Economist has an interesting article surveying some of the efforts in Latin America to expand health insurance coverage.  Below is an excerpt:

One model is that of a tax-financed system with government as sole payer (as in Britain’s National Health Service). That applies, of course, to the famed health service in communist Cuba, as well as in Costa Rica. It also applies in Brazil, where the 1988 constitution set up the Sistema Único de Saúde, merging the health schemes of the Social Security Institute and the health ministry. It has delivered improvements. The problem has been how to finance and staff it in a country where nearly everyone turns to public hospitals for treatment after retirement, even though 25% of the population has private insurance.

Other countries, including Mexico and Peru, have bolted on a subsidised insurance system for the poor. Colombia has taken insurance-based reform further, though not without problems. A new constitution in 1991 proclaimed universal care; a law separated purchasers from providers. The expectation was that two-thirds of the population would be covered by an expanded contributory scheme, says Alejandro Gaviria, the health minister. In practice, half are in a government insurance system in which they pay little or nothing. That encourages workers to remain in the informal economy.

Is publicly-provided health insurance a “luxury” good in an economic sense of the word at the country level? Although as individual incomes increase, the likelihood of receiving private health insurance grows, as countries increase their GDP the likelihood of universal publicly provided health insurance appear to grow. Or this could simply be a trend for politicians to provide entitlements to improve their odds of being elected. Regardless, ensuring that sick patients have access to high-quality, efficient health care is a laudable goal in any country.

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