Eduardo Levcovitz, MD, MSC, Ph.D Unit Chief, Health Policies and Systems Development

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Office of the Assistant Director Health Systems Strengthening Area DYNAMICS OF HEALTH POLICIES AND CHALLENGES FOR HEALTH SYSTEMS STRENGTHENING IN LATIN AMERICA AND THE CARIBBEAN Eduardo Levcovitz, MD, MSC, Ph.D Unit Chief, Health Policies and Systems Development Pan-American Health Organization - PAHO/WHO Health Systems Strengthening Workshop Belize, May/June2006

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Health Systems Strengthening Workshop Belize, May/June2006. DYNAMICS OF HEALTH POLICIES AND CHALLENGES FOR HEALTH SYSTEMS STRENGTHENING IN LATIN AMERICA AND THE CARIBBEAN. Eduardo Levcovitz, MD, MSC, Ph.D Unit Chief, Health Policies and Systems Development - PowerPoint PPT Presentation

Transcript of Eduardo Levcovitz, MD, MSC, Ph.D Unit Chief, Health Policies and Systems Development

  • El sistema nacional de salud est compuesto por varios sistemas

    103.0

    42.4

    5.7

    ESTIMADO

    IMSS

    Ejrcito, Marina y Pemex

    Poblacin no asegurada

    1.1

    3.2

    49.9

    Total de personas

    ISSSTE

    Otros y no especificados

    Poblacin por sistema de afiliacin 2002Millones de personas

    Fuente: Estimaciones propias con datos del CENSO, INEGI, IMSS, ENED 2002

    Office of the Assistant DirectorHealth Systems Strengthening Area

    Example: ChileLIMITATIONS/RISKS OF SEGMENTED SYSTEMSSegmentation of financial contributions/ risk pools

    Office of the Assistant DirectorHealth Systems Strengthening Area

    MEXICOSegmentation of financial contributions/ risk pools LIMITATIONS/RISKS OF SEGMENTED SYSTEMS

  • El sistema de salud en Mxico, flujos principales 2003

    Seguro privado en salud

    Fondos de seguridad social IMSS, ISSSTE, PEMEX SEDENA SEMAR

    Sistemas de Proteccin Social en Salud (SPSS) o Seguro Popular

    Poblacin y empresas

    Pacientes

    Instituciones 3 gubernamentales (SESA)

    IMSS Oportunidades 4

    Instituciones de seguridad social (IMSS, ISSSTE)

    Instituciones de seguridad social especializadas (PEMEX, SEDENA, SEMAR.)

    Instituciones privadas

    Gobierno federal

    Gobierno estatal 1

    Servicios pblicos para poblacin no asegurada

    Servicios pblicos para poblacin asegurada

    Primas

    Impuestos

    Contribuciones obligatorias de empleados y empleadores

    Pagos directos de bolsillo 51%

    Cuota por servicio 1% 2

    Prepago & pago por servicio

    Presupuesto anual global

    Presupuesto anual global

    Presupuesto anual global

    Presupuesto anual global

    Flujos financierosFlujos de servicios

    Aportacin anual de acuerdo con el nivel de ingreso de las familias 2

    Office of the Assistant DirectorHealth Systems Strengthening Area

    SEGMENTED SYSTEMS FROM THE USERS POINT OF VIEW: OUT-OF-POCKET PAYMENTS

    Gasto Nacional

    1.42

    2.1

    3.89

    4.07

    4.09

    4.24

    4.49

    4.56

    4.65

    4.67

    4.76

    4.92

    4.96

    5.48

    5.77

    5.84

    5.93

    6.1

    6.18

    6.21

    6.24

    6.38

    6.58

    6.6

    6.98

    7.18

    7.23

    7.62

    8.25

    8.59

    8.74

    8.88

    9.58

    12.3

    12.39

    Porcentaje del PIB Fuente: HP/HSS Indicadores Basicos, 2005

    Gasto Nacional en Salud como porcentaje del PIB: America Latina y el Caribe 2000-2004

    Chart2

    1.44.81

    1.42.69

    1.42SUR

    1.744.36

    1.92.86

    23.77

    22.56

    210.39

    2.12.86

    2.1GUY

    2.11.97

    2.12.82

    2.472.18

    2.63.78

    2.863.07

    2.94.08

    3.083.16

    3.20.69

    3.322.52

    3.361.31

    3.623.61

    3.753.87

    3.880.61

    42.58

    4.081.4

    4.21.98

    4.322.86

    4.42.2

    4.93.35

    4.993.89

    6.36

    6.741.85

    6.92.68

    7.681.06

    HAI4.24

    Publico

    Privado

    Porcentaje del PIB Fuente: HP/HSS Indicadores Basicos 2005

    Gasto Publico y Privado como porcentaje del PIB: America Latina y el Caribe, 2000-2004

    Sheet1

    PublicoPrivado

    SUR1.4GUT1.44.8GUT

    GUY2.1VEN1.42.7VEN

    ANT3.9SUR1.42SUR

    PER4.1JAM1.744.4JAM

    VEN4.1DOR1.92.9DOR

    HAI4.2ELS23.8ELS

    SVT4.5HON22.6HON

    HON4.6URU210.4URU

    SCN4.7ECU2.12.9ECU

    STL4.7GUY2.1GUY

    DOR4.8PER2.12.0PER

    TRT4.9TRT2.12.8TRT

    ECU5.0SCN2.472.2SCN

    BLZ5.5CHI2.63.8CHI

    ELS5.8MEX2.863.1MEX

    ANG5.8PAR2.94.1PAR

    MEX5.9GRE3.083.2GRE

    JAM6.1ANT3.20.7ANT

    PAN6.2ANG3.322.5ANG

    GUT6.2STL3.361.3STL

    GRE6.2BRA3.623.6BRA

    CHI6.4NIC3.753.9NIC

    COL6.6SVT3.880.6SVT

    DOM6.6COL42.6COL

    PAR7.0BLZ4.081.4BLZ

    BOL7.2PAN4.22.0PAN

    BRA7.2BOL4.322.9BOL

    NIC7.6DOM4.42.2DOM

    COR8.3COR4.93.4COR

    BAR8.6ARG4.993.9ARG

    MNT8.7USA6.36.0USA

    ARG8.9BAR6.741.9BAR

    CAN9.6CAN6.92.7CAN

    USA12.3MNT7.681.1MNT

    URU12.4HAI4.2HAI

    datos 200-2004

    Sheet2

    Sheet3

    Office of the Assistant DirectorHealth Systems Strengthening Area

    NGOMOHs Health CenterSocial Security ClinicHospitalMunicipalAmbulatoryOperational fragmentationSEGMENTED SYSTEMS FROM THE USERS POINT OF VIEW: FRAGMENTED DELIVERY NETWORKS

    Office of the Assistant DirectorHealth Systems Strengthening Area

    Health Systems in LAC

    EQUITY EFFICIENCY LIMITATIONS/RISKS OF SEGMENTED SYSTEMSMainstream economics:Trade Off: Equity X Efficiency

    Office of the Assistant DirectorHealth Systems Strengthening Area

    Segmentation according to ability to payFragmentation of the services delivery networkA GHOST THREATENS HEALTH CARE SYSTEMS IN LAC

    Office of the Assistant DirectorHealth Systems Strengthening Area

    CHALLENGES FOR HEALTH SYSTEMS STRENGTHENINGINTER-INSTITUTIONALCOORDINATION + OPERATIONALINTEGRATION

    Office of the Assistant DirectorHealth Systems Strengthening Area

    INTER-INSTITUTIONALCOORDINATIONOPERATIONALINTEGRATIONStrengthening the STEERING ROLE of National Health AuthoritiesALIGNMENT AND HARMONIZATION of International CooperationINTEGRATED health care delivery networksReorganization of health systems based on PHC STRATEGIESIncorporating scientific KNOWLEDGE from public health programs into the scaling up of health systemsSTRATEGIES TO REDUCE/ELIMINATE SEGMENTATION AND FRAGMENTATIONSOCIAL/POLICY DIALOGUE among multiple stakeholdersHarmonization and integration of FINANCING mechanismsCHALLENGES FOR HEALTH SYSTEMS STRENGTHENING

    Office of the Assistant DirectorHealth Systems Strengthening Area

    FRAMEWORK FOR HEALTH ACTION IN THE AMERICAS FOR THE XXI CENTURYAddressingtheunfinishedagendaProtecting theachievementsFacingthenewChallenges

    Office of the Assistant DirectorHealth Systems Strengthening Area

    POLICY FRAMEWORK FOR HEALTH SYSTEMS STRENGTHENINGHealth For All

    Office of the Assistant DirectorHealth Systems Strengthening Area

    LEADERSHIP AND INSTITUTIONAL CAPACITY BUILDING INFORMATION, KNOWLEDGE AND INNOVATION PLANNING AND COORDINATION INTELLIGENCE, CREATIVITY, OPEN DEBATE AND COMMITMENTCHALLENGES FOR HEALTH SYSTEMS STRENGTHENING