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Ciênc. saúde coletiva vol.16 n.6 Rio de Janeiro Jun. 2011
Challenges to Latin American health systems: some issues that can be focused by comparative analysis
The aim of this edition is to disseminate knowledge about health systems in Latin American countries with the main theme being the organization of public and universal systems. The expansion of rights has determined reforms to ensure existing guarantees or broadening health access that deals with the difficult relationship between sustainability and quality.
Portugal and Spain have accumulated an interesting experience in the conduction of their national health systems funded by taxes with public provision of services and emphasis on primary care. Such schemes are less known in Latin America. The knowledge about the systems of Anglo-Saxon countries is the most widespread in the region, despite a common Iberian political, cultural and institutional legacy. The exchange has also been limited of research and experiences among the Latin American countries.
Comparative analysis is a growing field with an important contribution to the organization and provision of services. Two aspects are identified as central in these studies: a dynamic of convergence/divergence between contemporary systems and the need to establish what represents a "transferable knowledge" in each situation. The selection of the articles was based on those aspects and is structured around three main issues:
- Papers that address common macro-social themes like the social, economic and political determinants of the organization and performance of health services, the development's model relationship with the financial bases of the protection systems, pressures of the productive sectors and the public-private mix;
- Papers that address problems in the area of meso and micro-management such as governance, integrated delivery services, waiting lists and human resources;
- Case studies and researches with information from various experiences in order to draw specific features and innovations.
Some important reforms have been undertaken in Latin America showing different paths to universal access, but segmentation and fragmentation of the services are still significant and a challenge to overcome. On the other hand, Spain and Portugal face impasses to improve the quality and efficiency of their services.
These impasses raise questions about measures that can ensure good governance in the health systems, which means to promote professional management with greater transparency, control and accountability, without incurring an excessive bureaucracy. We understand governance as the formal and informal rules that lead to interaction between the actors and influence the decisions in the institutions. Good governance occurs when it works according to the public interests, which involves crucial discussions about the nature of the State and its regulatory and provisional functions.
The interaction between social, political, economic determinants and health conditions is sufficiently well known. But there is a consensus that a set of synergetic actions taken by the health sector can also help the development, favoring more cohesive and healthier societies. This edition contributes in this way, but it was only possible with the collaboration of authors, the ones that accepted to write the book reviews coordinated by Marcia Fausto, the peer reviewers and executive editors.
Eleonor Minho Conill,
José-Manuel Freire, Lígia Giovanella