Sistemas de Aseguramiento en Salud 2008
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CISS 2008 Health Systems and Insurance Report
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Official Use
Conferencia Interamericana de Seguridad Social
Inter-American Conference on Social Security September 2008
English – Or. English
CISS 2008 Health Systems and
Insurance Report
(For Discussion)
For comments and suggestions please contact Gabriel Martínez at
gabriel.martinez@ciss.org.mx or Nelly Aguilera at
nelly.aguilera@ciss.org.mx.
CISS 2008 Health Systems and Insurance Report
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INDEX
II. THE EMERGING PARADIGM .......................................................................................................... 6
III. GOALS OF HEALTH SYSTEMS ...................................................................................................... 9
III.1 INTRODUCTION .................................................................................................................................. 9
III.2 OBJECTIVES OF HEALTH SYSTEMS .................................................................................................. 10
III.2.1 Health ...................................................................................................................................... 10
III.2.2 Equity ...................................................................................................................................... 13
III.2.3 Macro- and Microeconomic Efficiency .................................................................................. 15
III.2.4 Client Satisfaction ................................................................................................................... 18
III.3 ISSUES AND LESSONS ....................................................................................................................... 19
IV. OVERVIEW OF HEALTH SYSTEMS ............................................................................................ 20
IV.1 ARGENTINEAN HEALTH CARE SYSTEM ........................................................................................... 20
IV.2 BRAZILIAN HEALTH CARE SYSTEM ................................................................................................. 22
IV.3 CANADIAN HEALTH CARE SYSTEM ................................................................................................. 25
IV.4 CHILEAN HEALTH CARE SYSTEM .................................................................................................... 27
IV.5 COLOMBIAN HEALTH CARE SYSTEM ............................................................................................... 29
VI.6 COSTA RICAN HEALTH CARE SYSTEM ............................................................................................ 33
IV.7 CUBAN HEALTH CARE SYSTEM ....................................................................................................... 35
IV.8 DOMINICAN REPUBLIC HEALTH CARE SYSTEM .............................................................................. 39
IV.9 HONDURAN HEALTH CARE SYSTEM ................................................................................................ 39
IV.10 MEXICAN HEALTH CARE SYSTEM ................................................................................................. 39
IV.11 PANAMANIAN HEALTH CARE SYSTEM .......................................................................................... 39
IV.12 HEALTH CARE SYSTEM IN TRINIDAD AND TOBAGO ...................................................................... 45
IV.13 URUGUAY’S HEALTH CARE SYSTEM ............................................................................................. 48
IV.14 ISSUES AND LESSONS ..................................................................................................................... 52
V. ENTITLEMENT IN COUNTRIES OF THE AMERICAN CONTINENT .................................... 54
V.1 INTRODUCTION ................................................................................................................................. 54
V.2 ENTITLEMENT IN COUNTRIES OF THE AMERICAN CONTINENT .......................................................... 56
V.3 ISSUES AND LESSONS ........................................................................................................................ 58
V.4 BRIEF DESCRIPTION OF ENTITLEMENT BY COUNTRY ....................................................................... 59
V.4.1 Argentinean Health Care System ............................................................................................. 59
V.4.2 Brazilian Health Care System .................................................................................................. 62
V.4.3 Canadian Health Care System ................................................................................................. 65
V.4.4 Chilean Health Care System .................................................................................................... 66
V.4.5 Colombian Health Care System ............................................................................................... 69
V.4.6 Costa Rican Health Care System ............................................................................................. 72
V.4.7 Cuban Health Care System ...................................................................................................... 74
V.4.8 Dominican Republic Health Care System ................................................................................ 75
V.4.9 Honduran Health Care System ................................................................................................. 76
V.4.10 Mexican Health Care System ................................................................................................. 78
V.4.11 Panamanian Health Care System ........................................................................................... 82
V.4.12 Health Care System in Trinidad and Tobago ......................................................................... 84
V.4.13 Health Care System in Uruguay ............................................................................................. 86
VI. FUNDING ............................................................................................................................................ 89
VI.1 INTRODUCTION ................................................................................................................................ 89
VI.2 LEVEL OF HEALTH CARE SPENDING ................................................................................................ 89
VI.3 MEANS AND SOURCES OF FINANCING ............................................................................................. 91
VI.4 ALLOCATION OF FUNDS ................................................................................................................... 96
VI.5 ISSUES AND LESSONS ....................................................................................................................... 96
VI.6 DESCRIPTION OF FINANCING BY COUNTRY ..................................................................................... 98
VI.6.1 Argentina ................................................................................................................................. 98
VI.6.2 Brazil ....................................................................................................................................... 99
VI.6.3 Canada .................................................................................................................................. 100
VI.6.4 Chile ...................................................................................................................................... 101
CISS 2008 Health Systems and Insurance Report
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VI.6.5 Colombia ............................................................................................................................... 102
VI.6.6 Costa Rica ............................................................................................................................. 104
VI.6.7 Cuba ...................................................................................................................................... 105
VI.6.8 Dominican Republic .............................................................................................................. 106
VI.6.9 Honduras ............................................................................................................................... 106
VI.6.10 Mexico ................................................................................................................................. 106
VI.6.11 Panama ............................................................................................................................... 106
VII.6.12 Trinidad and Tobago ......................................................................................................... 112
VII.6.13 Uruguay ............................................................................................................................. 113
VII. ORGANIZATION AND MANAGEMENT OF CARE CONSUMPTION (OMCC) ............... 115
VII.1INTRODUCTION ............................................................................................................................. 115
VII.2 DESCRIPTION OF THE OMCC FUNCTION ...................................................................................... 115
VII.3 OMCC AND THE EP ..................................................................................................................... 116
VII.4 OMCC FUNCTION THROUGHOUT THE CONTINENT ...................................................................... 119
VII.5 ISSUES AND LESSONS ................................................................................................................... 123
VII.6 DESCRIPTION OF THE OMCC FUNCTION IN THE COUNTRIES UNDER STUDY ............................... 124
VII.6.1Argentina .............................................................................................................................. 124
VII.6.2 Brazil .................................................................................................................................... 125
VII.6.3 Canada ................................................................................................................................. 128
VII.6.4 Chile ..................................................................................................................................... 128
VII.6.5 Colombia .............................................................................................................................. 130
VII.6.6 Costa Rica ............................................................................................................................ 131
VII.6.7 Cuba ..................................................................................................................................... 132
VII.6.8 Dominican Republic ............................................................................................................ 133
VII.6.9 Honduras ............................................................................................................................. 133
VII.6.10 Mexico ................................................................................................................................ 133
VII.6.11 Panama .............................................................................................................................. 133
VII.6.12 Trinidad and Tobago ......................................................................................................... 139
VII.6.13 Uruguay ............................................................................................................................. 141
VIII. PROVISION ................................................................................................................................... 143
VIII.1Argentina ................................................................................................................................ 124
VIII.2 Brazil ..................................................................................................................................... 125
VIII.3 Canada .................................................................................................................................. 128
VIII.4 Chile ...................................................................................................................................... 128
VIII.5 Colombia ............................................................................................................................... 130
VIII.6 Costa Rica ............................................................................................................................. 131
VIII.7 Cuba ...................................................................................................................................... 132
VIII.8 Dominican Republic .............................................................................................................. 133
VIII.9 Honduras ............................................................................................................................... 133
VIII.10 Mexico ................................................................................................................................. 133
VIII.11 Panama ................................................................................................................................ 133
VIII.12 Trinidad and Tobago ........................................................................................................... 139
VIII.13 Uruguay ............................................................................................................................... 141
IX. CONCLUSIONS AND POLICY RECOMMENDATIONS ......................................................... 143
X. REFERENCES ................................................................................................................................... 160
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