[Health systems reform and equity in Latin America and the Caribbean: lessons from the 1980s and 1990s].
This essay proposes a review of the issues of equity and reform in Latin America and the Caribbean in the context of changes in recent decades, emphasizing the discussion of health systems reform. The economic, political, and social context prevailing in the critical 1970s extensively favored budget cuts for public expenditures, cost containment, changes in the health sector power structure, and health services reorganization from an 'economicist', pragmatic, and restrictive perspective. An inventory of the Latin American economic and social situation is markedly negative, and efforts to recover from the damage done in the 1980s were largely unsuccessful in the 1990s. The reforms implemented in some paradigmatic countries (Chile, Colombia, Costa Rica, Argentina, and Brazil), in light of their specific characteristics, demonstrate the dissemination of a common agenda, adapted to the various national conditions. Some positive results of these processes were diluted in new problems caused by the reforms themselves, especially in countries with more radical adherence to the new reformist model; meanwhile, in the country where the public, universal system based on solidarity was most consolidated, the management changes have obtained the best results. However, overcoming inequalities is still a distant goal.
Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21041-210, Brasil. calmeida@ensp.fiocruz.br
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D017691:Caribbean Region; D003105:Colombia; D003364:Costa Rica; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards; D018166:Health Care Reform / Q000191:economics / Q000639:trends; D005102:Health Expenditures; D006801:Humans; D007843:Latin America; D011203:Poverty; D012935:Social Justice; D012959:Socioeconomic Factors