Evidences on weaknesses and strengths from health financing after decentralization: lessons from Latin American countries.
OBJECTIVE
The main objective was to identify trends and evidence on health financing after health care decentralization.


METHODS
Evaluative research with a before-after design integrating qualitative and quantitative analysis. Taking into account feasibility, political and technical criteria, three Latin American countries were selected as study populations: Mexico, Nicaragua and Peru.


METHODS
The methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country.


RESULTS
The trends and evidence reported in all five financing indicators may identify major weaknesses and strengths in health financing.


CONCLUSIONS
Weaknesses: a lack of human resources trained in health economics who can implement changes, a lack of financial resource independence between the local and central levels, the negative behavior of the main macro-economic variables, and the difficulty in developing new financing alternatives. Strengths: the sharing between the central level and local levels of responsibility for financing health services, the implementation of new organizational structures for the follow-up of financial changes at the local level, the development and implementation of new financial allocation mechanisms taking as a basis the efficiency and equity principles, new technique of a per-capita adjustment factor corrected at the local health needs, and the increase of financing contributions from households and local levels of government.
Arredondo
Armando
A
Research Center on Health Systems, National Institute of Public Health, Cuernavaca, Morelos, Mexico. aarredon@insp.mx
Orozco
Emanuel
E
De Icaza
Esteban
E
D003659:Decision Making, Organizational; D005380:Financing, Government / Q000458:organization & administration* / Q000639:trends; D015276:Health Care Rationing; D018166:Health Care Reform / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics; D006302:Health Services Research; D006801:Humans; D007182:Income / Q000145:classification; D008137:Longitudinal Studies; D008800:Mexico; D009527:Nicaragua; D010568:Peru; D011057:Politics; D036301:Qualitative Research; D040841:Resource Allocation