title: The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia.
abstract: BACKGROUND
  Brazil and Colombia have pursued extensive reforms of their health care systems in the last couple of decades. The purported goals of such reforms were to improve access, increase efficiency and reduce health inequities. Notwithstanding their common goals, each country sought a very different pathway to achieve them. While Brazil attempted to reestablish a greater level of State control through a public national health system, Colombia embraced market competition under an employer-based social insurance scheme. This work thus aims to shed some light onto why they pursued divergent strategies and what that has meant in terms of health outcomes.
  
  
  METHODS
  A critical review of the literature concerning equity frameworks, as well as the health care reforms in Brazil and Colombia was conducted. Then, the shortfall inequality values of crude mortality rate, infant mortality rate, under-five mortality rate, and life expectancy for the period 1960-2005 were calculated for both countries. Subsequently, bivariate and multivariate linear regression analyses were performed and controlled for possibly confounding factors.
  
  
  RESULTS
  When controlling for the underlying historical time trend, both countries appear to have experienced a deceleration of the pace of improvements in the years following the reforms, for all the variables analyzed. In the case of Colombia, some of the previous gains in under-five mortality rate and crude mortality rate were, in fact, reversed.
  
  
  CONCLUSIONS
  Neither reform seems to have had a decisive positive impact on the health outcomes analyzed for the defined time period of this research. This, in turn, may be a consequence of both internal characteristics of the respective reforms and external factors beyond the direct control of health reformers. Among the internal characteristics: underfunding, unbridled decentralization and inequitable access to care seem to have been the main constraints. Conversely, international economic adversities, high levels of rural and urban violence, along with entrenched income inequalities seem to have accounted for the highest burden among external factors.
authors.affiliation: Secretariat of Labor and Education Management for Health, SGTES, Ministry of Health of Brazil, Esplanada dos Ministérios, Bloco G, Ed, Sede, Sala 704, Brasília, DF 70680-350, Brazil. resteves@mail.com
authors.forename: Roberto J F
authors.initials: RJ
authors.lastname: Esteves
mesh_terms: D001723:Birth Rate / Q000208:ethnology / Q000639:trends; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D003105:Colombia / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D003431:Cross-Cultural Comparison; D004465:Economic Competition / Q000639:trends*; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards*; D006303:Health Services, Indigenous / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000208:ethnology / Q000639:trends; D007231:Infant, Newborn; D008017:Life Expectancy / Q000208:ethnology / Q000639:trends; D016014:Linear Models; D008297:Male; D009026:Mortality / Q000208:ethnology / Q000639:trends; D009313:National Health Programs; D013997:Time Factors