title: Universal health coverage in Latin American countries: how to improve solidarity-based schemes.
abstract: In this Health Policy we examine the association between the financing structure of health systems and universal health coverage. Latin American health systems encompass a wide range of financial sources, which translate into different solidarity-based schemes that combine contributory (payroll taxes) and non-contributory (general taxes) sources of financing. To move towards universal health coverage, solidarity-based schemes must heavily rely on countries' capacity to increase public expenditure in health. Improvement of solidarity-based schemes will need the expansion of mandatory universal insurance systems and strengthening of the public sector including increased fiscal expenditure. These actions demand a new model to integrate different sources of health-sector financing, including general tax revenue, social security contributions, and private expenditure. The extent of integration achieved among these sources will be the main determinant of solidarity and universal health coverage. The basic challenges for improvement of universal health coverage are not only to spend more on health, but also to reduce the proportion of out-of-pocket spending, which will need increased fiscal resources.
authors.affiliation: Economic Development Division, Economic Commission for Latin America and the Caribbean (ECLAC), Santiago, Chile. Electronic address: daniel.titelman@cepal.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Titelman
authors.affiliation: Universidad Buenos Aires, Buenos Aires, Argentina.
authors.forename: Oscar
authors.initials: O
authors.lastname: Cetrángolo
authors.affiliation: ECLAC Bogotá, Bogotá, Colombia.
authors.forename: Olga Lucía
authors.initials: OL
authors.lastname: Acosta
mesh_terms: D005102:Health Expenditures; D006291:Health Policy; D006292:Health Priorities / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration*; D007843:Latin America; D013660:Taxes; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration*