title: Health-system reform and universal health coverage in Latin America.
abstract: Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage.
authors.affiliation: Harvard School of Public Health, Harvard University, Boston, MA, USA. Electronic address: ratun@hsph.harvard.edu.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.affiliation: Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: Luiz Odorico Monteiro
authors.initials: LO
authors.lastname: de Andrade
authors.affiliation: Pan American Health Organization, Washington, DC, USA.
authors.forename: Gisele
authors.initials: G
authors.lastname: Almeida
authors.affiliation: The World Bank, Washington, DC, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cotlear
authors.affiliation: The World Bank, Washington, DC, USA.
authors.forename: T
authors.initials: T
authors.lastname: Dmytraczenko
authors.affiliation: School of Public Health, University of Chile, Santiago, Chile.
authors.forename: Patricia
authors.initials: P
authors.lastname: Frenz
authors.affiliation: School of Public Health and Administration (FASPA), Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Garcia
authors.affiliation: National Institute of Public Health of Mexico, Cuernavaca, Mexico.
authors.forename: Octavio
authors.initials: O
authors.lastname: Gómez-Dantés
authors.affiliation: Harvard Global Equity Initiative, Harvard University, Boston, MA, USA.
authors.forename: Felicia M
authors.initials: FM
authors.lastname: Knaul
authors.affiliation: Institute for Global Health Equity and Innovation, Dalla Lana School of Public Health, University of Toronto, ON, Canada.
authors.forename: Carles
authors.initials: C
authors.lastname: Muntaner
authors.affiliation: Pan American Health Organization, Brasília, Brazil.
authors.forename: Juliana Braga
authors.initials: JB
authors.lastname: de Paula
authors.affiliation: Pan American Health Organization, Brasília, Brazil.
authors.forename: Felix
authors.initials: F
authors.lastname: Rígoli
authors.affiliation: National School of Public Health, Havana, Cuba.
authors.forename: Pastor Castell-Florit
authors.initials: PC
authors.lastname: Serrate
authors.affiliation: The World Bank, Washington, DC, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Wagstaff
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D018166:Health Care Reform / Q000458:organization & administration*; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000458:organization & administration; D054625:Healthcare Disparities; D061889:Healthcare Financing; D006806:Human Rights; D006801:Humans; D007843:Latin America; D008017:Life Expectancy; D019472:Universal Health Insurance / Q000458:organization & administration*