title: Overcoming social segregation in health care in Latin America.
abstract: Latin America continues to segregate different social groups into separate health-system segments, including two separate public sector blocks: a well resourced social security for salaried workers and their families and a Ministry of Health serving poor and vulnerable people with low standards of quality and needing a frequently impoverishing payment at point of service. This segregation shows Latin America's longstanding economic and social inequality, cemented by an economic framework that predicted that economic growth would lead to rapid formalisation of the economy. Today, the institutional setup that organises the social segregation in health care is perceived, despite improved life expectancy and other advances, as a barrier to fulfilling the right to health, embodied in the legislation of many Latin American countries. This Series paper outlines four phases in the history of Latin American countries that explain the roots of segmentation in health care and describe three paths taken by countries seeking to overcome it: unification of the funds used to finance both social security and Ministry of Health services (one public payer); free choice of provider or insurer; and expansion of services to poor people and the non-salaried population by making explicit the health-care benefits to which all citizens are entitled.
authors.affiliation: World Bank, Health, Nutrition and Population Global Practice, Washington, DC, USA. Electronic address: dcotlear@worldbank.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cotlear
authors.affiliation: National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico.
authors.forename: Octavio
authors.initials: O
authors.lastname: Gómez-Dantés
authors.affiliation: Havard Global Equity Initiative, Harvard University, Boston, MA, USA.
authors.forename: Felicia
authors.initials: F
authors.lastname: Knaul
authors.affiliation: Havard School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.affiliation: The Federal University of Ceará and Ceará School of Public Health, Fortaleza, Ceará, Brazil.
authors.forename: Ivana C H C
authors.initials: IC
authors.lastname: Barreto
authors.affiliation: Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Oscar
authors.initials: O
authors.lastname: Cetrángolo
authors.affiliation: Fiocruz, Manguinhos, Rio de Janeiro, Brazil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Cueto
authors.affiliation: Pontificia Universidad Católica del Peru, Lima, Peru.
authors.forename: Pedro
authors.initials: P
authors.lastname: Francke
authors.affiliation: School of Public Health, University of Chile, Santiago, Chile.
authors.forename: Patricia
authors.initials: P
authors.lastname: Frenz
authors.affiliation: Centro de Estudios en Protección Social y Economía de la Salud (PROESA), Universidad Icesi, Cali, Colombia.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Guerrero
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, Mexico and Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Lozano
authors.affiliation: Rockefeller Foundation, New York, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Marten
authors.affiliation: Escuela de Salud Pública, Universidad de Costa Rica, San Pedro de Montes de Oca, Costa Rica.
authors.forename: Rocío
authors.initials: R
authors.lastname: Sáenz
mesh_terms: D003695:Delivery of Health Care / Q000266:history / Q000458:organization & administration*; D018166:Health Care Reform / Q000266:history / Q000458:organization & administration; D006297:Health Services Accessibility / Q000266:history / Q000458:organization & administration; D054625:Healthcare Disparities / Q000266:history; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007843:Latin America; D012959:Socioeconomic Factors; D019472:Universal Health Insurance / Q000266:history / Q000458:organization & administration*