Suchergebnisse

Vergleichende Betrachtung über den Ausbau des Gesundheitswesens in 16 lateinamerikanischen Ländern. Mehr als die Hälfte der Bevölkerung dieser Länder ist krankenversichert, allerdings gibt es prozentual starke regionale Unterschiede. Der Autor wendet sich gegen die These, die Krankenversicherung in Lateinamerika komme nur einer kleinen privilegierten Minderheit zugute; vielmehr gelte dies nur für einige ärmere Länder, während in den entwickelteren Staaten auch die unteren Bevölkerungsschichten medizinisch versorgt würden, oft in Kombination zwischen Krankenkassenleistungen und kostenlosen staatlichen Maßnahmen im Gesundheitswesen

Social insurance entitlements represent one of the more controversial aspects of social sector development in Latin America. The most comprehensive critique of social security views the system's coverage and organization as a reflection of the region's social stratification (Mesa-Lago 1978). According to this view, power groups in public administration, private industry, and labor unions exercise control over the organization and financing of sickness, invalidity, and pension funds, and they seek to restrict benefits to their respective memberships. The noninsured lack market power and political organization because of their low levels of human resources development and lack of social cohesion. Mesa-Lago's critique may be more justified for the lower-income than for the higher-income countries in Latin America, however, at least regarding medical care, which is the system's largest single entitlement program in most Latin American countries.

The goal of "health for all by the year 2000" was endorsed by member nations of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) at the International Conference on Primary Health Care, held at Alma Ata, U.S.S.R., in September 1978. The goal of attaining total health care coverage of the population had been agreed upon by the Ministers of Health of the Americas at their III Special Meeting in 1972. Meeting again in 1977, the ministers took stock of the region's accomplishments and remaining shortcomings in preparation for the Alma Ata conference. They concluded that their institutional health care systems, which bear the major responsibility for providing total coverage, had not yet attained this goal; among the reasons mentioned were institutional rigidities that made it difficult to determine and respond to unattended needs for health care, and the financial inaccessibility to large population groups of the institutions providing health services. These problems were compounded by a "significant increase in the cost of medical care … which reduces the resources available for providing universal coverage."

THE GOVERNMENTS OF LATIN AMERICA, HAVING BEEN PREOCCUPIED MAINLY with industrialization since World War II, began to give more attention to social development during the Sixties. Priorities of development policy, stressed under the Alliance for Progress, now include education and health; improvements in both areas are regarded as means of raising output as well as furthering social progress. Analyses of Latin America's human resources, however, have concentrated mainly on manpower requirements and corresponding educational needs. They have been supported by evidence of high returns to investment in education,2 while studies of the region's health conditions have yielded no comparable evidence in support of health sector investments. Health improvements are evident, but economic analysis has not yet shown to what extent they are attributable to health expenditures alone. Poor health is closely associated with poverty, low education, and rural residence, but causal relationships among these and other variables remain largely unexplored.