Propuestas de reforma en salud y equidad en Uruguay: ¿redefinición del Welfare State?

Cadernos de Saúde Pública

Myriam Mitjavila¹  José Fernández¹  Constanza Moreira¹ 

[1] ,Centro de Informaciones y Estudios del UruguayMontevideo,Uruguay

关键词: Equity;    Health Sector Reform;    Health System;    Health Care Reform;    Equidad;    Reforma del Sector Salud;    Sistema de Salud;    Reforma en Atención de la Salud;   

DOI  :  10.1590/S0102-311X2002000400015

来源: SciELO

【 摘 要 】

This article reviews and analyzes health sector reform proposals in Uruguay and the possible effects of such reforms in terms of equity, the health sector's institutional structure, and the power relationship between the various actors in the process. The authors contend that a highly structured yet simultaneously fragmented system has conspired against any attempt to introduce major reforms into the system. Thus the only possibility for reform resides neither in the consolidation of the so-called Institutions for Collective Medical Care (IAMCs) nor in the move towards a residual model. Rather, Uruguay is witnessing the system's passive restructuring (i.e., reform by default). In this context and given the system's built-in inequities, the current trend is towards an even more regressive distribution of goods and services. The authors use qualitative and quantitative techniques to show that inequities in expenditure, access, and quality have resulted from long-term developments and adaptive movements of an IAMC system in fiscal stress and the public system's declining quality. Thus, in the absence of changes in state policy that redefine the actors' power or in the absence of system collapse, the country should expect this same regressive trend to deepen.

【 授权许可】

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