Challenges for Universal Health Coverage in Latin America for the next decade.

Challenges for Universal Health Coverage in Latin America for the next decade

Introduction

• How can we understand the condition of universal healthcare coverge which positive impacts should it bring to our societies?

• Which are the most pressing challenges for its consolidation in the short-term?

Is this goal possible?

Ensure that all people receive the healthcare they need, while ensuring that the use of such services does not expose users to financial difficulties

Introduction

According to PAHO:

• A solid healthcare system; • A financing system for healthcare services;• Access to medication and essential

technologies,• Along with well trained health personnel.

Introduction

For country, is must have:

The purpose of Universal Healthcare Coverage (UHC) is to ensure that all people receive the healthcare services they require without having to face economic difficulties to afford them.

Introduction

UHC is a key component for the sustainable development of countries.

WHO ConstitutionHealth is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Introduction

The right to healthcare must guarantee access to timely and high-quality healthcare services, based on social justice and an equity approach.

Introduction

Public health requiresIntegral care to guarantee certainty and quality of services throughout the life cycle and during all stages of medical care:

• Prevention.• Care at all levels.• Rehabilitation.

Introduction

• Health services must be conceived under the universality scheme.

• Universal healthcare must focused on prevention, so as to avoid high costs deriving from treatment and medication.

Introduction

Demographic transition and loss of demographinc bonus.

The number of older adults over 60 is seeing a growth that tends to become predominant in an already near future.

Challenges of universal coverage

This will undoubtedly result in the financial unbalance of public health institutions.

Increased care costs chronic-degenerative diseases: • Diabetes• Hypertension• Senile dementia• Motor disability• Cancer• Cardiovascular diseases

Challenges of universal healthcare

Establish access to health on basic packages that only include care for catastrophic diseases, as a means to focus on the healthcare expenditure, represents a long-term cost that is larger than investing on prevention


If to this information, we add social contexts with high informality and marked social asymmetries, the result is that healthcare expenditures are not eliminated but rather transferred to people in a situation of larger vulnerability.


A particular example is that of Argentina, Brazil, Chile, Colombia, Ecuador, Mexico and Uruguay, countries that have high ageing rates, present larger hospital expenditure rates, as well as, in terms of treatment and medication for curing catastrophic diseases.


Source: ECLAC

According to ECLAC, each year around 44 million households (approximately 2.5% of the world population) face catastrophic expenditures in health.


Latin American countries selected: Expenditure in medication, of the total out-of-pocket expenditures

(Percentage)

Source: National Public Health Institute (INSP), 2012.

Main causes behind mortality in Mexico


Main causes of general mortality in Mexico, 2012(% of total deaths)

Guarantee access to primary healthcare

This undoubtedly calls for multiple reforms that would imply making big changes at the social level, that are often hampered by:

• Globalizing model• Commodification of medicine• Political conditions


It is fundamental to increase investment in healthcare

If the world average of expenditure in health per capita is of $1,041.9 dollars, in Latin America and the Caribbean is of

$761.4 dollars, that is, 27% lower in the region.


Source: Elaborated by author, with data from the World Bank, 2015

Per capita Health expediture(american dollars)


Source: Elaborated by author, with data from the World Bank, 2015.


Per capita Health expeditureComparison between global expenditure and some countries

Another challenge for Universal healthcare and social security

coverage is Informality

Dominates the labor relations in the world, therefore populations lack the benefits of being affiliated to social security.


Only 20% of the world population has adequate social protection and more than half has no coverage at all.


According to ILO

ONLY

Social security healthcare coverage has increased in Latin America, by shifting from 54% in 2002 to 66% in 2011, it still has reached, in real terms, a little less than half of the population



Source: Cechini and Martinez, 2011

Countries that invest more in social security and healthcare also have larger percentages of affiliated employees.

In 2015, in Latin America we can expect that the weak generation of employment this year also translates into a moderate increase of the unemployment rate at the regional level, shifting back to the level registered in 2013, of 6.2%”


Migration represents a main challenge for coverage and, in general, for

social security.


International tools that have allowed providing guarantees

1. The International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (1990)

2. The Multilateral Iberic-American Convention in Social Security.


The neo-liberal economic globalization

As one of the consequences of this global structure has been the presence of multiple psychosocial disorders, mainly related to work such:

• Stress• Depression and anxiety• Other diseases related to poor nutrition and inactivity (hypertension, diabetes, cholesterol, gastritis, etc.)

Which will soon bring about high costs for health institutions, given the lack of preventive public policies, thus generating multiple complications at the social level.


The importance of mental healthcare is an issue that has been posponed when planning public health policies, considering in a lesser manner the high influence that the present neo-liberal model may come to have in many nations.

WHO data indicates that each year around a million people of all ages, income and nationalities commit suicide


The most important factors to reach healthcare areprevention and self-care.

Prevention itself represents the most important challenge of all

• Change in the cultural paradigm of societies - actions implemented today, will have consequences tomorrow.

The creation of awareness based on specialized training and formation from public employees to the first level of medical care that people may have.


To study and learn to be able to prevent, as well as, to share knowledge as a force for change


Invest in the physical, operational and technological ability to provide efficient services for all citizens, throughout all of their life stages, and in line with their needs based on equity and quality.

How to face challenges

UHC is not only a synonym of adding populations or extending healthcare in a geographical manner, but that this construction should also include a variety of services and adequate benefits for the epidemiological reality of the populations, along with reduced cost sharing.



Source: Mexican Health Foundation, 2013

Coverageof healthservices

The challenge of universal health coverage is more complex than just adding populations

Scheme for measuring universal coverage proposed by WHO

Conclusions

Points to be undertaken may lead to a more effective approach to universal coverage:

• To rely on solid first care level and an effective and integral system for service delivery, basing values on solidarity and equity.

• To avoid the impoverishment of populations by establishing protection mechanisms to face catastrophic expenditures.

Conclusions

• To generate mechanisms that promote equitable contributions to health securities, as well as, to strengthen the fight against evasion.

• To reduce restrictions of social protection of health to counteract serious and/or recurring morbidity events that may result in high out-of-pocket expenditures.

• To consider equitable access to portability in the consolidation of integral social security systems.

Conclusions

In this economic, political and social context, affected by insecurity, unemployment and catastrophic diseases, we cannot get used to the fact that access to healthcare and social security are paradoxically an uncertainty for wide sectors of the population.

Conclusions

Strengthening universal social security programs is a fundamental proposal.

Conclusions

Social security is a condition for development based on equity.

Conclusions

Leonel Antonio Flores SosaDirector

Thank You

Challenges for Universal Health Coverage in Latin America for the next decade.

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