social health protection the view from the pan-american health organization ruben torres manager...
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Social Health Protection Social Health Protection The view from the Pan-American Health OrganizationThe view from the Pan-American Health Organization
Ruben TorresManager
Area of Health Systems based on Preventive Health CarePublic Health Policy and Research Project Coordinator
Inter-American Social Protection Network (IASPN) Technical Consolidation Meeting, August 10 and 11, 2011 Mexico City, Mexico
Social Health Protection
GDP Growth-2003/2009GDP Growth-2003/2009Selected countries Selected countries source: ECLACsource: ECLAC
Trend in Public Social Spending and Trend in Public Social Spending and Total Public Spending as a % of GDPTotal Public Spending as a % of GDP
1990-2008 (18 LAC countries)1990-2008 (18 LAC countries)
Public Social Spending by sectorPublic Social Spending by sector1990-2007 (in % of GDP-21 countries1990-2007 (in % of GDP-21 countries
Fuente: CEPAL
Fuente: CEPAL, sobre la base de información proveniente de la base de datos sobre gasto social de la Comisión.a Promedio ponderado de los países, excluida Nicaragua.b La información disponible no permite separar ambas partidas de gasto. Según antecedentes de estudios nacionales, la seguridad social representaría alrededor de 78% del monto de recursos aquí consignados.
Selected countries in America PRIVATE SPENDING in HEALTH (OOP and PP)(PPP int $)
(Organized by TOTAL EXPENSE)
Fuente: NHA-WHO 2007
Private Insurance Expenditure & Private Insurance Expenditure & Income Per CapitaIncome Per Capita
The way to universal coverageThe way to universal coverage
LIMITEDPUBLIC FUNDING
PRIVATESPENDINGPREVAILS
INCREASEPUBLIC FUNDING(insurance,etc.)
PRIVATE INSURANCECOVERS OTHER SEGMENTS OF
THE POPULATION
MOST OF THEPOPULATION COVERED
BY MEANS OF PUBLIC
FUNDING PLANS
PRIVATE INSURANCEOFFERS SECONDARY
COVERAGE(complementary or
supplementary)
PUBLIC FUNDINGPUBLIC FUNDING
PRIVATE FUNDINGPRIVATE FUNDING
RegulationsRegulations
• What and how much to regulate?
• Single regulatory framework for the public and private system?
• Objectives of regulation and externalities.
Three dimensions of progress toward Three dimensions of progress toward universal coverageuniversal coverage
International Comparison of Tax Burden International Comparison of Tax Burden 1980/20051980/2005
Tax Burden 1990-2005Tax Burden 1990-2005
International Comparison of Tax Burden International Comparison of Tax Burden
The Diversity of Latin AmericaThe Diversity of Latin America
80’s & 90’s
SISTEMAS
SISTEMAS
SEGMENTADOS
SEGMENTADOSREFORMAS DEL
SISTEMA DE
SALUD
“REFORMED”
HEALTH SYSTEMS
SERVICIO NACIONAL DE SALUD
SEGURO SOCIAL DE SALUD
“EMPRESARIAL”
Total Worldwide Health Financing Total Worldwide Health Financing (4,4 trillion in 2005)(4,4 trillion in 2005)
Public Spending
(Social Security not included)
33 %
Private Insurance19 %
Social Security26 %
Out of pocket18 %
Other4 %
Welcome toThe Health System
Entrance
Effect of out of pocket spending on Effect of out of pocket spending on catastrophic spending and impoverishmentcatastrophic spending and impoverishment
Distribution of health expenditure 30% or Distribution of health expenditure 30% or more than more than
tri-monthly available income, per tri-monthly available income, per household & incomehousehold & income
<knaul,F.M. et al. Salud pública de México/vol.49,sup.1, 2007
Social Factors Determining Health
Equity & Health in all policies
GoodGlobalGovernance
GenderEquity
Empowerment(Inclusion & voice)
Market Responsibility
AdequateFinancing
Early-childhood dev.
Education
Healthy environment
Adequate employment
Social protection
Universal health care
Conditions in which people are born, raised, live, work and age
Level of income in countries and deaths at ages 0-4 and over 60.Level of income in countries and deaths at ages 0-4 and over 60.
Source: Deaton (2006).
• Social ObsolescenceSocial Obsolescence:
Inadequate attention to people’s needs: high-tech services Inadequate attention to people’s needs: high-tech services that are expensive and inaccessiblethat are expensive and inaccessible
Components of the growth in health expenditure
California HealthCare Foundation, 2010.
Accelerated production of health technology
Healthcare market and introduction of technological innovation
“De-medicalization” of initially medical technological resources
Regulation and Evaluation of health technology
Technology as problem
HEALTH FOR ALL
Information & KnowledgeInformation & Knowledge
Human RightsHuman Rights
PreventivPreventive Health e Health
CareCareSocial Social
ProtectionProtectionPromoting Promoting
Health Health