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In Search of the Authentic Universalism in Latin American Healthcare Systems: The Cases of Chile and Mexico
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| Fecha de publicación: | 2019 |
| Año de Inicio/Término: | 26-28 June 2019 |
| Idioma: | Inglés |
| URL: | https://www.ippapublicpolicy.org/conference/icpp4-montreal-2019/panel-list/10/panel/the-global-quest-for-universal-health-coverage/876 |
| Notas: | In the present century, governments throughout Latin America have made important efforts to expand healthcare coverage. Reforms to reach groups of the population previously neglected can be observed in several countries. Yet, expansion models adopted in different countries show significant differences. The reforms introduced in Chile and Mexico represent examples of such differences. In Chile, the conversion of the existing system that integrated different modes of public and private provision, with different options for users of distinct socio-economic background. In Mexico, on the other hand, a horizontal reform that layered a voluntary insurance programme for informal workers and their families along the existing social insurance programmes. This article aims to understand how far the reformed systems have advanced towards universal coverage in these two countries. Universalism has been at the centre of current international and national social policy debates. Such debates are especially meaningful in the Global South, where social policy has showed a low potential to guarantee social rights for the entire population. The analysis adopts the framework of universalism developed by Martínez Franzoni and Sánchez-Ancochea (2016), which links universal policy outputs to a triangle of massive coverage, generous benefits and equity in coverage and benefits. The research is based on the comparison of healthcare architectures and their outputs in terms of coverage, quality and equity in access. Findings show that although both countries have significantly expanded formal coverage, healthcare systems remain highly fragmented and stratified, with considerable equity gaps in the access to quality healthcare of different segments of the population. Still, the Chilean system performs better because, despite being a dual public-private system, commodification is counterbalanced by a public sector that integrates social security and non-contributory subsidised pillars in a unified system that pools resources, allowing higher internal solidarity. In Mexico, on the other hand, commodification is made implicit by pushing families from all income levels into scarcely regulated private service providers because of the low quality and limited access to comprehensive health care services and the fragmentation of the system. Conclusions highlight the importance of analysing policy architectures and their outputs to identify failures in the design of healthcare systems and opportunities to advance in the construction of genuine universal systems, which can effectively secure the right to health to the entire population. |