Abstract

To provide coverage, quality health care and financial protection to the whole population, Universal Health Coverage (UHC) needs to address socially initiated inequalities and exclusion of the most disadvantaged groups. In Latin America (LA), people working informally are among those disadvantaged groups and, due to the organisation of most health systems based on contributory social health insurances, frequently lack proper inclusion. Although most LA countries have developed health-policy reforms for UHC, very few of them explicitly target employment conditions and informal work as a central barrier in the access to health care, and remarkable gaps of information in this regard remain. To address this lack of attention, this article seeks to examine the ability to promote the inclusion of informal workers of health-policy reforms stated in three LA countries, namely Chile, Uruguay and Colombia, each having a different type of welfare regime. The analysis focuses on the eligibility criteria for coverage and access to quality services: benefit packages and financial protection, as they are key dimensions for moving towards UHC. By considering these dimensions it fills a gap in the existing literature about the extension of health coverage to informal workers, almost exclusively focused on the financing arrangements. The enquiry is grounded on country case studies conducted between 2013 and 2015 as part of the project ´Health Inequalities, Work and Access to Social Security of Informal Workers: Latin America, Africa and Asia` led by Flacso-Chile and it is complemented by an updated literature review. The analysis shows that these three countries have applied relevant reforms for UHC, expressed in their success in covering previously excluded groups such as informal workers. Chile makes special efforts to provide quality services for all; Uruguay has promoted the extension of health coverage based on principles of citizen rights, and is moving to greater redistribution of risks and resources; while Colombia notoriously increased the coverage of people with informal jobs through the introduction of a subsidiary regime. Nonetheless, equity in access and financial protection still are major challenges. Data analysis unveils that informal workers have more limited access to health services specially in the secondary level of attention, which is related to the persistence of segmentation in these health systems as well as to the prominent and scarcely regulated role of the private offer (e.g. private providers), that provides more direct access to contributors in comparison to informal workers, mostly covered by subsidized schemes.