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The Lancet: Universal health coverage in Latin America series

The Lancet

The Lancet is pleased to announce the publication of a new Series on Universal Health Coverage in Latin America.

  • Health system reform and universal health coverage in Latin America
  • Overcoming social segregation in health care in Latin America
  • Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries
  • Leading the way towards universal health coverage: a call to action
  • Series comments

The Series will be launched on Thursday 16 October, at the Pan American Health Organization (PAHO) headquarters in Washington, D.C., USA, and the Series is supported by the Economic Commission for Latin America and the Caribbean (ECLAC) and the Rockefeller Foundation.

Universal health coverage in Latin America 1: Health system reform and universal health coverage in Latin America by Professor R Atun et al

In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. The distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage.

Universal health coverage in Latin America 2: Overcoming social segregation in health care in Latin America by Dr D Cotlear et al

This Series paper outlines four phases in the history of Latin American countries that explain the roots of segmentation in health care and describe three paths taken by countries seeking to overcome it: unification of the funds used to finance both social security and Ministry of Health services (one public payer); free choice of provider or insurer; and expansion of services to poor people and the non-salaried population by making explicit the health-care benefits to which all citizens are entitled.

Universal health coverage in Latin America 3: Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries by Professor R Atun et al

Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies.

Universal health coverage in Latin America 4: Leading the way towards universal health coverage: a call to action by Dr J Frenk

Policy innovations and lessons associated with the quest for universal health coverage in Latin America are the result of a complex epidemiological transition, an extended process of democratisation, and high economic growth in recent times that has facilitated additional investments in health. The goal of universal health coverage is part of a third generation of health-system reforms, which implies a comprehensive scope of policy interventions, including the introduction of explicit ethical frameworks, the enhanced attention to financial arrangements, and the transformation of major dimensions of the organisation of health systems. The call for action emphasises the next steps that could help reach the goal of universal health coverage in both the Latin American region and the rest of the developing world.

Health Policy: Financing universal health coverage in Latin American countries: How to improve financing and solidarity by Mr Daniel Titelman et al

Latin American health systems encompass a wide range of financial sources, which translate into different solidarity-based schemes that combine contributory (payroll taxes) and non-contributory (general taxes) sources of financing. To move towards universal health coverage, solidarity-based schemes must heavily rely on countries' capacity to increase public expenditure in health. Improvement of solidarity-based schemes will need the expansion of mandatory universal insurance systems and strengthening of the public sector including increased fiscal expenditure. These actions demand a new model to integrate different sources of health sector financing, including general tax revenue, social-security contributions, and private expenditure. The extent of integration achieved among these sources will be the main determinant of solidarity and universal health coverage. The basic challenges for improvement of universal health coverage are not only to spend more on health, but also to reduce the proportion of out-of-pocket spending, which will need increased fiscal resources.

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