This paper raises the point that only few health reforms implemented in Latin American countries modified the existing health systems in order to fix the problems brought by the institutional fragmentation typical of this sector. A great part of these reforms did not implemented the necessary measures to improve coordination among health systems in the prevailing pluralistic model and besides, they faced strong opposition from relevant actors who obstructed the completion of these reforms. In addition, this work points out that in countries which have implemented comprehensive structural reforms,, health indicators such as child mortality, malnourishment, maternal mortality and specialized care during childbirth have improved faster than in those which conducted only partial reforms or have no reforms at all. This paper analyses some of the processes and constrains of a selected group of countries in implementing health reforms in the Region.

This paper aims at analyzing healthcare expenditure and demand of families, by estimating income-elasticity and price-elasticity for ten groups of products using the so-called model Linear Almost Ideal Demand System (LAIDS). The 2002/03 consumer expenditure surveys (POF) of the Fundação Instituto Brasileiro de Geografia e Estatística – FIBGE (Brazilian census bureau) are used, providing extremely detailed information on family expenditure for the Brazilian states and major metropolitan areas. The variables used in estimating the model were directly taken from the microdata of such surveys. Such a procedure has allowed that logarithms of prices and monthly family earnings per capita could be estimated directly from individual observations and not from the aggregate data for the original income groups of POFs. Estimating the demand by using a two-stage model has pointed out to an incomeelasticity of healthcare higher than the unit, showing that healthcare is price-inelastic, a result valid for all observed healthcare subgroups.

The objective of this article is to put in economic perspective the expenditure in health within the pattern of family expenditure of the Mexican households. Information of the National Survey on Income Expenditure of Households (ENIGH) of Mexico of 2004 is analyzed on: structure of the expenditure of the households, expenditure in health and income-expenditure elasticities in health; by quintiles of income and to the condition of insurance in health. It is revealed that the poorest households in Mexico do not rely on their structure of expenditure to support out of the pocket expenses in health, reason why an unexpected event of disease places the families at risk of impoverishment, sale of assets or indebtedness. Other results are the elasticities that were obtained by condition of insurance, quintile of income and type of expenditure; and that there are basic services in health that the Mexican population perceives as if they were luxury goods, among them the orthopedic, dental care and hospitalization. It is emphasized that the income elasticities found can serve as baseline measurement of the effectiveness of the Popular Insurance of Health just orchestrated on the modification of the pattern of family expenditure on health for the first quintiles of income.

This paper reviews the determinants and conditionalities of the process of universalizing public health in developed countries, notably the European ones, and in Brazil, and is aimed at highlighting their differences. The first part discloses the main interpretations on the constructing of the Welfare State, emphasizing the characteristics of that historical moment and its articulation with prevailing accumulation standards. The second part is orientated towards understanding the conditions in which universality in Brazil’s health service actions has been defined, highlighting the fact that the general patterns of capitalism’s are no longer those of the post-war period. It emphasizes that the new environment interacts with and constrains the Brazilian trajectory, especially in regard to Federal Government actions, stressing inequality as an indelible feature of Brazilian society, which could be considered as an obstacle to enforcing universality in the country. Nevertheless, despite the impairments, there has been some uneven progress in the Brazilian population’s health status, achieved after the establishment of the Brazilian Unified Health System (Sistema Único de Saúde – SUS), notably through the Family Health Program (Programa de Saúde da Família).

This paper analyzes the roles of health goods and services markets within the regional integration process. It is a known fact that the consolidation of integrated markets is slower regarding social goods and services (as health and education) than among other goods and services (e.g. durable consumption goods). The paper discusses the nature of the health sector and its global dimension, showing the peculiar features of health goods and services marked by economic complexity and (according to Arrow) information asymmetry. Despite that, the paper emphasizes old and new reasons that place Health as a pre-requisite to commercial integration. It approaches the role played by the State in health financing, provision and regulation and the commercial integration process. Moreover, it brings relevant concepts on the topic studied, like the factors that lead to regional public health financing, the concept of Regional Public Good and its use in the health sector, additionally to the concerns related with health care reciprocity among countries. Finally, it approaches health markets regional integration in the European Union, NAFTA, and Mercosur.

This article examines health sector reforms in Latin America and the Caribbean to discuss the ideological, theoretical, and conceptual elements that inform the reform agenda and the models put forward for attaining greater equity in the region’s countries. Its starting assumption is that the relevant literature generally neglects the economic, social, and political aspects underlying the processes of change, reinforcing the idea that these are purely technical processes and to be settled technically. It presents a brief review of political science literature on the issue of the State, its relative autonomy and its relationship to society, emphasizing moments of crisis and reform. It analyses the contemporary health sector reform agenda, the leading role of international organisations – especially the World Bank – and some results of its implementation. It concludes that politics must be restored as essential to the reform process, given that the tendency is to discredit politics and spread the belief that important technical changes can be made to health system structures without contemplating the various contending projects and the resistance from actors opposed to change. It is therefore fundamental to think in depth about the role of the State and its ability to formulate and implement policies, and to analyse national options in the light of the constraints and proposals formulated/induced by outside forces, but also of national contexts, a perspective that has been largely overlooked in health sector studies.

This paper describes the Chilean experience concerning the implementation of a new unemployment insurance (UI) program. The use of individual savings accounts and private management are essential elements. In addition, a redistributive fund (Common Fund) helps workers pool risks, distributing resources from employed to unemployed workers and from stable firms to workers with low incomes and unstable jobs. The combination of personal accounts and redistribution reduces moral hazard problems endemic to traditional UI schemes and keeps costs at manageable levels. The paper discusses the political, social, and economic context in which this program was enacted and implemented, it reviews its key characteristics, it assesses the initial performance of the system in terms of coverage and benefits and it assesses the challenges that lie ahead. Finally the paper discusses the potential of this system as a model for other middle- and low- income countries.