Rubén Darío Gómez-Arias [email protected]Round table 2 COMMERCIALLY ORIENTED HEALTH SYSTEMS: A MODEL? Evidence from Latin America 16:00-16:10 Introduction PROF . RUBEN DARÍO GOMEZ ARIAS, University of Antoquia, Medellín, Colombia Reforms of first and second generation in Colombia 16:10-16:20 DR. EDUARDO ESPINOZA, Vice Minister for Health Policies, El Salvador Socially oriented reforms of the El Salvador health system – lessons for Europe 16:20-16:30 PROF . ALICIA STOLKINER University of Buenos Aires The impact on health of the 90’s neo liberal reform and the 2001 crisis in Argentina 16:30-16:40 PROF . LIGIA GIOVANELLA FIOCRUZ A comparison between Latin America and Europe: the organization of first line services, with special emphasis on the role of nurses 16:40-17:00 P ANEL: Mariza Matías, European Parliamentary Ivonne Cisneros, University of Vera Cruz María Luiza Vásquez Hospitals Consortium of Catalonia
Round table 2 COMMERCIALLY ORIENTED HEALTH SYSTEMS: A
MODEL?
Evidence from Latin America
16:00-16:10
Introduction
PROF. RUBEN DARÍO GOMEZ ARIAS, University of Antoquia, Medellín, Colombia
Reforms of first and second generation in Colombia
16:10-16:20 DR. EDUARDO ESPINOZA, Vice Minister for Health Policies, El
Salvador
Socially oriented reforms of the El Salvador health system –
lessons for Europe
16:20-16:30 PROF. ALICIA STOLKINER University of Buenos Aires
The impact on health of the 90’s neo liberal reform and the 2001
crisis in Argentina
16:30-16:40 PROF. LIGIA GIOVANELLA FIOCRUZ
A comparison between Latin America and Europe: the
organization of first line services, with special emphasis on the
role of nurses
16:40-17:00 PANEL: Mariza Matías, European Parliamentary Ivonne Cisneros, University of Vera Cruz María Luiza Vásquez Hospitals Consortium of Catalonia
Executive Secretary. Colombian Network of Research on Health Policy and Systems Professor of Epidemiology. National School of Public Health University of Antioquia. Medellin [email protected]
The case of Colombia may illustrate the dynamics and consequences of these reforms.
The health reforms that began at the end of the 80's in LA were not the result of internal consensus nor of endogenous analysis, but of foreign interests and pressures that were imposed on the domestic political systems with the support of local elites.
1. Social investment is channeled to basic needs 2. The low cost production is pushed 3. It invests in public services for people 4. Consumption capacity is improved
The great crisis of the postwar
In Europe, to address the crisis, Keynesian models propose Welfare States
John Meynard Keynes 1883-1946
The State is the protagonist of social development
1. Williamson, John: What Washington Means by Policy Reform. Conference. Institute for International Economics. 1989. 2. Williamson, John: What Washington Means by Policy Reform, in: Williamson, John (ed.): Latin American Readjustment: How Much has
Happened, Washington: Institute for International Economics 1989. 3. Williamson, John; A Short History of the Washington Consensus, Barcelona, 2004
1980: The Washington Consensus Guidelines for LA and the rest of the World
1. Fiscal discipline in spending 2. Reordering of spending priorities 3. Broad-based tax reforms 4. Liberalization of interest rates 5. Competitive exchange rates 6. Liberalization of international trade 7. Liberalization of inward foreign direct investment 8. Privatization of public goods and services 9. Deregulation of transactions 10. Protection of private property rights
Law 60. Decentralization of public administration Strengthening the financial sector to make it attractive to the private sector 1990 Law 10 dismantling the NHS 1993 Investing in Health Policy. World Bank
Strengthen investment in the sector Organize services under market principles Promote competition Approval of Law 100
1994-1995. Regulation of transition
Desde 1996 Proceso de implementación 2007 Ley 1122 Consolidates the model
1990 Second generation reforms
Designed to ensure the appropriation of public resources by private investors. Are proposed by international banking and political elite, supported on the model of first generation reforms.
Arbeláez M, Gaviria M, Franco A, Restrepo R, Hincapié D, Blas E. Tuberculosis control and managed competition in Colombia. Int J Health Plann Mgmt 2004;
2004(19):S25-S43
Gómez-Arias RD. La mortalidad evitable como indicador de impacto de la reforma sanitaria. Colombia 1985 – 2001. Revista Facultad Nacional de Salud Pública.
Universidad de Antioquia. Medellín. 2008
After 20 years of law 100
1. Public health indicators deteriorated Health authority weakened Drug and services costs increased Health service network became fragmented Health activities were disassembled Information system was dismantled Planning system was dismantled The crisis of the state hospitals was generated Popular protests have increased
1. Healthcare market was established in one of the most lucrative areas of business
2. The public services network passed to the private sector
3. Insurers consolidated as a one of the major economic and political power of the country
