Eduardo Levcovitz, MD, MSC, Ph.D Unit Chief, Health Policies and Systems Development
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Transcript of Eduardo Levcovitz, MD, MSC, Ph.D Unit Chief, Health Policies and Systems Development
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El sistema nacional de salud est compuesto por varios sistemas
103.0
42.4
5.7
ESTIMADO
IMSS
Ejrcito, Marina y Pemex
Poblacin no asegurada
1.1
3.2
49.9
Total de personas
ISSSTE
Otros y no especificados
Poblacin por sistema de afiliacin 2002Millones de personas
Fuente: Estimaciones propias con datos del CENSO, INEGI, IMSS, ENED 2002
Office of the Assistant DirectorHealth Systems Strengthening Area
Example: ChileLIMITATIONS/RISKS OF SEGMENTED SYSTEMSSegmentation of financial contributions/ risk pools
Office of the Assistant DirectorHealth Systems Strengthening Area
MEXICOSegmentation of financial contributions/ risk pools LIMITATIONS/RISKS OF SEGMENTED SYSTEMS
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El sistema de salud en Mxico, flujos principales 2003
Seguro privado en salud
Fondos de seguridad social IMSS, ISSSTE, PEMEX SEDENA SEMAR
Sistemas de Proteccin Social en Salud (SPSS) o Seguro Popular
Poblacin y empresas
Pacientes
Instituciones 3 gubernamentales (SESA)
IMSS Oportunidades 4
Instituciones de seguridad social (IMSS, ISSSTE)
Instituciones de seguridad social especializadas (PEMEX, SEDENA, SEMAR.)
Instituciones privadas
Gobierno federal
Gobierno estatal 1
Servicios pblicos para poblacin no asegurada
Servicios pblicos para poblacin asegurada
Primas
Impuestos
Contribuciones obligatorias de empleados y empleadores
Pagos directos de bolsillo 51%
Cuota por servicio 1% 2
Prepago & pago por servicio
Presupuesto anual global
Presupuesto anual global
Presupuesto anual global
Presupuesto anual global
Flujos financierosFlujos de servicios
Aportacin anual de acuerdo con el nivel de ingreso de las familias 2
Office of the Assistant DirectorHealth Systems Strengthening Area
SEGMENTED SYSTEMS FROM THE USERS POINT OF VIEW: OUT-OF-POCKET PAYMENTS
Gasto Nacional
1.42
2.1
3.89
4.07
4.09
4.24
4.49
4.56
4.65
4.67
4.76
4.92
4.96
5.48
5.77
5.84
5.93
6.1
6.18
6.21
6.24
6.38
6.58
6.6
6.98
7.18
7.23
7.62
8.25
8.59
8.74
8.88
9.58
12.3
12.39
Porcentaje del PIB Fuente: HP/HSS Indicadores Basicos, 2005
Gasto Nacional en Salud como porcentaje del PIB: America Latina y el Caribe 2000-2004
Chart2
1.44.81
1.42.69
1.42SUR
1.744.36
1.92.86
23.77
22.56
210.39
2.12.86
2.1GUY
2.11.97
2.12.82
2.472.18
2.63.78
2.863.07
2.94.08
3.083.16
3.20.69
3.322.52
3.361.31
3.623.61
3.753.87
3.880.61
42.58
4.081.4
4.21.98
4.322.86
4.42.2
4.93.35
4.993.89
6.36
6.741.85
6.92.68
7.681.06
HAI4.24
Publico
Privado
Porcentaje del PIB Fuente: HP/HSS Indicadores Basicos 2005
Gasto Publico y Privado como porcentaje del PIB: America Latina y el Caribe, 2000-2004
Sheet1
PublicoPrivado
SUR1.4GUT1.44.8GUT
GUY2.1VEN1.42.7VEN
ANT3.9SUR1.42SUR
PER4.1JAM1.744.4JAM
VEN4.1DOR1.92.9DOR
HAI4.2ELS23.8ELS
SVT4.5HON22.6HON
HON4.6URU210.4URU
SCN4.7ECU2.12.9ECU
STL4.7GUY2.1GUY
DOR4.8PER2.12.0PER
TRT4.9TRT2.12.8TRT
ECU5.0SCN2.472.2SCN
BLZ5.5CHI2.63.8CHI
ELS5.8MEX2.863.1MEX
ANG5.8PAR2.94.1PAR
MEX5.9GRE3.083.2GRE
JAM6.1ANT3.20.7ANT
PAN6.2ANG3.322.5ANG
GUT6.2STL3.361.3STL
GRE6.2BRA3.623.6BRA
CHI6.4NIC3.753.9NIC
COL6.6SVT3.880.6SVT
DOM6.6COL42.6COL
PAR7.0BLZ4.081.4BLZ
BOL7.2PAN4.22.0PAN
BRA7.2BOL4.322.9BOL
NIC7.6DOM4.42.2DOM
COR8.3COR4.93.4COR
BAR8.6ARG4.993.9ARG
MNT8.7USA6.36.0USA
ARG8.9BAR6.741.9BAR
CAN9.6CAN6.92.7CAN
USA12.3MNT7.681.1MNT
URU12.4HAI4.2HAI
datos 200-2004
Sheet2
Sheet3
Office of the Assistant DirectorHealth Systems Strengthening Area
NGOMOHs Health CenterSocial Security ClinicHospitalMunicipalAmbulatoryOperational fragmentationSEGMENTED SYSTEMS FROM THE USERS POINT OF VIEW: FRAGMENTED DELIVERY NETWORKS
Office of the Assistant DirectorHealth Systems Strengthening Area
Health Systems in LAC
EQUITY EFFICIENCY LIMITATIONS/RISKS OF SEGMENTED SYSTEMSMainstream economics:Trade Off: Equity X Efficiency
Office of the Assistant DirectorHealth Systems Strengthening Area
Segmentation according to ability to payFragmentation of the services delivery networkA GHOST THREATENS HEALTH CARE SYSTEMS IN LAC
Office of the Assistant DirectorHealth Systems Strengthening Area
CHALLENGES FOR HEALTH SYSTEMS STRENGTHENINGINTER-INSTITUTIONALCOORDINATION + OPERATIONALINTEGRATION
Office of the Assistant DirectorHealth Systems Strengthening Area
INTER-INSTITUTIONALCOORDINATIONOPERATIONALINTEGRATIONStrengthening the STEERING ROLE of National Health AuthoritiesALIGNMENT AND HARMONIZATION of International CooperationINTEGRATED health care delivery networksReorganization of health systems based on PHC STRATEGIESIncorporating scientific KNOWLEDGE from public health programs into the scaling up of health systemsSTRATEGIES TO REDUCE/ELIMINATE SEGMENTATION AND FRAGMENTATIONSOCIAL/POLICY DIALOGUE among multiple stakeholdersHarmonization and integration of FINANCING mechanismsCHALLENGES FOR HEALTH SYSTEMS STRENGTHENING
Office of the Assistant DirectorHealth Systems Strengthening Area
FRAMEWORK FOR HEALTH ACTION IN THE AMERICAS FOR THE XXI CENTURYAddressingtheunfinishedagendaProtecting theachievementsFacingthenewChallenges
Office of the Assistant DirectorHealth Systems Strengthening Area
POLICY FRAMEWORK FOR HEALTH SYSTEMS STRENGTHENINGHealth For All
Office of the Assistant DirectorHealth Systems Strengthening Area
LEADERSHIP AND INSTITUTIONAL CAPACITY BUILDING INFORMATION, KNOWLEDGE AND INNOVATION PLANNING AND COORDINATION INTELLIGENCE, CREATIVITY, OPEN DEBATE AND COMMITMENTCHALLENGES FOR HEALTH SYSTEMS STRENGTHENING