social health protection the view from the pan-american health organization ruben torres manager...

Social Health Protection Social Health Protection The view from the Pan-American Health OrganizationThe view from the Pan-American Health Organization

Ruben TorresManager

Area of Health Systems based on Preventive Health CarePublic Health Policy and Research Project Coordinator

Inter-American Social Protection Network (IASPN) Technical Consolidation Meeting, August 10 and 11, 2011 Mexico City, Mexico

Social Health Protection

GDP Growth-2003/2009GDP Growth-2003/2009Selected countries Selected countries source: ECLACsource: ECLAC

Trend in Public Social Spending and Trend in Public Social Spending and Total Public Spending as a % of GDPTotal Public Spending as a % of GDP

1990-2008 (18 LAC countries)1990-2008 (18 LAC countries)

Public Social Spending by sectorPublic Social Spending by sector1990-2007 (in % of GDP-21 countries1990-2007 (in % of GDP-21 countries

Fuente: CEPAL

Fuente: CEPAL, sobre la base de información proveniente de la base de datos sobre gasto social de la Comisión.a Promedio ponderado de los países, excluida Nicaragua.b La información disponible no permite separar ambas partidas de gasto. Según antecedentes de estudios nacionales, la seguridad social representaría alrededor de 78% del monto de recursos aquí consignados.

Selected countries in America PRIVATE SPENDING in HEALTH (OOP and PP)(PPP int $)

(Organized by TOTAL EXPENSE)

Fuente: NHA-WHO 2007

Private Insurance Expenditure & Private Insurance Expenditure & Income Per CapitaIncome Per Capita

The way to universal coverageThe way to universal coverage

LIMITEDPUBLIC FUNDING

PRIVATESPENDINGPREVAILS

INCREASEPUBLIC FUNDING(insurance,etc.)

PRIVATE INSURANCECOVERS OTHER SEGMENTS OF

THE POPULATION

MOST OF THEPOPULATION COVERED

BY MEANS OF PUBLIC

FUNDING PLANS

PRIVATE INSURANCEOFFERS SECONDARY

COVERAGE(complementary or

supplementary)

PUBLIC FUNDINGPUBLIC FUNDING

PRIVATE FUNDINGPRIVATE FUNDING

RegulationsRegulations

• What and how much to regulate?

• Single regulatory framework for the public and private system?

• Objectives of regulation and externalities.

Three dimensions of progress toward Three dimensions of progress toward universal coverageuniversal coverage

International Comparison of Tax Burden International Comparison of Tax Burden 1980/20051980/2005

Tax Burden 1990-2005Tax Burden 1990-2005

International Comparison of Tax Burden International Comparison of Tax Burden

The Diversity of Latin AmericaThe Diversity of Latin America

80’s & 90’s

SISTEMAS

SISTEMAS

SEGMENTADOS

SEGMENTADOSREFORMAS DEL

SISTEMA DE

SALUD

“REFORMED”

HEALTH SYSTEMS

SERVICIO NACIONAL DE SALUD

SEGURO SOCIAL DE SALUD

“EMPRESARIAL”

Total Worldwide Health Financing Total Worldwide Health Financing (4,4 trillion in 2005)(4,4 trillion in 2005)

Public Spending

(Social Security not included)

33 %

Private Insurance19 %

Social Security26 %

Out of pocket18 %

Other4 %

Welcome toThe Health System

Entrance

Effect of out of pocket spending on Effect of out of pocket spending on catastrophic spending and impoverishmentcatastrophic spending and impoverishment

Distribution of health expenditure 30% or Distribution of health expenditure 30% or more than more than

tri-monthly available income, per tri-monthly available income, per household & incomehousehold & income

<knaul,F.M. et al. Salud pública de México/vol.49,sup.1, 2007

Social Factors Determining Health

Equity & Health in all policies

GoodGlobalGovernance

GenderEquity

Empowerment(Inclusion & voice)

Market Responsibility

AdequateFinancing

Early-childhood dev.

Education

Healthy environment

Adequate employment

Social protection

Universal health care

Conditions in which people are born, raised, live, work and age

Level of income in countries and deaths at ages 0-4 and over 60.Level of income in countries and deaths at ages 0-4 and over 60.

Source: Deaton (2006).

• Social ObsolescenceSocial Obsolescence:

Inadequate attention to people’s needs: high-tech services Inadequate attention to people’s needs: high-tech services that are expensive and inaccessiblethat are expensive and inaccessible

Components of the growth in health expenditure

California HealthCare Foundation, 2010.

Accelerated production of health technology

Healthcare market and introduction of technological innovation

“De-medicalization” of initially medical technological resources

Regulation and Evaluation of health technology

Technology as problem

HEALTH FOR ALL

Information & KnowledgeInformation & Knowledge

Human RightsHuman Rights

PreventivPreventive Health e Health

CareCareSocial Social

ProtectionProtectionPromoting Promoting

Health Health