Desigualdad Social y Equidad en Salud: Perspectivas Internacionales

esults of the decentralization in terms of geographical equity are less clear. Althoughdifferent policies to control the problem in equity exist, various studies show nochanges or negative results from the reforms in relation to the previous tendencies inutilization of services between small and big municipalities and between rural andurban areas (Bossert, Larranaga et al. 2003; Homedes and Ugalde 2005). Health insurancecoverage displayed major geographic variations. Outpatient and in-patientmedical care in the public sector showed substantial geographic variations. Accordingto patient discharge records from national referral hospitals, only some 20% oftotal health care capability is used to treat 60% of the Chilean population living inregions outside the Greater Metropolitan area. In addition, the rural and poorestareas are covered preferably by the public sector, while the private is concentrated inthe urban and wealthiest regions. (Arteaga, Astorga et al. 2002)The evidence from Mexico suggests that there are more differences between geographicalareas due to the reform. There, decentralization was originally initiated in13 states in 1985 and was put on hold in 1987 owing to its negative effects on servicedelivery and acute conflicts between local health authorities and the populationcaused by the virtual closure of rural hospitals. (Laurell 2001)Allocation of resourcesThe relation between decentralization and improvement of geographical equity inresources’ allocation is inconsistent. For instance, it promoted a more equitable allocationof health resources among rich and poor municipalities of different incomesin Colombia (Bossert, Larranaga et al. 2003; Homedes and Ugalde 2005) althougha bigger capacity of negotiation of new resources in rich municipalities as well as inthe private sector has been mentioned (Guimarâes 2001). In Costa Rica, where thereis a centralized fund for resources’ allocation, it has been reported that there is a betterredistributive capacity. (Guimarâes 2001)A less clear relation has been shown in Chile and Brazil, where it seems to be atendency to maintain inequities in allocation of resources. Although, a probable positiverole of a fund for a more equitable reallocation of resources has been describedin Chile, where, the tendency has been shown as steady (Bossert, Larranaga et al.2003) or contrary (Guimarâes 2001; Homedes and Ugalde 2005). There, analysisof primary care funding, however, suggests that municipalities allocating the highestper capita funds are not the ones with the greatest health care needs (Arteaga,Astorga et al. 2002). In addition, in Brazil, a look at the estimated distribution ofresources by region according to population demonstrates that the poorer areas havethe biggest differential rates. (Almeida, Travassos et al. 2000)In Mexico, a clearer negative trend in geographical equity of allocation of resourceshas been found (Ugalde and Homedes 2002). There, the inequity betweenregions is also likely to increase despite the previous unfair geographic distributionRiutort, Cabarcas19