Desigualdad Social y Equidad en Salud: Perspectivas Internacionales

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has to be discussed by taking into account the costs of the services. Even though,there has been an increment of 2 to 4 times the amount of financial resources of thesystem, the results are not proportional to these costs. The role of the intermediationof the private sector in Colombia has to be discussed in order to explain the inefficacyof the system.The role of the partnership between decentralization and privatization should bediscussed in the case of Chile, where negative effects in equity of access and permanencyof inequities of allocation of resources are found. Chile has a fragmentationof the population in terms of the public and private sectors of health that the processof decentralization has not been able to correct.With a lower process of privatization, Costa Rica is the country that shows theclearest benefit effect of decentralization in terms of access to services and allocationof resources. However, the rationality of the intention of some stakeholders in thatcountry to introduce changes toward the suggestions of the World Bank must bediscussed.Decentralization has also been accompanied by negative effects in Mexico, wherean increment of inequity of access and allocation of resources has been described,and contradictory effects in Brazil, where although some advances have been madethe inequities are still marked. Contrary to the Colombian case, in these countries,there has been a reduction of financial resources for health, which is specially describedin the IMSS. This is accompanied with economical crisis in both countrieswith adjust measures under the guidelines of the neo-liberal ideology of the internationalorganizations.To summarize, although decentralization in theory may be a powerful mechanismto promote equity in health, it may be insufficient or prejudicial in the context ofunclear policy intended to promote equity by the state. Moreover, the role of otherconcomitant phenomena like privatization and shortage of state funding of healthmust also be discussed. However, the evidence regarding the results of decentralizationin LAC is still contradictory and ambiguous. It is not clear that its achievementscould reach its intentions of improved equity in health in the region. This literaturereview demonstrated the increasing need of more systematic studies in this area.ReferencesALMEIDA, C. (2002). "[Health systems reform and equity in Latin America and the Caribbean:lessons from the 1980s and 1990s]." Cad Saude Publica 18(4): 905-25.ALMEIDA, C., C. TRAVASSOS, ET AL. (2000). "Health sector reform in Brazil: a case studyof inequity." Int J Health Serv 30(1): 129-62.Riutort, Cabarcas21
ARREDONDO, A. AND I. PARADA (2000). "Health financing changes in the context ofhealth care decentralization: the case of three Latin American countries." Rev SaudePublica 34(5): 449-60.ARREDONDO, A., I. PARADA, ET AL. (2004). "[Impact of decentralization on health financingin Mexico]." Rev Saude Publica 38(1): 121-9.ARTEAGA, O., I. ASTORGA, ET AL. (2002). "[Inequalities in public health care provisionin Chile]." Cad Saude Publica 18(4): 1053-66.BARRAZA-LLORENS, M., S. BERTOZZI, ET AL. (2002). "Addressing inequity in healthand health care in Mexico." Health Aff (Millwood) 21(3): 47-56.BERTODANO ID, I. (2003). "The Costa Rican health system: low cost, high value." BullWorld Health Organ 81(8): 626-7.BOSSERT, T. J., O. LARRANAGA, ET AL. (2003). "Decentralization and equity of resourceallocation: evidence from Colombia and Chile." Bull World Health Organ 81(2): 95-100.CEPAL (1994). Salud, equidad y transformacion productiva en America Latina y el caribe.Washington, DC, Pan-American Health Organization.CESPEDES-LONDONO, J., I. JARAMILLO-PEREZ, ET AL. (2002). "[The impact of socialsecurity system reform on health services equity in Colombia]." Cad Saude Publica18(4): 1003-24.ELIAS, P. E. AND A. COHN (2003). "Health reform in Brazil: lessons to consider." Am JPublic Health 93(1): 44-8.FLEURY, S. (2000). Reshaping health care systems in Latin America: Toward fairness? ReshapingHealth Care in Latin America. A Comparative Analysis of Health Care Reformin Argentina, Brazil and México. S. Fleury, S. Belmartino and E. Baris. Ottawa, InternationalDevelopment Research Centre.GERSHBERG, A. I. AND M. JACOBS (1998). Decentralization and Recentralization: Lessonsfrom the Social Sectors in Mexico and Nicaragua. Washington, D.C., Inter-AmericanDevelopment Bank.GREEN, A. AND C. COLLINS (2003). "Health systems in developing countries: public sectormanagers and the management of contradictions and change." Int J Health PlannManage 18 Suppl 1: S67-78.GUIMARÂES, L. (2001). [Modalidades de descentralización en el sector salud y sus contribucionesa la equidad: elementos fundamentales para la formulación de un marconormativo]. Washington, DC, Programa de Políticas Públicas y Salud. División de Saludy Desarrollo Humano. Organización Panamericana de la Salud.Hernandez, M. (2002). "[Health reform, equity and the right to health in Colombia]."Cad Saude Publica 18(4): 991-1001.Homedes, N. and A. Ugalde (2002). "[Health services privatization: the experiences ofChile and Costa Rica]." Gac Sanit 16(1): 54-62.Homedes, N. and A. Ugalde (2005). "Why neoliberal health reforms have failed in LatinAmerica." Health Policy 71(1): 83-96.22 Decentralization And Equity
Page 2: DESIGUALDAD SOCIALY EQUIDAD EN SALU
Page 5 and 6: Título originalDesigualdad Social
Page 7 and 8: PARTE IIIDESIGUALDAD E INEQUIDAD EN
Page 10 and 11: Decentralization And Equity:A Revie
Page 12 and 13: multiple objectives, such as improv
Page 14 and 15: functions that may include autonomy
Page 16 and 17: 1.The public sector, which comprise
Page 18 and 19: Moreover, Costa Rica, where the emp
Page 20 and 21: esults of the decentralization in t
Page 24: Infante, A., I. de la Mata, et al.
Page 27 and 28: vida (Keppel et al., 2005). Existen
Page 29 and 30: El rangoEs una medida que puede ser
Page 31 and 32: Desviación media relativaEs un est
Page 33 and 34: tecimiento dividido por su compleme
Page 35 and 36: Índice de concentraciónEn este í
Page 37 and 38: heterocedásticos, por lo que un mo
Page 39 and 40: variables en salud que los signatar
Page 41 and 42: igualdad de las distribuciones, asu
Page 43 and 44: Referencias bibliograficasAnand, S.
Page 45 and 46: LOW, A. (2004) Measuring the gap: q
Page 48: PARTE IIgénero, discapacidady desi
Page 51 and 52: O Brasil apresenta uma das maiores
Page 53 and 54: ções no entendimento dos fatores
Page 55 and 56: ciada no pós-parto. Informação r
Page 57 and 58: porção de analfabetismo e melhor
Page 59 and 60: 1996% 1998% 2000% TOTAL Razão de C
Page 61 and 62: Tabela 3. (E1). Razão de chance de
Page 63 and 64: Variáveis N Cesariana % RPb RPaj I
Page 65 and 66: Figura 1(E2). Variações temporais
Page 67 and 68: Tabela 1.E3. Taxas de cesariana e R
Page 69 and 70: Tabela 2.E4. Características da ce
Page 71 and 72: ReferênciasAlthabe, F., Belizan, J
Page 73 and 74:
delivery rates and pregnancy outcom
Page 75 and 76:
AntecedentesComo antecedentes en el
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por la Sociedad Argentina de Cardio
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Figura 2. Utilización de trombolí
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Figura 6. Mortalidad en el IAM seg
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Datos cualitativosLa información c
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en cardiología en sus servicios ac
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dado que las mujeres tienen arteria
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d) Médicos con más de 10 años de
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que el médico varón.Como puede ob
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y los buenos equipos de trabajo. La
Page 95 and 96:
ConclusionesLa información analiza
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en las mujeres para realizar consul
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Es interesante observar que aun cua
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Arango Y, (2000) "Autocuidado de la
Page 103 and 104:
Tajer D, Fernández AM, Cernadas J,
Page 105 and 106:
Conceptos y definicionesConcepto de
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(ventaja / desventaja social, son o
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Surge entonces la perspectiva de la
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egistros), aunque es enorme y recog
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Gráfica 1. Discapacitados encuesta
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De esta forma se garantiza la impar
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Gradiente en contra de los estratos
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Gráfica 9. Mujeres discapacitadas
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de accidentalidad por grupos de eda
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La violencia como origen de la disc
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Braveman, Paula y Gruskin, Sofía (
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Las Desigualdades en Salud en Argen
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“Pobres siempre hubo”, fue una
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Investigaciones a nivel paísEl pa
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Figura 3. Relación entre razones d
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situación terminó con una saturac
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envejecida". Otra característica d
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Cuando fueron analizados los patron
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en el acceso a los medicamentos (Ca
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Universitaria, quizás sea un buen
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Instituto Nacional de Estadística
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de Lanús entre los años 1998 y 20
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condiciona las estrategias de atenc
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población abonaba una cobertura de
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Protección del capital físicoAlgu
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presenta en el cuadro 5 en el cual
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sugiere la existencia de subsidios
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Cuadro 8. Consultas Preventivas seg
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Implementación EconométricaLa pre
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ConclusionesEste trabajo retoma la
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Anexo ITabla de Equivalencias. Nece
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significado na perspectiva da saúd
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A Conferência Internacional sobre
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WHITEHEAD considera que nem todas a
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no esquema a seguir. Nela a equidad
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a equidade ao sugerir a distribuiç
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Isso, em certa medida, também expl
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têm influência sobre a saúde, qu
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Em correspondência com as taxas de
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o desenvolvimento do potencial de s
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Quadro 2. Unidades da Federação c
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política de saúde que desde o in
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Alocação de recursos financeiros
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maior carência de recursos (Norte
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Referências BibliográficasADAY, L
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Marginación Social y MortalidadEvi
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vida de las personas, sino también
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Cuadro 1. Numero de municipios y de
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La reducción más importante en n
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estrato de muy baja marginación- p
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Cuadro 5. Promedio de años de vida
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no pretende ser un análisis exhaus
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Indudablemente, la carencia de pol
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ecursos, por ejemplo- debe entender
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América Latina:Disparidad Social,
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desarrollar su máximo potencial y
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a la mitad (de 35,3% en 1990 a 17%
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Los datos también permiten constat
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cabría esperar que la cifra de ni
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Cuadro 3. Indicadores socioeconómi
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Cuadro 4. Indicadores seleccionados
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equidad como la ausencia de diferen
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Cuadro 9. Tasa de mortalidad de men
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años el número absoluto de niños
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PARTE IVeducación, políticas sani
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mediante el esfuerzo organizado de
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Poner a un mismo nivel de importanc
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dignidad humana e idénticos derech
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Dentro de este proceso educativo ex
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exige y fomenta la auto responsabil
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educación para el desarrollo de la
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tomar parte de la co munidad, en oc
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costumbres que logren cam bios de c
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formales y a través de los medios
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TORRES R. M. (2003) Educación popu
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justo e assim desejável, não se l
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tente de representar a condição d
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e’ afirmativa e foi corroborada p
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ou seja de diferenças sistemática
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as iniqüidades expressas na exposi
Page 269 and 270:
Estas quatro dimensões devem orien
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xidade e’ através de uma matriz
Page 273 and 274:
- renda familiar per capita igual o
Page 275 and 276:
Finalmente, podemos ilustrar (como
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mogêneo esta cidade terá um compo
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falam do estado da arte da democrac
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deverão estar estruturados em torn
Page 283 and 284:
A exigência de políticas pro equi
Page 286:
Desigualdad Social y Equidad en Sal
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