Abstract

JARAMILLO PEREZ, Iván. State's new role in the insurance and delivery of health services. Rev. salud pública [online]. 2001, vol.3, n.3, pp.191-222. ISSN 0124-0064.

After World War II, and based on the success of national health services developed by England and Cuba as centralized and state-centered models, Latin America began the establishment of National Health Systems as a strategy to construct unified national services within the context of the classic beneficent state. However, the crisis of the beneficent and interventionist state model lead to the development of the so called “modernization” policies which pretended to make the centralized States smaller, more equitable, efficient and agile. With these fundamental objectives, two types of public administration policy reforms have been implemented in the public and social services areas: decentralization and privatization. In the continent, the health services sector has been affected by these changes, and thus the vision of constituting unified national health services has been abandoned, assigning responsibilities and resources to municipalities and intermediate sub-national entities. Similarly, privatizing functions and transferring responsibilities and resources to the private sector consequently are generating an atmosphere of public-private competition. Within this context, Health Ministries have been forced to define their stewardship role, and to clearly state the non-transferable functions that must bee kept under their control. This paper analyses the new profile of stewardship organisms and the new forms of executing their functions in privatization and decentralization conditions.

Keywords : Health Services; Insurance; State; reform.

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