Lógicas de transformación de los sistemas de salud en América Latina y resultados en acceso y cobertura de salud

OBJECTIVE: Characterize health system reform processes implemented in eight Latin American countries and evaluate their results in terms of health access and coverage conditions. METHODS: Data from nationally representative household surveys were used to characterize health system reform processes in Chile, Colombia, El Salvador, Guatemala, Mexico, Paraguay, Peru, and Uruguay and to assess resulting conditions governing health care access and coverage. RESULTS: Five countries introduced changes to expand financial coverage, with a perspective on primary health care limited to the expansion of health service packages, while three countries prioritized changes in health service organization based on a more comprehensive approach to primary health care. Countries in the first group increased insurance coverage but saw no improvement in access to health services. In the second group of countries, important barriers to access continue to exist despite improvements. CONCLUSIONS: Health system reforms can be described in terms of the type of transformations promoted. Reforms that focus on expanding insurance coverage improve financial protection but do not result in positive changes in access. Reforms that prioritize transformations in the organization of health services lead to improved access, yet a large proportion of the population continues to report barriers to access in the countries studied. The socioeconomic conditions of the population and unstable policies stand in the way of achieving more significant progress.