Mecanismos de pago y gestión de recursos financieros para la consolidación del Sistema de Salud de Ecuador

OBJECTIVE. Analyze the proposal by the Ministry of Public Health to reform the public financing model in Ecuador with regard to pooling of funds and payment mechanisms. METHODS. A literature review was done of the financing model, the current legal framework, and the budgetary bases in Pubmed, SciELO, LILACS Ecuador, and regional LILACS using the key words health financing, health financing systems, capitation,pooling of funds, health system reform Ecuador, health system Ecuador, and health payment mechanisms. Books and other documents suggested by health systems experts were also included. RESULTS. Review of the financing model enabled identifying the historical segmentation of Ecuador’s health system; out of this, the Ministry of Public Health conceived its proposal to reform the financing model. The Ministry’s proposed solutions are pooling of funds and payment of services at the first level of care through payment percapita adjusted for socioeconomic and demographic risks. Progress made in reforming the financing model includes design of the proposals and their implementation mechanisms, and discussions with stakeholders. CONCLUSIONS. Implementation of these changes may produce improvements for the health system in efficiency, spreading of risks, incentives for meeting health objectives, as well as contribute to its sustainability and advance toward universal healthcoverage. Nevertheless, legal, political, and operational constraints are hampering their implementation.