Health Services in Latin America and Asia by IDB

Health Services in Latin America and Asia

FLEURY

tion by private health service providers. The tools of the ongoing reform processes include decentralization, privatization, competitiveness enhancement, and user empowerment. The present study will analyze the ways in which the emergence of new social-policy models is changing the power structure of the Latin American countries' health sectors. It will describe in some detail the reforms' equity consequences and governance-related impact in several different countries of the region, highlighting the interplay between efficiency and social integration that is one of the key issues of democratic self-government in Latin America. Historical Pattern of Development1 Despite the many differences among Latin American countries, the region showed a common pattern of social and economic development from the 1950s to the 1980s, characterized by a strong and active presence of the state, led by the import substitution model of industrialization. Concerning the political system, authority in the region is administered in an oligarchic way, combining mechanisms of patrimonialism, populism, and exclusion. We define as patrimonialism any kind of private appropriation of public goods by the elite; as populism, the exchange of privileges by means of workers' co-optation by the government; and as exclusion, the process of denying citizenship status and social rights to the poorest people. As a consequence, the region presents a strongly authoritarian political culture and the worst income distribution in the world. According to the IDE report2 for 1999, a mere 5 percent of the population receives 25 percent of the national income and 10 percent of the population receives 40 percent of the national income, while the poorest 30 percent of the population receives only 7.5 percent. During the second half of the century, there began an intense and varied process of urbanization in all the countries. But the period of rapid growth in the region from 1945 to 1973 did not lead to a notable improvement in income distribution, because of the nature of the institutions generated by the political, social, and economic structures.3 1

The English-speaking Caribbean countries have not been considered in the study because of their different pattern of development that has resulted in more extensive social protection systems. 2 IADB 1998-99. 3 Thorp 1999, chapter 2.