Social Health Protection The view from the Pan-American Health Organization Ruben Torres Manager Area of Health Systems based on Preventive Health Care Public Health Policy and Research Project Coordinator Inter-American Social Protection Network (IASPN) Technical Consolidation Meeting, August 10 and 11, 2011 Mexico City, Mexico

Social Health Protection

GDP Growth-2003/2009 Selected countries source: ECLAC

Trend in Public Social Spending and Total Public Spending as a % of GDP (18 LAC countries)

Public Social Spending by sector (in % of GDP-21 countries Fuente: CEPAL Fuente: CEPAL, sobre la base de información proveniente de la base de datos sobre gasto social de la Comisión. a Promedio ponderado de los países, excluida Nicaragua. b La información disponible no permite separar ambas partidas de gasto. Según antecedentes de estudios nacionales, la seguridad social representaría alrededor de 78% del monto de recursos aquí consignados.

Selected countries in America PRIVATE SPENDING in HEALTH (OOP and PP) (PPP int $) (Organized by TOTAL EXPENSE) Fuente: NHA-WHO 2007

Private Insurance Expenditure & Income Per Capita

The way to universal coverage LIMITED PUBLIC FUNDING PRIVATE SPENDING PREVAILS INCREASE PUBLIC FUNDING (insurance,etc.) PRIVATE INSURANCE COVERS OTHER SEGMENTS OF THE POPULATION MOST OF THE POPULATION COVERED BY MEANS OF PUBLIC FUNDING PLANS PRIVATE INSURANCE OFFERS SECONDARY COVERAGE (complementary or supplementary) PUBLIC FUNDING PRIVATE FUNDING

Regulations What and how much to regulate? Single regulatory framework for the public and private system? Objectives of regulation and externalities.

Three dimensions of progress toward universal coverage

International Comparison of Tax Burden 1980/2005

Tax Burden

International Comparison of Tax Burden

The Diversity of Latin America

80’s & 90’s SISTEMAS SEGMENTADOS REFORMAS DEL SISTEMA DE SALUD “REFORMED” HEALTH SYSTEMS SERVICIO NACIONAL DE SALUD SEGURO SOCIAL DE SALUD “EMPRESARIAL”

Total Worldwide Health Financing (4,4 trillion in 2005) Public Spending (Social Security not included) 33 % Private Insurance 19 % Social Security 26 % Out of pocket 18 % Other 4 %

Welcome to The Health System Entrance

Effect of out of pocket spending on catastrophic spending and impoverishment

Distribution of health expenditure 30% or more than tri-monthly available income, per household & income <knaul,F.M. et al. Salud pública de México/vol.49,sup.1, 2007

LATIN AMERICA : IMPACT OF REDISTRIBUTING PÚBLICO SOCIAL SPENDING ACCORDING TO QUINTILES OF PRIMARY INCOME (in percentages) Public social spending exerts important influence on welfare of the poorest segment… Fuente: CEPAL, sobre la base de estudios nacionales. a/ 18 países. Promedio ponderado por la significación del gasto en el ingreso primario de cada país.

Social Factors Determining Health Equity & Health in all policies Good Global Governance Gender Equity Empowerment (Inclusion & voice) Market Responsibility Adequate Financing Early-childhood dev. Education Healthy environment Adequate employment Social protection Universal health care Conditions in which people are born, raised, live, work and age

Level of income in countries and deaths at ages 0-4 and over 60. Source: Deaton (2006).

Social Obsolescence Social Obsolescence: Inadequate attention to people’s needs: high-tech services that are expensive and inaccessible Inadequate attention to people’s needs: high-tech services that are expensive and inaccessible

Components of the growth in health expenditure California HealthCare Foundation, 2010.

Accelerated production of health technology Healthcare market and introduction of technological innovation “De-medicalization” of initially medical technological resources Regulation and Evaluation of health technology Technology as problem

HEALTH FOR ALL Information & Knowledge Human Rights Preventive Health Care Social Protection Promoting Health