Extending health coverage to millions of people in the Americas is a challenge

Washington, DC, January 2, 2003 (PAHO) -- The extension of social protection in health is a powerful public policy tool destined mainly to combat exclusion in health. An estimated 100 million people in Latin America and the Caribbean are not covered by existing health systems, and some 240 million are not protected by social security or private health insurance programs. Since 1999, the Pan American Health Organization (PAHO), and the International Labor Organization have been collaborating on a regional initiative to support efforts of Member States to reduce this figure.

The strategies for social protection in health aimed at eliminating exclusion in health are public interventions designed to guarantee access by citizens to decent and effective health care and reduce the negative economic and social impact of adverse personal situations, such as illness or unemployment, or general events, such as natural disasters, on the population or most vulnerable groups in society. In this context, social protection in health can be defined as society's guarantee, through the public authorities, that individuals or groups of individuals can meet their health needs and demands through adequate access to the health services of the system or of any of the existing health subsystems in the country, regardless of their ability to pay. Social groups that cannot take advantage of this guarantee constitute "the excluded" in health.

Extension of social protection in health involves a group of mechanisms designed to guarantee access by the population to health protection and health care through the allocation of resources of diverse origin, and not only the measures taken directly by the State to ensure health care through the public delivery of services. Thus, social protection is understood as the State's guarantee of a right that citizens can exercise, and not as a type of social welfare benefit that can be granted at the discretion of the authorities.

Three conditions must be met for this extension to function as a guarantee in practice, according to the PAHO report: Access to services: that is, that the necessary services exist for the delivery of health care and that people have physical and economic access to them; Financial security of the family: that the financing of health services does not threaten the economic stability of families or the development of their members; and Dignity in care: that quality health care is provided in an environment that respects the racial and cultural background of the users and their economic situation, determined through a process of social dialogue. These three conditions must be met, and the absence of one or more of them leads to some form of exclusion in health.

Poverty is one of the most important determinants of exclusion in health, the report notes.

Although poverty and exclusion are not identical, they overlap. In the absence of social protection systems, not only does poverty impede access to costly benefits, but the poor live and work in environments that expose them to greater risk of disease and death. These risks are directly related to less and lower quality food, the absence of adequate housing, overcrowding, and a scarcity of suitable recreational spaces. Communicable diseases are found largely among the poor. Diseases and injuries have both direct costs (prevention, cure, and treatment) and opportunity costs (days of lost work or school), which depend on the duration and severity of the disability and often accentuate poverty.

Although the current laws in most of the countries of the Region give all citizens the right to some type of health coverage, the report notes, this is far from the case in practice. Around 218 million people in Latin America and the Caribbean lack protection against the risks of illness, while some 107 million have no access to the health services because of geography.

Ministers of Health of the Americas, at their last Pan American Sanitary Conference in September, resolved to urge their countries to define national strategies to extend social protection in health and include as a guiding element in health sector reform processes.

Some of these strategies include the creation of community systems of social coverage, establishment of special regimens of social insurance, and voluntary insurance schemes with government subsidies, among other tools. The report notes that a package of services guaranteed with public financing, designed in accordance with epidemiological patterns and priorities of the country is a useful way to extend coverage and contribute to a more efficient allocation of resources.

PAHO was established officially in 1902 and is the oldest health organization in the world. It has been working for 100 years to improve the health and raise the living standards of the peoples of the Americas, and also serves as the Regional Office for the Americas of the World Health Organization.

For more information, please contact: Daniel Epstein, Office of Public Information, (202) 974-3459, e-mail: epsteind@paho.org.