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On November 8 - 9, 2012, The Regional Workshop: “Financing Health Care Systems:  Macroeconomic and Fiscal Implications of Financing Universal Health Coverage” will be held in Washington, D.C. Participants will explore and discuss the macroeconomic and fiscal implications of pursuing universal health care coverage in the context of the current global economic environment.


Throughout the countries of the Americas governments have made strong commitments to reform health care services systems. The main goals are to expand coverage and ensure universal access in order to: a) provide all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality to be effective; and b) to ensure that the use of these services does not expose users to financial hardship (World Health Report 2010; WHO 2011)2. Some of the reform efforts have included changes in the organization and financing of public health care systems in order to expand or develop: a) a universal social health insurance (SHI) system, or b) a unified national (public) health care services system.

Evidence from comparative analyses of national health care expenditure of countries with health care systems characterized as having universal coverage shows some distinctive characteristics in the level and composition of national health care expenditures (NHEXP): an average NHEXP as percentage of GDP of about 10.6% and a 77/23 composition of the public/private mix of these expenditures ((OECD (2010); WHO (2010); CIHI (2011))3. These estimates suggest that in countries with national health care systems characterized as having universal coverage, public expenditure percentages represent, on average, around 8.2 % of GDP and private out-of-pocket expenditure about 2.4% of GDP (PAHO 2012). Among advanced economies with national health care systems characterized as having universal coverage, public expenditures ranged from around 6% to 12 % of GDP. Differences in the range of the share of public health care expenditures among health care systems organized as national/unified health care services systems, or as national social health insurance systems, are minor.

Several countries of the Americas4, including the United States of America, have made strong political commitments to the attainment of universal health coverage. However, few of these countries have health care systems with the organization, financing and expenditures features that characterize countries with universal health coverage. 5

Workshop Objectives:

To explore and discuss the macroeconomic and fiscal implications of pursuing universal health care coverage in the context of the current global economic environment.

Experts in the areas of: health economics and health systems financing, macroeconomic assessment and fiscal implications of public policies for health and health systems development; and professionals from health economics units or departments (UES/DES) from the Ministries of Health of countries in the region.

Documents and presentation:

November 8th.

icon Agenda

Session I: National Health Expenditure Trends in the Americas (Demographic, Epidemiological and Nutritional Transitions)

icon Rubén Suarez. National Health Care Expenditures in Latin America and the Caribbean: Trends, Macroeconomic and Fiscal Challenges (937.21 kB)

icon PAHO. Health Care Expenditure and Financing in Latin America and the Caribbean [Fact Sheet] 2012.                    (updated to January 31st, 2013)

icon Charles Roehrig. Health Care Expenditures Trends in the USA and the Fiscal Cliff: What´s ahead? (1.22 MB)

Session II: Reforming Health Care Systems and Universal Health Coverage; Experiences

icon Benedict Clements. The Economics of Public Health Care Reform in Advanced and Emerging Economies (337.77 kB)

icon Daniel Cotlear. Universal Health Coverage from the bottom-up: How it is being done in 25 countries and how researchers can help (321.14 kB)

icon Joseph Kutzin. Health financing for Universal Coverage: what’s working, and what issues between health and finance? (2.35 MB)

Session III: Round Table - Country Experiences: Financing Social Health Insurance Systems (SHI) in Latin America and the Caribbean: Macroeconomic and Fiscal Challenges

icon Jairo Humberto Restrepo Zea. Alternativas para financiar el Sistema de Seguridad Social en Salud de Colombia: avances, limitaciones y retos. (1.45 MB)

icon Gustavo Picado. Financing Social Health Insurance in Costa Rica: Fiscal Challenges. (765.54 kB)

icon Mónica Aravena Pastén. Acceso Universal Garantías Explicitas (AUGE) (1.87 MB)

icon Gaston Palópoli. Presentación de experiencia de Argentina (1.16 MB)

Session IV: Round Table - Country Experiences. Financing Unified and Segmented Public Health Care Services Systems in Latin America and the Caribbean: Macroeconomic and Fiscal Challenges

icon Stanley Lalta and Jasper Barn. Implications of Macroeconomic and Fiscal Space for Health Financing in the Caribbean (990.49 kB)

icon A. Lorena Prieto. Financing of public health care services in Andean countries: current patterns and fiscal challenges

icon Corah Prado. Financiamiento del Sistema Único de Salud de Brasil. (1.21 MB)

November 9th

Session V: Macroeconomic and Fiscal Implications of Financing Universal Social Protection Programs: Health and Pensions

icon Oscar Cetrángolo. Financiamiento de la salud y protección social en América Latina: desafíos macroeconòmicos y fiscales (2.91 MB)

Session VI: Taxation and Equality in Latin America: Who benefits from Public Expenditure in Health Care?

icon Juan Pablo Jiménez. Taxation and equality in Latin America: an overview (435.6 kB)

icon Alejandra Contreras. The Regional Workshop: “Financing Health Care Systems: Macroeconomic and Fiscal Implications of Financing Universal Health Coverage November 8 - 9, 2012 (1.37 MB)

icon Camilo Cid Pedraza. El impacto distributivo del gasto público en bienes y servicios de salud (375.78 kB)

Session VII: Equity and Sustainability Issues: Health Systems and Fiscal Challenges of NCDs and Financing Social Protection in Health

icon Gisele Almeida. Building knowledge to inform policies (1.66 MB)

icon Claudia Pescetto. Economic dimensions of NCDs Region of the Americas - Overview (6.4 MB)

icon Julio A. Siede. Desafíos del Financiamiento de la Protección Social en Salud en America Latina y el Caribe (601.06 kB)

Session VIII: Round Table/Open Discussion; Financing Health Care Systems: Addressing Macroeconomic and Fiscal Challenges

Photo Gallery


English and Spanish (Simultaneous Interpretation)

Activity Coordinator:
Ruben M. Suarez-Berenguela
Senior Advisor, Health Economics and Financing
Ph. +1-202 974 3482

Administrative Support:

Ms. Jesecca Ortiz Huynh
Administrative Assistant
Ph. +1-202 974 3610



1 Most of the information summarized in this section is taken from Health in the Americas, Edition 2006; Pan American Health Organization, Washington DC, September 2007.

2 In 2010 the World Health Assembly unanimously adopted a resolution urging countries to develop their health financing systems to achieve these two goals, defined them as achieving universal health coverage. The more the countries rely on direct payments, such as user-fees, to fund their health systems, the more difficult it is to meet these two objectives (WHO 2011).

3 In the year 2000, the share of public expenditures in OECD countries health care systems of universal coverage represented around 6.4 % of the GDP (PAHO 2007; OECD 2005); in 2010, it represents about 7.2% of the GDP (CIHI, 2011).

4 The region of the Americas includes the countries of Latin America and the Caribbean; as well as Bermuda, Canada, the United of America (US) from the North American Region; and the French, United Kingdom and US island territories in the Caribbean.

5 Aruba, Antigua & Barbuda, Canada, Cuba, and the now-dissolved Netherlands Antilles (Now Curacao, Sint Marteen and BES Islands of Bonaire, Sint Eustatius and Saba as Netherland’s special territories).


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Última actualización el Miércoles 06 de Febrero de 2013 19:58

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