This event is the fourth in a series of virtual seminars to discuss strategies to increase access to health in the Americas with a PHC perspective. In the pathway to Universal Health, the participation of private sector actors presents several opportunities and challenges in their incorporation within national health policies and plans to ensure alignment with national priorities in health according to each context.
Date: Tuesday, October 31st, 2023
Hour: 10:00 a.m. - 11:30 a.m. (EDT)
Private health insurance refers to a set of diverse situations where an individual user of health services decides (or an actor on behalf of a group of users through, for example, their employer) to opt for insurance coverage provided by a private agent that can be of a for-profit or not for profit nature. Concerning public insurance coverage, this option can occur in several ways that imply either the substitution/replacement of a public agent in managing of the main insurance coverage or some form of complementary or supplemental of said primary coverage.
There is a widespread presence of private insurance mechanisms in Latin America and the Caribbean, both in systems that are predominantly financed through social security mechanisms and in health systems financed primarily from general taxes and public provision of services.
The significance of this market in terms of total resources mobilized and the population serves varies significantly between countries, as well as the role that private insurers play to the public coverage. These situations generate a set of challenges in to regulating and designing specific policies for each circumstance to guarantee that such participation aligns with the direction of Universal Health’s objectives and not to their detriment.
In this regard, the Pan American Health Organization is producing a characterization of the situation in the Region, starting with study cases of Chile, Colombia, and Jamaica. For this purpose, a pilot data collection guideline is being piloted in these countries, aiming at data collections broadly applicable to different contexts but that can also capture the singularities of each reality.
Objective
The main objective of the virtual event is to generate a Regional space for discussion about challenges and opportunities of private sector actor’s participation in health, emphasizing the insurance function, in the light of the preliminary results in the study cases. The presentation of these results and the technical-political discussion is guided by an analysis framework that understands regulation as a subfunction of the rectory function, that governs the relationship between different agents with participation in the health system.
Agenda
Natalia Houghton, Specialist, Health Systems and Services Analysis, Monitoring and Evaluation (PAHO/WHO): Master of ceremony
Ernesto Báscolo, Unit Chief, Primary Health Care and Integrated Service Delivery, (PAHO/WHO): Conceptual and institutional framework of the regulatory function in health
David Debrott, International Consultant, (PAHO/WHO): Information collection preliminary results: characterization of the situation in Chile, Colombia and Jamaica
Reactions from representatives of countries that are part of the study
- Chile: Víctor Torres, Superintendente de Salud
- Colombia: Margarita María Escudero Osorio, Directora de Regulación de la Operación del Aseguramiento en Salud, Riesgos Laborales y Pensiones
- Jamaica: Jasper Barnett, Chief Health Economist and Data Scientist, Ministry of Health and Wellness
Experts’ comments: country (Brazil) and regional perspective
- Ana Paula Silva Cavalcante, Gerente de Estímulo à Inovação e Avaliação da Qualidade Setorial, Especialista em Regulação de Saúde Suplementar Agencia Nacional de Salud Suplementar (ANS)
- Oscar Cetrángolo, Profesor Titular e Investigador IIEP (UBA - CONICET) Facultad de Ciencias Económicas - Universidad de Buenos Aires
Juan Pablo Pagano, Specialist, Health Economics and Financing, (PAHO/WHO): Common challenges, lines of work and conclusions
James Fitzgerald, Director, Health Systems and Services Department, (PAHO/WHO): Closing remarks