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Colombia and Cuba, contrasting models in Latin America's health sector reform

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Abstract
Latin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far-reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful - and radical - example of 'market-oriented' health care reform, and Cuba, which followed a highly 'conservative' path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign - especially North American - corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.
Keywords
Latin America, Cuba, Colombia, health sector reform, privatization, national health system, MANAGED CARE, UNITED-STATES, TRANSFORMATION, SYSTEM, POLICY, COSTS

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Chicago
De Vos, Pol, Wim De Ceukelaire, and Patrick Van Der Stuyft. 2006. “Colombia and Cuba, Contrasting Models in Latin America’s Health Sector Reform.” Tropical Medicine & International Health 11 (10): 1604–1612.
APA
De Vos, Pol, De Ceukelaire, W., & Van Der Stuyft, P. (2006). Colombia and Cuba, contrasting models in Latin America’s health sector reform. TROPICAL MEDICINE & INTERNATIONAL HEALTH, 11(10), 1604–1612.
Vancouver
1.
De Vos P, De Ceukelaire W, Van Der Stuyft P. Colombia and Cuba, contrasting models in Latin America’s health sector reform. TROPICAL MEDICINE & INTERNATIONAL HEALTH. 2006;11(10):1604–12.
MLA
De Vos, Pol, Wim De Ceukelaire, and Patrick Van Der Stuyft. “Colombia and Cuba, Contrasting Models in Latin America’s Health Sector Reform.” TROPICAL MEDICINE & INTERNATIONAL HEALTH 11.10 (2006): 1604–1612. Print.
@article{360755,
  abstract     = {Latin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far-reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful - and radical - example of 'market-oriented' health care reform, and Cuba, which followed a highly 'conservative' path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign - especially North American - corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.},
  author       = {De Vos, Pol and De Ceukelaire, Wim and Van Der Stuyft, Patrick},
  issn         = {1360-2276},
  journal      = {TROPICAL MEDICINE & INTERNATIONAL HEALTH},
  keywords     = {Latin America,Cuba,Colombia,health sector reform,privatization,national health system,MANAGED CARE,UNITED-STATES,TRANSFORMATION,SYSTEM,POLICY,COSTS},
  language     = {eng},
  number       = {10},
  pages        = {1604--1612},
  title        = {Colombia and Cuba, contrasting models in Latin America's health sector reform},
  url          = {http://dx.doi.org/10.1111/j.1365-3156.2006.01702.x},
  volume       = {11},
  year         = {2006},
}

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