2023-09-28 14:46:10 +00:00
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abstract: 'Introduction: Brazil and Colombia have pursued extensive reforms of
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their health care systems in the last couple of decades. The purported
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goals of such reforms were to improve access, increase efficiency and
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reduce health inequities. Notwithstanding their common goals, each
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country sought a very different pathway to achieve them. While Brazil
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attempted to reestablish a greater level of State control through a
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public national health system, Colombia embraced market competition
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under an employer-based social insurance scheme. This work thus aims to
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shed some light onto why they pursued divergent strategies and what that
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has meant in terms of health outcomes.
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Methods: A critical review of the literature concerning equity
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frameworks, as well as the health care reforms in Brazil and Colombia
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was conducted. Then, the shortfall inequality values of crude mortality
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rate, infant mortality rate, under-five mortality rate, and life
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expectancy for the period 1960-2005 were calculated for both countries.
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Subsequently, bivariate and multivariate linear regression analyses were
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performed and controlled for possibly confounding factors.
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Results: When controlling for the underlying historical time trend, both
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countries appear to have experienced a deceleration of the pace of
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improvements in the years following the reforms, for all the variables
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analyzed. In the case of Colombia, some of the previous gains in
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under-five mortality rate and crude mortality rate were, in fact,
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reversed.
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Conclusions: Neither reform seems to have had a decisive positive impact
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on the health outcomes analyzed for the defined time period of this
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research. This, in turn, may be a consequence of both internal
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characteristics of the respective reforms and external factors beyond
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the direct control of health reformers. Among the internal
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characteristics: underfunding, unbridled decentralization and
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inequitable access to care seem to have been the main constraints.
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Conversely, international economic adversities, high levels of rural and
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urban violence, along with entrenched income inequalities seem to have
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accounted for the highest burden among external factors.'
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affiliation: 'Esteves, RJF (Corresponding Author), Esplanada Minist, Secretariat Labor
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\& Educ Management Hlth SGTES, Minist Hlth Brazil, Bloco G,Ed Sede,Sala 704, BR-70680350
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Brasilia, DF, Brazil.
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Esplanada Minist, Secretariat Labor \& Educ Management Hlth SGTES, Minist Hlth Brazil,
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BR-70680350 Brasilia, DF, Brazil.'
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article-number: '6'
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author: Esteves, Roberto J. F.
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author-email: resteves@mail.com
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author_list:
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- family: Esteves
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given: Roberto J. F.
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da: '2023-09-28'
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doi: 10.1186/1475-9276-11-6
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files: []
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issn: 1475-9276
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journal: INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH
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keywords: 'Brazil; Colombia; health care reform; health care system; equity; health
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inequities; comparative analysis; health policy'
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keywords-plus: INEQUALITIES; POLICY
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language: English
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month: FEB 2
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number-of-cited-references: '39'
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papis_id: 241f5c4c0926abffc4a834ca30c32088
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ref: Esteves2012questequity
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times-cited: '18'
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title: 'The quest for equity in Latin America: a comparative analysis of the health
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care reforms in Brazil and Colombia'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000302479900001
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usage-count-last-180-days: '0'
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usage-count-since-2013: '15'
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volume: '11'
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web-of-science-categories: Public, Environmental \& Occupational Health
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year: '2012'
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