Abstract
Introduction: Latin American health systems are generally described as comprising three health sub-systems that segregate the population in separate segments. The private sub-system (PrS) is usually described as serving the rich population with high quality standards; the public sub-system (PubS) as serving the poor population with low quality standards; and the social security (SS) falling some place in between. We argue that this is an oversimplified picture that persists because of the lack and fragmentation of data and the failure to recognize changes occurred in the private health market during the last decades. This work compares the performance of the PubS, SS and PrS health services in Rosario city. The findings are intended to contribute to the reflection and the current efforts to move forward to integrated and PHC-based health systems and to achieve universal health access and coverage in Latin America. Theory/Methods: This cross-sectional study compares the performance of the PubS, SS and PrS through a household survey to a representative sample of 822 inhabitants of Rosario Municipality, stratified by age with a confidence interval of 95% and 3.5% precision. The questionnaire included questions on population health status and insurance, demographic and socio-economic conditions, health services use and perception for core dimensions and sub-dimensions of PHC performance. The individuals were assigned to a health sub-system based on their affiliation of the self-reported usual provider to one of the health sub-systems. We did not consider health insurance as a stratified variable because of the high percentage of people with more than one type of insurance, as well as insured individuals that use public services. Sub-systems were compared to look for significant differences in PHC performance and in demographic socio-economic and health status) using Chi Square analysis for categorical variables and one-way ANOVA test for numerical variables. We use a categorical nonlinear
Highlights
Latin American health systems are generally described as comprising three health sub-systems that segregate the population in separate segments
The private sub-system (PrS) is usually described as serving the rich population with high quality standards; the public sub-system (PubS) as serving the poor population with low quality standards; and the social security (SS) falling some place in between. We argue that this is an oversimplified picture that persists because of the lack and fragmentation of data and the failure to recognize changes occurred in the private health market during the last decades
These components were negatively correlated in the PubS and PrS and non-correlated in the SS, so the CATPCA suggests the existence of a trade-off between access conditions to healthcare and the quality of the healthcare provided
Summary
39.3% of the population have their regular place of care in a PubS provider, 32.3% in the SS and 15.8% in the PrS. 35.8% of the PubS users have private or social security insurance, and 50.7% of the SS users have a private insurance. PubS had the best rate for individual, familiar and community orientation of care and appropriateness of care (use of the right place, provider and service), a strong rate for continuity of care and a poor rate for accommodation and comprehensiveness of care. PrS had the best rate for accommodation, strong results for comprehensiveness of care and a poor rate for continuity of care, healthcare orientation and appropriateness of care. The CATPCA grouped the variables in two components in all samples: the first one around accommodation and the second integrating the rest of the dimensions These components were negatively correlated in the PubS and PrS and non-correlated in the SS, so the CATPCA suggests the existence of a trade-off between access conditions to healthcare and the quality of the healthcare provided
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