Abstract
BackgroundMost Latin American health systems are comprised of public (PubS), social security (SSS) and private (PrS) subsystems. These subsystems coexist, causing health care fragmentation and population segmentation.ObjectiveTo estimate the extent of subsystem cross-coverage in a geographically bounded population (Rosario city) and to compare the subsystems’ performance on primary health care (PHC) dimensions.MethodsThrough a cross-sectional, interviewer-administered survey to a representative sample (n = 822) of the Rosario population, we measured the percentage of cross-coverage (people with usual source of care in one subsystem but also covered by another subsystem) and the health services’ performance by core PHC dimensions, as reported by each subsystem’s usual users. We compared the subsystems’ performance using chi-square analysis and one-way analysis of variance testing. We analyzed whether the observed differences were coherent with the predominant institutional and organizational features of each subsystem.ResultsOverall, 39.3% of the population was affiliated with the PubS, 44.8% with the SSS and 15.9% with the PrS. Cross-coverage was reported by 40.6% of respondents. The performance of the PubS was weak on accessibility but strong on person-and-community-oriented care, the opposite of the PrS. The SSS combined the strengths of the other two subsystems.ConclusionRosario’s health system has a high percentage of cross-coverage, contributing to issues of fragmentation, segmentation, financial inequity and inefficiency. The overall performance of the SSS was better than that of the PrS and PubS, though each subsystem had a particular performance pattern with areas of strength and weakness that were consistent with their institutional and organizational profiles.
Highlights
Most Latin American ‘health systems’ are composed of public (PubS), social security (SSS) and private (PrS) subsystems
Dimensions of primary health care performance We reduced the large number of reported variables into broad dimensions of PHC using a categorical nonlinear principal components analysis (CATPCA) [14]
The positive correlation between the CAPTCA components suggests that improvements in overall accessibility and in the identification and ongoing care of people with chronic conditions would have a positive effect on the overall direction and continuity of care and would lower emergency care usage, in turn resulting in more integrated use of the health system
Summary
Most Latin American ‘health systems’ are composed of public (PubS), social security (SSS) and private (PrS) subsystems. Though the performance of their respective health services is expected to vary depending on the population served and each subsystem’s organizational and institutional features [1], an oversimplified portrait persists in policy documents and some of the peer-reviewed literature This portrait characterizes the private subsystem as more efficient, accountable and quality driven than the public health subsystem, in turn biasing public opinion and policy debate [2]. Rosario’s health system has a high percentage of cross-coverage, contributing to issues of fragmentation, segmentation, financial inequity and inefficiency.The overall performance of the SSS was better than that of the PrS and PubS, though each subsystem had a particular performance pattern with areas of strength and weakness that were consistent with their institutional and organizational profiles
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