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Revista Cubana de Salud Pública

versión impresa ISSN 0864-3466versión On-line ISSN 1561-3127


HERNANDEZ ALVAREZ, Mario. El enfoque sociopolítico para el análisis de las reformas sanitarias en América Latina. Rev Cubana Salud Pública [online]. 2003, vol.29, n.3, pp.228-235. ISSN 0864-3466.

The sociopolitical approach for the analysis of the health reforms in Latin America Taking into account the world health report 2000 of the World Health Organization, it is analyzed why its result is self deefeating and does not agree with what is considered by most of the health specialists studying it. The content of the world health report 2000 and other documents on health reform are analyzed by using the sociopolitical approach as a method and heuristic resource, or as a way to see the problem. The debate about the health systems is focused on the dilemma between equity and efficiency. The positions vary from those who consider that there is not such a dilemma, as long as the market resolves directly the distribution and the individual election is respected, to those who consider that it is necessary to prioritize the political option for equity to develop further strategies to attain an efficient management of resources. That´s the way the author thinks. Going deep into the Colombian case (the author is Colombian, too), it is asserted that the design of the reform in his country and in other Latin American countries do not guarantee the right to health care, as it is promised. The components of the system reform in Colombia are the following: compulsory insurance with a unique fund administered by the State, to establish a minimum compulsory plan of benefits, to contract the managers of the individual insurance policies adjusted to risk and to develop mechanisms focused on the public expenses to incorporate the extremely poor into the market. To analyze the health reforms, the organized and superposed perspectives of the power networks allows to explore the articulation among the state polycies, such as health and social security and the economic, social and political relations in a particular society. The states are built within the conflict between the social forces. This conflict results from the relation between the different possible orders constructed, lived and imagined by the diverse forms of social organization. They are normative conflicts based on social and economic relations. In the case of modern medical care the systems of values are compared trying to establish what is considered as fair, that is, to what you have the right. The models designed by technocracy are there, but there are always many more that are constructed by the social actors from their own conception. The cultural policies, that is, the set of symbolic structures and social practices by which the power is exerted, are established in the middle of the normative conflicts. This way, permanent confrontations are produced between the forces of conservation and transformation personified in social actors, and it is, in a wide sense, the «sociopolitical process» of societies


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