Crónica de las mesas redondas con los socios de AES de Latinoamérica

With the purpose of strengthening ties with our collaborators from the Latin American Health Economics associations, the Board of Directors of AES Spain organized two round tables in order to deliberate on the current situation of the financing models of health systems and the main challenges and changes that they will experience in the near future.

On June 24, the first of these round tablesin which each of the speakers addressed the problem of financing the health system from their geographical area. In this way, the illustrators representing the National Health Fund (FONASA) and AES of Chile, Mr. Camilo Cid and Mr. Patricio Lagos, respectively, presented the current situation of the Andean country. Mr. Jairo Restrepo, from the University of Antioquia (Colombia), spoke on the financing of the health system in Colombia. The director of the School of Economics of the University of Costa Rica, Ms. Yanira Xirinachs, was in charge of explaining the case of Costa Rica. Ms. Erika Santos de Aragão, from the Federal University of Bahia (Brazil), was in charge of presenting, precisely, the situation in Brazil. Ms. Ana Balsa, from the University of Montevideo (Uruguay), presented the case of her country, and, finally, José María Abellán, from the University of Murcia (Spain), closed the session with the presentation of the financing model of the health system in Spain.

Among the topics addressed, it is worth highlighting collection systems, the evolution of out-of-pocket spending and financing by activity, all framed under the principles of universality, equity and decentralization.

A total of 40 listeners participated in the session, being able to contribute to the debate through their written messages in the chat and especially by asking questions out loud. The possibility of comparing the current situation with future possibilities for improvement, in different countries such as Chile, Colombia, Costa Rica, Brazil, Uruguay and Spain, generated a session rich in its debate and in the reflections transmitted.

Speakers and some of the listeners at the first round table.

The second round was held on September 24, focusing attention on the main challenges facing financing systems in Latin America and Spain. We have the same speakers, with the exception of Ms. Ana Balsa, who was replaced by Ms. Patricia Triunfo, from the University of the Republic of Uruguay. The event had the participation of more than 70 registrants, with a significant representation of professionals from Argentina and Spain, as well as Chile, Colombia and Uruguay.

The challenges are common in the various Latin American countries, as well as in Spain. The key questions that must be addressed for adequate financing are related to 1) the quantity and quality of resources to be allocated, in accordance with the needs of the country and in line with international standards, and the advice of global health agencies; 2) their distribution among the regions, being necessary to avoid territorial inequalities; 3) the review of user contributions to the financing of the system – where appropriate with the modality of complementary coverage, with new taxes or with co-payments. Some speakers highlighted the importance of containing the growth of spending on high-cost medicines and technologies and also underlined the growing spending needs derived from the components of aging (chronicity and dependency), making it imperative to face the challenge represented by financial insufficiency and the evolution of debt.

Speakers and moderator at the second round table. In order from left to right, 1st row: S. Gorgemans, C. Cid, P. Triunfo and JM Abellán. 2nd row: Y. Xirinachs, P. Lagos and E. Santos de Aragão.

In order to optimize activity and results in centers, it is necessary to consider precise strategies that promote performance and efficiency. In relation to this topic, José María Abellán cited a publication of our partners. Furthermore, he carefully examined the opinion issued by the Commission for Social and Economic Reconstruction, published in the Official Gazette of the Cortes Generales, on July 21, 2020.

In general, the main challenges of financing health systems would be related to the adequacy of financing to real needs, sustainability, efficiency, equity, access and quality of services without losing sight of the fact that health is also present, as indicated. Stringhini et al.in all policies, so the impact of each of them on health must be evaluated.

The main conclusions reached in this second round table show variations according to the countries:

• In Chile, it is vitally important to implement the universal coverage system in an effective and timely manner.
• In Brazil, the challenge is to achieve public spending on health that represents 6% of GDP.
• In Colombia, it is imperative to ensure coverage financing, even if this means resorting to the implementation of new taxes.
• Costa Rica, for its part, faces important challenges, such as reducing territorial inequalities, reducing waiting lists and improving infrastructure.
• In Uruguay, the principle of efficiency is required to be the guiding factor that governs access, cost control, care models, as well as remuneration systems for professionals.
• In Spain, it would be desirable to have greater resources, strengthen the increase in general income through the creation of specific funds, optimize pharmaceutical co-payments and avoid disparities between autonomous communities.

After the presentations, a lively debate began between the listeners and the cast of experts. Among other issues, the issue of the new tender for the complementary coverage modality in Chile was addressed.

The debates of these two round tables, as well as the presentations, will give rise to a specific “AES Document”, with all the participants in its authorship team and with its editing directed by Prof. JM Abellán. The webinars can be viewed on the AES YouTube channel.

The AES Board of Directors would like to express its sincere gratitude to the speakers, who have generously shared their time and experience to present the situation of health system financing in their respective countries.