Jens Holst

Latin America, the region with the highest social inequalities, faces the challenge of guaranteeing all citizens an adequate level of health care in terms of access, quality and opportunity, regardless of their individual or current ability to pay. In contradiction with legal regulations in most countries, approximately 220 million people in Latin America and the Caribbean lack social protection against the risks of illness. Health systems in most Latin American countries are characterised by the coexistence of various sub-systems with different financing, membership, and benefit regimes, covering different socio-economic groups. This segmentation tends to enhance social exclusion in health because the subsystems are vertically integrated and offer coverage to specific population groups only. Universal coverage is difficult to achieve in segmented systems as long as no overall regulation and contractual obligations are in place.

Recently, a series of initiatives have started in Latin America to reduce social exclusion and improve social protection in health. The enforcement of social policy measures by international donors (HPIC-Initiative, MDGs) was a strong motivation for governments to create targeted insurance plans with a limited benefit package dedicated to maternal and infant health problems. Bolivia started to implement a mother-child health insurance scheme on the national level, while Peru initiated a pilot program that has continuously extended ist geographic scope. The Paraguayan health ministry has also started a mother-child plan pilot scheme. On the other hand, specific social security systems have emerged to improve access and quality of care for professional groups.

Health Microinsurance: A Comparison of Four Publicly-run Schemes. Latin America.

CGAP Working Group on Microinsurance Good and Bad Practices, Case Study No. 18