Republic of Uruguay Integrated National Health System : Analysis of the Governability of the SNIS Benefit Plan
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Washington, DC
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Today the health reform in Uruguay is a
mature, ongoing process in which major progress has been
consolidated. At the same time, like all systems, it faces
challenges in the immediate, medium, and long term, and how
they are resolved will not only shape the ultimate outcome
of many of the processes currently under way, and but will
also impact the sustainability of the accomplishments so
far. The purpose of this study is to contribute to
development of the integrated national health system (SNIS)
by analyzing and identifying policy options aimed at
improving its governance, equity, efficiency, and
sustainability through the government's use of control
variables in order to achieve and maintain conditions of
governability and efficiency, which will contribute to the
stability and sustainability of the results. The present
study analyzes the main variables that Uruguay has at its
disposal to manage a central aspect of regulating the sector
namely, the plan of benefits that the population receives to
cover their health needs. This plan has important
consequences for both health and the economy. The specific
objectives of the study were to analyze the following three
aspects of the SNIS: (i) the conditions of governance and
governability of its benefit plan, (ii) methodological
aspects of determining the premium to be received by
insurers, and (iii) the capacity of the management
information systems that are being used to monitor and
evaluate the benefit plan. The document has three sections:
(i) background; (ii) health coverage: critical aspects that
affect its governability, specifically: (a) the benefit plan
and the conditions of its governance, (b) the methodologies
used to determine the premium, and (c) the health
information systems used to monitor and evaluate the benefit
plan; and (iii) conclusions and policy options. Finally,
there are seven annexes that provide details on the topics discussed.
Palabras clave
ACQUIRED IMMUNODEFICIENCY SYNDROME, ADOLESCENT HEALTH, ADVERSE SELECTION, ALLOCATIVE EFFICIENCY, BASIC LEGISLATION, BIOETHICS, CANCER, CAPITATION, CARDIOVASCULAR DISEASES, CENSUSES, CENTER FOR HEALTH, CHILD HEALTH, CITIZEN, CITIZENS, COMMUNICABLE DISEASES, COMPETENCIES, COMPREHENSIVE HEALTH INSURANCE, COST ANALYSIS, COST DIFFERENTIALS, COST EFFECTIVENESS, DELIVERY OF HEALTH SERVICES, DEMAND FOR SERVICES, DEVELOPING COUNTRIES, DIAGNOSIS, DIAGNOSTIC PROCEDURES, DIALYSIS, DISABILITIES, DISABILITY, DISSEMINATION, DRUG USERS, DRUGS, DYNAMIC BALANCE, ELDERLY, EMERGENCY CARE, EPIDEMIOLOGY, EQUILIBRIUM, EXPENDITURES, FAMILY MEMBERS, GENDER DISCRIMINATION, GOOD GOVERNANCE, HEALTH AFFAIRS, HEALTH CARE, HEALTH CARE COSTS, HEALTH CARE INSTITUTIONS, HEALTH CARE PLAN, HEALTH CARE PRODUCTS, HEALTH CARE PROVIDERS, HEALTH CARE SERVICES, HEALTH CONDITIONS, HEALTH CONTROL, HEALTH COVERAGE, HEALTH ECONOMICS, HEALTH EXPENDITURE, HEALTH INDICATORS, HEALTH INFORMATION, HEALTH INFORMATION SYSTEM, HEALTH INFORMATION SYSTEMS, HEALTH INSURANCE, HEALTH MARKET, HEALTH NEEDS, HEALTH ORGANIZATION, HEALTH OUTCOMES, HEALTH POLICY, HEALTH PROBLEMS, HEALTH PROFESSIONALS, HEALTH PROGRAMS, HEALTH PROMOTION, HEALTH PROVIDERS, HEALTH REFORM, HEALTH REGULATION, HEALTH RESULTS, HEALTH SECTOR, HEALTH SECTOR REFORM, HEALTH SECTOR WORKERS, HEALTH SERVICE, HEALTH SERVICE PROVIDERS, HEALTH SERVICES, HEALTH SERVICES ADMINISTRATION, HEALTH SYSTEM, HEALTH SYSTEM REFORM, HEALTH SYSTEMS, HEALTH TARGETS, HEALTH TECHNOLOGY EVALUATION, HEALTH WORKERS, HIV, HIV INFECTION, HOSPITAL, HOSPITAL INPATIENT, HOSPITALS, HOUSEHOLD SIZE, HR, HUMAN DEVELOPMENT, HUMAN IMMUNODEFICIENCY VIRUS, HUMAN RESOURCES, ILLNESS, ILLNESSES, IMMUNODEFICIENCY, INCOME, INDEXES, INDIVIDUAL MEMBERS, INDIVIDUAL RIGHTS, INFANT, INFANT MORTALITY, INSTITUTIONAL MECHANISMS, INSURANCE COMPANIES, INSURANCE COVERAGE, INSURANCE PREMIUM, INSURANCE SYSTEM, INSURANCE SYSTEMS, INTEGRAL HEALTH CARE, INTEGRATED HEALTH CARE, INTEGRATION, INTERVENTION, IUD, JUDICIAL OVERSIGHT, LARGE NUMBER OF PEOPLE, LAWS, LEGAL FRAMEWORK, LEGAL RIGHTS, LIFE YEARS, LIVE BIRTHS, MANDATES, MEDICAL ASSOCIATION, MEDICAL BENEFITS, MEDICAL CARE, MEDICAL SERVICES, MEDICAL TECHNOLOGY, MEDICATION, MEDICINES, MENTAL HEALTH, MENTAL HEALTH SERVICES, MIGRATION, MINISTRY OF HEALTH, MINORITY, MORBIDITY, MORTALITY, MORTALITY RATE, NATIONAL HEALTH, NATIONAL HEALTH INSURANCE, NATIONAL HEALTH SERVICE, NATIONAL HEALTH SYSTEM, NATIONAL HEALTH SYSTEMS, NATIONAL LEGISLATION, NATIONAL LEVEL, NATIONAL POPULATION, NUTRITION, OLDER ADULTS, ORAL HEALTH, PATIENT, PATIENTS, PEDIATRICS, PERSONS WITH DISABILITIES, PHYSICIANS, PLACE OF RESIDENCE, POINT OF DEPARTURE, POLICY DISCUSSIONS, POPULATION DENSITY, POPULATION GROUPS, PREGNANT WOMEN, PRIMARY CARE, PRIMARY HEALTH CARE, PRIVATE HEALTH INSURERS, PRIVATE INSURANCE, PRIVATE INSURERS, PRIVATE SECTOR, PROGRESS, PUBLIC HEALTH, PUBLIC HEALTH SERVICES, PUBLIC POLICY, PUBLIC PROVISION, PUBLIC SERVICE, QUALITY CARE, QUALITY OF CARE, QUALITY OF SERVICES, REHABILITATION, RESOURCE ALLOCATION, RESPECT, RISK FACTORS, SANITATION, SCREENING, SERVICE DELIVERY, SERVICE QUALITY, SEX, SEXUALLY TRANSMITTED INFECTIONS, SOCIAL CAPITAL, SOCIAL PARTICIPATION, SOCIAL PRESSURE, SOCIAL SECURITY, SOCIAL SECURITY HEALTH INSURANCE, SPOUSES, STDS, TREATMENTS, UNEMPLOYMENT, VASECTOMY, WORKERS, WORLD HEALTH ORGANIZATION