Reformas de Salud y uso de la atención a la salud en tres Estados de India: prospectos para la Salud Pública
Resumen
En 1991 se introdujeron reformas al sector salud en varios estados de la India. La lógica fue la de incrementar las opciones y competencias para mejorar la calidad y el acceso al cuidado de la salud. Tales incentivos basados en la demanda fueron parte integral de los programas de estabilización macroeconómica a nivel mundial en los 90s. Para la mayoría de la población en India los costos asociados a la comercialización de los servicios de salud indujeron al endeudamiento de sus hogares. Utilizando datos primarios sobre los patrones de uso de servicios de salud (2002), este artículo parte de evidencia empírica recabada sistemáticamente para explorar el impacto preliminar de los cambios ocurridos entre 1991 y 2000 en el sector sanitario de Bengala Occidental (BO), Tamil Nadu (TN) y en el sector hospitalario de Andhra Pradesh (AP). El objetivo es el de proveer un contexto histórico a la experiencia de dichas reformas en los grupos sociales más pobres y vulnerables así como el de comprender los discursos actuales en torno a los sistemas de salud en India, con un énfasis sobre los “cuidados administrados” mediante un programa de seguro de salud universal. Exploramos las asociaciones pasadas y futuras entre los recortes presupuestales al gasto en salud y sus efectos a largo plazo sobre el acceso equitativo al cuidado a la salud en estos tres estados y en otros lugares del país.
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