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Cad Saude Publica. 2002;18 Suppl:23-36. Epub 2003 Jan 21.

[Equity and health sector reform in Latin America: a necessary debate].

[Article in Portuguese]

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Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública, Fundaçao Oswaldo Cruz, Rio de Janeiro, RJ, 21041-210, Brasil.


Reform and equity are terms that have frequented political discourse, technical documents, and conceptual discussions in recent decades in different proposals with different ideological references. To understand the importance and centrality of these themes in the contemporary debate in Latin America implies a more in-depth reflection on health policy in the sphere of social policies and to define which reforms were are discussing and the place equity occupies in this discussion. The first part of this essay discusses the concepts of reform and equity, followed by a review of health policy as a social policy. The article ends by discussing the central elements on the health systems reform agenda in Latin America. The conclusion is that the situation is dramatic and that recent reforms have exacerbated inequalities and created new problems by replacing the values of solidarity and equal opportunity with those of "radical utilitarian individualism"; meanwhile, the principle of "health needs" has been replaced by that of "risk", "monetarized" and defined according to the individual's social and economic position. It becomes necessary to resume the discussion of social and health policies as the matrix of principles justifying the order ascribed to any other policies.

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