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Research for Innovation in Health Systems - Improving the Management of Health Care Services for Patients with Multiple Chronic Conditions in Three Latin American Countries: Brazil, Colombia and Uruguay - Key Messages
(Washington, DC: World Bank, 2024-06-24) World Bank
The accelerated aging of the Brazilian population, alongside the gradual increase in the concomitant occurrence of multiple chronic diseases in the same individual, brings important challenges to the Brazilian National Health System (SUS). n Colombia, during 2012 - 2016, multimorbidity had a prevalence of 19.5 percent for all ages, according to data from the study carried out by the World Bank and the Ministry of Health and Social Protection. The investigation also showed an increase in the use and cost of health services associated with older age and the complexity of multimorbidity, in an aging population that shifts its epidemiological profile towards chronic diseases. The expenditure with patients with multimorbidity in Uruguay is high. Persons with five or more of diseases (Cardiovascular Disease, High Blood Pressure, Diabetes, Chronic Obstructive Pulmonary Disease and Degenerative Neurological Disease) represent 8.44 percent of the total patient population, but their care accounts for 42.07 percent of the total expenditure, and 50.48 percent of the expenditure on medications.
Proposal to Optimize the Care Model for People with Chronic Diseases and Multimorbidity in Uruguay
(Washington, DC: World Bank, 2024-06-20) World Bank
The importance of Chronic Disease (CD) in Uruguay has been widely analyzed for many years and in multiple studies and reports 1, 2, 3. Its impact on mortality and its high cost of care was decisive in creating various health promotion and primary and secondary prevention strategies, whose impact has begun to be perceived in the change in trends in some specific areas, such as cardiovascular diseases. However, beyond measures to include specific programs and benefits for CD care and general organization guidelines for health services to satisfy the spontaneous demand generated by CD, there have not been many review initiatives of the care models for CD, especially about the multimorbidity problem, except for the development by the Ministry of Public Health (MPH) of the “Guide to Frailty in Older Adults: Practical Criteria and Research Instruments in The First Level of Care”, an aspect of great clinical relevance about both CD and multimorbidity for human resources and providers of the National Integrated Health System (NIHS). This document presents the work carried out in Uruguay, which culminates with the proposal of the Comprehensive Model of Care for Multimorbidity and includes the study’s results. As such, the authors present the general and specific objectives, the methodology for each of the proposed phases, the results and main contributions to the country and the region, and finally, future projections or possibilities.
Social Inclusion in Uruguay
(World Bank, Washington, DC, 2020-05-01) Freire, German; García Mora, María Elena; Lara Ibarra, Gabriel; Schwartz Orellana, Steven
Uruguay is a regional leader in the path toward social inclusion. Sustained economic growth and redistributive policies have made it the most egalitarian country in Latin America. However, some groups are still excluded. Afro-descendants, persons with disabilities, women particularly in female-headed households and LGBTI people are more likely to be excluded. They face unequal opportunities, lower accumulation of human capital and skills, and a lack of voice and agency to have their points of views and aspirations of development included in decision making. This translates into disadvantages in education, health, housing, political representation, and employment, among others, and a higher tendency to live in poorer regions and slums. Excluded groups are also confronted with glass ceilings in the job market, which result in lower incomes and fewer opportunities. Uruguay has a robust matrix of social policies and one of the highest levels of public social spending in the region, but atomization of social programs and lack of coordination between them compromises their effectiveness. Closing the remaining gaps is possible and may not require large additional spending. Very often, changes in preexisting programs is all it takes to make them more socially inclusive. Policies that put social inclusion at their core do not necessarily do more, but they do things differently.
Shared Prosperity and Poverty Eradication in Latin America and the Caribbean
(Washington, DC: World Bank, 2015-04) Cord, Louise; Genoni, Maria Eugenia; Rodriguez Castelan, Carlos; Cord, Louise; Genoni, Maria Eugenia; Rodriguez Castelan, Carlos
Over the last decade Latin America and the Caribbean region has achieved important progress towards the World Bank Group's goals of eradicating extreme poverty and boosting income growth of the bottom 40 percent, propelled by remarkable economic growth and falling income inequality. Despite this impressive performance, social progress has not been uniform over this period, and certain countries, subregions and even socioeconomic groups participated less in the growth process. As of today, more than 75 million people still live in extreme poverty in the region (using $2.50/day/capita), half of them in Brazil and Mexico, and extreme poverty rates top 40 percent in Guatemala and reach nearly 60 percent in Haiti. This means that extreme poverty is still an important issue in both low- and middle-income countries in the region. As growth wanes and progress in reducing the still high levels of inequality in the region slows, it will be more important than ever for governments to focus policies on inclusive growth. The book includes an overview that highlights progress towards the goals of poverty eradication and shared prosperity between 2003 and 2012, unpacks recent gains at the household level using an income-based asset model, and examines some of the policy levers used to affect social outcomes in the region. It draws on 13 country studies, eight of which are featured in this volume: Argentina, Brazil, Colombia, El Salvador, Mexico, Paraguay, Peru, and Uruguay. The other case studies include: Bolivia, Chile, Dominican Republic, Ecuador, and Honduras, which will be included in the web version of the book.
Discrimination in Latin America : An Economic Perspective
(Washington, DC: Inter-American Development Bank and World Bank, 2010) Moro, Andrea; Nopo, Hugo; Chong, Alberto; Nopo, Hugo; Chong, Alberto; Moro, Andrea
The chapters presented in this volume adopt a variety of these methodological tools in order to explore the extent to which discrimination against women and demographic minorities is pervasive in Latin America. In chapter two, Castillo, Petrie, and Torero present a series of experiments to understand the nature of discrimination in urban Lima, Peru. They design and apply experiments that exploit degrees of information on performance as a way to assess how personal characteristics affect how people sort into groups. Along similar lines, in chapter three, Cardenas and his research team use an experimental field approach in Colombia to better understand pro-social preferences and behavior of both individuals involved in the provision of social services (public servants) and potential beneficiaries of those services (the poor). In chapter four, Elias, Elias, and Ronconi try to understand social status and race during adolescence in Argentina. They asked high school students to select and rank ten classmates with whom they would like to form a team and use this information to construct a measure of popularity. In chapters five and six, Bravo, Sanhueza, and Urzua present two studies covering different aspects of the labor market using different methodological tools. Based on an audit study by mail, their first study attempts to detect gender, social class, and neighborhood of residence discrimination in hiring practices by Chilean fir. In a second study, they use a structural model to analyze gender differences in the Chilean labor market. In chapter seven, Soruco, Piani, and Rossi measure and analyze possible discriminatory behaviors against international emigrants and their families remaining in southern Ecuador (the city of Cuenca and the rural canton of San Fernando). Finally, in chapter eight, Gandelman, Gandelman, and Rothschild use micro data on judicial proceedings in Uruguay and present evidence that female defendants receive a more favorable treatment in courts than male defendants.