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  • Publication
    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.
  • Publication
    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.
  • Publication
    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.