World Bank2014-02-032014-02-032012-11https://hdl.handle.net/10986/16794Today 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.en-USCC BY 3.0 IGOACQUIRED IMMUNODEFICIENCY SYNDROMEADOLESCENT HEALTHADVERSE SELECTIONALLOCATIVE EFFICIENCYBASIC LEGISLATIONBIOETHICSCANCERCAPITATIONCARDIOVASCULAR DISEASESCENSUSESCENTER FOR HEALTHCHILD HEALTHCITIZENCITIZENSCOMMUNICABLE DISEASESCOMPETENCIESCOMPREHENSIVE HEALTH INSURANCECOST ANALYSISCOST DIFFERENTIALSCOST EFFECTIVENESSDELIVERY OF HEALTH SERVICESDEMAND FOR SERVICESDEVELOPING COUNTRIESDIAGNOSISDIAGNOSTIC PROCEDURESDIALYSISDISABILITIESDISABILITYDISSEMINATIONDRUG USERSDRUGSDYNAMIC BALANCEELDERLYEMERGENCY CAREEPIDEMIOLOGYEQUILIBRIUMEXPENDITURESFAMILY MEMBERSGENDER DISCRIMINATIONGOOD GOVERNANCEHEALTH AFFAIRSHEALTH CAREHEALTH CARE COSTSHEALTH CARE INSTITUTIONSHEALTH CARE PLANHEALTH CARE PRODUCTSHEALTH CARE PROVIDERSHEALTH CARE SERVICESHEALTH CONDITIONSHEALTH CONTROLHEALTH COVERAGEHEALTH ECONOMICSHEALTH EXPENDITUREHEALTH INDICATORSHEALTH INFORMATIONHEALTH INFORMATION SYSTEMHEALTH INFORMATION SYSTEMSHEALTH INSURANCEHEALTH MARKETHEALTH NEEDSHEALTH ORGANIZATIONHEALTH OUTCOMESHEALTH POLICYHEALTH PROBLEMSHEALTH PROFESSIONALSHEALTH PROGRAMSHEALTH PROMOTIONHEALTH PROVIDERSHEALTH REFORMHEALTH REGULATIONHEALTH RESULTSHEALTH SECTORHEALTH SECTOR REFORMHEALTH SECTOR WORKERSHEALTH SERVICEHEALTH SERVICE PROVIDERSHEALTH SERVICESHEALTH SERVICES ADMINISTRATIONHEALTH SYSTEMHEALTH SYSTEM REFORMHEALTH SYSTEMSHEALTH TARGETSHEALTH TECHNOLOGY EVALUATIONHEALTH WORKERSHIVHIV INFECTIONHOSPITALHOSPITAL INPATIENTHOSPITALSHOUSEHOLD SIZEHRHUMAN DEVELOPMENTHUMAN IMMUNODEFICIENCY VIRUSHUMAN RESOURCESILLNESSILLNESSESIMMUNODEFICIENCYINCOMEINDEXESINDIVIDUAL MEMBERSINDIVIDUAL RIGHTSINFANTINFANT MORTALITYINSTITUTIONAL MECHANISMSINSURANCE COMPANIESINSURANCE COVERAGEINSURANCE PREMIUMINSURANCE SYSTEMINSURANCE SYSTEMSINTEGRAL HEALTH CAREINTEGRATED HEALTH CAREINTEGRATIONINTERVENTIONIUDJUDICIAL OVERSIGHTLARGE NUMBER OF PEOPLELAWSLEGAL FRAMEWORKLEGAL RIGHTSLIFE YEARSLIVE BIRTHSMANDATESMEDICAL ASSOCIATIONMEDICAL BENEFITSMEDICAL CAREMEDICAL SERVICESMEDICAL TECHNOLOGYMEDICATIONMEDICINESMENTAL HEALTHMENTAL HEALTH SERVICESMIGRATIONMINISTRY OF HEALTHMINORITYMORBIDITYMORTALITYMORTALITY RATENATIONAL HEALTHNATIONAL HEALTH INSURANCENATIONAL HEALTH SERVICENATIONAL HEALTH SYSTEMNATIONAL HEALTH SYSTEMSNATIONAL LEGISLATIONNATIONAL LEVELNATIONAL POPULATIONNUTRITIONOLDER ADULTSORAL HEALTHPATIENTPATIENTSPEDIATRICSPERSONS WITH DISABILITIESPHYSICIANSPLACE OF RESIDENCEPOINT OF DEPARTUREPOLICY DISCUSSIONSPOPULATION DENSITYPOPULATION GROUPSPREGNANT WOMENPRIMARY CAREPRIMARY HEALTH CAREPRIVATE HEALTH INSURERSPRIVATE INSURANCEPRIVATE INSURERSPRIVATE SECTORPROGRESSPUBLIC HEALTHPUBLIC HEALTH SERVICESPUBLIC POLICYPUBLIC PROVISIONPUBLIC SERVICEQUALITY CAREQUALITY OF CAREQUALITY OF SERVICESREHABILITATIONRESOURCE ALLOCATIONRESPECTRISK FACTORSSANITATIONSCREENINGSERVICE DELIVERYSERVICE QUALITYSEXSEXUALLY TRANSMITTED INFECTIONSSOCIAL CAPITALSOCIAL PARTICIPATIONSOCIAL PRESSURESOCIAL SECURITYSOCIAL SECURITY HEALTH INSURANCESPOUSESSTDSTREATMENTSUNEMPLOYMENTVASECTOMYWORKERSWORLD HEALTH ORGANIZATIONWorld Bank10.1596/16794