Chao, Shiyan2013-05-022013-05-022013-01https://hdl.handle.net/10986/13290Jamaica's primary health care system was a model for the Caribbean region in the 1990s. Because of it, Jamaicans enjoy relatively better health status than people in other countries of similar income level in the Caribbean region. However, Jamaica's health system is being severely challenged by persistent and reemerging infectious diseases and by the rapid increase in noncommunicable diseases (NCDs) and injuries. At the same time, the country has suffered from low economic growth and carries a high debt burden, which leaves limited fiscal space for improving health care. The Government of Jamaica has been trying to sustain the gain in health outcomes and improve access to health care for its population in an environment of constrained resources during the last decade. With the establishment of the Jamaica National Health Fund (NHF) in 2003 and the abolition of user fees at public facilities in 2008, the Government of Jamaica has taken steps toward achieving universal coverage. This study reviews the achievements and challenges in expanding universal access in Jamaica and assesses the impact of the NHF's drug-subsidy programs and the abolition of user fees on universal access, and discusses policy options for achieving universal coverage.EL sistema de atención primaria de salud de Jamaica fue un modelo para la región del Caribe en los años noventa. Sin embargo, estos últimos años, el sistema enfrenta graves dificultades por causa de enfermedades infecciosas persistentes y reemergentes, por el rápido aumento de la incidencia de enfermedades no transmisibles y de lesiones. Al mismo tiempo, el país ha registrado un bajo crecimiento económico y soporta una elevada carga de endeudamiento, que deja poco espacio fiscal para mejorar la atención de la salud. En este estudio se analizan los logros alcanzados y los desafíos enfrentados en cuanto al acceso universal en Jamaica; asimismo se evalúan las repercusiones de los programas de subsidios de medicamentos del Fondo nacional de Salud y la eliminación de los pagos del usuario en el acceso universal. En su último apartado, se debaten varias opciones de política para lograr la cobertura universal.en-USCC BY 3.0 IGOaccess to health careaccess to health servicesaccess to servicesadolescentsAdult mortalityagedagingambulatory careambulatory servicesbasic health carebedsbreast cancerbudget allocationburden of diseasecapacity buildingchild mortalitychronic conditionsChronic Diseasecitizenscivil society organizationsclinicscommunicable diseasescommunity hospitalscontraceptionContraceptive prevalencecosts of health caredebtdemand for healthdemand for health careDependency ratiodeveloping countriesdevelopment of policiesdiabetesdoctorsDrugseconomic growthElderlyepilepsyequity in accessExpendituresfamiliesfamily membersfamily planningfertilityfertility ratefinancial barriersfinancial riskfinancial risksfree choicegeneric drugsglaucomaglobal healthgross domestic producthealth behaviorhealth carehealth care costshealth care coverageHealth Care Financinghealth care serviceshealth centersHealth CoverageHealth ExpenditureHealth Expenditure by Sourcehealth expenditureshealth facilitieshealth financinghealth infrastructurehealth managementHealth OrganizationHealth outcome indicatorshealth outcomeshealth planninghealth plansHealth Policyhealth promotionhealth promotion activitieshealth providershealth sectorhealth servicehealth service deliveryhealth serviceshealth statushealth systemhealth system efficiencyhealth systemshealth workershealthcare servicesHealthy LifestylesHIV/AIDShospitalHospital bedshospital carehospital serviceshospitalshuman resourceshuman resources developmenthuman resources managementhypertensionill healthillnessillnessesimmunizationimportant policyimproving health careincomeincome countriesinfantinfant mortalityinfant mortality rateinfectious diseasesinformation systeminformation systemsinfrastructure developmentinjuriesinsurance planleading causesLife expectancyLife expectancy at birthlive birthsLiving Conditionslow birth weightmalariamaternal mortalityMaternal mortality ratemedical careMedical ExpendituresMedical Schoolmedical servicesmedical standardsmidwivesMillennium Development GoalsMinistry of Healthmorbiditymortalitynational councilNational DevelopmentNational Development PlanNational Healthnational health insuranceNational Health ServicesNational PolicyNational strategiesNeonatal mortalitynongovernmental organizationsNumber of PeopleNursesobesityold ageolder womenpatientspharmaciesPhysicianphysicianspolicy analysispolicy changepolicy decisionspolicy makerspopulation groupspregnant womenprenatal careprimary careprimary health careprimary health care servicesprimary health care systemprivate health insuranceprivate health servicesprivate sectorprivate sectorsprivate spendingprogressprostate cancerprovision of carepublic discussionpublic healthPublic health expenditurepublic health programspublic health servicespublic health systempublic hospitalspublic informationpublic sectorpurchasing powerpurchasing power parityquality of carequality of healthquality of health carequality of servicesresearch programsrespectrisk factorsrural areassanitationsanitation facilitiesservice providerservice providerssexual behaviorSkilled birth attendancesocial factorsStable PopulationSustainable DevelopmentTuberculosisunemploymentUnemployment ratesUniversal Accessuniversal access to health careurban developmentuser feesviolencevulnerable populationswastewomanworkersworking-age populationWorld Health Organizationyoung adultsWorld Bank10.1596/13290