Deficiencies in evaluating health care reforms in the 1990s in Latin America

Some of the recurring themes seen on health-sector reform agendas of Western countries (those at the center as well as those on the periphery) over the last decade have been: the debate over new ways of organizing health systems, with sights set on achieving greater efficiency and quality; redefining health care benefit packages and services to better distribute health resources; and incorporating market mechanisms into the health care environment to better respond to expectations of health care consumers. The fundamental purpose of this article is to analyze certain concepts that define and explain the origin of the 1990s health care reforms in Latin America and to refute some of the more important principles, such as: the belief that improving the functional efficiency of the health care system alone would improve the health of the population; the excessive concern with the administrative and structural aspects of health systems without a discussion of the underlying theoretical models; the idea that access, in and of itself, can guarantee "equity in health"; and lastly, the undo emphasis that was placed on individual "risk factors" as the cause of all illness.