Latin America Lower-middle-income countries

Achieving universal health coverage in Bolivia

To celebrate the start of a new year, GNHE has published an assessment of progress towards universal health coverage in another country – Bolivia.

You can read the full assessment here.

The author is Cecilia Vidal Fuertes and her main conclusions are:

 

Bolivia has recently made important progress towards the goal of universal coverage by injecting additional funds (mainly from general revenues) into the health system and pooling them more effectively to spread financial risks. Total health expenditure as a percentage of GDP and total per capita health expenditure have also risen considerably over the past decade.

There have also been efforts to reduce financial barriers to access and the financial risks of illness. Over the past two decades, large inequalities in health outcomes and health service utilisation motivated the implementation and expansion of public insurance schemes, which covered vulnerable populations (pregnant woman, children and the elderly), providing access to government-financed services and eliminating fees for selected health services. As a result, general government expenditure on health as a percentage of total health expenditure rose to 78% in 2013, while out-of-pocket payments fell to 20%.

Despite this progress, there are several challenges in terms of risk pooling and strategic purchasing. In spite of more funds flowing into the system, risk pooling in Bolivia remains very fragmented. There are separate pools at the municipal level to finance national public health insurance schemes, as well as independent pools among social security managerial entities. This affects the efficiency and equity of the overall system and, more specifically, reduces its capacity to provide cross-subsidies between different income groups and health risks.

In terms of purchasing, different mechanisms apply to the national public health delivery system, public insurance schemes and social security. There is a need to analyse and implement the most efficient payment mechanisms in order to achieve strategic purchasing in support of universal health coverage.

In assessing progress towards universal health coverage, the most direct indicators of financial protection are the extent of catastrophic health expenditure and impoverishment due to health care spending. Both indicators for Bolivia are relatively low compared to other countries, suggesting improvements in financial protection. This result is consistent with decreasing levels of out-of-pocket payments. However, these indicators do not capture those people who cannot afford to pay for any care (even subsidised health care in public health facilities) and are still not covered by public insurance.

The question of who pays for health care is addressed through a progressivity analysis of multiple financing mechanisms. There is evidence that resources from general taxation are regressive, as well as employers’ contributions to mandatory social security. By contrast, there is evidence that out-of-pocket payments in Bolivia, which constitute the largest fraction of private spending, are progressive, as it is the more affluent population groups that incur higher payments. The net effect is probably a slightly regressive health financing system, however.

The analysis of equity in health care utilisation relative to need is important for the assessment of the health system in relation to the goal of universal health coverage. In Bolivia, the positive value of the concentration index for overall health service utilisation indicates that utilisation is still concentrated amongst the better-off. Although services provided in public facilities seem to be equally distributed across socioeconomic groups, those provided by social security and private for-profit facilities are highly pro-rich. Hospital health services, regardless of type of provider, tend to be more concentrated among the higher socioeconomic groups.

In terms of coverage, Bolivia still faces important challenges to securing financial protection for its whole population. Overall, health insurance coverage is still low. Public health insurance is heavily concentrated on specific vulnerable populations, and social security only reaches around one third of the population. It is a big challenge to find ways to expand financial protection to the self-employed and those in the informal sector using innovative schemes.

Another key challenge is equalising or universalising the benefits covered by all of these schemes. Only a small fraction of the population has access to a comprehensive set of services and is partially protected from severe financial risk (that is, those people belonging to social security affiliates). Services covered by public health insurance are limited in terms of scope, with only partial coverage for catastrophic conditions.

Finally, another main challenge that lies ahead is improving the overall efficiency and quality of the health service network, including expanding and improving health infrastructure to make services available to all. Distributing human resources efficiently and equitably is part of this challenge.

Further analysis is required to monitor and assess the health financing system in Bolivia comprehensively, to explore catastrophic health spending and impoverishment in vulnerable populations, and to evaluate the progressivity of health expenditure. For this task, updated National Health Accounts information and timely micro-level data from household surveys are a priority.

 

Fuertes, CV. 2016. Universal health coverage: Bolivia. Global Network for Health Equity (GNHE). Available at: http://gnhe.org.

408 comments

  1. Pingback: viagra and cialis sample pck

  2. Pingback: cheap viagra without a doctor prescription

  3. Pingback: cialis prescription

  4. Pingback: generic cialis 10mg

  5. Pingback: buy cialis tadalafil uk

  6. Pingback: buy cheap cialis overnight

  7. Pingback: buy cialis 36 hour online

  8. Pingback: can i buy cialis online

  9. Pingback: cialis 5mg tablet

  10. Pingback: cialis sale 20mg

  11. Pingback: buy cialis tadalafil uk

  12. Pingback: pzkcjunq

  13. Pingback: who makes viagra

  14. Pingback: where can i buy azithromycin near me

  15. Pingback: interactions for sildenafil

  16. Pingback: buy cialis tadalafil0 with pay pal

  17. Pingback: cialis generics

  18. Pingback: how to get viagra online

  19. Pingback: venta de viagra

  20. Pingback: how to buy cialis online from canada

  21. Pingback: last minute essay writing service

  22. Pingback: custom research paper writing services

  23. Pingback: how should i write my college essay

  24. Pingback: help me improve my argumentative essay

  25. Pingback: international business ethics essay

  26. Pingback: kelly king viagra model

  27. Pingback: cialis online daily

  28. Pingback: buy cialis tadalafil0 with pay pal

  29. Pingback: buy cialis tadalafil0 with pay pal

  30. Pingback: buy amoxicillin online canada

  31. Pingback: furosemide 20 mg for sale

  32. Pingback: zithromax canada pharmacy

  33. Pingback: stromectol 15 mg

  34. Pingback: ventolin online

  35. Pingback: doxycycline kidney pain

  36. Pingback: prednisolone warnings

  37. Pingback: nolvadex or clomid

  38. Pingback: buy priligy reddit

  39. Pingback: diflucan 100 mg

  40. Pingback: synthroid dry mouth

  41. Pingback: online propecia

  42. Pingback: neurontin pictures

  43. Pingback: 2000 mg metformin

  44. Pingback: paxil class

  45. Pingback: plaquenil and sjogren's

  46. Pingback: buy cheap cialis overnight

  47. Pingback: buy cialis 36 hour online

  48. Pingback: Zakhar Berkut hd

  49. Pingback: 4569987

  50. Pingback: fastest delivery of generic cialis

  51. Pingback: buy toronto

  52. Pingback: news news news

  53. Pingback: native american cash advance

  54. Pingback: psy

  55. Pingback: psy2022

  56. Pingback: projectio-freid

  57. Pingback: retino a cream to buy

  58. Pingback: payday advance loans bedford

  59. Pingback: ivermectin (stromectol)

  60. Pingback: tinderentrar.com

  61. Pingback: no prescription cialis

  62. Pingback: kinoteatrzarya.ru

  63. Pingback: topvideos

  64. Pingback: video

  65. Pingback: viagra no prior prescription

  66. Pingback: can i buy online

  67. Pingback: active ingredient in viagra

  68. Pingback: can you use tinder on a computer

  69. Pingback: can i buy online

  70. Pingback: canadian no prescription cialis

  71. Pingback: afisha-kinoteatrov.ru

  72. Pingback: buy ativan online overnight delivery

  73. Pingback: Ukrainskie-serialy

  74. Pingback: site

  75. Pingback: free dating sites in usa without credit card

  76. Pingback: what is cialis pills used for

  77. Pingback: buy cialis toronto

  78. Pingback: top

  79. Pingback: Aggrenox caps

  80. Pingback: does the va approve cialis for patients

  81. Pingback: cialis for women side effects

  82. Pingback: when is cialis off patent

  83. Pingback: american online pharmacy

  84. Pingback: is canadian neighbor pharmacy legitimate

  85. Pingback: cialis 2018 coupon

  86. Pingback: sildenafil citrate 100mg

  87. Pingback: cialis 500mg

  88. Pingback: 100mg viagra

  89. Pingback: tadalafil natural substitute

  90. Pingback: viagra uses

  91. Pingback: tadalafil generic 10mg

  92. Pingback: sildenafil tabs 20mg

  93. Pingback: tadalafil 6mg capsule

  94. Pingback: viagra for women

  95. Pingback: soderzhanki-3-sezon-2021.online

  96. Pingback: gabapentin

  97. Pingback: canada cialis

  98. Pingback: levitra by mail

  99. Pingback: chelovek-iz-90-h

  100. Pingback: 200 mg viagra

  101. Pingback: podolsk-region.ru

  102. Pingback: amlodipine besylate 5mg

  103. Pingback: lipitor 20mg price

  104. Pingback: metoprolol er 25mg

  105. Pingback: losartan and alcohol

  106. Pingback: viagra walmart

  107. Pingback: cialis 20mg usa

  108. Pingback: vardenafil price

  109. Pingback: cymbalta and alcohol

  110. Pingback: prednisone dosage

  111. Pingback: amitriptyline drug class

  112. Pingback: cymbalta

  113. Pingback: valsartan hydrochlorothiazide

  114. Pingback: metformin dosage

  115. Pingback: what is mirtazapine used for

  116. Pingback: bupropion and alcohol

  117. Pingback: buspirone for anxiety

  118. Pingback: citalopram

  119. Pingback: zanaflex 2mg

  120. Pingback: wellbutrin for adhd

  121. Pingback: diclofenac sodium topical gel

  122. Pingback: clonidine generic price

  123. Pingback: finasteride medication

  124. Pingback: side effects of carvedilol

  125. Pingback: bender na4alo 2021

  126. Pingback: blogery_i_dorogi

  127. Pingback: blogery_i_dorogi 2 blogery_i_dorogi

  128. Pingback: real cialis pills

  129. Pingback: canadian viagra 100mg

  130. Pingback: cheap cialis

  131. Pingback: sildenafil 20

  132. Pingback: levitra walgreens

  133. Pingback: acyclovir 800 mg

  134. Pingback: amoxicillin and alcohol

  135. Pingback: donepezil hcl

  136. Pingback: what does amoxicillin treat

  137. Pingback: zithromax cream

  138. Pingback: side effects of cefdinir

  139. Pingback: cephalexin indications

  140. Pingback: cleocin

  141. Pingback: erythromycin ointment

  142. Pingback: azithromycin 250

  143. Pingback: where can i buy cheap priligy

  144. Pingback: cialis by mail

  145. Pingback: cialis dosage for women

  146. Pingback: viagra prescription

  147. Pingback: cialis drug

  148. Pingback: viagra europe

  149. Pingback: cialis effects

  150. Pingback: levitra cost in usa

  151. Pingback: viagra

  152. Pingback: albuterol inhaler prescription sample

  153. Pingback: stock name for hydroxychloroquine

  154. Pingback: canadianmed cialis

  155. Pingback: cialis 100mg india

  156. Pingback: sildenafil 500 mg

  157. Pingback: sildenafil 10 mg tablet

  158. Pingback: no rx viagra

  159. Pingback: chernaya vodova

  160. Pingback: 66181

  161. Pingback: liquid viagra

  162. Pingback: best otc viagra

  163. Pingback: viagra by phone

  164. Pingback: buy sildenafil 20

  165. Pingback: fda has approved hydroxychloroquine

  166. Pingback: norvasc amlodipine

  167. Pingback: tadalafil generic pills

  168. Pingback: generic vardenafil 20mg

  169. Pingback: metformin er recall

  170. Pingback: cialis mastercard

  171. Pingback: Porno

  172. Pingback: vechernyy urgant

  173. Pingback: ukraine

  174. Pingback: fish mox amoxicillin

  175. Pingback: doxycycline antibiotic

  176. Pingback: xenical price in usa

  177. Pingback: dapoxetine 1mg

  178. Pingback: finasteride uses

  179. Pingback: careprost buy online india

  180. Pingback: clomid dosage for ovulation

  181. Pingback: A3ixW7AS

  182. Pingback: diflucan dosing uti

  183. Pingback: domperidone dose gastroparesis

  184. Pingback: postmenopausal tamoxifen

  185. Pingback: prednisolone for cats eyes

  186. Pingback: fibromyalgia low dose naltrexone

  187. Pingback: valacyclovir hcl 1

  188. Pingback: plaquenil for sale

  189. Pingback: tizanidine hcl reddit

  190. Pingback: hydroxychloroquine plaquenil side effects

  191. Pingback: viagra or cialis

  192. Pingback: cialis overnight pharmacy

  193. Pingback: gidonline-ok-google

  194. Pingback: buy ciprofloxacin

  195. Pingback: link

  196. Pingback: cialis from australia

  197. Pingback: cialis 40mg generic

  198. Pingback: cialis dosage recommend

  199. Pingback: generic sildenafil 100mg

  200. Pingback: viagra 100mg tablets

  201. Pingback: sildenafil medicine

  202. Pingback: KremlinTeam

  203. Pingback: medunitsa.ru

  204. Pingback: kremlin-team.ru

  205. Pingback: psychophysics.ru

  206. Pingback: yesmail.ru

  207. Pingback: Suicide Squad 2

  208. Pingback: psiholog

  209. Pingback: online pharmacy oxycodone 30mg

  210. Pingback: new york study hydroxychloroquine

  211. Pingback: hizhnyak-07-08-2021

  212. Pingback: cialis max dose

  213. Pingback: side effects viagra

  214. Pingback: trustworthy canadian pharmacy

  215. Pingback: can you take viagra with high blood pressure

  216. Pingback: how to buy viagra online

  217. Pingback: https://regcialist.com

  218. Pingback: topical rx pharmacy tallahassee fl

  219. Pingback: stromectol coupon

  220. Pingback: danek acyclovir berlanga

  221. Pingback: antibiotic ivermect

  222. Pingback: chloroquine online sale

  223. Pingback: priligy and sildenafil tablets

  224. Pingback: amlodipine besylate 5mg tab

  225. Pingback: atorvastatin lawsuit

  226. Pingback: generic prozac

  227. Pingback: side effects of omeprazole

  228. Pingback: sertraline and grapefruit

  229. Pingback: olanzapine and quetiapine

  230. Pingback: lexapro for ptsd

  231. Pingback: when will lyrica go generic

  232. Pingback: female viagra pills

  233. Pingback: cymbalta and weight loss

  234. Pingback: hydrochlorothiazide warnings

  235. Pingback: sildenafil 50mg

  236. Pingback: nursing implications for atorvastatin

  237. Pingback: viagra pills

  238. Pingback: buy generic viagra

  239. Pingback: buy generic viagra online

  240. Pingback: para que sirve el ivermectin

  241. Pingback: can you buy cialis online

  242. Pingback: cialis cost

  243. Pingback: what is the side effects of escitalopram

  244. Pingback: get cialis online

  245. Pingback: ivermectin de 6 mg

  246. Pingback: nelpa plaquenil price

  247. Pingback: cialis online no prescription

  248. Pingback: generic ivermectin cream

  249. Pingback: Duna 2021

  250. Pingback: buy viagra online cheapest

  251. Pingback: order viagra canada pharmacy

  252. Pingback: viagra alternatives

  253. Pingback: 1

  254. Pingback: starting cymbalta what to expect

  255. Pingback: purchase viagra online

  256. Pingback: generic cialis tadalafil

  257. Pingback: viagra connect

  258. Pingback: how to buy cialis in uk

  259. Pingback: sildenafil 50 mg tablet coupon

  260. Pingback: many pills cialis

  261. Pingback: ivermectaicilina acid clavulanic aurobindo

  262. Pingback: purchase sildenafil pills

  263. Pingback: taking amoxicillin

  264. Pingback: cialis pills

  265. Pingback: viagra buy

  266. Pingback: viagra sample

  267. Pingback: propecia equivalent

  268. Pingback: how do i get cialis

  269. Pingback: buy deltasone

  270. Pingback: buy real viagra online

  271. Pingback: cialis 60 mg pills

  272. Pingback: viagra online uk

  273. Pingback: ivermectin for pinworm

  274. Pingback: purchase viagra canadian pharmacy

  275. Pingback: once a day cialis

  276. Pingback: ivermectin for swine

  277. Pingback: real viagra uk

  278. Pingback: scabies ivermectin

  279. Pingback: treating heartworms with ivermectin and doxycycline

  280. Pingback: can you use ivermectin on cats

  281. Pingback: how to order cialis

  282. Pingback: zithramax children

  283. Pingback: durvet ivermectin paste equine dewormer

  284. Pingback: how to buy viagra online in canada

  285. Pingback: salbutamol inhaler over the counter

  286. Pingback: viagra generic walmart pharmacy sildenafil

  287. Pingback: can you buy ivermectin over the counter

  288. Pingback: where can i get samples if cialis or viagra

  289. Pingback: ivermectin buy online

  290. Pingback: equine ivermectin paste

  291. Pingback: over the counter viagra in the us

  292. Pingback: sildenafil tadalafil

  293. Pingback: buy cialis professional online

  294. Pingback: cost of tadalafil

  295. Pingback: zithromax price south africa

  296. Pingback: cheap viagra no prescription canada

  297. Pingback: where is a safe place to buy viagra online

  298. Pingback: what is generic cialis

  299. Pingback: brand viagra online pharmacy

  300. Pingback: sildenafil generic

  301. Pingback: ed pills that work

  302. Pingback: lisinopril dose for htn

  303. Pingback: generic viagra 100mg

  304. Pingback: where can i buy viagra in london

  305. Pingback: dapoxetine stability indicating method

  306. Pingback: viagra sale uk online

  307. Pingback: over the counter azithromycin cvs

  308. Pingback: viagra buy online

  309. Pingback: azithromycin walgreens over the counter

  310. Pingback: buy viagra malaysia online

  311. Pingback: viagra cvs

  312. Pingback: cleantalkorg2.ru

  313. Pingback: how to get viagra without doctor

  314. Pingback: viagra without dr prescription pharmacy

  315. Pingback: viagra walmart

  316. Pingback: viagra cialis

  317. Pingback: buy amoxil 1000mg uk

  318. Pingback: bestellen viagra

  319. Pingback: where can i buy lasix

  320. Pingback: cost of neurontin

  321. Pingback: online casinos that accept echeck

  322. Pingback: plaquenil cost uk

  323. Pingback: 60 mg of prednisone

  324. Pingback: chewable viagra

  325. Pingback: buy priligy in usa

  326. Pingback: provigil buy

  327. Pingback: ivermectin 2

  328. Pingback: albuterol 0.63

  329. Pingback: buy zithromax online

  330. Pingback: viagra use

  331. Pingback: gabapentin in mexico

  332. Pingback: buy viagra

  333. Pingback: plaquenil best price

  334. Pingback: 10 mg prednisone

  335. Pingback: priligy price

  336. Pingback: liquid cialis review

  337. Pingback: viagra generic

  338. Pingback: buy zithromax online

  339. Pingback: walmart cialis pharmacy

  340. Pingback: levitra vs viagra

  341. Pingback: viagra for females

  342. Pingback: viagra tablets australia

  343. Pingback: walgreens viagra

  344. Pingback: women viagra

  345. Pingback: 3d sex games make you cum in 5 secinds

  346. Pingback: sildenafil 25mg tablets

  347. Pingback: how much is cialis

  348. Pingback: viagra pill

  349. Pingback: natural viagra

  350. Pingback: sildenafil prices

  351. Pingback: stromectol 6 mg dosage

  352. Pingback: viagra tablet

  353. Pingback: stromectol 12 mg

  354. Pingback: cialis 20 mg sample dosage

  355. Pingback: sildenafil 25 mg mexico

  356. Pingback: meritking

  357. Pingback: elexusbet

  358. Pingback: eurocasino

  359. Pingback: madridbet

  360. Pingback: meritroyalbet

  361. Pingback: eurocasino

  362. Pingback: eurocasino

  363. Pingback: meritking

  364. Pingback: meritroyalbet

  365. Pingback: cialis online paypal

  366. Pingback: azithromycin antibiotic class

  367. Pingback: aabbx.store

  368. Pingback: meritroyalbet

  369. Pingback: online casino real money philippines

  370. Pingback: generic viagra cost

  371. Pingback: ne-smotrite-naverx

  372. Pingback: what is levitra

  373. Pingback: arrogant

  374. Pingback: Dead-Inside

  375. Pingback: sildenafil 50 mg cost

  376. Pingback: order cialis

  377. Pingback: cialis prices

  378. Pingback: otc generic cialis

  379. Pingback: cialis pills for sale

  380. Pingback: sildenafil price 100mg

  381. Pingback: sildenafil citrate tablets 150 mg

  382. Pingback: perabet

  383. Pingback: best way t o take viagra

  384. Pingback: viagra cialis and levitra

  385. Pingback: who sells viagra over the counter

  386. Pingback: viagra for women

  387. Pingback: works as well as viagra for most men at fraction of the cost

  388. Pingback: cialis daily side effects

  389. Pingback: madridbet

  390. Pingback: cheap stromectol

  391. Pingback: trcasino

  392. Pingback: elexusbet

  393. Pingback: combivent respimat

  394. Pingback: ivermectin 6 mg tablets

  395. Pingback: where to buy cialis otc

  396. Pingback: viagra alternative

  397. Pingback: viagra natural

  398. Pingback: ivermectin tablet price

  399. Pingback: trcasino

  400. Pingback: india ivermectin news

  401. Pingback: ventolin inhaler buy online uk

  402. Pingback: tombala siteleri

  403. Pingback: tombala siteleri

  404. Pingback: tombala siteleri

  405. Pingback: flccc ivermectin

  406. Pingback: flccc alliance website

  407. Pingback: new covid drug

  408. Pingback: olumiant tablet

Comments are closed.