Health care financing in Latin America and the Caribbean : project completion report

The component was implemented under a contract with the State University of New York at Stony Brook. The contract was a success. It effectively engaged local researchers and health policymakers in the targeted countries (which included Belize, Peru, Ecuador, St. Lucia, Bolivia, Guatemala, and the Dominican Republic). Local institutions gained experience in carrying out health economics research, and more than 40 scholars in the region participated in 4 regional seminars designed to analyze research results and derive policy implications from them. These individuals also benefitted from the opportunity to develop a professional and personal relationship with members of the contract's Technical Advisory Group, which included professionals from the World Bank, PAHO, and U.S. public and private health organizations. The contract was also successful in developing and/or adapting technologies for application in the field, including a hospital costing scheme for Belize and St. Lucia and methodologies for costing primary care in Ecuador and Belize. In applying rigorous demand analysis in Santo Domingo (the first such application in the Caribbean Basin), the contract used interactive data entry programs which reduced the time needed for compiling household survey data by 75%. The contract also presented reviews of private sector options in Peru and Guatemala, and developed an exceptionally successful methodology for projecting the financial viability of a model private health organization. Three major lessons were learned. (1) Studies conducted in response to specific Mission requests tend to be utilized and applied. (2) Policy dialogue in the health sector takes time and requires ongoing support. Future research contracts should provide follow-up support. (3) Costing methodologies used in the U.S. private sector must be greatly modified or simplified for application in Latin America, while other technologies, such as the use of microcomputers and interactive data entry programs, are directly usable and can be invaluable.