Article - Dov Chernichovsky

Brechas regionales de la mortalidad infantil en Colombia Marta C. Jaramillo-Mejía, Dov Chernichovsky, José J. Jiménez-Moleón

ABSTRACT
Objectives. To study the variations in infant mortality rate (IMR) across Colombia’s 33 administrative departments over the period 2003-2009, examine persistency of variations across departments over time, and relate those variations to the impact of socio-economic conditions and availability of care on IMR. Materials and methods. Using vital statistics and related socio-economic data we establish three types of analysis according to: (a) the variation of the departmental IMR (2003- 2009), (b) the association between the departmental IMR and its key determinants over time, and (c) the lines of causality and relative impact of different factors, by using structural equations. Results. The 4.7 fold ratio between the highest and lowest departmental IMR (2009) may be underestimated considering underreporting, especially in low-income departments. There is a negative association between the departmental IMR with time and a set of highly correlated variables, such as the mother education, income per capita, health insurance level and access to services. Conclusions. The effect of better insurance, availability of private beds, and having doctors attending mothers, eclipse the impact of better socioeconomic conditions. The range of services does not appear to be influenced by a rational policy; resources are not allocated according to the need, but with the general development. Private beds are made available where there is better health insurance.

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מאמר זה פורסם בחודש אפריל האחרון בכתב העת המדעי Health Affairs. המגזין רב היוקרה מתפרסם בארצות הברית ומיועד בעיקר לקובעי המדיניות. אף על פי שהמאמר דן במערכת הבריאות הישראלית, נושא שלכאורה אינו רלוונטי עבור מרבית קוראי כתב העת, עורכיו מצאו עניין מיוחד בניסיון הישראלי, שניתן להגדירו כשבירה חסרת תקדים של "כללי המשחק" במימון מערכות בריאות המעניקות ביטוח בריאות ממלכתי. בשל חשיבותו לציבור הרחב ולקובעי המדיניות בישראל, אישרה מערכת העיתון למרכז טאוב – אשר המאמר מבוסס על עבודה שנכתבה במסגרתו – לפרסם ולהפיץ את תרגום המאמר לעברית, ועל כך נתונה לה תודתנו. "

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המאמר פורסם באנגלית במגזין health affairs

Health AffairsHistorically, the Israeli health care system has been considered a high-performance system, providing universal, affordable, high-quality care to all residents. However, a decline in the ratio of physicians to population that reached a modern low in 2006, an approximate ten-percentage-point decline in the share of publicly financed health care between 1995 and 2009, and legislative mandates that favored private insurance have altered Israel’s health care system for the worse. Many Israelis now purchase private health insurance to supplement the state-sponsored universal care coverage, and they end up spending more out of pocket even for services covered by the entitlement. Additionally, many publicly paid physicians moonlight at private facilities to earn more money. In this article I recommend that Israel increase public funding for health care and adopt reforms to address the rising demand for privately funded care and the problem of publicly paid physicians who moonlight at private facilities.

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