TY - JOUR
T1 - Petro-state constraints on health policy
T2 - Guidelines for workable reform in Venezuela
AU - Trujillo, Antonio J.
N1 - Funding Information:
This paper grew out of ideas first presented in “El sector salud en Venezuela: Más allá de un problema presupuestario” [56] . The University of Central Florida Foundation, Inc. provided financial support for this work. Patrick B. Inman, Jorge Portillo, Luis Sosa, and Gerver Torres made valuable comments and suggestions. The author takes sole responsibility for the facts and opinions expressed.
PY - 2004/1
Y1 - 2004/1
N2 - This article reviews the performance of the Venezuelan health care sector and suggests guidelines for workable health policy under difficult conditions. Two special circumstances constrain policy options. First, Venezuelans share a traditional value, solidarity, which includes a strong desire for equity. Reforms must comply with this norm to succeed. Second, foreign sales of state-controlled oil constitute the bulk of the government budget and the gross domestic product (GDP). Petroleum market fluctuations expose the country to extreme economic cycles. In response, policy making and stakeholders adopt a rentier attitude, focusing on preserving or enlarging entitlements to government oil monies. The side effects of this largesse include poor productivity, a weak private sector, a widespread sense of entitlement without accountability, and a crippled state which controls most of the available resources yet is unable to effectively tax, regulate, steer the economy, or pursue long-term policies. The health care sector shares these problems. As a result, Venezuela's health systems are fragmented, poorly coordinated, excessively centralized, inequitable, and ineffective. Policies to improve public health and public and private medical care must take into account these constraints.
AB - This article reviews the performance of the Venezuelan health care sector and suggests guidelines for workable health policy under difficult conditions. Two special circumstances constrain policy options. First, Venezuelans share a traditional value, solidarity, which includes a strong desire for equity. Reforms must comply with this norm to succeed. Second, foreign sales of state-controlled oil constitute the bulk of the government budget and the gross domestic product (GDP). Petroleum market fluctuations expose the country to extreme economic cycles. In response, policy making and stakeholders adopt a rentier attitude, focusing on preserving or enlarging entitlements to government oil monies. The side effects of this largesse include poor productivity, a weak private sector, a widespread sense of entitlement without accountability, and a crippled state which controls most of the available resources yet is unable to effectively tax, regulate, steer the economy, or pursue long-term policies. The health care sector shares these problems. As a result, Venezuela's health systems are fragmented, poorly coordinated, excessively centralized, inequitable, and ineffective. Policies to improve public health and public and private medical care must take into account these constraints.
KW - Health care reform
KW - Health economics
KW - Managed competition
KW - Petro-state
KW - Social health insurance
KW - Venezuela
KW - Venezuelan health care system
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U2 - 10.1016/S0168-8510(03)00084-8
DO - 10.1016/S0168-8510(03)00084-8
M3 - Article
C2 - 14726006
AN - SCOPUS:0347355428
VL - 67
SP - 39
EP - 55
JO - Health Policy
JF - Health Policy
SN - 0168-8510
IS - 1
ER -