Cambios estructurales y nueva configuración de riesgos: desbalances e inequidades en el sistema de salud uruguayo.

This research concludes that the recent evolution of the Uruguayan health system has aggravated the existing problems of vertical inequality (class and social stratum) and horizontal inequality (increasing the vulnerability of women, children and teenagers). This tendency does not correspond to a conjuncture but to the divorce between the generation of social and health risks on the one hand, and the architecture of the Uruguayan health system, on the other hand. The analysis of the secondary data from the last two decades provided by the National Institute of Statistics (Instituto Nacional de Estadística), the Public Health Ministry (Ministerio de Salud Pública) and the cooperative health institutions (IAMC, instituciones de asistencia médica colectiva), reflect the increasing gaps of inequality in the access, quality and outcomes of the health care system. Two processes emerge from the research: 1) ebb in the access of poor people to quality health care services and 2) cream- off (migration of the high-income families and individuals to the private health care system), and the causes and effects of each one of them are analyzed in the paper. Both processes especially affect poor women and children in a country which biological reproduction concentrates in the lower socio-economical level and which also presents an increasing proportion of children among the poor. In the context of an integral reform in the Uruguayan health care system, the conclusions serve as a diagnosis of its requirements and flaws in order to avoid patches. [ABSTRACT FROM AUTHOR]