the Uruguayan health system; financial aspects of the social security system

Slowly but surely I’m getting to know the ins and outs of the Uruguayan health care system.  Through references made in my classes, some outright asking people for information, and, yes, studying and reading over the past eight months I’ve been able to learn the following:

In Uruguay, health care is a mixture of a social security system (like in the US) and a National Health Care System (NHS, like in the UK).  In this post I’ll talk about the social security aspect.

All people who work pay into a fund called FONASA.  FONASA is run by the JUNASA which is part of the Ministry of Public Health (MSP).  Thus, it’s a state-run fund.  (Some people here might cry out: “socialized health care!” but they would be only partially right).  The MSP signs contracts with health providers who are paid a set rate per affiliate according to the persons risk profile.  Currently, the risk profile and thus the per person payment is made up of age and gender factors.  (The idea is, in the long run, change the risk profile to include ancestral biological factors, lifestyle factors, geographic location, etc, to make the profiles and the payment better reflect risk, but this has yet to be done.)  Health care providers are also paid for meeting specific health care goals.  For example, one of the current goals is raising the percent of pregnant women who receive care during their first trimester.  If health providers meet this goal. they’re paid a certain amount of money per affiliate; if not, they’re not.  (They are always paid the initial per capita payment, regardless of whether they meet the goals or not).

providers are called policinicas.  They are by and large not state-run; this is what makes the health system different from the NHS of the UK and a traditional “socialized” health system.  (That said, there is a state-run option that workers can opt for instead of a policlinica; I’ll speak about it in the next NHS post). In all of Uruguay there are 42 policinicas that working Uruguayan citizens and residents can affiliate themselves with.  All affiliates are entitled to a set group of services called the PAIS.  These services are what are being paid for in the per capita payment from the MSP to the policinicas.  Just like in the US, copays are used to theoretically avoid unnecessary over use of services on the part of the affiliates.

So, where does the cash that the MSP pays to the policinicas come from?  All workers pay a percent of their income into FONASA, depending on their income level and on whether or not they have children.  Low income workers pay 3%, middle and high income workers without children pay 4.5%, and workers with children pay 6%.  All of this money, as previously mentioned, goes into a single fund, FONASA.  The idea of using a single fund is one of risk and wealth transfer.  By pooling funds, the wealthy pay a part of the per capita payment of the poor, and the healthy pay a part of the per capita payment of the sick.  Because all workers pay into the same fund, resources can be pooled more efficiently than if they were paid into a number of different funds (which is what happens with insurance companies in the States).

So, that’s a brief overview of the social security aspect of the health care system.  Up next, an overview of the NHS and the emergency fund aspect of the health care system; stay tuned!.

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3 responses to “the Uruguayan health system; financial aspects of the social security system

  1. We only seem to hear about a few healthcare systems (UK, US, Canada, etc.) in national debates on the topic. It’s refreshing to hear a different perspective/model and see what can be learned from it. Looking forward to the next post! :)

  2. Leonard Rodberg

    Fascinating. So Uruguay has what we would call a single payer, tax-funded health care system similar to that in Canada, and similar to what we in the Medicare for All movement in the US are advocating. They also, quite intelligently, and unlike both we in the US and the Canadians, pay their providers on a risk-adjusted capitation system. Smart people! Too bad the political system in the US is so clogged and corrupted that we can’t seem to achieve the same thing!
    Looking forward to your next post…
    Len Rodberg

  3. FYI, Julia, this served as a great talking point for our first meeting with the new Loewenstern Fellows last night! :)

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