Efectos de las relaciones económicas internacionales en los programas de ajuste estructural: análisis de la salud preventiva en Costa Rica
Fecha
1996
Autores
Ulloa Aiza, Sara
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Editor
Universidad Nacional, Costa Rica
Resumen
La inquietud acerca de los efectos que la crisis económica, la aplicación de los programas de ajustes estructural y la concurrente aceleración del fenómeno de globalización económica, estén produciendo en la sociedad costarricense, fue el móvil que indujo a realizar un estudio de carácter retrospectivo sobre la situación de algunos programas en el Sector Salud y más específicamente en la Salud Preventiva. Se realizó el estudio en el sector salud, por constituir un área muy sensible, que sirve de parámetro para evaluar otros sectores de la sociedad. La Organización Mundial de la Salud (OMS) define la salud como “un estado completo de bienestar físico, mental y social del ser humano”. Esto hace que esta concepción esté íntimamente ligada a que se le facilite al individuo, los elementos necesarios dentro de la sociedad, para que pueda gozar de buena salud. Queda claro que para comprobar la existencia de dichas condiciones, un análisis de los programas de salud preventiva está sujeto a variables como salario, empleo, nutrición, recreación, etc. Que son condiciones sine que non en la consecución del bienestar físico, social y mental del ser humano. El objetivo del estudio, fue determinar el impacto que los factores externos han tenido en el deterioro del sector salud, específicamente en los programas de salud preventiva. Se trató de documentar cómo la implementación en el País de políticas económicas y sociales inspiradas en las recomendaciones y condiciones de los Organismos Financieros Internacionales (OFIS) han llevado a una disminución de la injerencia estatal en algo tan esencial, como es su responsabilidad de velar por la calidad de vida y la salud de los ciudadanos, lo que ha producido como resultado inmediato un incremento en los niveles de pobreza y una disminución de los recursos para el Sector Salud. Al disminuir este sector su participación en el Producto Interno Bruto (PIB) en más de la mitad de 1980 a 1990, ocasionó la modificación y cancelación de muchos programas de salud preventiva, razones que han originado la ineficacia e ineficiencia del sistema, pues se han debido alterar programas y proyectos motivados por la fuga de cerebros, carencia de personal, infraestructura deficiente, disminución de la población cubierta, falta de equipo, etc. Se manifiesta la agudización de una serie de problemas, como son el aumento de la brecha entre las zonas urbanas, urbanas marginales y las rurales lo cual se evidencia por la disparidad que muestra la tasa de mortalidad y las diferentes patologías entre zonas. La zona urbana (excepto la marginal) tiene como principales problemas de salud, la obesidad, la neurosis, accidentes de tránsito, hipertensión arterial mientras que la zona rural y marginal están sufriendo la reaparición o el incremento de antiguas enfermedades como son la parasitosis, diarrea, hepatitis, malaria, desnutrición, sarampión y tuberculosis. Se logra constatar, que existen una dualidad entre las prepuestas y las acciones de los Organismo Financieros, ya que sus acciones hacen evidente que el móvil principal de su propuesta es la reducción del aparato estatal, de manera que se liberen recursos para el pago de la deuda externa y se induzca más rápidamente a estos países a la globalización económica, pues queda demostrar a través de la investigación, que la aplicación de estos programas en Costa Rica han dado como resultado el aumento de la pobreza y una concentración mayor de la riqueza, afectando de hecho la Salud de los individuos. Se encontró que en las políticas para el sector salud hay una marcada tendencia a pasar de un sistema universalista en salud a la adopción de un programa focalizador. Este sistema selectivo en la práctica se torna más discriminador que el actual sistema universalista, siendo esta una de las mayores críticas que el Banco Mundial y algunos críticos hacen al actual sistema de salud. La aplicación del modelo focalizador, tiene como peligro primordial el hecho de hacer que se retroceda a la medicina de caridad. Queda plenamente demostrado con la investigación, que la aplicación del ajuste estructural, ha dado resultados que evidencian un divorcio entre la teoría y la práctica, que condiciona la necesidad de plantear un análisis exhaustivo de los resultados obtenidos hasta el momento en los diferentes sectores del País.
Concern about the effects that the economic crisis, the application of structural adjustment programs and the concurrent acceleration of the phenomenon of economic globalization are having on Costa Rican society was the motive that led us to conduct a retrospective study on the situation of some programs in the Health Sector and more specifically in Preventive Health. The study was carried out in the health sector because it is a very sensitive area, which serves as a parameter to evaluate other sectors of society. The World Health Organization (WHO) defines health as "a complete state of physical, mental and social well-being of the human being". This means that this concept is closely linked to providing the individual with the necessary elements within society, so that he/she can enjoy good health. It is clear that in order to prove the existence of such conditions, an analysis of preventive health programs is subject to variables such as salary, employment, nutrition, recreation, etc. These are sine qua non conditions in the attainment of physical, social and mental well-being of the human being. The objective of the study was to determine the impact that external factors have had on the deterioration of the health sector, specifically on preventive health programs. The aim was to document how the implementation in the country of economic and social policies inspired by the recommendations and conditions of the International Financial Organizations (OFIS) have led to a decrease in state interference in something as essential as its responsibility to ensure the quality of life and health of citizens, which has produced as an immediate result an increase in poverty levels and a decrease in resources for the Health Sector. As this sector decreased its participation in the Gross Domestic Product (GDP) by more than half from 1980 to 1990, it caused the modification and cancellation of many preventive health programs, reasons that have originated the ineffectiveness and inefficiency of the system, since programs and projects have had to be altered due to the brain drain, lack of personnel, deficient infrastructure, decrease in the population covered, lack of equipment, etc. A series of problems have worsened, such as the widening of the gap between urban, marginal urban and rural areas, as evidenced by the disparity in mortality rates and the different pathologies between areas. The urban zone (except the marginal zone) has as its main health problems, obesity, neurosis, traffic accidents, arterial hypertension, while the rural and marginal zones are suffering from the reappearance or increase of old diseases such as parasitosis, diarrhea, hepatitis, malaria, malnutrition, measles and tuberculosis. It was found that there is a duality between the proposals and actions of the Financial Organizations, since their actions make it evident that the main motive of their proposal is the reduction of the state apparatus, in order to free resources for the payment of the foreign debt and to induce these countries more quickly to economic globalization, since it is demonstrated through the research that the application of these programs in Costa Rica has resulted in an increase in poverty and a greater concentration of wealth, affecting the health of individuals. It was found that in the policies for the health sector there is a marked tendency to move from a universalist health system to the adoption of a selective program. This selective system in practice becomes more discriminatory than the current universalist system, which is one of the major criticisms that the World Bank and some critics make of the current health system. The application of the focalizing model has as its main danger the fact that it leads to a regression to charity medicine. It is fully demonstrated with the research that the application of structural adjustment has given results that show a divorce between theory and practice, which conditions the need to propose an exhaustive analysis of the results obtained so far in the different sectors of the country.
Concern about the effects that the economic crisis, the application of structural adjustment programs and the concurrent acceleration of the phenomenon of economic globalization are having on Costa Rican society was the motive that led us to conduct a retrospective study on the situation of some programs in the Health Sector and more specifically in Preventive Health. The study was carried out in the health sector because it is a very sensitive area, which serves as a parameter to evaluate other sectors of society. The World Health Organization (WHO) defines health as "a complete state of physical, mental and social well-being of the human being". This means that this concept is closely linked to providing the individual with the necessary elements within society, so that he/she can enjoy good health. It is clear that in order to prove the existence of such conditions, an analysis of preventive health programs is subject to variables such as salary, employment, nutrition, recreation, etc. These are sine qua non conditions in the attainment of physical, social and mental well-being of the human being. The objective of the study was to determine the impact that external factors have had on the deterioration of the health sector, specifically on preventive health programs. The aim was to document how the implementation in the country of economic and social policies inspired by the recommendations and conditions of the International Financial Organizations (OFIS) have led to a decrease in state interference in something as essential as its responsibility to ensure the quality of life and health of citizens, which has produced as an immediate result an increase in poverty levels and a decrease in resources for the Health Sector. As this sector decreased its participation in the Gross Domestic Product (GDP) by more than half from 1980 to 1990, it caused the modification and cancellation of many preventive health programs, reasons that have originated the ineffectiveness and inefficiency of the system, since programs and projects have had to be altered due to the brain drain, lack of personnel, deficient infrastructure, decrease in the population covered, lack of equipment, etc. A series of problems have worsened, such as the widening of the gap between urban, marginal urban and rural areas, as evidenced by the disparity in mortality rates and the different pathologies between areas. The urban zone (except the marginal zone) has as its main health problems, obesity, neurosis, traffic accidents, arterial hypertension, while the rural and marginal zones are suffering from the reappearance or increase of old diseases such as parasitosis, diarrhea, hepatitis, malaria, malnutrition, measles and tuberculosis. It was found that there is a duality between the proposals and actions of the Financial Organizations, since their actions make it evident that the main motive of their proposal is the reduction of the state apparatus, in order to free resources for the payment of the foreign debt and to induce these countries more quickly to economic globalization, since it is demonstrated through the research that the application of these programs in Costa Rica has resulted in an increase in poverty and a greater concentration of wealth, affecting the health of individuals. It was found that in the policies for the health sector there is a marked tendency to move from a universalist health system to the adoption of a selective program. This selective system in practice becomes more discriminatory than the current universalist system, which is one of the major criticisms that the World Bank and some critics make of the current health system. The application of the focalizing model has as its main danger the fact that it leads to a regression to charity medicine. It is fully demonstrated with the research that the application of structural adjustment has given results that show a divorce between theory and practice, which conditions the need to propose an exhaustive analysis of the results obtained so far in the different sectors of the country.
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Palabras clave
AJUSTE ESTRUCTURAL (POLÍTICA ECONÓMICA), ECONOMÍA, INDICADORES DE SALUD, MEDICINA PREVENTIVA, RELACIONES ECONÓMICAS INTERNACIONALES, ECONOMY, HEALTH INDICATORS, INTERNATIONAL ECONOMIC RELATIONS, PREVENTIVE MEDICINE, STRUCTURAL ADJUSTMENT (ECONOMIC POLICY)