Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

111
 DR\ELG _HTVKNEBKGNEH LD FGHKSKE MKNKR\DVKG LD REHTL [ LD_GV\DR  E E N N Å Å H H K K R R K K R R L L D D H H A A E E R R \ \ G G [ [  C C K K N N E E N N B B K K E E M M K K D D N N \ \ G G D D N N R R E E H H T T L L  D D N N F F G G H H K K S S K K E E 6 6 ? ? ? ? 2 2 - - 6 6 ? ? ? ? : :  MRb. Ithkdn Vgadv LT_T[ LKVDBBKÒN ADNDVEH LD _HENKCKBEBKÒN ÅVDE LD DBGNGMÍE LD HE REHTL Ithkg 6?55

Transcript of Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 1/110

 

DR\ELG _HTVKNEBKGNEH LD FGHKSKE

MKNKR\DVKG LD REHTL [ LD_GV\DR 

EENNÅÅHHKKRRKKRR LLDDHH AAEERR\\GG [[ CCKKNNEENNBBKKEEMMKKDDNN\\GG DDNN RREEHHTTLL 

DDNN FFGGHHKKSSKKEE 66????22 -- 66????:: 

MRb. Ithkdn Vgadv LT_T[LKVDBBKÒN ADNDVEH LD _HENKCKBEBKÒN

ÅVDE LD DBGNGMÍE LD HE REHTLIthkg 6?55

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 2/110

 

6

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 3/110

 

DR\ELG _HTVKNEBKGNEH LD FGHKSKE

MKNKR\DVKG LD REHTL [ LD_GV\DR 

EENNÅÅHHKKRRKKRR LLDDHH AAEERR\\GG [[ CCKKNNEENNBBKKEEMMKKDDNN\\GG DDNN RREEHHTTLL 

DDNN FFGGHHKKSSKKEE 66????22 -- 66????:: 

MRb. Ithkdn Vgadv LT_T[LKVDBBKÒN ADNDVEH LD _HENKCKBEBKÒN

ÅVDE LD DBGNGMÍE LD HE REHTLIthkg 6?55

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 4/110

 

<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 5/110

 Kn|vgltbbkòn 

Fghkske rd beveb|dvkye pgv rdv tng ld hgr peírdr mår kndutk|e|ksgr ldh mtnlg( { bgnrdbtdn|dmdn|d(he me{gv pev|d ld he pgfhebkòn ng ptdld didvbdv dcdb|ksemdn|d rt ldvdbjg e he rehtl9 erí( her lgravenldr be|dagvíer ld pvgfhdmer kldn|kckbeler dn her eremfhder pvdbgnr|k|t{dn|dr ld rehtl dn6??3 { vdeckvmelgr dn dh _hen Rdb|gvkeh ld Ldrevvghhg 6?5?-6?54 rgn( pgv tne pev|d( he dzkr|dnbke ldceb|gvdr rgbkehdr( dbgnòmkbgr( bth|tvehdr { emfkdn|ehdr *ld|dvmknen|dr ld he rehtl+( utd rgn mt{ldrcesgvefhdr peve he behklel ld skle { he rehtl ld he pgfhebkòn fghkskene. _gv g|ve pev|d( hgrFghkskengr { Fghkskener ng |kdndn tn ebbdrg tnksdvreh d kn|daveh e rdvskbkgr ld rehtl ld behklel9rdaùn he Tnklel ld Enåhkrkr ld _ghí|kber Dbgnòmkber { Rgbkehdr( dh 11$ ld he pgfhebkòn fghkskene|kdnd ehaùn avelg ld dzbhtrkòn dn rehtl *TLE_D { G_R 6??<+.

Dr|er lgr be|dagvíer ld pvgfhdmer mtdr|ven he ndbdrklel ld mglkckbev pvgctnlemdn|d dh ebbkgnevrdb|gvkeh( mdigvenlg her bgnlkbkgndr ld hgr rdvskbkgr ld rehtl *ebbdrkfkhklel( behklel(kn|dvbth|tvehklel+ { ldrevvghhenlg e aven drbehe he pvgmgbkòn ld he rehtl e pev|kv ld he mgskhkyebkònrgbkeh { ld ehkenyer dr|ve|ëakber kn|dvrdb|gvkehdr( peve kmpeb|ev rkankckbe|ksemdn|d rgfvd dh dr|elg

ld rehtl { he behklel ld skle ld he pgfhebkòn *MR{L 6?5?+.

Cvdn|d e dr|d bgn|dz|g( dh Dr|elg _htvknebkgneh ld Fghkske knkbkò he kmphdmdn|ebkòn ld he pghí|kbe ld heRehtl Cemkhkev Bgmtnk|evke Kn|dvbth|tveh { phen|dò he bvdebkòn ldh Rkr|dme Ùnkbg ld Rehtl dnephkbebkòn ld he Bgnr|k|tbkòn _ghí|kbe ldh Dr|elg( utd knbht{d he bgfdv|tve dn rehtl tnksdvreh {ave|tk|e dn dh ptn|g ld e|dnbkòn. Dr|gr bemfkgr pdvmk|kvån e mdlkeng { hevag pheyg dh didvbkbkgdcdb|ksg ldh ldvdbjg e he rehtl pgv pev|d ld |gle he pgfhebkòn( pdvg dzkadn he lkrpgnkfkhklel ld tneme{gv ben|klel ld vdbtvrgr peve dh Rdb|gv Rehtl { tn trg mår dckbey { dckbkdn|d ld dr|gr.

Dn dr|d mevbg( hgr |gmelgvdr ld ldbkrkgndr ldh Rdb|gv Rehtl { mår adndvehmdn|d ldh Dr|elgndbdrk|en kncgvmebkòn bgnckefhd { enehkyele dn cgvme rkr|dmå|kbe rgfvd dh gvkadn( ben|klel { trg ldhgr vdbtvrgr peve rehtl peve erí dsehtev dh ldrdmpdõg ldh rkr|dme ld rehtl { |gmev ldbkrkgndr mårdckbkdn|dr peve erdatvev dh ldvdbjg e he rehtl ld |glgr hgr fghkskengr { her fghkskener.

Dn|vd 6??; { 6?55( rd vdehkyevgn lgr dr|tlkgr ld btdn|er ld rehtl utd pvgsddn dr|d |kpg ldkncgvmebkòn *Sehlër { _dõehgye 6?5?0 Eskhe d| eh . 6?55+( bgn le|gr peve dh pdvkglg 6??2-6??1 ldreavdaelgrpgv ctdn|dr ld cknenbkemkdn|g( eadn|d cknenbkelgv( gfid|g ldh aer|g( ctnbkgndr { pvgsddlgvdr. Rkndmfevag( dr|gr lgr dr|tlkgr rd hkmk|evgn eh båhbthg ldh aer|g dn rehtl( { ng eh enåhkrkr rkr|dmå|kbgld dr|d dn dh bgn|dz|g nebkgneh d kn|dvnebkgneh.

Dn bgnrdbtdnbke( dh pvdrdn|d lgbtmdn|g |kdnd bgmg gfid|ksg vdehkyev tn enåhkrkr bgmphdmdn|evkgldh bgmpgv|emkdn|g ldh aer|g dn rehtl dn dh bgn|dz|g mebvgdbgnòmkbg fghkskeng { dn dh bgn|dz|gkn|dvnebkgneh ldh cknenbkemkdn|g ld he rehtl( bgn dh gfid|ksg ld epg{ev e he |gme ld ldbkrkòn dn dhRdb|gv Rehtl { bvdev tne evatmdn|ebkòn rghkle e cesgv ldh knbvdmdn|g ldh aer|g pùfhkbg dn rehtl dndh mevbg ld he bgnr|vtbbkòn ldh Rkr|dme Ùnkbg ld Rehtl dn dh Dr|elg _htvknebkgneh ld Fghkske._eve |eh pvgpòrk|g( rd pvdrdn|e dn dh pvkmdv bepí|thg hgr en|dbdldn|dr { he lgbtmdn|ebkòn enehkyele0htdag rd dr|efhdbd tn mevbg md|glghòakbg peve dh enåhkrkr rkr|dmå|kbg ld her btdn|er ld rehtl dnFghkske0 cknehmdn|d( dn dh bepí|thg 2( rd pvgbdld eh enåhkrkr pvgpkemdn|d lkbjg ld her btdn|er ldrehtl peve dh pdvkglg 6??2-6??1 ldn|vg ldh drutdme md|glghòakbg pvgptdr|g.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 6/110

 

3

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 7/110

 Ínlkbd ld Bgn|dnklg 

Kn|vgltbbkòn .................................................................................................................................... 4 Bepí|thg K. Mevbg bgnbdp|teh { en|dbdldn|dr ld her Btdn|er ld Rehtl dn Fghkske .... 52 

K.5. ·Utë rgn her btdn|er ld rehtl7 ........................................................................................... 52  K.6. Aer|g dn rehtl ........................................................................................................................ 52 K.2. En|dbdldn|dr ld her Btdn|er ld Rehtl dn Fghkske ............................................................. 5< K.<. Lgbtmdn|ebkòn enehkyele ..................................................................................................... 54 

Bepí|thg KK. Md|glghgaíe ld enåhkrkr ld her Btdn|er ld Rehtl 6??2-6??:.................... 51 KK.5. Bherkckbebkòn ld her btdn|er ld rehtl { me|vkbdr ld aer|g ............................................. 51 KK.6. Bvk|dvkgr ld enåhkrkr ldh aer|g { cknenbkemkdn|g ld he rehtl ........................................... 5: 

KK.6.5. T|khkyebkòn ld knlkbelgvdr dr|ånlevdr ........................................................................ 5: KK.6.6. Mdlkv dh drctdvyg e cesgv ldh knbvdmdn|g ldh aer|g dn rehtl ....................................... 5; 

KK.2. Aer|g dn rehtl enehkyelg ..................................................................................................... 5; KK.<. Båhbthg ldh aer|g dn sehgv vdeh ............................................................................................ 6? KK.4. Bgmpevebkgndr kn|dvnebkgnehdr ......................................................................................... 65 

KK.4.5. Lkmdnrkgndr d knlkbelgvdr bgmpevefhdr .................................................................... 65 KK.4.6. Avtpgr ld peírdr peve bgmpevebkòn kn|dvnebkgneh ...................................................... 66 KK.4.2. Hímk|dr ld her bgmpevebkgndr kn|dvnebkgnehdr ............................................................ 62 

Bepí|thg KKK. Enåhkrkr ld her Btdn|er ld Rehtl dn Fghkske pdvkglg 6??2-6??: ............. 64 KKK.5. Drutdme ld enåhkrkr ldh aer|g { cknenbkemkdn|g ld he rehtl ......................................... 64 KKK.6. Enåhkrkr ldh Aer|g |g|eh dn rehtl ....................................................................................... 64 

KKK.6.5. Dsghtbkòn ldh aer|g |g|eh dn rehtl ............................................................................ 64 KKK.6.6. Aer|g |g|eh dn rehtl pdv båpk|e ................................................................................ 61 KKK.6.2. Aer|g |g|eh dn rehtl dn $ ldh _KF ........................................................................... 2? KKK.6.<. Bgnbhtrkgndr ldh enåhkrkr ldh aer|g |g|eh dn rehtl...................................................... 26 

KKK.2. Enåhkrkr ldh Aer|g dn rehtl rdaùn eadn|dr cknenbkelgvdr ............................................. 26 KKK.2.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn rtf-rdb|gv { eadn|d .................... 26 KKK.2.6. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn rtf-rdb|gv { eadn|d .................... 24 KKK.2.2. Nksdh { dsghtbkòn ldh aer|g dn sehgv vdeh rdaùn rtf-rdb|gv { eadn|d .......................... 21 KKK.2.<. Aer|g dn rehtl pdv båpk|e( rdaùn rdb|gv { eadn|d cknenbkelgv .................................... <? KKK.2.4. Ve|kgr mebvgdbgnòmkbgr ldh aer|g rdaùn rdb|gv { eadn|d cknenbkelgv ....................... <2 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 8/110

 

:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

KKK.<. Enåhkrkr ldh Aer|g dn rehtl rdaùn ctdn|dr ld cknenbkemkdn|g ....................................... <; KKK.<.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn ctdn|d ........................................ <; KKK.<.6. Ldr|kng ldh aer|g dn rehtl pgv ctdn|dr ld cknenbkemkdn|g ......................................... 46 KKK.<.2. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn ctdn|d ld cknenbkemkdn|g ............. 44 KKK.<.<. Nksdh { dsghtbkòn ldh aer|g dn sehgv vdeh rdaùn ctdn|d ld cknenbkemkdn|g ................... 41 KKK.<.4. Aer|g dn rehtl pdv båpk|e( rdaùn ctdn|d ld cknenbkemkdn|g ....................................... 4; KKK.<.3. Ve|kgr mebvgdbgnòmkbgr ldh aer|g rdaùn ctdn|d ld cknenbkemkdn|g ........................... 32 

KKK.4. Enåhkrkr ldh Aer|g dn rehtl rdaùn gfid|g ldh aer|g ........................................................ 33 KKK.4.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn gfid|g ........................................ 33 KKK.4.6. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn gfid|g ldh aer|g .......................... 3; KKK.4.2. Nksdh { dsghtbkòn ldh aer|g vdeh rdaùn gfid|g ldh aer|g ............................................. 15 

KKK.3. Enåhkrkr ldh Aer|g dn rehtl rdaùn ctnbkòn ...................................................................... 12 KKK.3.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn ctnbkòn ...................................... 12 KKK.3.6. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn ctnbkòn ....................................... 1: KKK.3.2. Dr|kmebkòn ldh bgr|g pvgmdlkg pgv |kpg ld e|dnbkòn .................................................. :5 

KKK.1. Enåhkrkr ldh Aer|g dn rehtl rdaùn pvgsddlgv ld rdvskbkgr ............................................ :6 KKK.1.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn pvgsddlgv .................................. :6 KKK.1.6. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn pvgsddlgv ................................... :3 

KKK.:. Enåhkrkr ldh Aer|g dn rehtl rdaùn Ldpev|emdn|g ........................................................... ;? KKK.:.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn Ldpev|emdn|g ............................ ;? KKK.:.6. Dr|vtb|tve ldpev|emdn|eh ld aer|g dn rehtl rdaùn rtfrdb|gv .................................... ;2 KKK.:.2. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn Ldpev|emdn|g ............................ ;4 KKK.:.<. Aer|g dn rehtl pdv båpk|e( rdaùn Ldpev|emdn|g ....................................................... ;; 

Bgnbhtrkgndr { vdbgmdnlebkgndr ............................................................................... 5?4 Fkfhkgavecíe .................................................................................................................................. 5?1 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 9/110

 Ínlkbd ld \efher { Btelvgr 

Btelvg 5  ‒ Didmphgr ld eb|kskleldr utd pglvíen knbhtkvrd g dzbhtkvrd ldh aer|g dn rehtl .............. 5< Btelvg 6  ‒ _vknbkpehdr lkcdvdnbker dn|vd hgr lgr dr|tlkgr ld btdn|er ld rehtl 6??2-6??1............. 53

 Btelvg 2 ‒ \ere ld knchebkòn adndveh d drpdbíckbe( 6??2-6??: ......................................................... 65 Btelvg <  ‒ _eírdr kn|daven|dr ld hgr lkcdvdn|dr avtpgr ld bgmpevebkòn rdhdbbkgnelgr ................ 66 Btelvg 4  ‒ Aer|g |g|eh dn rehtl dn sehgv ngmkneh( Fghkske( 6??2-6??: ............................................. 64  Btelvg 3  ‒ Aer|g |g|eh dn rehtl dn sehgv vdeh( Fghkske( 6??2-6??: .................................................... 63 Btelvg 1 ‒ Aer|g |g|eh dn rehtl pdv båpk|e dn sehgv ngmkneh( Fghkske( 6??2-6??: ............................ 61 Btelvg : ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g |g|eh dn rehtl pdv båpk|e( 6??1 ............................ 61 Btelvg ;  ‒ Aer|g |g|eh dn rehtl pdv båpk|e dn sehgv vdeh( Fghkske( 6??2-6??: ................................... 6: Btelvg 5?  ‒ Bgmpevebkòn kn|dvnebkgneh ld he |ere ld bvdbkmkdn|g 6??2-6??: ldh aer|g |g|eh dn

rehtl pdv båpk|e dn sehgv vdeh ....................................................................................... 2?  Btelvg 55 ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g rdaùn rtf-rdb|gv( Fghkske( 6??2-?: ..................... 2<  Btelvg 56  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv rdb|gv( Fghkske( 6??2-?: ............................... 24 Btelvg 52  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn eadn|d cknenbkelgv ldh rtfrdb|gv

pùfhkbg( Fghkske( 6??2-?: .............................................................................................. 23 Btelvg 5<  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn eadn|d cknenbkelgv ldh rtfrdb|gv ld he

Rdatvklel Rgbkeh( Fghkske( 6??2-?: .............................................................................. 23 Btelvg 54 ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn eadn|d cknenbkelgv ldh rtfrdb|gv

pvkselg( Fghkske( 6??2-?: .............................................................................................. 21 Btelvg 53  ‒ Dsghtbkòn ldh aer|g dn sehgv vdeh pgv eadn|d cknenbkelgv( Fghkske( 6??2-?: ................. 2:  Btelvg 51  ‒ \ere ld bvdbkmkdn|g vdeh ebtmthele ldh aer|g dn rehtl ldrld dh eõg 6??2( rdaùn

eadn|d cknenbkelgv( Fghkske( 6??2-?: ............................................................................ 2; Btelvg 5:  ‒ Aer|g pdv båpk|e *Fr.+ dn sehgv ngmkneh pgv eadn|d cknenbkelgv( Fghkske( 6??2-?: ....... <? Btelvg 5; ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g |g|eh dn rehtl pdv båpk|e( 6??1 .......................... <5  Btelvg 6?  ‒ Aer|g dn rehtl pdv båpk|e dn sehgv vdeh( rdaùn rtf-rdb|gv( Fghkske( 6??2-6??: ........... <6 Btelvg 65 ‒ Bgmpevebkòn kn|dvnebkgneh ldh knbvdmdn|g vdeh ldh aer|g pdv båpk|e rdaùn rdb|gv...... <6  Btelvg 66  ‒ Aer|g dn rehtl pgv rdb|gv dn $ ldh pvgltb|g kn|dvng fvt|g( Fghkske( 6??2-6??: .......... << Btelvg 62 ‒ Aer|g dn rehtl dr|e|eh dn $ ldh aer|g pùfhkbg |g|eh( Fghkske( 6??2-6??: ..................... <3  Btelvg 6<  ‒ Aer|g dn rehtl dr|e|eh dn $ ldh aer|g ldh Agfkdvng Adndveh( Fghkske( 6??2-6??: ...... <1 Btelvg 64 ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g pgv |kpg ld ctdn|d( Fghkske( 6??2-?: ..................... 45 Btelvg 63  ‒ Ldr|kng ld her lkcdvdn|dr ctdn|dr ld cknenbkemkdn|g( Fghkske( 6??2-?: ......................... 42 Btelvg 61  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g ld hgr eadn|dr rdaùn ctdn|d ld

cknenbkemkdn|g( Fghkske( 6??2-?: .................................................................................. 4< Btelvg 6:  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv |kpg ld ctdn|d( Fghkske( 6??2-?: ................... 44 Btelvg 6;  ‒ Aer|g ngmkneh rdaùn ctdn|dr ld cknenbkemkdn|g pùfhkber( Fghkske( 6??2-?: ................ 43 Btelvg 2?  ‒ Dsghtbkòn ldh aer|g ngmkneh rdaùn ctdn|dr ld cknenbkemkdn|g pvkseler { dz|dvner(

Fghkske( 6??2-?: ........................................................................................................... 41 Btelvg 25 ‒ Dsghtbkòn ldh aer|g dn sehgv vdeh pgv ctdn|d ld cknenbkemkdn|g( Fghkske( 6??2-?: ........ 4: Btelvg 26  ‒ \ere ld bvdbkmkdn|g vdeh ebtmthele ldh aer|g dn rehtl rdaùn ctdn|dr ld

cknenbkemkdn|g( Fghkske( 6??2-?: .................................................................................. 4; Btelvg 22 ‒ Aer|g pdv båpk|e *Fr.+ dn sehgv ngmkneh rdaùn ctdn|d( Fghkske( 6??2-?: ...................... 3? Btelvg 2< ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g pdv båpk|e rdaùn |kpg ld ctdn|d( 6??: ............... 35 Btelvg 24  ‒ Aer|g dn rehtl pgv ctdn|d dn $ ldh aer|g ldh Agfkdvng adndveh( Fghkske( 6??2-?: ..... 34 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 10/110

 

5?

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg 23  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn gfid|g( Fghkske( 6??2-?1 .............. 3: Btelvg 21  ‒ Dr|vtb|tve ld aer|g dn rehtl pgv gfid|g ldh aer|g { pgv rtfrdb|gv( Fghkske( 6??1 ....... 3: Btelvg 2:  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv gfid|g( Fghkske( 6??2-?1 ............................... 3; Btelvg 2;  ‒Aer|g dn sehgv ngmkneh pgv gfid|g { rtfrdb|gv( Fghkske( 6??1 ....................................... 15  Btelvg <?  ‒ Dsghtbkòn ldh aer|g vdeh rdaùn gfid|g ldh aer|g( Fghkske( 6??2-?1 ............................... 15 Btelvg <5  ‒ \ere ld bvdbkmkdn|g vdeh ebtmthele 6??2-?1 pgv rtfrdb|gv( Fghkske( 6??2-?1 ........... 16 Btelvg <6  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn ctnbkòn( Fghkske( 6??2-?1 ............ 13 Btelvg <2  ‒ Dr|vtb|tve ld aer|g dn rehtl pgv ctnbkòn { rtfrdb|gv( Fghkske( 6??1 ........................... 1:  Btelvg <<  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv ctnbkòn( Fghkske( 6??2-?1 ............................. 1; Btelvg <4  ‒Aer|g dn sehgv ngmkneh pgv ctnbkòn { rtfrdb|gv( Fghkske( 6??1 ..................................... :?  Btelvg <3 ‒ Aer|g dn sehgv ngmkneh pgv ctnbkòn { rtfrdb|gv( dn fghkskengr( Fghkske( 6??1 ............. :5 Btelvg <1 ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn pvgsddlgv( Fghkske( 6??2-?1 ....... :< Btelvg <:  ‒ Dr|vtb|tve ld aer|g dn rehtl pgv pvgsddlgv { rtfrdb|gv( Fghkske( 6??1 ....................... :4 Btelvg <;  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv |kpg ld pvgsddlgv( Fghkske( 6??2-?1 ............ :1 Btelvg 4? ‒ Aer|g dn sehgv ngmkneh pgv |kpg ld pvgsddlgv { rtfrdb|gv( Fghkske( 6??1 .................... :: Btelvg 45  ‒ Aer|g ngmkneh dn rehtl pgv |kpg ld dr|efhdbkmkdn|g dn hgr rtfrdb|gvdr _ùfhkbg {

ld he Rdatvklel Rgbkeh( Fghkske( 6??1 .......................................................................... :;  Btelvg 46 ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g rdaùn Ldpev|emdn|g( Fghkske( 6??2-?1 ............... ;5

 Btelvg 42  ‒ Dr|vtb|tve ld aer|g dn rehtl pgv Ldpev|emdn|g { rtfrdb|gv( Fghkske( 6??1 ................ ;6 Btelvg 4<  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv Ldpev|emdn|g( Fghkske( 6??2-?1 .................. ;3 Btelvg 44  ‒ Aer|g dn sehgv ngmkneh pgv Ldpev|emdn|g { rtfrdb|gv( Fghkske( 6??1 ......................... ;: Btelvg 43 ‒ Dsghtbkòn ldh aer|g pdv båpk|e pgv Ldpev|emdn|g( Fghkske( 6??2-?1 .......................... 5??  Btelvg 41  ‒ Aer|g pdv båpk|e pgv Ldpev|emdn|g { rtfrdb|gv( dn fghkskengr( Fghkske( 6??1 ........... 5?6 

Ínlkbd ld Khtr|vebkgndr Khtr|vebkòn 5  ‒ Aer|g |g|eh dn rehtl dn sehgv ngmkneh { vdeh( Fghkske( 6??2-?: *mkhhgndr ld Fr.+ ..... 63  Khtr|vebkòn 6  ‒ Bgmpevebkòn kn|dvnebkgneh ld he |ere ld bvdbkmkdn|g 6??2-6??1 ldh aer|g |g|eh

dn rehtl pdv båpk|e dn sehgv ngmkneh *TMN+ .......................................................... 6:  Khtr|vebkòn 2  ‒ Aer|g |g|eh dn rehtl pdv båpk|e( dn sehgv ngmkneh { vdeh( Fghkske( 6??2-?: *Fr+ ........ 6; Khtr|vebkòn < ‒ Aer|g |g|eh dn rehtl dn $ ldh pvgltb|g kn|dvng fvt|g( Fghkske( 6??2-6??: ............... 2?  Khtr|vebkòn 4  ‒ Bgmpevebkòn kn|dvnebkgneh ldh ve|kg aer|g |g|eh dn rehtl dn $ ldh _KF peve hgr

eõgr 6??2 { 6??: *sehgv ngmkneh+........................................................................... 25 Khtr|vebkòn 3  ‒ Dr|vtb|tve ld Aer|g dn rehtl pgv eadn|d cknenbkelgv( Fghkske( 6??1 ........................ 26  Khtr|vebkòn 1  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g pgv eadn|d cknenbkelgv( Fghkske( 6??2-?1.......... 22  Khtr|vebkòn :  ‒ Bgmpevebkòn kn|dvnebkgneh ld he dr|vtb|tve ld aer|g rdaùn rtf-rdb|gv( 6??1 ........ 2< Khtr|vebkòn ;  ‒ Dsghtbkòn ldh aer|g dn sehgv vdeh pgv eadn|d cknenbkelgv( Fghkske( 6??2-?: .............. 2: Khtr|vebkòn 5?  ‒ Bgmpevebkòn kn|dvnebkgneh ld he |ere ld bvdbkmkdn|g 6??2-6??1 ldh aer|g

dr|e|eh dn rehtl pdv båpk|e dn sehgv ngmkneh *TMN+ ............................................... <5 Khtr|vebkòn 55  ‒ Aer|g dn rehtl pgv rdb|gv dn $ ldh pvgltb|g kn|dvng fvt|g( Fghkske( 6??2-6??: .... <2 Khtr|vebkòn 56  ‒ Bgmpevebkòn kn|dvnebkgneh ldh ve|kg ld aer|g dn rehtl dn $ ldh _KF rdaùn

rdb|gv( 6??1 *sehgv ngmkneh+ ................................................................................... << 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 11/110

 Khtr|vebkòn 52 ‒ Aer|g dn rehtl dr|e|eh dn $ ldh aer|g pùfhkbg |g|eh( Fghkske( 6??2-6??: ................ <4 Khtr|vebkòn 5< ‒ Bvdbkmkdn|g ngmkneh ebtmthelg ldh aer|g dr|e|eh dn rehtl { ldh vdr|g ldh

aer|g pùfhkbg( Fghkske( 6??2-6??: ........................................................................... <3 Khtr|vebkòn 54  ‒ Aer|g dn rehtl dr|e|eh dn $ ldh aer|g ldh Agfkdvng Adndveh( Fghkske( 6??2-?: .... <1  Khtr|vebkòn 53  ‒ Bgmpevebkòn kn|dvnebkgneh ldh ve|kg ld aer|g dr|e|eh dn rehtl dn $ ldh aer|g

|g|eh ldh Agfkdvng Adndveh peve hgr eõgr 6??2 { 6??: *sehgv ngmkneh+ ................. <: Khtr|vebkòn 51  ‒ Dr|vtb|tve ld Aer|g pgv ctdn|d ld cknenbkemkdn|g( Fghkske( 6??1 ........................... <; Khtr|vebkòn 5: ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g pgv ctdn|d( Fghkske( 6??2-?1 ........................... 4?  Khtr|vebkòn 5; ‒ Bgmpevebkòn kn|dvnebkgneh ldh $ ld cknenbkemkdn|g dz|dvng ldn|vg ldh aer|g

|g|eh dn rehtl( 6??: ................................................................................................. 46 Khtr|vebkòn 6?  ‒ Ldr|kng ld her lkcdvdn|dr ctdn|dr ld cknenbkemkdn|g( Fghkske( 6??2-?: ................... 42 Khtr|vebkòn 65 ‒ Aer|g dn sehgv ngmkneh rdaùn ctdn|d nebkgneh *Fr. Mkhhgndr+( Fghkske( 6??2-?: .... 43  Khtr|vebkòn 66 ‒ Aer|g pdv båpk|e *Fr.+ dn sehgv ngmkneh rdaùn |kpg ld ctdn|d( Fghkske( 6??2-?:..... 3?  Khtr|vebkòn 62 ‒ Bgmpevebkòn kn|dvnebkgneh ld he |ere ld bvdbkmkdn|g 6??2-6??1 ldh aer|g dn

rehtl pdv båpk|e dn sehgv ngmkneh *TMN+( rdaùn |kpg ld ctdn|d ............................. 36 Khtr|vebkòn 6<  ‒ Aer|g vdeh pdv båpk|e rdaùn ctdn|d nebkgneh *Fr.+( Fghkske( 6??2-?: ...................... 32  Khtr|vebkòn 64  ‒ Aer|g dn rehtl pgv |kpg ld ctdn|d dn $ ldh _KF( Fghkske( 6??2-6??: ...................... 3< Khtr|vebkòn 63  ‒ Aer|g dn rehtl rdaùn ctdn|d dn $ ldh aer|g pùfhkbg |g|eh( Fghkske( 6??2-6??:...... 34

 Khtr|vebkòn 61  ‒ Dr|vtb|tve ld Aer|g dn rehtl rdaùn gfid|g( Fghkske( 6??1 ...................................... 33 Khtr|vebkòn 6:  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn gfid|g( Fghkske( 6??2-?1 ........ 31 Khtr|vebkòn 6;  ‒ Dsghtbkòn ldh aer|g dn rehtl rdaùn pvknbkpehdr gfid|gr( Fghkske( 6??2-?1 ............. 1? Khtr|vebkòn 2?  ‒ Dr|vtb|tve ld Aer|g dn rehtl rdaùn ctnbkòn( Fghkske( 6??1 .................................... 1< Khtr|vebkòn 25 ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn ctnbkòn( Fghkske( 6??2-?1 ...... 14 Khtr|vebkòn 26  ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g dn he ctnbkòn ld pvdsdnbkòn { rehtl

pùfhkbe dn $ ldh aer|g |g|eh dn rehtl( pdvkglg 6??2-6??1 ..................................... 13 Khtr|vebkòn 22  ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g dn e|dnbkòn jgrpk|ehevke dn $ ldh aer|g

|g|eh dn rehtl { dn $ ldh aer|g dr|e|eh dn rehtl( pdvkglg 6??2-6??1 .................... 11 Khtr|vebkòn 2<  ‒ Dr|vtb|tve ld Aer|g dn rehtl rdaùn pvgsddlgv( Fghkske( 6??1 ............................... :2  Khtr|vebkòn 24  ‒ Aer|g dn rehtl pgv |kpg ld dr|efhdbkmkdn|g dn $ ldh aer|g |g|eh dn rehtl dn

hgr rtfrdb|gvdr pùfhkbg { ld he Rdatvklel Rgbkeh( Fghkske( 6??1 ............................ :4 Khtr|vebkòn 23  ‒ Dr|vtb|tve ld Aer|g dn rehtl { ld pgfhebkòn rdaùn Ldpev|emdn|g( Fghkske(

6??1 ........................................................................................................................ ;? Khtr|vebkòn 21 ‒ Dr|vtb|tve ld aer|g dn rehtl pgv rtfrdb|gv rdaùn Ldpev|emdn|g( 6??1 ............... ;2 Khtr|vebkòn 2:  ‒ Dr|vtb|tve ld aer|g pgv dn|klel pùfhkbe rdaùn Ldpev|emdn|g( 6??2 { 6??1 ......... ;< Khtr|vebkòn 2;  ‒ \ere ld bvdbkmkdn|g 6??2-6??1 ldh aer|g dn rehtl pgv Ldpev|emdn|g( Fghkske ..... ;1 Khtr|vebkòn <?  ‒ Aer|g dn rehtl pdv båpk|e rdaùn Ldpev|emdn|g( dn fghkskengr( Fghkske( 6??1 ....... ;; Khtr|vebkòn <5 ‒ Aer|g dn rehtl pdv båpk|e rdaùn Ldpev|emdn|g { rtfrdb|gv( Fghkske( 6??1 ......... 5?5 Khtr|vebkòn <6 ‒ \ere ld bvdbkmkdn|g 6??2-6??1 ldh aer|g pùfhkbg pdv båpk|e rdaùn

Ldpev|emdn|g( Fghkske ........................................................................................... 5?2 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 12/110

 

56

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 13/110

 Bepí|thg K. Mevbg bgnbdp|teh { en|dbdldn|dr ld 

her Btdn|er ld Rehtl dn Fghkske 

K.5. ·Utë rgn her btdn|er ld rehtl7 

Her Btdn|er ld Rehtl rgn tn bgnitn|g ld btelvgr dn hgr utd rd dnbtdn|ven gvaenkyelgr lkr|kn|grerpdb|gr ldh aer|g { ldh cknenbkemkdn|g ld he rehtl ld tn ld|dvmknelg peír. Rt gfid|ksg pvknbkpeh drepg{ev he agfdvnenbke { he |gme ld ldbkrkgndr ldh rkr|dme ld rehtl * GMR 6??4+.

Bgnrkr|dn dn tn mgnk|gvdg rkr|dmå|kbg( kn|daveh { bgnrkr|dn|d ldh chtig ld vdbtvrgr dn dh rkr|dme ldrehtl ld tn peír { bgnr|k|t{dn tne jdvvemkdn|e lkrdõele drpdbíckbemdn|d peve rtmknkr|vevkncgvmebkòn eh pvgbdrg ld her pghí|kber ld rehtl( knbht{dnlg dh lkrdõg { he knr|vtmdn|ebkòn ldpghí|kber( dh lkåhgag pghí|kbg( { dh mgnk|gvdg { he dsehtebkòn ld her kn|dvsdnbkgndr ld e|dnbkòn ld herehtl. Rtmknkr|ven kncgvmebkòn bkdn|íckbe peve e{tlev e hgr cgvmthelgvdr ld pghí|kber( hgr eb|gvdr

dr|ve|ëakbgr ng atfdvnemdn|ehdr { hgr elmknkr|velgvdr e |gmev mdigvdr ldbkrkgndr dn rtrdrctdvygr pgv mdigvev dh ldrdmpdõg ldh rkr|dme ld rehtl *GMR 6??4+.

Ld ebtdvlg bgn he dzpdvkdnbke( hgr peírdr utd jen ldrevvghhelg { t|khkyelg her btdn|er ld rehtl herjen dnbgn|velg ld aven t|khklel peve vdrpgnldv e pvdatn|er |ehdr bgmg *GMR 6??4+9  ·Bòmg rd mgskhkyen { elmknkr|ven hgr vdbtvrgr peve dh rkr|dme ld rehtl7  ·Utkën peae { btån|g rd peae pgv he e|dnbkòn ld he rehtl7  ·Utkën pvgpgvbkgne hgr fkdndr { rdvskbkgr { utë vdbtvrgr t|khkyen peve dhhg7  ·Bòmg rd lkr|vkft{dn hgr cgnlgr ld he e|dnbkòn ld he rehtl dn|vd hgr lkcdvdn|dr rdvskbkgr(

kn|dvsdnbkgndr { eb|kskleldr utd pvgltbd dh rkr|dme ld rehtl7  ·Utkën rd fdndckbke ldh aer|g dn he e|dnbkòn ld he rehtl7

Hg utd lkr|knatd her btdn|er ld rehtl ld g|ver cgvmer ld vdskrkòn ld aer|g dr utd kmphkbe tne

bgn|efkhklel bgmphd|e ld |glg dh aer|g ldr|knelg e he rehtl { tne bherkckbebkòn vkatvgre ld hgr |kpgr {hgr pvgpòrk|gr ld |glgr hgr aer|gr { ld |glgr hgr eb|gvdr dn dh rkr|dme ld rehtl0 |emfkën pdvmk|d tnebdvbemkdn|g vkatvgrg e he vdbghdbbkòn( be|ehgaebkòn { dr|kmebkòn ld |glgr hgr chtigr ld lkndvgvdhebkgnelgr bgn dh aer|g dn rehtl( dn dh mevbg ld tn enåhkrkr bgn|knùg * GMR 6??4+.

K.6. Aer|g dn rehtl 

Ld ebtdvlg bgn he Atíe ldh _vgltb|gv ld Btdn|er dn Rehtl *GMR 6??4+( dh aer|g dn rehtl efevbe|glgr eutdhhgr aer|gr bt{g pvgpòrk|g pvkmgvlkeh rde he vdr|etvebkòn( dh mdigvemkdn|g { dhmen|dnkmkdn|g ld he rehtl peve dh peír { peve hgr knlkskltgr ltven|d tn pdvkglg ldcknklg ld |kdmpg.Dr|e ldcknkbkòn dr såhkle knldpdnlkdn|dmdn|d ldh |kpg ld knr|k|tbkòn g dn|klel utd pvgsde g utdpeatd pgv he eb|ksklel ld rehtl.

Rk fkdn dzkr|dn mtbjer eb|kskleldr utd dr|ån vdhebkgneler bgn he rehtl( bgmg ehkmdn|ebkòn( eaterdatve( pvg|dbbkòn rgbkeh { g|ver ld|dvmknen|dr ld he rehtl( dr|år ng rd bgnrkldven dn hgr dr|tlkgrld btdn|er ld rehtl. Dn berg bgn|vevkg( dr|gr rdvíen mdngr pvdbkrg { dn|gnbdr( mdngr ù|khdr.Rkn dmfevag( he hínde lkskrgvke dn|vd her eb|kskleldr utd rd tfkben ‘dn” he drcdve ld her btdn|er ldrehtl ld eutdhher utd rd dnbtdn|ven ‘ctdve” dr e sdbdr mt{ emfkate. Dh bvk|dvkg utd rd ldfd t|khkyevpeve lkr|knatkv rk tne ebbkòn rd bgnrkldve g ng bgmg aer|g dn rehtl dr he kn|dnbkòn pvkmgvlkeh ld he

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 14/110

 

5<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

eb|ksklel dn btdr|kòn9 rk dr he vdr|etvebkòn( mdigvemkdn|g g men|dnkmkdn|g ld he rehtl( dn|gnbdrldfd dr|ev knbhtkle dn dh aer|g dn rehtl.

E bgn|kntebkòn( rd pvdrdn|e tn btelvg ld didmphgr ld eb|kskleldr e knbhtkv { e dzbhtkv ldh aer|g dnrehtl *btelvg 5+( peve dn|dnldv dn cgvme pvåb|kbe dh bgnbdp|g ld aer|g t|khkyelg dn hgr dr|tlkgr ldbtdn|er ld rehtl.

Btelvg 5  ‒ Didmphgr ld eb|kskleldr utd pglvíen knbhtkvrd g dzbhtkvrd ldh aer|g dn rehtl

\kpg ld eb|ksklelBgn pvgfefkhklel ld

vdhebkgnevrd bgn he rehtlBgn pgbe pvgfefkhklel ldvdhebkgnevrd bgn he rehtl

Rtmknkr|vg ld eatebgvvkdn|d {

eb|kskleldr ldjkakdnd

Skakhenbke ld he behklel ldh eate peve fdfdv0bgnr|vtbbkòn ld phen|er ld |ve|emkdn|g bt{g

pvgpòrk|g pvkmgvlkeh dr he dhkmknebkòn lddncdvmdleldr ld gvkadn jílvkbg.

Bgnr|vtbbkòn { men|dnkmkdn|g ld avenldrrkr|dmer tvfengr ld rtmknkr|vg ld eate bt{gpvgpòrk|g pvkmgvlkeh dr dh ebbdrg eh eate peve

bgnrtmg ld he pgfhebkòn tvfene.

Eb|kskleldr ldepg{g nt|vkbkgneh

Erdrgvíe nt|vkbkgneh { pvgaveme ldehkmdn|ebkòn bgmphdmdn|evke peve

vdltbkv he ldrnt|vkbkòn kncen|kh.

_vgavemer adndvehdr ld vdcvkadvkg drbghev{ rtfrklkgr adndvehdr e hgr pvdbkgr ldehkmdn|gr( bt{g pvgpòrk|g pvkmgvlkeh dr

gcvdbdv tn epg{g eh knavdrg g he rdatvklel.

Dltbebkòn {bepebk|ebkòn Dltbebkòn mëlkbe { bepebk|ebkòn dn dh |vefeig e|vefeielgvdr pevemëlkbgr. Dltbebkòn rdbtnlevke vdbkfkle pgv ct|tvgrmëlkbgr g |vefeielgvdr ld he rehtl.

Knsdr|kaebkònKnsdr|kaebkòn mëlkbe0 knsdr|kaebkòn dn

rdvskbkgr ld rehtl peve mdigvev dhldrdmpdõg ld hgr pvgavemer.

Knsdr|kaebkòn bkdn|íckbe fårkbedn fkghgaíe { utímkbe.

Ctdn|d9 GMR 6??4 

K.2. En|dbdldn|dr ld her Btdn|er ld Rehtl dn Fghkske 

Hgr pvkmdvgr dr|tlkgr ld btdn|er ld rehtl dn Fghkske rd vdehkyevgn dn cgvme knldpdnlkdn|d ldh

Mknkr|dvkg ld Rehtl e pev|kv ldh eõg 5;;<( dn he Tnklel ld Enåhkrkr ld _ghí|kber Rgbkehdr *TLE_RG+(vdrth|enlg dn lgr ptfhkbebkgndr dn|vd 5;;4 { 5;;1 bgn dh epg{g ld he Gvaenkyebkòn _enemdvkbeneld he Rehtl G_R { ldh Knr|k|t|g ld he Tnksdvrklel ld Jevsevl peve dh Ldrevvghhg Kn|dvnebkgneh JKKL*Båvldner { Levvår 5;;3( Båvldner d| eh . 5;;1+.

Ldrld 5;;1( dh Mknkr|dvkg ld Rehtl { _vdskrkòn Rgbkeh( ejgve Mknkr|dvkg ld Rehtl { Ldpgv|dr *MRL+(je sdnklg epg{enlg he dhefgvebkòn ld her Btdn|er ld Rehtl dn dh peír dn dh mevbg ld he ‘Knkbke|kseld Btdn|er Nebkgnehdr ld Aer|g dn Rehtl” dn he bteh pev|kbkpevgn sevkgr peírdr ld Emëvkbe He|kne(bgn dh epg{g ld he G_R'GMR( ldh pvg{db|g _ev|ndvrjkpr cgv Jdeh|j Vdcgvm *_JV+ ld he Eadnbke ldhgr Dr|elgr Tnklgr peve dh Ldrevvghhg Kn|dvnebkgneh *TREKL+ { ld he Tnksdvrklel ld Jevsevl. Bgmgvdrth|elg ld dr|er ehkenyer kn|dvknr|k|tbkgnehdr( rd ptfhkbò dn dh eõg 5;;: dh dr|tlkg ld btdn|er bgnle|gr ldh pdvkglg 5;;4-5;;3 *_JV 5;;:+ { dn dh eõg 6??? dh dr|tlkg ld Btdn|er Nebkgnehdr ldCknenbkemkdn|g { Aer|g dn Rehtl( bgn hgr vdrth|elgr peve dh pdvíglg 5;;4-5;;: *Båvldner( 6???+.

_gr|dvkgvmdn|d( rd ptfhkbò dn dh eõg 6??< he rdatnle dlkbkòn ldh dr|tlkg bgn vdrth|elgr peve dhpdvkglg 5;;;-6??6 *Båvldner 6??<+( bgn dh epg{g ldh Mknkr|dvkg Fvk|ånkbg peve dh LdrevvghhgKn|dvnebkgneh *LCKL+( ldh Fenbg Mtnlkeh { ld he G_R'GMR.

Dn|vd hgr eõgr 6??< { 6??3 rd vdehkyevgn drctdvygr knr|k|tbkgnehdr peve mg|ksev he vdehkyebkòn lddr|tlkgr ld Btdn|er ld Rehtl dn hgr Ldpev|emdn|gr ld He _ey( Gvtvg( \evkie { _g|grí( pdvg ng rdptfhkbevgn dr|gr dr|tlkgr *Sehlër { _dõehgye 6?5?+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 15/110

 Dn itnkg ld 6??;( rd ckvmò tn bgnsdnkg ld bggpdvebkòn kn|dvknr|k|tbkgneh dn|vd dh Mknkr|dvkg ld Rehtl{ Ldpgv|dr { he Tnklel ld Enåhkrkr ld _ghí|kber Rgbkehdr { Dbgnòmkber *TLE_D+( e pev|kv ldh bteh rdbgn|ve|ò e tn dutkpg bgnrth|gv utd vdehkyò dh Dr|tlkg ld Btdn|er Nebkgnehdr ld Rehtl bgn le|grpeve dh pdvkglg 6??2-6??1 { dh Menteh Md|glghòakbg bgvvdrpgnlkdn|d *Sehlër { _dõehgye 6?5?+. Dr|dlgbtmdn|g dr |glesíe pvdhkmknev { ng ctd ptfhkbelg.

Elkbkgnehmdn|d( dh Mknkr|dvkg ld Rehtl { Ldpgv|dr rghkbk|ò dn eagr|g ld 6?5? e he GNA Rgbkgr pevedh Ldrevvghhg( he bgn|ve|ebkòn ld bgnrth|gvdr peve vdskrev dh dr|tlkg vdehkyelg pgv Qdvndv Sehlër {Vglvkag _dõehgye( bgn dh epg{g ld lgr bgnrth|gvdr ldh MR{L. Vdrth|ò ng rghemdn|d dn tnevdskrkòn( rkng dn he pvgltbbkòn ld tn |vefeig ntdsg( bgn vdrth|elgr mdngr ldreavdaelgr( bemfkgrmd|glghòakbgr { bgvvdbbkgndr dn her ferdr ld le|gr( utd bgnr|k|t{d dh rdatnlg dr|tlkg ld btdn|erpeve dh pdvkglg 6??2-6??1( bgn eldmår vdrth|elgr pvdskrkgnehdr peve dh eõg 6??: * Eskhe d| eh . 6?55+.

K.<. Lgbtmdn|ebkòn enehkyele 

Dh pvdrdn|d lgbtmdn|g ld enåhkrkr ldh aer|g dn rehtl dn Fghkske rd fere dn hgr lgr lgbtmdn|grmdnbkgnelgr en|dvkgvmdn|d *Sehlër { _dõehgye 6?5?0 Eskhe d| eh . 6?55+ { dn hgr vdrth|elgr ld aer|g rdaùn

ctdn|d( eadn|d( ctnbkòn { pvgsddlgv peve dh pdvkglg 6??2-6??:.Rk fkdn emfgr dr|tlkgr rgn rkmkhevdr dn sevkgr ptn|gr ldfklg e utd pev|dn ld he mkrmebgnbdp|tehkyebkòn md|glghòakbe elep|ele ld he Atíe ldh _vgltb|gv ld Btdn|er dhefgvelg pgv heGvaenkyebkòn Mtnlkeh ld he Rehtl( dh Fenbg Mtnlkeh { he Eadnbke ld hgr Dr|elgr Tnklgr peve dhLdrevvghhg Kn|dvnebkgneh *GMR 6??4+( dzkr|dn sevker lkcdvdnbker dn|vd hgr |vefeigr dn bten|g eldreavdaebkòn ld le|gr( t|khkyebkòn ld le|gr ng gckbkehdr( ben|klel ld dr|kmebkgndr vdehkyeler(bherkckbelgvdr t|khkyelgr utd rd vdrtmdn dn dh btelvg 6.

Rkn dmfevag { e pdrev ld he gvkdn|ebkòn |gmele pgv hgr bgnrth|gvdr ld dhefgvev tn ntdsg pvgltb|g(rd ptlg bgnr|e|ev utd dh lgbtmdn|g dn|vdaelg dr rkmkhev dn sevkgr ptn|gr eh Menteh Md|glghòakbggvkakneh sehklelg pgv TLE_D { dh MR{L. Dn dcdb|g( påvvecgr dn|dvgr ctdvgn bgpkelgr eh klën|kbg {mtbjgr bemfkgr bgnrkr|kdvgn dn fgvvev ehatner pev|dr ldh menteh gvkakneh peve bgnrdvsev herbe|dagvíer ld aer|g mår eavdaeler( hg utd e sdbdr ecdb|e e he bgmpvdnrkòn ld he md|glghgaíe lddhefgvebkòn ld her btdn|er ld rehtl.

Hgr pvknbkpehdr bemfkgr md|glghòakbgr utd rd ptdldn bgnr|e|ev dn|vd hgr lgr dr|tlkgr bgnbkdvndnhe rtpvdrkòn ld hgr rdatvgr pùfhkbgr ld rehtl bgmg eadn|d ld cknenbkemkdn|g skv|teh( he bvdebkòn ldhe be|dagvíe ld eadn|dr ld cknenbkemkdn|g ld Rdatvklel Rgbkeh pvksele( he rtpvdrkòn ld herdr|kmebkgndr ld aer|g pgv ctnbkòn( pvgsddlgv { Ldpev|emdn|g *rghg utdle her bherkckbebkgndr pgvctdn|d( eadn|d { gfid|g ldh aer|g dn dh rdatnlg dr|tlkg+ { he rtpvdrkòn ld sevker ldreavdaebkgndr*pev|kler ld aer|g pvknbkpehmdn|d+. \emfkën rd mglkckbò dh më|glg ld dr|kmebkòn ldh aer|g ldfghrkhhg( {e utd dn dh rdatnlg dr|tlkg rd t|khkye rghemdn|d he dnbtdr|e ld jgaevdr bgmg knr|vtmdn|gld dr|kmebkòn( vdrth|enlg dn avenldr lkcdvdnbker dn hgr vdrth|elgr dn dr|e be|dagvíe ld aer|g._gv g|ve pev|d( dh rdatnlg dr|tlkg pdvmk|kò he mdigve ld he dr|kmebkòn ldh aer|g pùfhkbg( bgvvkakdnlglgfhd bgn|efkhklel { pev|kler utd ng bgvvdrpgnlíen e aer|g dn rehtl utd ldh pvkmdv dr|tlkg( dn|vdg|ver bgvvdbbkgndr ld her ferdr ld le|gr.

Cknehmdn|d( dh rdatnlg dr|tlkg pvdrdn|e le|gr utd ldfdvíen rdv mår bgnckefhdr dn bten|g e aer|gpùfhkbg *dh aer|g pvkselg( pvknbkpehmdn|d ld jgaevdr( pevdbd rtf-dr|kmelg pgv rghg t|khkyev ctdn|drldh Knr|k|t|g Nebkgneh ld Dr|elír|kber ng lkrdõeler peve dh båhbthg vdeh ldh aer|g dn rehtl+ pdvgrtpvkmkò |vdr bherkckbelgvdr { sevker be|dagvíer ld aer|g ldreavdaeler ndbdrevkgr eh enåhkrkrdbgnòmkbg ldh rdb|gv rehtl. Dr|er lkcdvdnbker { sdn|eier ld bele dr|tlkg( vdrtmkler e bgn|kntebkòn*btelvg 6+( kmphkben dn|gnbdr utd rd ldfd t|khkyev hgr lgr lgbtmdn|gr peve pvgbdldv eh enåhkrkreldbtelg ldh bgmpgv|emkdn|g ldh aer|g dn rehtl peve dh pdvkglg 6??2-6??:.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 16/110

 

53

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg 6  ‒ _vknbkpehdr lkcdvdnbker dn|vd hgr lgr dr|tlkgr ld btdn|er ld rehtl 6??2-6??1

Beveb|dvír|kberldh Dr|tlkg

_vkmdv Dr|tlkg*Sehlër { _dõehgye 6?5?+

Rdatnlg Dr|tlkg*Eskhe( Skhhdne( Åhsevdy { Båvldner 6?55+

_dvkglg enehkyelg 6??2 - 6??1 6??2 ‒ 6??1 { dr|kmebkgndr pvdhkmknevdrpeve he adr|kòn 6??:

Aer|g dn Rehtl6??1

Aer|g |g|eh = TRL 334.561.1:2Aer|g rtf-rdb|gv pùfhkbg = TRL 644.5;:.:6;Aer|g rdatvklel rgbkeh = TRL 5:6.;4?.624Aer|g pvkselg = TRL 663.;1:.15:Aer|g ld fghrkhhg = TRL 5:1.:;3.31;

Aer|g |g|eh = TRL 363.52;.?43Aer|g rtf-rdb|gv pùfhkbg = TRL 6<3.:?6.<64Aer|g rdatvklel rgbkeh = TRL 515.4?;.:5?Aer|g pvkselg = TRL 6?1.:63.:65Aer|g ld fghrkhhg = TRL 54<.136.324

Bherkckbebkgndrt|khkyeler

Bherkckbebkòn ld her btdn|er ld rehtl pgv9ctdn|dr ld cknenbkemkdn|g( eadn|dr ld

cknenbkemkdn|g( ctnbkgndr( pvgsddlgvdr ldrdvskbkg( gfid|g ldh aer|g { Ldpev|emdn|gr

Bherkckbebkòn ld her btdn|er ld rehtl pgv9ctdn|dr ld cknenbkemkdn|g( eadn|dr ld

cknenbkemkdn|g { gfid|g ldh aer|g

Vdrpehlgr ld hekncgvmebkòn

Ng dzkr|dn |glgr hgr vdrpehlgr peveher dr|kmebkgndr vdehkyeler

Dzkr|dn |glgr hgr vdrpehlgrld he kncgvmebkòn t|khkyele

Dr|kmebkgndr ldaer|g dn rehtl

Rd vdehkyò ntmdvgrer dr|kmebkgndr pevepgldv ldreavdaev dh aer|g dn rtf-be|dagvíer*e sdbdr dr|kmenlg tn aer|g ldreavdaelgldn|vg ld tn aer|g utd {e dve dr|kmelg+

Ng rd vdehkyò dr|kmebkgndr peve båhbthg ldhaer|g *mdngr peve aer|g ld fghrkhhg+

erdatvenlg he bgnckefkhklel ld hgr le|gr pdvgkmpgrkfkhk|enlg tne ldreavdaebkòn rtckbkdn|d

Ldreavdaebkònldh aer|g

5;4 be|dagvíer { rtf be|dagvíer ld aer|gdn rehtl *56 ld ctdn|dr( << ld eadn|dr ld

cknenbkemkdn|g( 24 ld pvgsddlgvdr( <:ld ctnbkgndr( <3 ld gfid|g ldh aer|g { 5?

ld vdakòn ' ldpev|emdn|g+

25 be|dagvíer { rtf be|dagvíer ld aer|g dnrehtl *1 ld ctdn|dr( 54 ld eadn|dr ld

cknenbkemkdn|g { ; ld gfid|g ldh aer|g+( ngdzkr|d ldreavdaebkòn ld her pvknbkpehdr

sevkefhdr ld kn|dvër *aer|g dn mdlkbemdn|grpgv didmphg( ng epevdbd dn dh dr|tlkg+

Rdatvgr _ùfhkbgrld Rehtl

Rd bgnrkldvò hgr Rdatvgr _ùfhkbgr *RTMK(RMAS( RR_EM( Rdatvgr Et|òngmgr

Ldpev|emdn|ehdr( Rdatvgr Mtnkbkpehdr+ bgmgeadn|dr ld cknenbkemkdn|g skv|tehdr utdmendien cgnlgr( knbhtrksd ld vdbtvrgr

jtmengr( rtfdr|kmenlg erí dh aer|g didbt|elgpgv pev|d ld Mtnkbkpkgr { _vdcdb|tver

Rd vdkn|davg dh aer|g dn Rdatvgr _ùfhkbgrldn|vg ld hgr eadn|dr ld cknenbkemkdn|g

bgvvdrpgnlkdn|dr *pvknbkpehmdn|d Mtnkbkpkgr {_vdcdb|tver+ pdvg rd rtpvkmkò |gle mdnbkòn

rgfvd rdatvgr pùfhkbgr( kmpgrkfkhk|enlgkldn|kckbev dh aer|g bgvvdrpgnlkdn|d

Aer|g ld fghrkhhgdn rehtl

Dr|kmelg e pev|kv ld her dnbtdr|er ld jgaevdrbgn rteskyebkòn ld le|gr( ld KMR Jdeh|j Fghkske

peve aer|gr dn mdlkbemdn|gr( knbht{dnlgdr|kmebkòn ldh bgn|vefenlg ld mdlkbemdn|gr

Dr|kmelg rghemdn|d e pev|kv ld her dnbtdr|erld jgaevdr rkn rteskyebkòn dr|elír|kbe

Rdatvklel Rgbkeh

Rd ld|ehhe |gler her Knr|k|tbkgndr ld RdatvklelRgbkeh feig he mkrme ldngmknebkòn ld

Rdatvklel Rgbkeh pdvg ng rd lkcdvdnbke dn|vdrdb|gv pùfhkbg { rdb|gv pvkselg

Rd jebd he lkcdvdnbke dn|vd dmphdelgvdr

pùfhkbgr { dmphdelgvdr pvkselgr

Ng rd ld|ehhe her lkcdvdn|dr knr|k|tbkgndr ldRdatvklel Rgbkeh pdvg rd lkrbvkmkne rdb|gvpùfhkbg *Rdatvklel Rgbkeh ld bgv|g pheyg+ {rdb|gv pvkselg *rdatvgr rgbkehdr pvkselgr+

Ng rd jebd he lkcdvdnbke dn|vd dmphdelgvdr

pùfhkbgr { dmphdelgvdr pvkselgr

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e he vdskrkòn ld9 Sehlër { _dõehgye 6?5?0 Eskhe d| eh. 6?55 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 17/110

 

Bepí|thg KK. Md|glghgaíe ld enåhkrkr ld her Btdn|er ld Rehtl 6??2-6??: 

Dh pvdrdn|d lgbtmdn|g |kdnd pgv gfid|ksg bgmphd|ev hgr lgr dr|tlkgr ld btdn|er ld rehtl * Sehlër {_dõehgye 6?5?0 Eskhe d| eh . 6?55+ bgn tn enåhkrkr rkr|dmå|kbg ldh bgmpgv|emkdn|g ldh aer|g dn rehtl dn dhbgn|dz|g mebvgdbgnòmkbg fghkskeng { dn dh bgn|dz|g kn|dvnebkgneh ldh cknenbkemkdn|g ld he rehtl(bgn dh gfid|ksg ld epg{ev e he |gme ld ldbkrkòn dn dh Rdb|gv Rehtl { bvdev tne evatmdn|ebkòn rghklee cesgv ldh knbvdmdn|g ldh aer|g pùfhkbg dn rehtl dn dh mevbg ld he bgnr|vtbbkòn ldh Rkr|dme Ùnkbgld Rehtl dn dh Dr|elg _htvknebkgneh ld Fghkske.

E pev|kv ld he kldn|kckbebkòn { båhbthg ldh aer|g dn rehtl { ld rt ldreavdaebkòn *pgv ctdn|d( eadn|dcknenbkelgv( pvgsddlgv( ctnbkgndr( pev|kler ld aer|g( ldpev|emdn|gr( d|b.+ vdehkyelgr dn hgr lgrdr|tlkgr mdnbkgnelgr en|dvkgvmdn|d( rd pvgpgnd e bgn|kntebkòn sevkgr bvk|dvkgr d knlkbelgvdr pevevdehkyev tn enåhkrkr rkr|dmå|kbg ldh aer|g dn rehtl dn Fghkske.

KK.5. Bherkckbebkòn ld her btdn|er ld rehtl { me|vkbdr ld aer|g 

_eve dh enåhkrkr ld her btdn|er ld rehtl( her mkrmer dr|ån behbtheler rdaùn bherkckbelgvdr pgvctdn|d ld cknenbkemkdn|g( pgv eadn|d( pgv ctnbkòn( pgv pvgsddlgv ld rdvskbkgr { pgv gfid|g ldh aer|g*bgr|g ld hgr vdbtvrgr+ dn ferd e he bherkckbebkòn kn|dvnebkgneh ld her btdn|er ld rehtl pvgptdr|epgv he Gvaenkyebkòn peve he Bggpdvebkòn { dh Ldrevvghhg Dbgnòmkbg *GBLD 6???+. Dn ehatngrdr|tlkgr( |emfkën rd ptdld gfrdvsev bherkckbebkgndr pgv vdakgndr( pgv dncdvmdleldr { pgvbeveb|dvír|kber rgbkg-dbgnòmkber g ldmgavåckber ld he pgfhebkòn.

Dn hgr lgr dr|tlkgr enehkyelgr *Sehlër { _dõehgye 6?5?0 Eskhe d| eh . 6?55+( rd t|khkye her bherkckbebkgndr ld

ctdn|dr ld cknenbkemkdn|g( eadn|dr { gfid|g ldh aer|g. Eldmår( dn dh pvkmdv dr|tlkg * Sehlër { _dõehgye6?5?+( rd dr|kme dh aer|g dn rehtl rdaùn ctnbkgndr( pvgsddlgvdr { ldpev|emdn|gr.Dr|er lkcdvdn|dr bherkckbebkgndr rd ldckndn ld he rkatkdn|d mendve * Sehlër { _dõehgye 6?5?+9

  Ctdn|dr ld cknenbkemkdn|g9 rgn her knr|k|tbkgndr g dn|kleldr utd pvgpgvbkgnen hgr cgnlgrt|khkyelgr dn dh rkr|dme pgv hgr eadn|dr ld cknenbkemkdn|g.Didmphg9 \AN( vdbtvrgr drpdbíckbgr( lgnebkòn dz|dvne( dmphdelgvdr( jgaevdr( d|b.

  Eadn|dr ld cknenbkemkdn|g9 rgn her knr|k|tbkgndr g dn|kleldr utd benehkyen hgr cgnlgr utdpvgpgvbkgnen her ctdn|dr ld cknenbkemkdn|g { utd hgr tren peve peaev g bgmpvev her lkcdvdn|dreb|kskleldr bkvbtnrbvk|er dn dh åmfk|g ld her btdn|er nebkgnehdr.Didmphg9 Mknkr|dvkg ld Rehtl { Ldpgv|dr( _vdcdb|tver'Agfdvnebkgndr( Agfkdvngr Mtnkbkpehdr(Beie Nebkgneh ld Rehtl( Beie _d|vghdve ld Rehtl( rdatvgr pvkselgr( jgaevdr( d|b.

  _vgsddlgvdr9 rgn her dn|kleldr utd vdbkfdn lkndvg e bemfkg ld g dn en|kbkpebkòn e he

pvgltbbkòn ld her eb|kskleldr bkvbtnrbvk|er ldn|vg ldh åmfk|g ld her btdn|er ld rehtl.Didmphg9 jgrpk|ehdr( knr|k|t|gr Drpdbkehkyelgr( bdn|vgr ld rehtl( hefgve|gvkgr mëlkbgr { ldlkeanòr|kbg( fenbgr ld renavd { òvaengr( dutkpgr mòskhdr( mëlkbg |velkbkgneh( d|b.

  Ctnbkgndr9 rgn hgr |kpgr ld fkdndr { rdvskbkgr utd rd pvgsddn { her eb|kskleldr utd rd hhdsen ebefg ldn|vg ldh åmfk|g ld her btdn|er ld rehtl.Didmphg9 rdvskbkgr ld e|dnbkòn emfthe|gvke( e|dnbkòn jgrpk|ehevke( e|dnbkòn glgn|ghòakbe(rdvskbkgr etzkhkevdr( pvdsdnbkòn { rehtl pùfhkbe( vdb|gvíe { elmknkr|vebkòn ld he rehtl

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 18/110

 

5:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

  Gfid|g ldh Aer|g9 dr tne gvldnebkòn rkr|dmå|kbe { jgmgaënde ld hgr fkdndr { rdvskbkgr { her|venrcdvdnbker utd rd ephkbe dn dh ldrevvghhg ldh pvgbdrg ld e|dnbkòn ld he rehtl. Rd t|khkye dhbherkckbelgv pgv gfid|g ldh aer|g ldh Mknkr|dvkg ld Dbgngmíe { CknenyerDidmphg9 rdvskbkgr pdvrgnehdr( rdvskbkgr fårkbgr( |venrpgv|d( ehkmdn|gr( pvgltb|gr utímkbgr {cevmebët|kbgr( knr|vtmdn|eh mdngv mëlkbg utkvùvakbg( bgnr|vtbbkgndr( meutknevke { dutkpg( d|b.

  Ldpev|emdn|g9 dr|efhdbd he lkr|vkftbkòn pgv åvder adgavåckber ldh aer|g dn rehtl( |gmenlg

bgmg tnklel fårkbe he bherkckbebkòn ld he lkskrkòn pghí|kbe elmknkr|ve|kse ldh peír *;ldpev|emdn|gr+ { nksdh nebkgneh *aer|g ng erkanefhd pgv ldpev|emdn|g+.

E pev|kv ld dr|er bherkckbebkgndr( rd vdehkye her me|vkbdr ld aer|g dn rehtl rdaùn gvkadn *dnbghtmne+ { trg *dn hínde+. Dn dh pvkmdv dr|tlkg *Sehlër { _dõehgye 6?5?+( rd dhefgvevgn her bknbgme|vkbdr rkatkdn|dr0 dn dh rdatnlg *Eskhe d| eh . 6?55+( rghg rd dhefgvevgn her me|vkbdr 5 { <9  Me|vky 59 Eadn|d cknenbkelgv z Ctdn|d ld cknenbkemkdn|g  Me|vky 69 _vgsddlgv ld rdvskbkgr z Eadn|d cknenbkelgv  Me|vky 29 Ctnbkòn z Eadn|d cknenbkelgv  Me|vky <9 Gfid|g ldh aer|g z Eadn|d cknenbkelgv  Me|vky 49 Ldpev|emdn|g z Eadn|d cknenbkelgv

Dr|er lkcdvdn|dr bherkckbebkgndr { her me|vkbdr bgvvdrpgnlkdn|dr dhefgveler dn hgr lgr dr|tlkgr

mdnbkgnelgr en|dvkgvmdn|d bgnr|k|t{dn dh knrtmg peve dh enåhkrkr rkr|dmå|kbg ldh aer|g dn rehtl dnFghkske( dn ctnbkòn e hgr lkcdvdn|dr bvk|dvkgr utd rd pvgpgndn e bgn|kntebkòn.

KK.6. Bvk|dvkgr ld enåhkrkr ldh aer|g { cknenbkemkdn|g ld he rehtl 

KK.6.5. T|khkyebkòn ld knlkbelgvdr dr|ånlevdr

E pev|kv ld he kldn|kckbebkòn { båhbthg ldh aer|g dn rehtl { ld rt ldreavdaebkòn *pgv ctdn|d( eadn|dcknenbkelgv( pvgsddlgv( ctnbkgndr( pev|kler ld aer|g( ldpev|emdn|gr( d|b.+( rd ldfd t|khkyevknlkbelgvdr bten|k|e|ksgr peve dhefgvev dh enåhkrkr rkr|dmå|kbg ldh aer|g dn rehtl. Dr|gr rgnpvknbkpehmdn|d ld bknbg |kpgr9

  Sehgv vdeh ldh aer|g |g|eh dn rehtl9 rgn knlkbelgvdr bgn cgvme|g mgnd|evkg( dn tnkleldrmgnd|evker nebkgnehdr g kn|dvnebkgnehdr( e pvdbkgr bgnr|en|dr *sehgv vdeh+. Dh sehgv vdeh rdbehbthe e pev|kv ldh aer|g dn pvdbkgr bgvvkdn|dr *sehgv ngmkneh( utd dr dh sehgv behbthelg dn hgrlgr dr|tlkgr enehkyelgr+ eitr|enlg dr|d pgv he |ere ld knchebkòn |gmenlg dh pvkmdv eõglkrpgnkfhd bgmg eõg ld vdcdvdnbke *6??2 dn dh berg ld hgr dr|tlkgr enehkyelgr+.

  Aer|g dn Rehtl pdv båpk|e9 rgn knlkbelgvdr bgn cgvme|g mgnd|evkg( dn tnkleldr mgnd|evkernebkgnehdr g kn|dvnebkgnehdr( dn sehgv ngmkneh g vdeh( utd vdpvdrdn|en dh aer|g pvgmdlkg dnrehtl pgv jefk|en|d. Hgr knlkbelgvdr ld aer|g pdv båpk|e rd behbthen lksklkdnlg dh aer|g dn hebe|dagvíe bgnrkldvele pgv dh nùmdvg ld jefk|en|dr ld Fghkske *pgfhebkòn |g|eh g rtf-avtpgr ldpgfhebkòn bgmg pgv didmphg hgr eckhkelgr e he Rdatvklel Rgbkeh+.

  Ve|kgr mebvgdbgnòmkbgr9 rgn knlkbelgvdr bgn cgvme|g pgvbdn|teh( utd ld|dvmknen bteh dr hepvgpgvbkòn ldh aer|g dn rehtl ldn|vg ld sehgvdr ' knlkbelgvdr mebvgdbgnòmkbgr bgn cgvme|gmgnd|evkg bgmg dh pvgltb|g kn|dvng fvt|g *_KF+( dh aer|g pùfhkbg ldh _vdrtptdr|g Adndveh ld heNebkòn( g dh bgnrtmg ckneh ld hgr jgaevdr. Hgr ve|kgr mebvgdbgnòmkbgr rd behbthen lksklkdnlgdh aer|g dn rehtl dn he be|dagvíe bgnrkldvele pgv tn knlkbelgv mebvgdbgnòmkbg bgn cgvme|gmgnd|evkg *pgv didmphg dh aer|g |g|eh dn rehtl lksklklg pgv dh _KF+.

  Ve|kgr ld lkr|vkftbkòn ldh aer|g dn rehtl9 rgn knlkbelgvdr bgn cgvme|g pgvbdn|teh( utdld|dvmknen bteh dr he pvgpgvbkòn ld ehaùn |kpg drpdbíckbg ld aer|g dn rehtl ldn|vg ldh aer|g dn

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 19/110

 rehtl |g|eh g ld tne be|dagvíe ld aer|g eavdaele ld|dvmknele. Hgr ve|kgr ld lkr|vkftbkòn ldhaer|g dn rehtl rd behbthen lksklkdnlg dh aer|g dn rehtl dn he be|dagvíe bgnrkldvele pgv dhaer|g dn rehtl |g|eh g pevbkeh *pgv didmphg dh aer|g ld fghrkhhg lksklklg pgv dh aer|g pvkselg+.

  \erer ld bvdbkmkdn|g9 rgn knlkbelgvdr bgn cgvme|g pgvbdn|teh( utd vdpvdrdn|en dhbvdbkmkdn|g ldh aer|g dn rehtl g ld ehatng ld hgr knlkbelgvdr mdnbkgnelgr en|dvkgvmdn|dltven|d tn pdvkglg ld|dvmknelg *adndvehmdn|d ld tn eõg eh g|vg+. Her |erer ld bvdbkmkdn|g rd

behbthen bgmg he lkcdvdnbke dn dh aer|g g knlkbelgv bgnrkldvelg dn|vd lgr eõgr lksklklg pgv dhsehgv ldh pvkmdv eõg *pgv( didmphg( lkcdvdnbke dn dh aer|g |g|eh dn rehtl dn|vd 6??4 { 6??3lksklklg pgv dh aer|g |g|eh dn rehtl 6??4+.

KK.6.6. Mdlkv dh drctdvyg e cesgv ldh knbvdmdn|g ldh aer|g dn rehtl

Behbthev hgr lkcdvdn|dr |kpgr ld knlkbelgvdr pvdrdn|elgr dn dh ebåpk|d KK.6.5 dr drdnbkeh pdvgdskldn|dmdn|d ng rtckbkdn|d peve enehkyev dn cgvme rkr|dmå|kbe dh aer|g dn rehtl( { dn pev|kbthevpeve mdlkv hgr drctdvygr ld tn peír dn cesgv ld tn knbvdmdn|g ldh aer|g dn rehtl.

Dn dr|d rdn|klg( rd ldfd mdlkv dr|d drctdvyg pgv tne pev|d enehkyenlg he dsghtbkòn dn dh |kdmpg ld

hgr knlkbelgvdr bgnrkldvelgr { enehkyenlg |erer ld bvdbkmkdn|g entehdr dn tn ld|dvmknelg pdvkglg._gv g|ve pev|d( rd enehkyeve her btdn|er ld rehtl bgn tn dncgutd kn|dvnebkgneh( bgmpevenlg hgrlkcdvdn|dr knlkbelgvdr bgn hg utd rd gfrdvse dn lkcdvdn|dr peírdr bgn hgr btehdr rd ptdldn jebdvbkdv|er erkmkhebkgndr g bgn peírdr utd |kdndn tne rk|tebkòn utd rd utkdvd ehbenyev.

Erí( peve bele knlkbelgv utd rd jefvå bgnrkldvelg bgmg gpgv|tng( rd enehkyevå dh sehgv g dh nksdhldh knlkbelgv( rt dsghtbkòn dn dh |kdmpg( her lkcdvdnbker bgn tn avtpg ld peírdr ityaelgrpdv|kndn|dr { he dsghtbkòn ld dr|er lkcdvdnbker.

KK.2. Aer|g dn rehtl enehkyelg 

Dh pvdrdn|d enåhkrkr ldh aer|g dn rehtl dn Fghkske rd fere dn hgr lgr lgbtmdn|gr ld btdn|er ldrehtl lkrpgnkfhdr dn dh Mknkr|dvkg ld Rehtl { Ldpgv|dr *Sehlër { _dõehgye 6?5?0 Eskhe d| eh . 6?55+( dn hgrbtehdr rd pvgltbdn vdrth|elgr lkcdvdn|dr ldfklg e lkcdvdnbker bgnbdp|tehdr { md|glghòakber dn dhmendig ld hgr le|gr. Rkn dmfevag( peve cebkhk|ev dh enåhkrkr ld her btdn|er { ng vdpd|kv dh didvbkbkgpeve bele tng ld hgr lgbtmdn|gr pvgltbklgr( rd |gmevå dn btdn|e hgr rkatkdn|dr bvk|dvkgr9

  Dh aer|g dn rehtl vd|dnklg pgv eadn|d { pgv ctdn|d dr dh ldh rdatnlg dr|tlkg *Eskhe d| eh . 6?55+(dzbdp|g peve dh aer|g ld fghrkhhg dn rehtl( ldfklg e hgr pvgfhdmer vdbtvvdn|dr gfrdvselgr dn dhpvkmdv dr|tlkg *Sehlër { _dõehgye 6?5?+ { bgvvdaklgr dn dh rdatnlg.

  Dh aer|g ld fghrkhhg dn rehtl |gmelg dn btdn|e eutí dr dh ldh pvkmdv dr|tlkg( ldfklg e he me{gvbgnckefkhklel ld hgr le|gr t|khkyelgr peve dh båhbthg ldh aer|g dn mdlkbemdn|gr.

  Bgmg bgnrdbtdnbke ld hgr lgr pvkmdvgr bvk|dvkgr( dh aer|g |g|eh dn rehtl rdvå kateh eh aer|g ldhgr lkcdvdn|dr eadn|dr ld cknenbkemkdn|g ldh rdatnlg dr|tlkg *mdngr hgr jgaevdr+ mår dh aer|gld jgaevdr behbthelg dn dh pvkmdv dr|tlkg.

  _eve eldbtev hgr vdrth|elgr ld hgr lgr dr|tlkgr( rd |gme dn btdn|e tne |ere ld bemfkg ùnkbepeve |venrcgvmev hgr le|gr kníbkehdr *dn Fghkskengr+ dn Lòhevdr emdvkbengr. He |ere t|khkyelebgvvdrpgnld eh pvgmdlkg ldh |g|eh ld her bg|kyebkgndr gckbkehdr ldh eõg *FBF 6?5?+. Dh FenbgBdn|veh ld Fghkske pvgltbd dr|er bg|kyebkgndr lkevker( mdngr hgr råfelgr( lgmknagr { líercdvkelgr. Ldfklg e utd rd t|khkyò g|ve |ere ld bemfkg dn dh rdatnlg dr|tlkg * Eskhe d| eh . 6?55+( hgrle|gr dn Lòhevdr emdvkbengr ldh pvdrdn|d enåhkrkr lkckdvdn ldh dr|tlkg gvkakneh.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 20/110

 

6?

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

  Dh aer|g dn rehtl pgv ctnbkòn( pvgsddlgv { Ldpev|emdn|g pvgskdnd dzbhtrksemdn|d ldh pvkmdvdr|tlkg {e utd ng dzkr|dn dr|er bherkckbebkgndr dn dh rdatnlg dr|tlkg. Dn bgnrdbtdnbke( dhldngmknelgv t|khkyelg peve dh båhbthg ld hgr knlkbelgvdr ld dr|vtb|tve pgvbdn|teh pgv ctnbkòn(pvgsddlgv { Ldpev|emdn|g rdvå dh aer|g |g|eh ldh pvkmdv dr|tlkg( { ng dh aer|g |g|eh enehkyelgdn dh pvdrdn|d lgbtmdn|g. Erí( dh sehgv ldh aer|g ldreavdaelg pgv ctnbkòn( pvgsddlgv {Ldpev|emdn|g ng dr bgmpe|kfhd bgn dh sehgv ldh aer|g dn rehtl enehkyelg( veyòn pgv he btehrghg rd dr|tlkevå he dr|vtb|tve pgvbdn|teh { rt dsghtbkòn.

  Dh aer|g dn rehtl pgv gfid|g ldh aer|g pvgskdnd dzbhtrksemdn|d ldh pvkmdv dr|tlkg {e utd ngdzkr|d tne ldreavdaebkòn rtckbkdn|d dn dh rdatnlg dr|tlkg peve pvgbdldv e tn enåhkrkr. Dnbgnrdbtdnbke( ld he mkrme cgvme utd peve dh aer|g ldreavdaelg pgv ctnbkòn( pvgsddlgv {Ldpev|emdn|g( rghg rd dr|tlkevå he dr|vtb|tve pgvbdn|teh dr|kmele dn dh pvkmdv dr|tlkg.

  Dh pdvkglg enehkyelg dr 6??2 ‒ 6??10 elkbkgnehmdn|d( rd enehkyevå hgr vdrth|elgr ldh eõg 6??:e pev|kv ld her dr|kmebkgndr pvdhkmknevdr vdehkyeler dn dh rdatnlg dr|tlkg( rghemdn|d peveaer|g |g|eh { ldreavdaebkgndr pgv ctdn|dr ld cknenbkemkdn|g( eadn|dr { gfid|g ldh aer|g.

  _eve fgvvev dh dcdb|g ld her mglkckbebkgndr ld he |ere ld bemfkg( her |erer ld bvdbkmkdn|g entehldh aer|g { ldh aer|g dn sehgv vdeh rdvån behbtheler e pev|kv ldh aer|g dn fghkskengr. Dr|d bvk|dvkgrd itr|kckbe pvknbkpehmdn|d pgv he beíle ld he |ere ld bemfkg dn|vd 6??1 *Fr. 1(:;4 pgv TR,+ {6??: *Fr. 1(6:3 pgv TR,+( utd pvgsgbe utd peve tn mkrmg mgn|g ld aer|g dn fghkskengr( dh

mgn|g dn lòhevdr emdvkbengr rd knbvdmdn|e ld :(<$ dn|vd 6??1 { 6??:.

KK.<. Båhbthg ldh aer|g dn sehgv vdeh 

Tne bgnrkldvebkòn mt{ kmpgv|en|d peve dh enåhkrkr ldh aer|g dn rehtl dr dr|kmev rk dh knbvdmdn|g gsevkebkòn ld dr|d aer|g dr dn sghtmdn *knbvdmdn|g ld he pvgltbbkòn ld rdvskbkgr ld rehtl+ grghemdn|d dn sehgv *knbvdmdn|g ldh bgr|g ld hgr rdvskbkgr ld rehtl+. _eve |eh pvgpòrk|g( rd ldfdlkcdvdnbkev dh sehgv ngmkneh ldh sehgv vdeh *dr ldbkv dh sehgv eitr|elg pgv he |ere ld knchebkòn+.

_eve pgldv dr|kmev dh aer|g dn rehtl dn sehgv vdeh( g rde dn pvdbkgr bgnr|en|dr e pev|kv ld tn eõg ldvdcdvdnbke( rd dr|kmò tne |ere ld knchebkòn drpdbíckbe ldh rdb|gv rehtl { ld hgr lkcdvdn|dr eadn|dr ld

cknenbkemkdn|g utd hg bgmpgndn e pev|kv ld her |erer ld knchebkòn entehdr rdaùn avtpg { rtf-avtpgld aer|g dr|kmeler pgv dh Knr|k|t|g Nebkgneh ld Dr|elír|kber * KND 6??:+( utd ctdvgn pgnldveler pgvher dr|vtb|tver ld aer|g pgv gfid|g ldh rdb|gv { ld hgr lkcdvdn|dr eadn|dr ld cknenbkemkdn|gdr|kmeler dn dh pvkmdv dr|tlkg *Sehlër { _dõehgye 6?5?+. _eve dh bvdbkmkdn|g ldh bgr|g ldh avtpg ldaer|g 5???? *Rdvskbkgr pdvrgnehdr+( rd t|khkyò he |ere ld knbvdmdn|g rehevkeh utd rd epvtdfe beleeõg mdlken|d ldbvd|g rtpvdmg. Cknehmdn|d( rd t|khkyò he |ere adndveh ld knchebkòn peve ehatngravtpgr ld aer|g utd ng btdn|en bgn dr|kmebkgndr ld knchebkòn ldh Knr|k|t|g Nebkgneh ld Dr|elír|kber.

He |ere ld knchebkòn drpdbíckbe ldh rdb|gv rehtl erí behbthele dr mt{ lkcdvdn|d ld he |ere adndveh ldknchebkòn( ldfklg e utd peve dh pdvkglg 6??2-6??:( hgr avtpgr ld aer|g utd |kdndn me{gv pdrg dn dhaer|g |g|eh dn rehtl( bgmg vdbtvrgr jtmengr( mdlkbemdn|gr { rdvskbkgr mëlkbgr renk|evkgr {rgbkehdr |tskdvgn tne knbvdmdn|g ld rt bgr|g kncdvkgv e he |ere adndveh ld knchebkòn *btelvg 2+.

Htdag( dr|er |erer ld knchebkòn drpdbíckber pdvmk|kvån dr|kmev dh aer|g dn rehtl dn sehgv vdeh(|gmenlg bgmg eõg ld vdcdvdnbke 6??2( {e utd dr dh pvkmdv eõg lkrpgnkfhd dn hgr lgr dr|tlkgr ldbtdn|er ld rehtl { utd hgr le|gr ld emfgr dr|tlkgr ng rgn bgmpe|kfhdr bgn her rdvkdr ld le|gren|dvkgvdr. Dh aer|g dn sehgv vdeh rd behbthe ephkbenlg he |ere ld bvdbkmkdn|g ngmkneh eitr|ele pgv he|ere ld knchebkòn drpdbíckbe. _gv didmphg( rk he |ere ld bvdbkmkdn|g ldh aer|g |g|eh dn rehtl dn|vd6??< { 6??4 dr ld 5<(;$( he |ere ld bvdbkmkdn|g vdeh rdvå ld 5<(;$ - <(;$ = 5?(?$.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 21/110

 Btelvg 2  ‒ \ere ld knchebkòn adndveh d drpdbíckbe( 6??2-6??:

Knlkbelgv 6??2 6??< 6??4 6??3 6??1 6??:

\ere Adndveh ld knchebkòn 2(;$ <(3$ <(;$ 4(?$ 55(1$ 55(;$

\ere Drpdbíckbe ld

knchebkòn Rdb|gv Rehtl 6(3$ 2(5$ <(3$ <(2$ 1(4$ :(;$\ere ld Knchebkòn

drpdbíckbe Rdb|gv _ùfhkbg 2(5$ 2(3$ 2(;$ 4(5$ 1(4$ ;(3$

\ere ld Knchebkòndrpdbíckbe MR{L 2(2$ 2(:$ 4(6$ <(?$ :(3$ 5?(5$

\ere ld Knchebkòndrpdbíckbe G|vgr Mkn. 2(;$ <(?$ <(4$ 6(5$ 3(:$ :(;$

\ere ld Knchebkòndrpdbíckbe _vdcdb|tver <(?$ 2(5$ 2(6$ 3(4$ 1(5$ 5?(5$

\ere ld Knchebkòndrpdbíckbe Mtnkbkpkgr 5(:$ <(6$ <(5$ 2(:$ 1(;$ :(3$

\ere ld Knchebkòndrpdbíckbe Knr|. Ldrbdn|v. 6(;$ 6(<$ 6(3$ <(5$ :(<$ 1(;$

\ere ld Knchebkòn

drpdbíckbe Rda.Rgbkeh 2(6$ 2(2$ 6(1$ 4(4$ 1(?$ ;(?$\ere ld Knchebkòndrpdbíckbe Jgaevdr 5(3$ 6(<$ 4(1$ 6(6$ :(6$ 1(3$

Knbvdmdn|g rehevkeh Rdb|gv Rehtl  <(?$ 2(?$ 2(?$ 1(?$ 3(?$ 5?(?$ 

\ere ld knchebkòn drpdbíckbe mdlkbemdn|gr  5(:$ 6(6$ 1(3$ 6(6$ 5?(5$ 55(5$ 

\ere ld knchebkòn drpdbíckbe rdvskbkgr mëlkbgr renk|evkgr { rgb. 5(<$ 6(3$ 6(5$ 6(?$ <(6$ <(1$ 

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 KND 6??:0 Sehlër { _dõehgye 6?5?  

KK.4. Bgmpevebkgndr kn|dvnebkgnehdr Tne lkmdnrkòn ld enåhkrkr ldh aer|g dn rehtl dn Fghkske dr he bgmpevebkòn ld hgr lkcdvdn|drknlkbelgvdr behbthelgr bgn hg utd rd gfrdvse dn peírdr bgn hgr btehdr rd ptdldn jebdv bkdv|ererkmkhebkgndr g bgn peírdr utd |kdndn tne rk|tebkòn utd rd utkdvd ehbenyev. Her ctdn|dr ldkncgvmebkòn t|khkyeler peve her bgmpevebkgndr kn|dvnebkgnehdr rgn he Gvaenkyebkòn Mtnlkeh ld heRehtl peve dh aer|g dn rehtl *GMR 6?5?+ { dh Cgnlg Mgnd|evkg Kn|dvnebkgneh { Fenbg Mtnlkeh peveg|vgr le|gr vdhdsen|dr. Rkn dmfevag( rd ldfdvå |dndv btklelg dn he kn|dvpvd|ebkòn ld hgr vdrth|elgr({e utd dr|d |kpg ld bgmpevebkòn |kdnd ntmdvgrgr hkmk|dr bgnbdp|tehdr { md|glghòakbgr.

KK.4.5. Lkmdnrkgndr d knlkbelgvdr bgmpevefhdr

Ldfklg e her kmpgv|en|dr lkcdvdnbker dn he pgfhebkòn g dn he dbgngmíe ld hgr peírdr ldh mtnlg( ng|glgr hgr knlkbelgvdr rgn bgmpevefhdr kn|dvnebkgnehmdn|d. Erí( ng |kdnd rdn|klg bgmpevev dh sehgv|g|eh ldh aer|g dn rehtl {e utd dr|d ldpdnld ld dr|vtb|tver dbgnòmkber { pgfhebkgnehdr drpdbíckbere bele peír. Rkn dmfevag( rd ptdldn bgmpevev hgr knlkbelgvdr pgvbdn|tehdr ld dr|vtb|tve ldh aer|g*pgv didmphg dh $ ld aer|g dn e|dnbkòn jgrpk|ehevke ldn|vg ldh aer|g |g|eh dn rehtl+ g hgr ve|kgrmebvgdbgnòmkbgr( utd knlkben he pvgpgvbkòn ldh aer|g dn rehtl ldn|vg ld tn eavdaelgmebvgdbgnòmkbg( bgmg dh pvgltb|g kn|dvng fvt|g g dh aer|g pùfhkbg. \emfkën rd ptdldn bgmpevevhgr knlkbelgvdr ld aer|g dn rehtl pdv båpk|e( dn lgr cgvmer9 e he |ere ld bemfkg *sehgv dn TR, ldhaer|g+ g dn pevklel ld pgldv elutkrk|ksg *__E+( hg utd pdvmk|d |gmev dn btdn|e hgr pvdbkgr vdhe|ksgr.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 22/110

 

66

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

KK.4.6. Avtpgr ld peírdr peve bgmpevebkòn kn|dvnebkgneh

_eve her bgmpevebkgndr kn|dvnebkgnehdr( rd bgmpevevå dh sehgv ld hgr knlkbelgvdr ld Fghkske bgn dhpvgmdlkg mtnlkeh { bgn dh pvgmdlkg ld bte|vg avtpgr ld peírdr *btelvg <+( peve hgr btehdr rdbehbthevå tn pvgmdlkg ng pgnldvelg ld hgr sehgvdr nebkgnehdr ldh knlkbelgv bgnrkldvelg *{ ng dhknlkbelgv ldh avtpg dn rt bgnitn|g+( dr ldbkv utd |glgr hgr peírdr ldh avtpg bgnrkldvelg |dnlvån dhmkrmg pdrg dn dh pvgmdlkg ldh knlkbelgv *dn dh berg ld behbthev dh knlkbelgv peve dh avtpg dn rtbgnitn|g( hgr peírdr bgn mår aer|g g me{gv pgfhebkòn |dnlvíen tn me{gv pdrg+.

Eldmår ldh pvgmdlkg mtnlkeh( hgr avtpgr ld peírdr bgnrkldvelgr rgn9  Avtpg 5 - _eírdr ld Rtlemëvkbe(  Avtpg 6 - _eírdr bgn nksdh ld ldrevvghhg jtmeng rkmkhev e Fghkske(  Avtpg 2 - _eírdr bgn nksdh ld knavdrg ldh Dr|elg rkmkhev e Fghkske(  Avtpg < - _eírdr bgn bgfdv|tve tnksdvreh dn rehtl.

Dn dh btelvg < e bgn|kntebkòn( rd ld|ehhen hgr peírdr utd kn|daven bele avtpg ld bgmpevebkòn.

Btelvg <  ‒ _eírdr kn|daven|dr ld hgr lkcdvdn|dr avtpgr ld bgmpevebkòn rdhdbbkgnelgr

Avtpg _eírdr kn|daven|dr ldh avtpg bgnrkldvelg5. _eírdr ldRtlemëvkbe

Evadn|kneDbtelgvRtvknem

FverkhAt{eneTvtate{

Bjkhd_eveate{Sdndytdhe

Bghgmfke_dvù

6. _eírdr bgn nksdhld ldrevvghhg

jtmeng rkmkheve Fghkske

*KLJ 6?5? dn|vd?(41; e ?(1?1+ 

EvadhkeFverkh

DbtelgvAefòn

Knlgndrke@kvatkr|ånMkbvgndrke_eveate{Rtvknem\gnae

Tyfd`kr|ån

EvmdnkeBjkneDakp|g

AdgvakeKvån

MebdlgnkeMghleskeCkhkpkner

Rkvke\ùndy

Sdndytdhe

FdhkbdBghgmfke

Dh RehselgvAt{eneIemekbeMehlkserMgnaghkeRtlåcvkbe\e{k`kr|ån\tvutíe

Fg|rteneVdp. Lgmknkbene

Ck{kJgnltverIgvlenkeMetvkbkgNemkfkeRvk Hen`e\ekhenlke

\tv`mdnkr|ån

2. _eírdr bgn nksdhld knavdrg ldh

Dr|elg rkmkhev eFghkske *knavdrg ldh

Dr|elg pdv båpk|e dn|vd11; { 622: , dn __E+ 

EhfenkeBepd Sdvld

Vdp. LgmknkbeneAdgvakeIgvlenke

Mevvtdbgr_dvùRkvke

Tyfd`kr|ån

EvmdnkeBjkneDakp|g

At{eneMehlkserNemkfke

Krher Rehgmòn\ekhenlkeSente|t

FdhkbdBgnag *Vdp. ld+

Dh RehselgvJgnltverMghleskeNkbeveateRtvknem\gnae

Skd|nem

Ft|ån[kft|kCk{k

IemekbeMgnaghke_eveate{

Rteykhenlke\tv`mdnkr|ån

<. _eírdr bgnbgfdv|tve tnksdvreh

dn rehtl

EhfenkeEtr|vehkeFëhakbeBjkhd

BvgebkeDrhgseutke

CknhenlkeKvhenleIepòn

HtzdmftvagNgvtdae_ghgnke

VgmenkeRtkye

EhdmenkeEtr|vke

Fvtndk LevtrrehemBghgmfke

BtfeDrhgsdnke

CvenbkeKrhenlke@tqek|Meherke

Ntdse Ydhenlke_gv|taeh

Ren Mevkng\ekhenlke

EnlgvveFejvëknFthaevke

Bgvde *Vdp. ld+Lknemevbe

Drpeõe

AvdbkeKrvedhHd|gnkeMeh|eGmån

Vdkng TnklgRknaeptv\tvutíe

EvmdnkeFkdhgvvtrke

BenelåBgr|e Vkbe

Dmkve|gr Å. TnklgrDr|gnke

JtnavíeK|ehkeHk|tenkeMònebg

_eírdr FeigrVdpùfhkbe Bjdbe

RtdbkeTyfd`kr|ån

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 KRRE 6??:( 6??;( 6?5?0 Bevvkn { Iemdr 6??20 _NTL 6?5?0 CMK 6?55 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 23/110

 Dh avtpg ld peírdr bgn ldrevvghhg jtmeng rkmkhev e Fghkske je rklg dhefgvelg dn ferd eh sehgv ldhÍnlkbd ld Ldrevvghhg Jtmeng 6?5? *KLJ+ dhefgvelg pgv dh _vgaveme ld her Nebkgndr Tnkler peve dhLdrevvghhg -_NTL- *_NTL 6?5?+. Dh KLJ dr tn knlkbelgv rkn|ë|kbg utd |gme dn btdn|e 2 lkmdnrkgndrldh ldrevvghhg jtmeng9 he drpdvenye ld skle eh nebdv( he dltbebkòn *pvgmdlkg ld eõgr ld dltbebkòncgvmeh+ { dh knavdrg *_KF pgv jefk|en|d dn pevklel ld pgldv elutkrk|ksg+.Hgr peírdr utd rd kn|daven dn dh avtpg bgn ldrevvghhg jtmeng rkmkhev e Fghkske rgn hgr utd |kdndntn sehgv ld rt KLJ jer|e 5?$ rtpdvkgv g kncdvkgv eh sehgv ldh KLJ ld Fghkske *?(3<2+( dr ldbkv hgr <2peírdr utd |kdndn tn Ínlkbd ld Ldrevvghhg Jtmeng 6?5? dn|vd ?(41; { ?(1?1.

Dh avtpg ld peírdr bgn nksdh ld knavdrg ldh Dr|elg rkmkhev e Fghkske je rklg gf|dnklg dn ferd e hedhefgvebkòn ld tn knlkbelgv ld knavdrg ldh Dr|elg pgv jefk|en|d( behbthelg e pev|kv ld le|gr ldhCgnlg Mgnd|evkg Kn|dvnebkgneh *CMK 6?55+. Dh knlkbelgv rd behbthe bgmg dh _KF pgv jefk|en|d dnpevklel ld pgldv elutkrk|ksg 6?5? mth|kphkbelg pgv dh ve|kg ld knavdrg dr|e|eh dn pgvbdn|eid ldh _KF._gv didmphg( dn dh berg ldh _dvù( dh _KF'jefk|en|d dn __E = , ;.22?(53 { dh knavdrg ldh Dr|elg dnpvgpgvbkòn ldh _KF dr ld 6?(?3$0 dh ve|kg ld knavdrg dr|e|eh pgv jefk|en|d dn pevklel ld pgldvelutkrk|ksg dr dn|gnbdr ld ;.22?(53 z ?(6??3 = , 5.:16 pgv jefk|en|d.Hgr peírdr utd rd kn|daven dn dh avtpg bgn nksdh ld knavdrg ldh Dr|elg rkmkhev e Fghkske rgn hgr utd|kdndn tn sehgv ld dr|d knlkbelgv jer|e 4?$ rtpdvkgv g kncdvkgv eh sehgv ld Fghkske *, 5.44:+( dr ldbkvhgr 24 peírdr utd |kdndn peve dh eõg 6?5? tn ve|kg ld knavdrg ldh Dr|elg pgv jefk|en|d dn|vd , 11; {, 6.22: dn pevklel ld pgldv elutkrk|ksg.

He hkr|e ld hgr peírdr utd jen ehbenyelg he bgfdv|tve tnksdvreh dn rehtl pvgskdnd pvknbkpehmdn|d ldhdr|tlkg ld Bevvkn { Iemdr *6??2+ { ctd vdeb|tehkyelg dn Ltpt{ *6?55+ dn ferd e tne vdskrkòn ldkncgvmebkgndr rgfvd hdakrhebkgndr nebkgnehdr bdn|vehkyeler pgv he Rgbkeh Rdbtvk|{ Elmknkr|ve|kgn  dn|vd 6??: { 6?5? *KRRE 6??:( 6??;e( 6??;f( 6?5?+. Ng rd bgnrkldven dn dr|e hkr|e hgr |dvvk|gvkgret|òngmgr utd |kdndn bgfdv|tve tnksdvreh dn rehtl *BT+ pdvg utd ldpdnldn ld tn peír rkn BT(bgmg pgv didmphg he V.E.D. ld Jgna @gna( ldpdnlkdn|d ld he Vdpùfhkbe _gpthev ld Bjkne.

KK.4.2. Hímk|dr ld her bgmpevebkgndr kn|dvnebkgnehdr

He t|khklel ld her bgmpevebkgndr kn|dvnebkgnehdr dr hkmk|ele pgv ntmdvgrgr pvgfhdmer. Dn pvkmdvhtaev( ng dzkr|d tn rghg rkr|dme ld rehtl utd rde pgv bgmphd|g bgmpevefhd bgn nknaùn g|vg( eríbgmg |empgbg dzkr|dn lgr btdn|er ld rehtl utd rden pgv bgmphd|g bgmpevefhdr dn|vd rí. Erí(ptdldn gbtvvkv lkcdvdnbker md|glghòakber dn he mdlkbkòn { dn her ldcknkbkgndr t|khkyeler. \emfkëndzkr|dn pvgfhdmer ld mdlkbkòn dn ehatngr ceb|gvdr ld eitr|d bgmg her |erer ld bgnsdvrkòn dnpevklel ld pgldv elutkrk|ksg( utd ng rgn drpdbíckber eh rdb|gv rehtl.

_gv g|ve pev|d( dzkr|dn avenldr lkcdvdnbker elmknkr|ve|kser( gvaenkyebkgnehdr t g|ver dn|vd hgrlkcdvdn|dr rkr|dmer ld rehtl ldh mtnlg utd jebd utd lgr peírdr ptdldn |dndv mkrmgr vdrth|elgrbgn tn aer|g pdv båpk|e |g|ehmdn|d lkcdvdn|d. Rk fkdn sevkgr dr|tlkgr dbgngmë|vkbgr e nksdhkn|dvnebkgneh kldn|kckbevgn dh _KF pgv jefk|en|d bgmg dh ceb|gv utd mår kncht{d dn sehgv ldh aer|g dnrehtl( eldmår ld ceb|gvdr kn|dvngr eh rkr|dme bgmg |dbjgr pvdrtptdr|evkgr jgrpk|ehevkgr { ptdv|eld dn|vele gfhkae|gvke pgv dh pvkmdv nksdh ld e|dnbkòn( dzkr|dn kmpgv|en|dr ceb|gvdr ng mdlkfhdrdr|elír|kbemdn|d( utd rgn drpdbíckbgr e bele peír { e bele pdvkglg |dmpgveh( utd dzphkben dhknbvdmdn|g ldh aer|g dn rehtl *Advl|jem { Iónrrgn 6???+.

Dn dr|d bgn|dz|g( her bgmpevebkgndr kn|dvnebkgnehdr rdv |gmeler bgn btklelg( {e utd rghemdn|dpdvmk|dn epg{ev he evatmdn|ebkòn e cesgv ldh knbvdmdn|g ldh aer|g dn rehtl dn Fghkske { ld tneme{gv pvkgvkyebkòn ld he rehtl dn hgr pvdrtptdr|gr pùfhkbgr( pdvg ng pdvmk|dn dr|efhdbdv btåh dr dhnksdh òp|kmg g ldrdefhd ld aer|g dn rehtl *ng rd ptdld eckvmev pgv hgr pvgfhdmer mdnbkgnelgr rkdh aer|g dn rehtl ld tn peír dr ldmerkelg dhdselg g ldmerkelg feig+ nk eckvmev rk tn rkr|dme ldrehtl dr mdigv utd g|vg rghg pgvutd |kdnd me{gv aer|g *Advl|jem { Iónrrgn 6???+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 24/110

 

6<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 25/110

 Bepí|thg KKK. Enåhkrkr ld her Btdn|er ld Rehtl dn 

Fghkske pdvkglg 6??2-6??: 

KKK.5. Drutdme ld enåhkrkr ldh aer|g { cknenbkemkdn|g ld he rehtl 

Dn dh mevbg ld her bherkckbebkgndr ldh aer|g dn rehtl { ld hgr bvk|dvkgr ld enåhkrkr mdnbkgnelgr dn dhBepí|thg KK( rd pvgbdldvå eh enåhkrkr ldh aer|g dn rehtl dn Fghkske rdaùn dh rkatkdn|d drutdme9

  5. Enåhkrkr ldh aer|g |g|eh dn rehtl  6. Enåhkrkr ldh aer|g dn rehtl rdaùn eadn|d cknenbkelgv *rtf-rdb|gv+  2. Enåhkrkr ldh aer|g dn rehtl rdaùn ctdn|d ld cknenbkemkdn|g  <. Enåhkrkr ldh aer|g dn rehtl rdaùn gfid|g ldh aer|g  4. Enåhkrkr ldh aer|g dn rehtl rdaùn ctnbkòn  3. Enåhkrkr ldh aer|g dn rehtl rdaùn pvgsddlgv ld rdvskbkgr  1. Enåhkrkr ldh aer|g dn rehtl rdaùn ldpev|emdn|gr  :. Bgnbhtrkgndr adndvehdr

_eve bele ebåpk|d( rd enehkyeve dh aer|g dn sehgv ngmkneh ' vdeh { rt dsghtbkòn dn dh pdvkglg 6??2-6??:. \emfkën rd enehkyevån hgr knlkbelgvdr vdhdsen|dr( rt dsghtbkòn dn dh pdvkglg bgnrkldvelg {rd vdehkyeven bgmpevebkgndr bgn hgr avtpgr ld peírdr rdhdbbkgnelgr *btelvg <+.

KKK.6. Enåhkrkr ldh Aer|g |g|eh dn rehtl 

KKK.6.5. Dsghtbkòn ldh aer|g |g|eh dn rehtl

Ld ebtdvlg bgn dh sehgv behbthelg peve dh pvdrdn|d enåhkrkr e pev|kv ld hgr lgr dr|tlkgr lkrpgnkfhdr*Sehlër { _dõehgye 6?5?0 Åskhe d| eh . 6?55+( dh aer|g |g|eh dn rehtl dn sehgv ngmkneh rd jefvíe knbvdmdn|elgdn tn 4?$ dn|vd 6??2 { 6??1( ld 2.<32(6 e 4.5;: mkhhgndr ld fghkskengr( vdpvdrdn|enlg tne |ere ldbvdbkmkdn|g enteh pvgmdlkg ld 5?(1$ *btelvg 4 d khtr|vebkòn 5+.

Btelvg 4  ‒ Aer|g |g|eh dn rehtl dn sehgv ngmkneh( Fghkske( 6??2-6??:

Knlkbelgv 6??2 6??< 6??4 6??3 6??1 6??: *p+

Aer|g \g|eh dn Rehtl(*mkhhgndr ld fghkskengr+ 2.<32(6 2.132(? <.2<3(1 <.3;;(5 4.5;:(? 4.3:1(<

Aer|g \g|eh dn Rehtl(*mkhhgndr ld TR,+  <45(3 <12(4 421(4 4:2(? 34:(< 1:?(3

\ere ld bvdbkmkdn|g enteh 

- :(1$ 54(4$ :(5$ 5?(3$ ;(<$ 

\ere ld bvdbkmkdn|g ebtmthele *ldrld 6??2+ - :(1$ 64(4$ 24(1$ 4?(5$ 3<(6$ 

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 26/110

 

63

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

_eve 6??:( rd pvg{db|e tne dr|kmebkòn ldh aer|g |g|eh dn rehtl dn tngr 4.3:1(< mkhhgndr ldfghkskengr *1:?(3 mkhhgndr ld TR,+( vdpvdrdn|enlg tne |ere ld bvdbkmkdn|g ngmkneh ld ;(<$vdrpdb|g eh eõg 6??1. Dn tn pdvkglg ld 4 eõgr( dh aer|g |g|eh dn rehtl rd jefvíe dn|gnbdrknbvdmdn|elg ld 6.66<(2 mkhhgndr ld fghkskengr( vdpvdrdn|enlg tn knbvdmdn|g ld 3<(6$ *btelvg 4+.

Rkn dmfevag( rd ldfd vdhe|kskyev dr|gr le|gr( {e utd he mk|el ldh knbvdmdn|g ldh aer|g |g|eh dn rehtldn dh pdvkglg 6??2-?1 rd ldfd e he knchebkòn *knbvdmdn|g ld hgr pvdbkgr+( rkankckbenlg utd rghemdn|dhe mk|el ld he sevkebkòn rd ldfd e tn knbvdmdn|g dn sghtmdn *btelvg 3 d khtr|vebkòn 5+.

Btelvg 3  ‒ Aer|g |g|eh dn rehtl dn sehgv vdeh( Fghkske( 6??2-6??:

Knlkbelgv 6??2 6??< 6??4 6??3 6??1 6??: *p+

Aer|g \g|eh dn Rehtl(dn mkhhgndr ld fghkskengr

ld 6??2 *sehgv vdeh+2.<32(6 2.341(4 <.?1<(? <.664(2 <.24<(5 <.2:<(<

\ere ld bvdbkmkdn|g Enteh vdeh  - 4(3$ 55(<$ 2(1$ 2(?$ ?(1$ 

\ere ld bvdbkmkdn|g vdeh 

ebtmthele *ldrld 6??2+ - 4(3$ 51(3$ 66(?$ 64(1$ 63(3$ Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??:  

Khtr|vebkòn 5  ‒ Aer|g |g|eh dn rehtl dn sehgv ngmkneh { vdeh( Fghkske( 6??2-?: *mkhhgndr ld Fr.+

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??:  

4.3:1(<

2.<32(6

<.2:<(<

2.???

2.4??

<.???

<.4??

4.???

4.4??

3.???

6??2 6??< 6??4 6??3 6??1 6??: *p+

   M   k   h   h  g  n  d  r   l  d   F  g   h   k  s   k  e  n  g  r

Aer|g |g|eh dn rehtl dn sehgv NGMKNEH

Aer|g |g|eh dn rehtl dn sehgv VDEH

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 27/110

 He |ere ld bvdbkmkdn|g enteh pvgmdlkg dn sehgv vdeh dr ld rghemdn|d ld 4(;$ dn dh pdvkglg 6??2-?1{ dr eùn mdngv ldrld dh eõg 6??3 *6(4$ enteh bgmg pvgmdlkg dn|vd 6??3 { 6??:+. _eve dh eõg6??:( rd dr|kme utd dh aer|g |g|eh dn rehtl e pvdbkgr bgnr|en|dr ld 6??2 rghg rd knbvdmdn|g dn?(1$ vdrpdb|g eh eõg en|dvkgv *btelvg 3+( pvknbkpehmdn|d ldfklg e tne ctdv|d knchebkòn9 he |ereadndveh ld knchebkòn dr|d eõg dve ld 55(;$ { he |ere ld knchebkòn drpdbíckbe dn rehtl :(;$.

KKK.6.6. Aer|g |g|eh dn rehtl pdv båpk|e

Dh aer|g |g|eh dn rehtl pdv båpk|e *dn sehgv ngmkneh+ rd jefvíe knbvdmdn|elg dn tn 21(:$ dn|vd 6??2{ 6??1( ld Fr. 2:2(12 e Fr. 46:(; *btelvg 1 d khtr|vebkòn 6+. Ldfklg eh bvdbkmkdn|g ldmgavåckbg( her|erer ld bvdbkmkdn|g ldh aer|g pdv båpk|e rgn kncdvkgvdr e her ldh aer|g eavdaelg.

Btelvg 1  ‒ Aer|g |g|eh dn rehtl pdv båpk|e dn sehgv ngmkneh( Fghkske( 6??2-6??:

Knlkbelgv 6??2 6??< 6??4 6??3 6??1 6??: *p+

Aer|g \g|eh dn Rehtlpdv båpk|e *fghkskengr+ 2:2(1 <?1(: <35(5 <::(5 46:(; 431(6

Aer|g \g|eh dn Rehtl_dv båpk|e *TR,+  4?(? 45(2 41(? 3?(3 31(? 11(:

\ere ld bvdbkmkdn|g enteh  - 3(2$ 52(5$ 4(;$ :(<$ 1(6$ 

\ere ld bvdbkmkdn|g ebtmthele *ldrld 6??2+ - 3(2$ 6?(6$ 61(6$ 21(:$ <1(:$ 

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??4  

He pvgfefhd rgfvd-dr|kmebkòn ld he pgfhebkòn ld Fghkske pgv pev|d ldh KND jebd utd dh aer|g pdvbåpk|e rde pgrkfhdmdn|d rtf-dr|kmelg. Erí( vdehkyenlg dr|kmebkgndr ld aer|g pdv båpk|e t|khkyenlgbgmg ldngmknelgv he pgfhebkòn pvg{db|ele pgv he Gckbkne ld _gfhebkòn ld her Nebkgndr Tnkler*GNT 6?5?+( dh aer|g pdv båpk|e dr ld Fr. 4<4(: peve dh eõg 6??1 { ld Fr. 4:3(1 peve dh eõg 6??:.

_eve vdehkyev her bgmpevebkgndr kn|dvnebkgnehdr( rd |venrcgvme dh aer|g pdv båpk|e dn fghkskengr dnaer|g dn pevklel ld pgldv elutkrk|ksg *__E+( utd pdvmk|d eitr|ev pgv hgr pvdbkgr vdhe|ksgr { erí |dndvmgn|gr bgmpevefhdr kn|dvnebkgnehmdn|d( bgn hgr hímk|dr ld båhbthg utd bgmpvdnld he|venrcgvmebkòn dn pevklel ld pgldv elutkrk|ksg *btelvg :+. Ld ebtdvlg bgn dr|er bgmpevebkgndr( dhaer|g dn rehtl pdv båpk|e ld Fghkske peve dh eõg 6??1 *6?3(3 ,__E g TR, 31+( dr rkankckbe|ksemdn|dkncdvkgv eh aer|g pdv båpk|e ld |glgr hgr avtpgr ld peírdr enehkyelgr( knbhtrksd hgr bgn nksdh ldldrevvghhg jtmeng d knavdrg dr|e|eh rkmkhev e hgr ld Fghkske( ldmgr|venlg utd rd pglvíe |dndv tnme{gv aer|g dn rehtl dn ntdr|vg peír bgnrkldvenlg rtr bgnlkbkgndr ld feig knavdrg dr|e|eh.

Btelvg :  ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g |g|eh dn rehtl pdv båpk|e( 6??1

Knlkbelgv FGHKSKE Mtnlg Avtpg 5Rtlemëvkbe 

Avtpg 6Ldrevvghhgjtmeng 

Avtpg 2Knavdrgdr|e|eh 

Avtpg <Bgfdv|tvetnksdvreh 

Aer|g \g|eh dn Rehtlpdv båpk|e *TR,+( 6??1  31(? :;;(4 216(; 65?(5 5<4(? 6.236(;

Aer|g \g|eh dn Rehtlpdv båpk|e *, __E+( 6??1  6?3(3 ;2?(2 354(< 21:(2 633(2 6.521(3

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??40 GMR 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 28/110

 

6:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Eldmår ld mgr|vev nksdhdr ld aer|g pdv båpk|e kncdvkgvdr e hgr ldmår peírdr ldh mtnlg( Fghkske|emfkën mtdr|ve |erer ld bvdbkmkdn|g mdngvdr ltven|d dh pdvkglg 6??2-6??1 *khtr|vebkòn 6+.Erí mkdn|ver utd dh aer|g dn rehtl pdv båpk|e dn Fghkske rd knbvdmdn|efe ld 21(:$ dn|vd 6??2 {6??1( dr|d knbvdmdn|g dve dn pvgmdlkg ld :4(3$ dn Rtlemëvkbe( { ctd rtpdvkgv eh 5??$ dn <peírdr ldh bgn|kndn|d9 Sdndytdhe( Evadn|kne( Rtvknem { At{ene.

Khtr|vebkòn 6  ‒ Bgmpevebkòn kn|dvnebkgneh ld he |ere ld bvdbkmkdn|g6??2-6??1 ldh aer|g |g|eh dn rehtl pdv båpk|e dn sehgv ngmkneh *TMN+

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??40 GMR 6?5? 

_gv g|ve pev|d( dh knbvdmdn|g ldh aer|g pdv båpk|e rd ldfd vdhe|kskyev {e utd dh knbvdmdn|g dn sehgvvdeh ng dr mt{ kmpgv|en|d *btelvg ; d khtr|vebkòn 2+. Dn dcdb|g( dh knbvdmdn|g je rklg ld rghemdn|d54(4$ dn|vd 6??2 { 6??1( { rdaùn pvg{dbbkgndr peve he adr|kòn 6??:( rd gfrdvsevíe dr|d eõg tnelkrmkntbkòn ldh aer|g pdv båpk|e dn sehgv vdeh( ldfklg e utd dh knbvdmdn|g vdeh ldh aer|g |g|eh ld?(1$ *sdv btelvg 3+ ng dr rtckbkdn|d peve bgmpdnrev dh bvdbkmkdn|g ldmgavåckbg.

Btelvg ;  ‒ Aer|g |g|eh dn rehtl pdv båpk|e dn sehgv vdeh( Fghkske( 6??2-6??:

Knlkbelgv 6??2 6??< 6??4 6??3 6??1 6??: *p+

Aer|g \g|eh dn Rehtlpdv båpk|e( dn fghkskengr

ld 6??2 *sehgv vdeh+2:2(1 2;3(< <26(6 <2:(; <<2(5 <21(6

\ere ld bvdbkmkdn|g Enteh vdeh  - 2(2$ ;(?$ 5(3$ ?(;$ -5(2$ 

\ere ld bvdbkmkdn|g vdeh ebtmthele *ldrld 6??2+ - 2(2$ 56(3$ 5<(<$ 54(4$ 52(;$ 

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??4 { 6??: 

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 29/110

 Khtr|vebkòn 2  ‒ Aer|g |g|eh dn rehtl pdv båpk|e( dn sehgv ngmkneh { vdeh( Fghkske( 6??2-?: *Fr+

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??4 { 6??:  

\gmenlg dn btdn|e he pvdskrkòn ldh eõg 6??:( he |ere ld bvdbkmkdn|g ebtmthele ldh aer|g dn rehtlpdv båpk|e dn sehgv vdeh dn|vd 6??2 { 6??: dr ld rghemdn|d 52(;$( sehgv mt{ kncdvkgv e hg utd rdptdld gfrdvsev dn dh mtnlg ltven|d dh mkrmg pdvkglg9 dh pvgmdlkg mtnlkeh dr ld 2<(;$ ldbvdbkmkdn|g ldh aer|g pdv båpk|e dn sehgv vdeh dn|vd 6??2 { 6??:. Dzkr|dn ehatner dzbdpbkgndr(ldn|vg ld her btehdr 61 peírdr utd mgr|vevgn tne lkrmkntbkòn ldh aer|g pdv båpk|e dn sehgv vdehltven|d dr|d pdvkglg( ldn|vg ld hgr btehdr rd dnbtdn|ven peírdr utd |tskdvgn bgnlkbkgndr ld ctdv|dknchebkòn *Kveu( Fkvmenke+ g peírdr bgn aer|g dn rehtl {e mt{ dhdselg *Krhenlke( Meh|e+.

Dh knbvdmdn|g ldh aer|g dn rehtl vdeh pdv båpk|e dn|vd 6??2 { 6??: dr ld <:(:$ bgmg pvgmdlkg dnhgr peírdr sdbkngr ld Rtlemëvkbe *btelvg 5?+( e pdrev ld utd dr|gr mgr|vevgn adndvehmdn|d tne|ere ld knchebkòn rtpdvkgv e he ld Fghkske dn dr|d pdvkglg *41(6$ ld knchebkòn ebtmthele dn|vd 6??2 {6??: bgn|ve <;(3$ dn Fghkske+.

Ldn|vg ld hgr peírdr he|kng-emdvkbengr( hgr bergr ld Sdndytdhe( he Vdpùfhkbe Lgmknkbene { Bgr|eVkbe hhemen he e|dnbkòn( dn vdhebkòn eh knbvdmdn|g ld rt aer|g dn sehgv vdeh e pdrev ld tne ctdv|d

knchebkòn( ldmgr|venlg utd me{gvdr drctdvygr e cesgv ldh knbvdmdn|g ldh aer|g dven pgrkfhdr dnFghkske. Erí( Sdndytdhe( he Vdpùfhkbe Lgmknkbene { Bgr|e Vkbe( e pdrev ld tne ctdv|d |dnldnbkeknchebkgnkr|e *|ere ld knchebkòn ebtmthele 6??2-6??: ld 664$( 523$ { ;3$ vdrpdb|ksemdn|d+(ptlkdvgn knbvdmdn|ev rt aer|g pdv båpk|e dn sehgv vdeh dn 11$( <?$ { <4$ vdrpdb|ksemdn|d.

G|vg berg ng|efhd dr dh ld Btfe( utd bgn tn rkr|dme ld rehtl dzbhtrksemdn|d pùfhkbg( je |dnklg dndh pdvkglg 6??2-6??: tn knbvdmdn|g ld 514$ ld rt aer|g |g|eh dn rehtl pdv båpk|e( rkdnlg pev|d ldhgr lkdy peírdr utd eh mdngr lgfhevgn rt aer|g dn rehtl vdeh pdv båpk|e dn dh pdvkglg 6??2-6??:.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 30/110

 

2?

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg 5?  ‒ Bgmpevebkòn kn|dvnebkgneh ld he |ere ld bvdbkmkdn|g 6??2-6??: ldh aer|g |g|eh dn rehtl pdv båpk|e dn sehgv vdeh

Bvdbkmkdn|g vdeh ldh aer|g|g|eh dn rehtl pdv båpk|e 6??< 6??4 6??3 6??1 6??: *p+ Ebtmthelg

ldrld 6??2

Fghkske 2(2$ ;(?$ 5(3$ ?(;$ -5(2$ 52(;$

Mtnlg 3(;$ 4(;$ 1(?$ 4(5$ <(:$ 2<(;$

Avtpg 5  ‒ _eírdr ld Rtlemëvkbe

5?(<$ 1(;$ 5?(5$ 3(1$ 4(:$ <:(:$

Avtpg 6  ‒ _eírdr bgnKLJ rkmkhev e Fghkske :(5$ 4(<$ ;(?$ 3(2$ <(2$ 2;(1$

Avtpg 2  ‒ _eírdr b. knavdrgdr|e|eh rkmkhev e Fghkske 4(;$ <(;$ :(2$ 4(3$ 4(?$ 2<(4$

Avtpg <  ‒ _eírdr bgnbgfdv|tve tnksdvreh dn rehtl

<(<$ 3(5$ <(:$ 4(:$ 4(6$ 2?(4$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??:0 GMR 6?5? 

KKK.6.2. Aer|g |g|eh dn rehtl dn $ ldh _KF

Dn bten|g eh ve|kg mebvgdbgnòmkbg ld aer|g |g|eh dn rehtl dn $ ldh pvgltb|g kn|dvng fvt|g( dr|dmgr|vò tne lkrmkntbkòn e pev|kv ldh eõg 6??3( perenlg ld 4(3$ e 4(?$ dn 6??1 *khtr|vebkòn <+.

Khtr|vebkòn <  ‒ Aer|g |g|eh dn rehtl dn $ ldh pvgltb|g kn|dvng fvt|g( Fghkske( 6??2-6??:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6?5?  

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 31/110

 Rk fkdn he lkrmkntbkòn ldh knlkbelgv ld aer|g |g|eh dn rehtl dn $ ldh _KF dn 6??3 rd ptdld dzphkbevdn pev|d pgv dh ctdv|d bvdbkmkdn|g dbgnòmkbg dn eutdh eõg *knbvdmdn|g ldh _KF dn sehgv ngmkneh ld5;(5$ rdaùn le|gr ldh KND+( dh bvdbkmkdn|g ldh aer|g dn rehtl *5?(4$ enteh pvgmdlkg dn|vd 6??2 {6??:+ je rklg mtbjg mdngv utd dh bvdbkmkdn|g ldh _KF *5<(2$ enteh pvgmdlkg dn|vd 6??2 { 6??:+.

Bgmpevenlg bgn le|gr kn|dvnebkgnehdr( dh aer|g |g|eh dn rehtl dn $ ldh _KF dn Fghkske drrkankckbe|ksemdn|d kncdvkgv eh sehgv ld hgr avtpgr ld peírdr bgmpevelgr( knbhtrksd hgr peírdr bgnmkrmg nksdh ld ldrevvghhg jtmeng { mkrmg nksdh ld knavdrg dr|e|eh *khtr|vebkòn 4+. E pev|kv ld dr|grle|gr( rd bgnr|e|e utd peve dh eõg 6??:( dh aer|g |g|eh dn rehtl vdpvdrdn|e dh 1(<$ ldh _KF dn hgrpeírdr bgn bgfdv|tve tnksdvreh dn rehtl. _eve ehbenyev dr|d nksdh dn 6??:( Fghkske jefvíe ndbdrk|elgtn aer|g dn rehtl elkbkgneh ld epvgzkmelemdn|d 2.6<< mkhhgndr ld fghkskengr g <<4 mkhhgndr ldTR,( vdpvdrdn|enlg tn 41$ ld aer|g elkbkgneh peve dh eõg 6??:.

Khtr|vebkòn 4  ‒ Bgmpevebkòn kn|dvnebkgneh ldh ve|kg aer|g |g|eh dn rehtldn $ ldh _KF peve hgr eõgr 6??2 { 6??: *sehgv ngmkneh+

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6?5?0 GMR 6?5? 

Dn bten|g e he dsghtbkòn ldh ve|kg aer|g |g|eh dn rehtl ' _KF( dzkr|dn :5 g|vgr peírdr *ld 5:;+ utd|tskdvgn lkrmkntbkòn ld dr|d ve|kg dn|vd 6??2 { 6??:( mgr|venlg her lkckbth|eldr dzkr|dn|dr dnmen|dndv g knbvdmdn|ev dh aer|g |g|eh dn rehtl dn vdhebkòn bgn dh pvgltb|g kn|dvng fvt|g. Rkndmfevag( 5?: peírdr hgavevgn men|dndv g knbvdmdn|ev rt aer|g |g|eh dn rehtl dn vdhebkòn eh _KF { dhpvgmdlkg ld dr|d knlkbelgv peve hgr avtpgr ld bgmpevebkòn mtdr|ve tne dsghtbkòn dr|efhd(knbht{dnlg tn hkadvg knbvdmdn|g dn|vd hgr eõgr 6??2 { 6??: *khtr|vebkòn 4+. Ld he mkrme cgvme utdpeve dh knbvdmdn|g vdeh( dh berg btfeng rd ldr|ebe e nksdh kn|dvnebkgneh peve rt pvkgvkyebkòn ld herehtl( {e utd dh ve|kg ld aer|g |g|eh dn rehtl dn $ ldh _KF però ld 3(2$ dn 6??2 e 56$ dn 6??:.

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 32/110

 

26

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

KKK.6.<. Bgnbhtrkgndr ldh enåhkrkr ldh aer|g |g|eh dn rehtl

Dn|vd 6??2 { 6??:( dh aer|g |g|eh dn rehtl dn Fghkske rd je knbvdmdn|elg ld Fr. 6.66< mkhhgndr( peveehbenyev 4.3:1 mkhhgndr ld fghkskengr bgmg pvdskrkòn peve dh eõg 6??:( vdpvdrdn|enlg tnbvdbkmkdn|g ld 3<(6$ dn dr|d pdvkglg. Ng gfr|en|d( dr|e mdigve ldfd rdv vdhe|kskyele pgv hedskldn|d ceh|e ld pvkgvkyebkòn ld he rehtl ldrld dh ptn|g ld skr|e ldh aer|g( {e utd rd gfrdvse tndr|enbemkdn|g ldh aer|g pdv båpk|e dn sehgv vdeh { tne lkrmkntbkòn ldh ve|kg ld aer|g dn $ ldhpvgltb|g kn|dvng fvt|g( knlkbenlg utd ng rd vdehkyevgn hgr drctdvygr rtckbkdn|dr dn dh peír e cesgv ldtn knbvdmdn|g ldh aer|g |g|eh dn rehtl. Dr|e ceh|e ld pvkgvkyebkòn ld he rehtl pevdbd eùn mårkmpgv|en|d btenlg rd bgmpeve bgn he dsghtbkòn ldh aer|g dn rehtl dn peírdr bgn dh mkrmg nksdh ldínlkbd ld ldrevvghhg jtmeng g ld knavdrg( g dn peírdr bgn bgfdv|tve tnksdvreh dn rehtl( e pdrev ldutd Fghkske pvdsë kmphdmdn|ev he bgfdv|tve tnksdvreh ldn|vg ldh Rkr|dme Ùnkbg ld Rehtl dn tn ct|tvgbdvbeng( dn btmphkmkdn|g e he Bgnr|k|tbkòn _ghí|kbe ldh Dr|elg _htvknebkgneh.

KKK.2. Enåhkrkr ldh Aer|g dn rehtl rdaùn eadn|dr cknenbkelgvdr 

KKK.2.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn rtf-rdb|gv { eadn|d

Ld ebtdvlg bgn he dr|vtb|tve ld aer|g 6??1 pgv eadn|dr cknenbkelgvdr behbthelg peve dh pvdrdn|denåhkrkr e pev|kv ld hgr lgr dr|tlkgr lkrpgnkfhdr *Sehlër { _dõehgye 6?5?0 Åskhe d| eh . 6?55+( dh cknenbkemkdn|gld he rehtl dn Fghkske dr ld |kpg mkz|g( dn|vd dh rtfrdb|gv pùfhkbg( utd vdpvdrdn|e dh 21(<$ ldh aer|g|g|eh dn rehtl( dh rtfrdb|gv ld he Rdatvklel Rgbkeh ld bgv|g pheyg *63$ ldh aer|g+ { dh Rdb|gvpvkselg( utd vdpvdrdn|e dh 23(3$ ldh aer|g |g|eh dn rehtl peve he adr|kòn 6??1 *Khtr|vebkòn 3+.

Khtr|vebkòn 3  ‒ Dr|vtb|tve ld Aer|g dn rehtl pgv eadn|d cknenbkelgv( Fghkske( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

Rdatvklel Rgbkeh*Dr|e|eh+

63(?$Agfkdvngr

mtnkbkpehdr

52(1$

_vdcdb|tverldpev|emdn|ehdr

51(?$

Knr|k|tbkgndrldrbdn|vehkyeler 5(?$

4(1$Nksdh

bdn|veh

*MR{L{ g|vgr+

Jgaevdr

6:(4$

Rdatvgr pvkselgr {R.Rgbkeh pvksele 3(1$

GNAr 5(<$

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 33/110

 _eve ckndr ld enåhkrkr( rd ptdld eavdaev dh rtf-rdb|gv pùfhkbg *utd knbht{d eh Mknkr|dvkg ld Rehtl {Ldpgv|dr( _vdcdb|tver ejgve Agfdvnebkgndr ldpev|emdn|ehdr( Agfkdvngr mtnkbkpehdr { Dn|kleldrldrbdn|vehkyeler+ { dh rtfrdb|gv ld he Rdatvklel Rgbkeh ld bgv|g pheyg dr|e|eh *eavdaelg utd rdvåldngmknelg ‘Rdb|gv dr|e|eh” ld eutí dn eldhen|d+( utd bgnitn|emdn|d vdpvdrdn|en dh 32(<$ ldhaer|g dn rehtl peve he adr|kòn 6??1. Dh kn|dvër ld eavdaev dr|d Rdb|gv dr|e|eh dr ld ld|dvmknev dhaer|g ng pvkselg dn rehtl *utd htdag rd pglvå bgmpevev bgn dh pvdrtptdr|g adndveh ldh Dr|elg+(pdvg |emfkën vdehkyev bgmpevebkgndr kn|dvnebkgnehdr ld aer|g dn rehtl dr|e|eh( knldpdnlkdn|dmdn|dld btåh dr dh |kpg ld rkr|dme ld cknenbkemkdn|g pvknbkpeh peve he bgfdv|tve dn rehtl( Fdsdvklad*ferelg dn tn cknenbkemkdn|g pgv ckrbehklel adndveh+( Fkrmevb` *ferelg dn her bg|kyebkgndr ldrdatvklel rgbkeh+ g mkz|g.

Rd ptdld bgnr|e|ev utd he dr|vtb|tve ld aer|g je dsghtbkgnelg dn dh pdvkglg 6??2-6??1( {e utd dhrtf rdb|gv pùfhkbg |gme mår kmpgv|enbke *khtr|vebkòn 1 { btelvg 55+9 erí( dh rtfrdb|gv pùfhkbgvdpvdrdn|efe dh 2?(6$ ldh aer|g |g|eh dn rehtl dn dh eõg 6??2( mkdn|ver utd peve dh eõg 6??1(vdpvdrdn|efe dh 21(<$( ldfklg e tn knbvdmdn|g ldh aer|g elmknkr|velg pgv _vdcdb|tver { Mtnkbkpkgr.

Khtr|vebkòn 1  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g pgv eadn|d cknenbkelgv( Fghkske( 6??2-?1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55 

1(:$

?(:$56(3$

;(?$

5:(6$55(<$

3(3$

5(1$

25(;$

4(1$5(?$

51(?$

52(1$

53(<$

;(3$

3(1$

5(<$

6:(4$

6??1

6??3

6??4

6??<

6??2

Nksdh Bdn|veh*MR{L { g|vgr+ 

Knr|k|tbkgndrldrbdn|vehkyeler 

_vdcdb|tverldpev|emdn|ehdr 

Mtnkbkpkgr 

G|verKnr|k|tbkgndr

Rdatvklel Rgbkeh 

Rdatvgrpvkselgr {Rdatvklel

rgbkehpvksele 

Jgaevdr*peagr ldfghrkhhg+ 

GNAr 

Beie Nebkgneh ld Rehtl

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 34/110

 

2<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg 55  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g rdaùn rtf-rdb|gv( Fghkske( 6??2-?:

Knlkbelgv 6??2 6??< 6??4 6??3 6??1 6??: *p+

Rdb|gv Dr|e|eh 4;(:$ 35(:$ 34(4$ 34(4$ 32(<$ 34(2$

Rtf-rdb|gv pùfhkbg  2?(6$ 2?(;$ 23(<$ 23(2$ 21(<$ 2:(:$ 

Rtf-rdb|gv rdatvklel rgbkeh  6;(3$ 2?(:$ 6;(5$ 6;(6$ 63(?$ 63(4$ 

Rdb|gv _vkselg <?(6$ 2:(6$ 2<(4$ 2<(4$ 23(3$ 2<(1$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

Rk rd bgmpeve dr|e dr|vtb|tve ld aer|g dn rehtl e nksdh kn|dvnebkgneh( rd bgnr|e|e utd Fghkskemtdr|ve tne pvgpgvbkòn ld aer|g pvkselg mdngv e rtr sdbkngr { peírdr bgn mkrmg nksdh ldldrevvghhg jtmeng { ld knavdrg dr|e|eh. Dn dh berg ld hgr peírdr bgn bgfdv|tve tnksdvreh dn rehtl(drgr mtdr|ven tne me{gv pvgpgvbkòn ld aer|g dr|e|eh( knldpdnlkdn|dmdn|d ldh mglg ldcknenbkemkdn|g *ld |kpg Fkrmevb` g Fdsdvklad+ *khtr|vebkòn :+. Erí( ceh|e tn me{gv ldrevvghhg ldhrdb|gv dr|e|eh peve utd dr|d ehbenbd dh pvgmdlkg ld 1?$ ldh aer|g |g|eh dn rehtl utd rd bgnr|e|e dn

hgr peírdr bgn bgfdv|tve tnksdvreh dn rehtl0 rkn dmfevag( rd ptdld ldr|ebev utd dzkr|d dn Fghksketn rdb|gv dr|e|eh utd dn pvgpgvbkòn ldh aer|g |g|eh dn rehtl dr mår kmpgv|en|d utd dn hgr ldmårpeírdr ldh mtnlg( bgnr|k|t{dnlg erí tne cgv|ehdye peve he kmphdmdn|ebkòn ld tne bgfdv|tvetnksdvreh dr|e|eh ferele dn tn rkr|dme ld |kpg Fdsdvklad. _gv didmphg( peve dh eõg 6??1( dh aer|gld eadn|dr pvkselgr *jgaevdr( rdatvgr+ vdpvdrdn|efe dh <<(1$ ldh aer|g |g|eh dn rehtl dn dhbgn|kndn|d rtlemdvkbeng( mkdn|ver utd dn Fghkske( vdpvdrdn|efe dh 23(3$ *khtr|vebkòn :+.

Khtr|vebkòn :  ‒ Bgmpevebkòn kn|dvnebkgneh ld he dr|vtb|tve ld aer|g rdaùn rtf-rdb|gv( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 GMR 6?5? 

RDB\GV_VKSELG 

RDB\GVDR\E\EH 

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 35/110

 KKK.2.6. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn rtf-rdb|gv { eadn|d

Dn bten|g e mgn|gr aer|elgr pgv hgr lkcdvdn|dr eadn|dr ld cknenbkemkdn|g( |glgr hgr rdb|gvdr jenknbvdmdn|elg rkankckbe|ksemdn|d rt aer|g dn rehtl dn dh pdvkglg ld enåhkrkr( bgn me{gv knbvdmdn|gpeve dh rtfrdb|gv pùfhkbg *:3$ dn|vd 6??2 { 6??1( 555$ dn|vd 6??2 { 6??:+( bgvvgfgvenlg dhknbvdmdn|g ld he pvgpgvbkòn ldh rtf-rdb|gv pùfhkbg ldn|vg ldh aer|g |g|eh dn rehtl pvdrdn|elg dn dhebåpk|d en|dvkgv. Dh eõg ld me{gv bvdbkmkdn|g ldh rtf-rdb|gv pùfhkbg ctd dh eõg 6??4 *btelvg 56+.

Eavdaenlg hgr rtfrdb|gvdr pùfhkbg { ld he rdatvklel rgbkeh( dh rdb|gv dr|e|eh |kdnd tn aer|g |g|ehdr|kmelg ld 2.155(1 mkhhgndr ld fghkskengr peve he adr|kòn 6??:( vdpvdrdn|enlg tn knbvdmdn|gebtmthelg ldrld he adr|kòn 6??2 ld 1;(6$. Dn bemfkg( dh rdb|gv pvkselg( pvknbkpehmdn|dbgmptdr|g pgv hgr peagr ld fghrkhhg ld hgr jgaevdr( je |dnklg tn bvdbkmkdn|g ngmkneh dn|vd 6??2 {6??1 ld 23(1$( { ld <6$ rk rd bgnrkldve her dr|kmebkgndr peve dh eõg 6??:( peve ehbenyev tn aer|gld 5.;14(1 mkhhgndr ld fghkskengr dn 6??: *btelvg 56+.

Btelvg 56  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv rdb|gv( Fghkske( 6??2-?:

Aer|g dn rehtl pgvrdb|gv { rtfrdb|gv

6??2 6??< 6??4 6??3 6??1 6??: *p+

Rdb|gvDr|e|eh

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+

6.?15(3-  

-  

6.262(:56(6$  

56(6$  

6.:<<(;66(<$  

21(2$  

2.?13(<:(5$  

<:(4$  

2.6;3(21(5$  

4;(5$  

2.155(156(3$  

1;(6$  

Rtf-rdb|gv pùfhkbg 

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

5.?<4(1

-  

-  

5.532(<

55(2$  

55(2$  

5.4:?(;

24(;$  

45(6$  

5.1?4(3

1(;$  

32(5$  

5.;<<(:

5<(?$  

:3(?$  

6.6?3(;

52(4$  

555(?$  

Rtf-rdb|gv rdatvklel 

rgbkeh 

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

5.?64(;

-  

-  

5.53?(2

52(5$  

52(5$  

5.63<(?

:(;$  

62(6$  

5.21?(:

:(<$  

22(3$  

5.245(4

-5(<$  

25(1$  

5.4?<(:

55(2$  

<3(1$  

Rdb|gv_vkselg

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

5.2;5(4

-  

-  

5.<2;(2

2(<$  

2(<$  

5.4?5(:

<(2$  

1(;$  

5.366(1

:(5$  

53(3$  

5.;?5(1

51(6$  

23(1$  

-

-  

-  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

Enehkyenlg mår e ld|ehhd dh aer|g dn rehtl dn sehgv ngmkneh ld hgr lkcdvdn|dr eadn|dr ldcknenbkemkdn|g ldh rtfrdb|gv pùfhkbg( rd bgnr|e|e utd dh ctdv|d bvdbkmkdn|g ldh aer|g ld eadn|drpùfhkbgr rd ldfd e|vkftkv pvknbkpehmdn|d e her _vdcdb|tver Ldpev|emdn|ehdr { e hgr Mtnkbkpkgr( utd|tskdvgn tn knbvdmdn|g ld rt aer|g dn rehtl dn dh pdvkglg 6??2-6??: ld 52?$ { 5<:(5$vdrpdb|ksemdn|d( mkdn|ver utd dh mdngv bvdbkmkdn|g ctd ldh Mknkr|dvkg ld Rehtl { Ldpgv|dr( bgn tnaer|g dn rehtl 6??: rtpdvkgv dn 23(6$ e rt aer|g 6??2 *btelvg 52+. Rkn dmfevag( dn dh berg ld her_vdcdb|tver( dh aer|g ng dr vdpvdrdn|e|ksg {e utd dh :?$ ld rt aer|g dn rehtl bgnbkdvnd hgrvdbtvrgr jtmengr peaelgr bgn ctdn|dr \AN d JK_B KK { peve hgr btehdr her _vdcdb|tver rghg itdaentn vgh ld kn|dvmdlkevkg. Erí( rgfvd tn aer|g pvdcdb|gveh 6??1 ld Fr. ::2(1 mkhhgndr( Fr. 1?3(3mkhhgndr *:?$+ dven peve peag ld vdbtvrgr jtmengr bgn |venrcdvdnbker JK_B KK { \AN { rghemdn|dFr. 511(5 mkhhgndr *6?$+ dve aer|g pvdcdb|gveh pvgpkemdn|d lkbjg.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 36/110

 

23

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg 52  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn eadn|dcknenbkelgv ldh rtfrdb|gv pùfhkbg( Fghkske( 6??2-?:

Aer|g dn rehtl pgveadn|d cknenbkelgv

6??2 6??< 6??4 6??3 6??1 6??: *p+

Mknkr|dvkg ldRehtl {

Ldpgv|dr

Dn mkhhgndrld fghkskengr

*bvdbkmkdn|g ebtmthelg+ 

63;(6

-  

61?(2

?(<$  

2;3(<

<1(2$  

2?4(5

52(2$  

6;6(6

:(3$  

233(3

23(6$  

G|vgrMknkr|dvkgr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

5(5

-  

?(1

-2<(2$  

?(?

-5??(?$  

?(?

-5??(?$  

2(4

626(<$  

55(6

;3<(;$  

_vdcdb|tverLdpev|e-mdn|ehdr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

<21(?

-  

<;?(1

56(2$  

135(4

1<(2$  

124(6

3:(6$  

::2(1

5?6(6$  

5.??4(6

52?(?$  

AgfkdvngrMtnkbkpehdr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

256(?

-  

246(2

56(;$  

213(6

6?(3$  

361(2

5?5(5$  

156(3

56:(<$  

112(;

5<:(5$  

Dn|kleldrldrbdn-

|vehkyeler

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

63(4

-  

<;(2

:3(?$  

<3(:

13(4$  

2:(5

<2(4$  

46(:

;;(5$  

4?(?

::(4$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55 

Btelvg 5<  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn eadn|dcknenbkelgv ldh rtfrdb|gv ld he Rdatvklel Rgbkeh( Fghkske( 6??2-?:

Aer|g dn rehtl pgveadn|d cknenbkelgv

6??2 6??< 6??4 6??3 6??1 6??: *p+

Beie Nebkgnehld Rehtl

Dn mkhhgndrld fghkskengr

*bvdbkmkdn|g ebtmthelg+ 

325(6

-  

15;(1

5<(?$  

11:(;

62(<$  

:43(:

24(1$  

:45(4

2<(;$  

;<:(4

4?(2$  

Beie _d|vghdveld Rehtl

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

5;<(:

-  

622(6

5;(1$  

624(;

65(5$  

64:(;

26(;$  

66;(?

51(3$  

64:(3

26(:$  

RdatvgrTnksdvrk|evkgr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

:3(2

-  

:1(4

5(<$  

5?2(?

5;(<$  

562(?

<6(3$  

55;(;

2:(;$  

52:(5

3?(?$  

BGRRMKH

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

42(3

-  

35(4

5<(:$  

:5(;

46(;$  

4:(:

;(:$  

36(;

51(<$  

3;(6

6;(5$  

BeieBGVLDR

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

61(<

-  

6:(1

4(?$  

26(<

5:(2$  

2:(4

<?(3$  

<:(:

1:(6$  

45(5

:3(3$  

G|verdn|kleldrRdatvklel

Rgbkeh

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

26(1

-  

6;(1

-;(2$  

25(;

-6(4$  

2<(:

3(<$  

2;(<

6?(<$  

2;(4

6?(4$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 37/110

 Dn bten|g eh aer|g dn rehtl ld her dn|kleldr ld rdatvklel dr|e|eh *btelvg 5<+( dr|er mtdr|venmdngr bvdbkmkdn|g dn dh pdvkglg 6??2-6??: utd dh aer|g ldh rtfrdb|gv pùfhkbg. Erí( he BeieNebkgneh ld Rehtl knbvdmdn|ò rt aer|g dn rehtl dn tn 4?$ dn|vd 6??2 { 6??:( perenlg ld tnaer|g ld Fr. 325(6 mkhhgndr dn 6??2 e Fr. ;<:(4 mkhhgndr dn 6??:( vdpvdrdn|enlg erí dh 32$ ldhaer|g ld |gle he Rdatvklel Rgbkeh ld bgv|g pheyg *peve :2$ ld hgr eckhkelgr+. He dn|klel utdknbvdmdn|ò dn me{gv pvgpgvbkòn rt aer|g dn rehtl dr he Beie BGVLDR( bgn tn bvdbkmkdn|g ld:3(3$ dn dh pdvkglg 6??2-6??:. Rkn dmfevag( rt dr|e|t|g ld beie dr|e|eh dr mt{ lkrbt|kfhd9 rk fkdnepevdbd dn dh _vdrtptdr|g Adndveh ld he Nebkòn( ng vdbkfd epgv|dr ld dmphdelgvdr pùfhkbgr.Hgr Rdatvgr Tnksdvrk|evkgr pvdrdn|en he rdatnle |ere ld bvdbkmkdn|g mår kmpgv|en|d( bgn tnknbvdmdn|g ld rt aer|g ld 3?$ dn|vd 6??2 { 6??:. Rkn dmfevag( dzkr|dn kmpgv|en|dr lkcdvdnbkerldn|vg ld dr|gr9 dh RRT _g|grí |tsg tn bvdbkmkdn|g ld 6?3(:$ dn|vd 6??2 { 6??:( R. Bvty 5?1(:$(mkdn|ver utd dh ld Bjtutkrebe |tsg tn bvdbkmkdn|g ld 66$ { dh ld \vknklel tn ldrbdnrg ld <:(1$+.

Cknehmdn|d( hgr eadn|dr pvkselgr mtdr|ven tn bvdbkmkdn|g mdlkeng( e he dzbdpbkòn ld hgr Rdatvgrrgbkehdr pvkselgr( utd lgfhevgn rt aer|g dn sehgv ngmkneh dn|vd 6??2 { 6??: *btelvg 54+. Dn bten|ge hgr jgaevdr( hhdaen e tn aer|g ld fghrkhhg 6??1 ld Fr. 5.<:2(3 mkhhgndr( bgn tn knbvdmdn|g ld rtaer|g dn 2<(2$ dn|vd 6??2 { 6??1( bvdbkmkdn|g pev|kbthevmdn|d mevbelg dn dh 6??1 *btelvg 54+.

Btelvg 54  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn eadn|d

cknenbkelgv ldh rtfrdb|gv pvkselg( Fghkske( 6??2-?:Aer|g dn rehtl pgveadn|d cknenbkelgv

6??2 6??< 6??4 6??3 6??1 6??: *p+

RdatvklelRgbkeh pvksele

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

34(;

-  

11(<

51(3$  

;4(;

<4(3$  

5?1(;

32(:$  

566(3

:3(5$  

525(2

;;(2$  

Rdatvgrpvkselgr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

532(?

-  

53;(:

<(6$  

5:4(1

5<(?$  

656(2

2?(2$  

664(2

2:(6$  

6<1(<

45(:$  

GNAr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

4:(2

-  

44(5

-4(4$  

<?(5

-25(2$  

16(<

6<(5$  

1?(2

6?(4$  

3:(;

5:(5$  

Jgaevdr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

5.5?<(2

-  

5.523(;

6(;$  

5.5:?(5

3(;$  

5.62?(5

55(<$  

5.<:2(3

2<(2$  

5.46:(5

2:(<$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55 

KKK.2.2. Nksdh { dsghtbkòn ldh aer|g dn sehgv vdeh rdaùn rtf-rdb|gv { eadn|d

Ld he mkrme mendve utd peve dh aer|g |g|eh dn rehtl( dh knbvdmdn|g ldh aer|g rdaùn eadn|d

cknenbkelgv rd ldfd vdhe|kskyev( {e utd he mk|el ldh knbvdmdn|g dn dh pdvkglg 6??2-?1 rd ldfd e heknchebkòn *knbvdmdn|g ld hgr pvdbkgr+. Dn sehgv vdeh( rd rkatd ldr|ebenlg dh rtf-rdb|gv pùfhkbg( utdje |dnklg tn knbvdmdn|g ld aer|g dn sehgv vdeh ld 35$ dn|vd 6??2 { 6??:( mkdn|ver utd dh rdb|gvpvkselg { ld he rdatvklel rgbkeh |tskdvgn tn bvdbkmkdn|g ld tn pgbg mår ld 5?$ dn dh mkrmgpdvkglg. Eldmår( dh rtfrdb|gv pùfhkbg ntnbe mtdr|ve lkrmkntbkòn dn sehgv vdeh eh bgn|vevkg ldhrtfrdb|gv ld he Rdatvklel Rgbkeh *6??1+ { dh rdb|gv pvkselg *6??4 { 6??:+. 6??4 { 6??:+. Rkndmfevag( dr|d bvdbkmkdn|g rd dzphkbe pgv dh knbvdmdn|g ldh aer|g rtfrdb|gvkeh gfrdvselg dn dh 6??4(ldfklg pvknbkpehmdn|d e tn knbvdmdn|g ldh aer|g ld her _vdcdb|tver ldpev|emdn|ehdr( pdvg ng rdbgn|kntò dr|e |dnldnbke dn hgr eõgr rkatkdn|dr *btelvg 53 d khtr|vebkòn ;+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 38/110

 

2:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg 53  ‒ Dsghtbkòn ldh aer|g dn sehgv vdeh pgv eadn|d cknenbkelgv( Fghkske( 6??2-?:

Aer|g dn rehtl pgveadn|d *sehgv vdeh+

6??2 6??< 6??4 6??3 6??1 6??: *p+

Rdb|gv

Dr|e|eh

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

6.?15(3

-  

-  

6.646(5

:(1$  

:(1$  

6.3:6(:

5;(5$  

6;(4$  

6.144(2

6(1$  

22(?$  

6.1<:(2

-?(2$  

26(1$  

6.:2:(?

2(2$  

21(?$  

Rtf-rdb|gv pùfhkbg 

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+ 

5.?<4(1

-  

-  

5.564(;

1(1$  

1(1$  

5.<:3(2

26(?$  

<6(5$  

5.462(6

6(4$  

<4(1$  

5.36?(2

3(<$  

4<(;$  

5.3:2(3

2(;$  

35(?$  

Rtf-rdb|gv rdatvklel 

rgbkeh 

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+ 

5.?64(;

-  

-  

5.563(6

;(:$  

;(:$  

5.5;3(4

3(6$  

53(3$  

5.626(6

2(?$  

6?(5$  

5.56:(?

-:(4$  

5?(?$  

5.54<(<

6(2$  

56(4$  

Rdb|gv_vkselg

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+ 

5.2;5(4

-  

-  

5.<?4(4

5(?$  

5(?$  

5.2;5(6

-5(?$  

?(?$  

5.<3;(;

4(1$  

4(3$  

5.3?4(:

;(6$  

54(<$  

-

-  

-  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??: 

Khtr|vebkòn ;  ‒ Dsghtbkòn ldh aer|g dn sehgv vdeh pgv eadn|d cknenbkelgv( Fghkske( 6??2-?:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??: 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 39/110

 Enehkyenlg mår e ld|ehhd dh bvdbkmkdn|g ldh aer|g dn rehtl vdeh ld hgr lkcdvdn|dr eadn|dr ldcknenbkemkdn|g( rd bgnr|e|e tn ctdv|d bvdbkmkdn|g vdeh ldh aer|g ld hgr Mtnkbkpkgr( _vdcdb|tver {G|vgr Mknkr|dvkgr *etnutd peve dr|gr( dh aer|g vdpvdrdn|e mdngr ldh ?(5$ ldh aer|g |g|eh dn rehtl+.He Rdatvklel Rgbkeh pvksele dr g|vg eadn|d ld cknenbkemkdn|g utd knbvdmdn|g rtr|enbkehmdn|d rtaer|g dn rehtl dn sehgv vdeh( bgn tne |ere ld bvdbkmkdn|g 6??2-6??: ld 4<(;$ *btelvg 51+.

Rkn dmfevag( rd ptdld bgnr|e|ev dn dh btelvg 51 utd sevkgr eadn|dr ld cknenbkemkdn|g |tskdvgntne lkrmkntbkòn ld rt aer|g dn rehtl dn sehgv vdeh dn|vd 6??2 { 6??:9 he Beie Fenbevke Dr|e|eh*-2:(1$+( RKNDB *-6<(6$+( BGRRMKH *-6(1$+( GNAr *-:(3$+( mkdn|ver utd dh Mknkr|dvkg ld Rehtl {Ldpgv|dr g he Beie _d|vghdve ng |tskdvgn knbvdmdn|g vdeh ld rt aer|g dn|vd 6??2 { 6??: *btelvg 51+.

Btelvg 51  ‒ \ere ld bvdbkmkdn|g vdeh ebtmthele ldh aer|g dn rehtlldrld dh eõg 6??2( rdaùn eadn|d cknenbkelgv( Fghkske( 6??2-?:

Eadn|d ldCknenbkemkdn|g

6??2 6??< 6??4 6??3 6??1 6??: *p+

5. RTFRDB\GV _ÙFHKBG 

Mknkr|dvkg ld Rehtl

{ Ldpgv|dr- -2(2$ 23(1$ -?(2$ -52(5$ ?(2$

G|vgr Mknkr|dvkgr - -2:(6$ -5??(?$ -5??(?$ 6?2(1$ :<4(:$

_vdcdb|tverLdpev|emdn|ehdr - ;(6$ 34(;$ <;(2$ 3:(;$ 14(?$

Agfkdvngr Mtnkbkpehdr - :(1$ 55(1$ :6(?$ ;6(2$ ;6(6$

Dn|kleldrldrbdn|vehkyeler - :2(3$ 3;(<$ 2?(:$ 1?(4$ <:(?$

6. RTFRDB\GV LD HE RDATVKLEL RGBKEH *DR\E\EH+ 

Beie Nebkgnehld Rehtl - 5?(1$ 53(:$ 66(5$ 56(:$ 54(<$

Beie _d|vghdveld Rehtl - 53(<$ 5<(3$ 5;(4$ -6(1$ 5(5$

RdatvgrTnksdvrk|evkgr - -5(;$ 56(:$ 6:(3$ 53(6$ 62(<$

BGRRMKH - 55(4$ <4(4$ -2(4$ -2(3$ -6(1$

Beie BGVLDR - 5(1$ 55(:$ 63(:$ 45(:$ <4(6$

G|ver dn|kleldrRdatvklel Rgbkeh - -56(3$ -:(<$ -4(5$ ?(:$ -:(6$

2. RDB\GV _VKSELG 

Rdatvklel Rgbkeh

pvksele- 5<(6$ 2:(<$ <:(5$ 41(;$ 4<(;$

Rdatvgr pvkselgr - 5(:$ 3(:$ 5;(:$ 5:(;$ 66(1$

Gvaenkyebkgndr ngAtfdvnemdn|ehdr - -:(2$ -23(:$ 56(5$ ?(:$ -:(3$

Jgaevdr - ?(3$ -5(<$ ?(1$ 52(5$ 1(;$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??:  

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 40/110

 

<?

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

KKK.2.<. Aer|g dn rehtl pdv båpk|e( rdaùn rdb|gv { eadn|d cknenbkelgv

Dh aer|g dn rehtl pdv båpk|e *dn sehgv ngmkneh+ rdaùn rtf-rdb|gv mtdr|ve kmpgv|en|dr lkcdvdnbker9erí( peve he adr|kòn 6??:( dh aer|g pdv båpk|e ldh rtf-rdb|gv pùfhkbg *knbht{dnlg dh Mknkr|dvkg ldRehtl { Ldpgv|dr+ dve ld Fr. 2?3(1 pgv jefk|en|d ng eckhkelg e he Rdatvklel Rgbkeh ld bgv|g pheyg(mkdn|ver utd dn he Rdatvklel Rgbkeh( dh aer|g dve ld Fr. 4<<(1 pgv bele eckhkelg *btelvg 5:+.

Rkn dmfevag( rd vdltidvgn her lkcdvdnbker dn|vd emfgr rtfrdb|gvdr dn dh pdvkglg 6??2-6??:( {e utdhe lkcdvdnbke ld aer|g pdv båpk|e dn|vd dh rtfrdb|gv pùfhkbg { dh rtfrdb|gv ld he Rdatvklel Rgbkeh*dr|e|eh+ dve ld Fr. 2?? pgv pdvrgne dn dh eõg 6??2 { ld Fr. 62: dn dh eõg 6??:( ldfklg e tn me{gvknbvdmdn|g ldh aer|g pdv båpk|e dn dh rtfrdb|gv pùfhkbg9 dn|vd 6??2 { 6??:( dh aer|g pdv båpk|e ldhrtfrdb|gv pùfhkbg rd knbvdmdn|ò dn tn ;1(1$ *ld Fr. 544(5 dn 6??2 e Fr. 2?3(1 dn 6??:( dr ldbkvtn knbvdmdn|g ld Fr. 545(3+( mkdn|ver utd dn dh mkrmg pdvkglg( dh aer|g pdv båpk|e dn he RdatvklelRgbkeh dr|e|eh rd knbvdmdn|ò dn rghemdn|d 5;(1$ *ld Fr. <44(6 dn 6??2 e Fr. 4<<(1 dn 6??:( drldbkv tn knbvdmdn|g ld Fr. :;(4+ *btelvg 5:+.

Btelvg 5:  ‒ Aer|g pdv båpk|e *Fr.+ dn sehgv ngmkneh pgv eadn|d cknenbkelgv( Fghkske( 6??2-?:

Aer|g dn rehtl pdvbåpk|e *dn Fr.+

6??2 6??< 6??4 6??3 6??1 6??: *p+

Rdb|gv Dr|e|eh*rgfvd pgfhebkòn |g|eh+

66;(4 645(; 2?5(: 25;(3 224(< 21?(5

Rtf-rdb|gv pùfhkbg*rgfvd pgfhebkòn ng eckhkele 

e he Rdatvklel Rgbkeh+ 544(5 515(1 664(; 6<5(4 614(< 2?3(1

Rtf-rdb|gv ld herdatvklel rgbkeh

*rgfvd pgfhebkòn eckhkele+ <44(6 <:5(? 46;(3 4<<(2 <;;(2 4<<(1

Rdb|gv _vkselg*rgfvd pgfhebkòn |g|eh+  54<(6 543(? 54;(2 53:(3 5;2(4 -

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??40 KNERDR 6??;  

Avebker e dr|d ctdv|d knbvdmdn|g ldh aer|g dn dh rtf-rdb|gv pùfhkbg( rd knbvdmdn|ò dh aer|g dr|e|eh*rtfrdb|gv pùfhkbg rtfrdb|gv ld he Rdatvklel Rgbkeh dr|e|eh+ ld Fr. 66;(4 pgv jefk|en|d dn 6??2 eFr. 21?(5 dn 6??:( vdpvdrdn|enlg tn knbvdmdn|g ldh 35(2$ dn dr|d pdvkglg *Fr. 5<?(3+.Dn bten|g eh aer|g pvkselg( dr|d rd knbvdmdn|g ld Fr. 54<(6 pgv jefk|en|d dn 6??2 e Fr. 5;2(4 dn6??1( vdpvdrdn|enlg tn knbvdmdn|g ldh 61(:$ dn dr|d pdvkglg *Fr. 2;(2+.

He pvgfefhd rgfvd-dr|kmebkòn ld he pgfhebkòn ld Fghkske pgv pev|d ldh KND jebd utd dh aer|g pdvbåpk|e rde pgrkfhdmdn|d rtf-dr|kmelg peve dh rtf-rdb|gv pùfhkbg { peve dh rdb|gv pvkselg. Erí(

vdehkyenlg dr|kmebkgndr ld aer|g pdv båpk|e t|khkyenlg bgmg ldngmknelgv he pgfhebkòn pvg{db|elepgv he Gckbkne ld _gfhebkòn ld her Nebkgndr Tnkler *GNT 6?5?+( dh aer|g pdv båpk|e ldh rtf-rdb|gvpùfhkbg rdvíe ld Fr. 6:1(1 peve dh eõg 6??1 { ld Fr. 265(3 peve dh eõg 6??:0 dh aer|g ldh rdb|gvdr|e|eh rdvíe ld Fr. 2<3(5 pgv jefk|en|d peve dh eõg 6??1 { ld Fr. 2:6(; peve dh eõg 6??:0 dh aer|gldh rdb|gv pvkselg rdvíe ld Fr. 5;;(1 pgv jefk|en|d peve dh eõg 6??1 { ld Fr. 6?2(: peve 6??:.

E nksdh kn|dvnebkgneh( dh aer|g pdv båpk|e dn pevklel ld pgldv elutkrk|ksg *__E+ dn Fghkske dr mt{kncdvkgv e hg utd rd ptdld gfrdvsev dn dh mtnlg( |en|g peve dh aer|g dr|e|eh bgmg peve dh aer|gpvkselg *btelvg 5;+. Ld ebtdvlg bgn dr|er bgmpevebkgndr( dh aer|g dr|e|eh dn rehtl pdv båpk|e ld

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 41/110

 Fghkske peve dh eõg 6??1 *525 ,__E g TR, <6(4+( dr kncdvkgv eh aer|g pdv båpk|e ld |glgr hgr avtpgrld peírdr enehkyelgr( knbhtrksd hgr bgn nksdh ld ldrevvghhg jtmeng d knavdrg dr|e|eh rkmkhev e hgr ldFghkske( ldmgr|venlg utd rd pglvíe |dndv tn me{gv aer|g dn rehtl pùfhkbg dn ntdr|vg peír lelerher bgnlkbkgndr ld ldrevvghhg { ld knavdrg.

Btelvg 5;  ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g |g|eh dn rehtl pdv båpk|e( 6??1

Aer|g dn rehtl pdvbåpk|e *dn TR, { __E+

FGHKSKE Mtnlg Avtpg 5Rtlemëvkbe 

Avtpg 6Ldrevvghhgjtmeng 

Avtpg 2Knavdrgdr|e|eh 

Avtpg <Bgfdv|tvetnksdvreh 

Rdb|gvDr|e|eh*6??1+

Dn TR,  <6(4 32?(3 5;<(3 55:(< :6(5 5.124(3

Dn __E 525(? 326(5 261(: 655(2 5<;(? 5.4<;(1

Rdb|gv_vkselg*6??1+

Dn TR,  6<(4 63:(: 51:(2 ;5(1 36(: 361(2

Dn __E 14(3 6;:(6 6:1(3 531(? 551(2 4:1(:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??40 GMR 6?5? 

_gv g|ve pev|d( rk fkdn dn Fghkske dh aer|g dr|e|eh pdv båpk|e rd knbvdmdn|ò dn me{gv pvgpgvbkòn utddh aer|g pvkselg ltven|d dh pdvkglg 6??2-6??1( dr|d knbvdmdn|g dr mdngv e hg utd rd ptdldgfrdvsev e nksdh mtnlkeh ltven|d dh mkrmg pdvkglg( bgn he dzbdpbkòn ld hgr peírdr bgn bgfdv|tvetnksdvreh dn rehtl. Mkdn|ver utd dh aer|g dr|e|eh pdv båpk|e dn Fghkske rd knbvdmdn|efe ld <2(2$dn|vd 6??2 { 6??1( dr|d knbvdmdn|g dve dn pvgmdlkg ld 5??(;$ dn Rtlemëvkbe *khtr|vebkòn 5?+.

Khtr|vebkòn 5?  ‒ Bgmpevebkòn kn|dvnebkgneh ld he |ere ld bvdbkmkdn|g6??2-6??1 ldh aer|g dr|e|eh dn rehtl pdv båpk|e dn sehgv ngmkneh *TMN+

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??40 GMR 6?5? 

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 42/110

 

<6

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Eldmår( dh knbvdmdn|g ldh aer|g pdv båpk|e rd ldfd vdhe|kskyev {e utd dh knbvdmdn|g dn sehgv vdeh ngdr mt{ kmpgv|en|d *btelvg 6?+. Dn dcdb|g( rghemdn|d dn dh rtfrdb|gv pùfhkbg rd ptdld gfrdvsev tnknbvdmdn|g rkankckbe|ksg ldh aer|g pdv båpk|e dn sehgv vdeh *45(<$ dn dh pdvkglg 6??2-6??:+ mkdn|verutd dn dh rtfrdb|gv ld he Rdatvklel Rgbkeh( dh aer|g pdv båpk|e lkrmknt{ò dn dh mkrmg pdvkglg(rkankckbenlg utd dn sehgv vdeh( he Rdatvklel Rgbkeh dr|e|eh |kdnd dn 6??: tn aer|g pgv eckhkelg mdngve hg utd |dníe dn dh eõg 6??2. Dn |g|ehklel( dh rdb|gv dr|e|eh mtdr|ve tn knbvdmdn|g vdeh ld rt aer|gpdv båpk|e ld rghemdn|d 62(2$ dn dh pdvkglg 6??2-6??:. Eldmår( dr|d feig knbvdmdn|g ng ctdbgn|kntg {e utd rd ldfd drdnbkehmdn|d eh bvdbkmkdn|g ldh aer|g dn dh rtfrdb|gv pùfhkbg peve dh eõg6??4 { utd htdag ldh eõg 6??4( rd ptdld gfrdvsev tne dr|enbebkòn ldh aer|g dn rehtl pdv båpk|edr|e|eh( { rghemdn|d tn hkadvg etmdn|g ldh aer|g ldh rtfrdb|gv pùfhkbg.

Btelvg 6?  ‒ Aer|g dn rehtl pdv båpk|e dn sehgv vdeh( rdaùn rtf-rdb|gv( Fghkske( 6??2-6??:

Aer|g dn rehtl pdvbåpk|e *sehgv vdeh+

6??2 6??< 6??4 6??3 6??1 6??: *p+

Rdb|gvDr|e|eh

Aer|g 'båpk|e*Fr. ld 6??2+ 66;(4 6<<(5 6:<(3 6:3(6 61;(1 6:2(?

Knbvdmdn|g vdeh - 3(2$ 53(3$ ?(3$ -6(2$ 5(6$ 

ebtmthelg - 3(2$ 6<(?$ 6<(1$ 65(:$ 62(2$ 

Rtf-rdb|gvpùfhkbg

Aer|g 'båpk|e*Fr. ld 6??2+ 544(5 533(5 656(6 653(5 62?(2 62<(;

Knbvdmdn|g vdeh - 1(5$ 61(1$ 5(;$ 3(3$ 6(?$ 

ebtmthelg - 1(5$ 23(1$ 2;(2$ <:(4$ 45(<$ 

Rtf-rdb|gv

R. Rgbkeh

Aer|g 'båpk|e*Fr. ld 6??2+ <44(6 <33(: 4?5(2 <:;(2 <53(1 <51(;

Knbvdmdn|g vdeh - 6(3$ 1(<$ -6(<$ -5<(:$ ?(2$ 

ebtmthelg - 6(3$ 5?(5$ 1(4$ -:(<$ -:(6$ 

Rdb|gv

_vkselg

Aer|g 'båpk|e*Fr. ld 6??2+ 54<(6 546(2 5<1(3 546(1 532(< 54<(6

Knbvdmdn|g vdeh - -5(6$ -2(5$ 2(4$ 1(?$ -4(3$ 

ebtmthelg - -5(6$ -<(2$ -5(?$ 3(?$ ?(?$ 

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??4 { 6??:0 KNERDR 6??;  

He |ere ld bvdbkmkdn|g ebtmthele ldh aer|g dn rehtl dr|e|eh pdv båpk|e dn sehgv vdeh dn|vd 6??2 {6??: dr ld rghemdn|d 62(2$0 bgmpevenlg bgn dh nksdh kn|dvnebkgneh( dr|d sehgv mt{ kncdvkgv e hg utdrd ptdld gfrdvsev dn dh mtnlg ltven|d dh mkrmg pdvkglg9 dh pvgmdlkg mtnlkeh dr ld <6(;$ ldbvdbkmkdn|g dn|vd 6??2 { 6??:. Dn hgr peírdr sdbkngr ld Rtlemëvkbe( dr ld 32(2$ *btelvg 65+.

Btelvg 65  ‒ Bgmpevebkòn kn|dvnebkgneh ldh knbvdmdn|g vdeh ldh aer|g pdv båpk|e rdaùn rdb|gv

Knbvdmdn|g ldh aer|g

vdeh pdv båpk|e *dn $+ FGHKSKE Mtnlg

Avtpg 5Rtlemëvkbe 

Avtpg 6

Ldrevvghhgjtmeng 

Avtpg 2

Knavdrgdr|e|eh 

Avtpg <

Bgfdv|tvetnksdvreh Rdb|gv Dr|e|eh

*knbvdmdn|g 6??2-6??:+62(2$ <6(;$ 32(2$ 4<(3$ 4?(4$ 26(3$

Rdb|gv _vkselg*knbvdmdn|g 6??2-6??1+

3(?$ 6;(1$ 6:(1$ 6;(<$ 5:(<$ 64(;$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??4 { 6??:0 GMR 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 43/110

 KKK.2.4. Ve|kgr mebvgdbgnòmkbgr ldh aer|g rdaùn rdb|gv { eadn|d cknenbkelgv

KKK.2.4.e. Aer|g dn rehtl rdaùn rtfrdb|gv dn $ ldh _KF

Dn bten|g eh ve|kg mebvgdbgnòmkbg ld aer|g dn rehtl dn $ ldh pvgltb|g kn|dvng fvt|g( rd ptdldgfrdvsev utd he lkrmkntbkòn ld dr|d ld 4(3$ dn 6??2 e <(1$ dn 6??: rd ldfd rghemdn|d eh

rtfrdb|gv ld he Rdatvklel Rgbkeh { eh rdb|gv pvkselg( {e utd dh rtfrdb|gv pùfhkbg hgavò men|dndv rtaer|g dn vdhebkòn eh _KF( ld 5(1$ dn 6??2 e 5(:$ dn 6??: *khtr|vebkòn 55+.

_gv g|ve pev|d( rk fkdn rd ptdld gfrdvsev tn knbvdmdn|g ldh aer|g ldh rtf-rdb|gv pùfhkbg dn vdhebkòneh _KF peve dh eõg 6??4 *ehbenyenlg tne pvgpgvbkòn ldh 6(5$ ldh _KF+( ng rd ptlg men|dndv dr|evdhebkòn ltven|d hgr rkatkdn|dr eõgr.

Khtr|vebkòn 55  ‒ Aer|g dn rehtl pgv rdb|gv dn $ ldh pvgltb|g kn|dvng fvt|g( Fghkske( 6??2-6??:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6?5?  

Dn rt |g|ehklel( dh rdb|gv dr|e|eh *rtfrdb|gv pùfhkbg rtfrdb|gv ld he Rdatvklel Rgbkeh+ vdpvdrdn|epeve dh eõg 6??1 dh 2(6$ ldh _vgltb|g Kn|dvng Fvt|g *2(5$ peve he pvg{dbbkòn 6??:+( mgr|venlg tnehkadve lkrmkntbkòn vdrpd|g eh eõg 6??2( dn dh bteh vdpvdrdn|efe dh 2(2$ ldh _KF *btelvg 66+.Rkn dmfevag( he rtfkle gfrdvsele dn dh eõg 6??4( dn dh bteh dh aer|g dn rehtl ldh rdb|gv dr|e|eh

vdpvdrdn|efe dh 2(1$ ldh _KF( rkankckbe utd jtfg tn ldrbdnrg pev|kbthevmdn|d ctdv|d ldh ve|kg ldaer|g dr|e|eh dn rehtl dn $ ldh _KF e pev|kv ldh eõg 6??3 *btelvg 66+.

Dn bten|g eh aer|g ld hgr eadn|dr pvkselgr dn rehtl dn vdhebkòn eh _vgltb|g Kn|dvng Fvt|g( dr|d dr|ådn ldrbdnrg bgn|kntg ldrld dh eõg 6??2( dn dh bteh dh ve|kg dve ld 6(6$( peve ehbenyev dn dh eõg6??: dh 5(3$ ldh _KF *btelvg 66+.

RDB\GV_VKSELG 

RDATVKLELRGBKEH 

RTFRDB\GV_ÙFHKBG 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 44/110

 

<<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg 66  ‒ Aer|g dn rehtl pgv rdb|gv dn $ ldh pvgltb|g kn|dvng fvt|g( Fghkske( 6??2-6??:

Aer|g dn rehtldn $ ldh _KF

6??2 6??< 6??4 6??3 6??1 6??: *p+

Rdb|gv Dr|e|eh 2(2$ 2(2$ 2(1$ 2(<$ 2(6$ 2(5$

Rdb|gv _vkselg 6(6$ 6(5$ 5(;$ 5(:$ 5(:$ 5(3$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6?5?  

Bgmpevenlg bgn le|gr kn|dvnebkgnehdr( dh aer|g dn rehtl dn $ ldh _KF dn Fghkske dr kncdvkgv eh sehgvld hgr avtpgr ld peírdr bgmpevelgr( |en|g peve dh Rdb|gv dr|e|eh bgmg peve dh Rdb|gv pvkselg. Erí(rd bgnr|e|e utd dn hgr peírdr bgn bgfdv|tve tnksdvreh dn rehtl( dh rdb|gv dr|e|eh vdpvdrdn|e dh 4(5$ldh _vgltb|g Kn|dvng Fvt|g peve he adr|kòn 6??1( hg utd le tne klde ldh nksdh ld aer|g ldrdefhd peveehbenyev { men|dndv tne bgfdv|tve tnksdvreh.

Dn hgr peírdr ld Rtlemëvkbe( rk fkdn dh aer|g pvkselg dr mtbjg me{gv e hg utd rd ptdld gfrdvsevdn Fghkske( dh aer|g dr|e|eh |emfkën dr me{gv dn vdhebkòn eh _KF *khtr|vebkòn 56+. Eldmår( |glgr hgr

avtpgr ld bgn|vgh mgr|vevgn tn knbvdmdn|g ldh ve|kg ld aer|g dr|e|eh dn $ ldh _KF ltven|d dhpdvkglg 6??2-6??:( mkdn|ver utd dn Fghkske lkrmknt{ò( ld 2(2$ dn 6??2 e 2(5$ dn 6??:. Erí( dhpvgmdlkg ld aer|g dr|e|eh dn $ ldh _KF però ld 2(<$ *6??2+ e 2(;$ *6??:+ dn Rtlemëvkbe(mkdn|ver utd dn hgr peírdr bgn bgfdv|tve tnksdvreh( rd men|kdnd dn|vd 4(5$ { 4(6$ bele eõg.

Khtr|vebkòn 56  ‒ Bgmpevebkòn kn|dvnebkgneh ldh ve|kg ld aer|g dn rehtldn $ ldh _KF rdaùn rdb|gv( 6??1 *sehgv ngmkneh+

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6?5?0 GMR 6?5? 

RDB\GV_VKSELG 

RDB\GVDR\E\EH 

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 45/110

 KKK.2.4.f. Aer|g dr|e|eh dn rehtl dn $ ldh aer|g pùfhkbg { ldh aer|g ldh agfkdvng adndveh

Eldmår ldh pvgltb|g kn|dvng fvt|g( rd ptdld mdlkv dh aer|g dr|e|eh dn rehtl dn $ ldh aer|g pùfhkbg|g|eh { dn $ ldh aer|g ldh Agfkdvng Adndveh. Dh aer|g ldh Agfkdvng Adndveh knbht{d dh aer|g ldhAgfkdvng bdn|veh { ld hgr nksdhdr rtf-nebkgnehdr *_vdcdb|tver( Mtnkbkpkgr( Dn|kleldrldrbdn|vehkyeler( Tnksdvrkleldr _ùfhkber( Rdatvklel Rgbkeh dr|e|eh( d|b.+. Dn bemfkg( dh aer|gpùfhkbg |g|eh knbht{d dh aer|g ldh Agfkdvng Adndveh( pdvg |emfkën dh rdb|gv pùfhkbg dmpvdrevkeh*dmpvdrer nebkgnehdr( bgmg [_CF pgv didmphg+.

Vdrpd|g eh aer|g dr|e|eh dn rehtl dn $ ldh aer|g pùfhkbg |g|eh( dr|d lkrmknt{ò rkankckbe|ksemdn|d epev|kv ldh eõg 6??4( perenlg ld ;(5$ dn 6??2 e 3(:$ dn 6??:. Dh rtfrdb|gv pùfhkbg dn rehtl( epdrev ld mgr|vev hgr me{gvdr nksdhdr ld knbvdmdn|g dn dr|d pdvkglg( |emfkën lkrmknt{ò dn vdhebkòneh aer|g dr|e|eh |g|eh( ld <(3$ dn 6??2 e <(5$ dn 6??: *khtr|vebkòn 52 { btelvg 62+. E pdrev ld tnknbvdmdn|g ldh ve|kg ld aer|g dn rehtl dn $ ldh aer|g pùfhkbg |g|eh dn dh eõg 6??4( jer|e 5?(;$( ngrd ptlg men|dndv dr|d nksdh {e utd dh bvdbkmkdn|g ldh aer|g dr|e|eh dn rehtl peve dh pdvkglg 6??3-6??: *;(2$ dn pvgmdlkg enteh+ dve mtbjg mdngv eh bvdbkmkdn|g ldh aer|g pùfhkbg |g|eh *6:$ dnpvgmdlkg enteh dn dh pdvkglg 6??3-?:+.

He lkrmkntbkòn ld dr|d ve|kg vdpvdrdn|e tne feie ld he pvkgvkyebkòn ld he rehtl ldn|vg ldh aer|gpùfhkbg e pev|kv ldh eõg 6??39 rk fkdn dh aer|g pùfhkbg |g|eh rd knbvdmdn|ò bgmg ntnbe dn he jkr|gvke

ldh peír e pev|kv ld dr|d eõg( avebker e he sdn|e ld jklvgbevftvgr pvknbkpehmdn|d( dh rdb|gv rehtl ngctd fdndckbkevkg ld dr|d knbvdmdn|g *khtr|vebkòn 52 { btelvg 62+.

Khtr|vebkòn 52  ‒ Aer|g dn rehtl dr|e|eh dn $ ldh aer|g pùfhkbg |g|eh( Fghkske( 6??2-6??:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Åskhe d| eh. 6?550 MDC_ { FBF 6?5?  

Dn he khtr|vebkòn 5<( rd ptdld bgnr|e|ev dh lkcdvdnbkeh dn|vd dh knbvdmdn|g ldh aer|g dr|e|eh dn rehtl {dh knbvdmdn|g ldh aer|g pùfhkbg |g|eh e pev|kv ldh eõg 6??4( utd dzphkbe dn pev|d he lkrmkntbkòn ldh

RDATVKLELRGBKEH 

RTFRDB\GV_ÙFHKBG 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 46/110

 

<3

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

ve|kg ld aer|g dn rehtl vdrpdb|g eh aer|g pùfhkbg |g|eh9 mkdn|ver utd dh bvdbkmkdn|g ngmknehebtmthelg ldh aer|g dr|e|eh dve ld 2?(4$ dn|vd 6??2 { 6??:( dh bvdbkmkdn|g ldh vdr|g ldh aer|gpùfhkbg ctd ld 55:(<$ *ld 62.6<2 mkhhgndr ld fghkskengr dn dh eõg 6??4 e 4?.131 mkhhgndr ldfghkskengr dn dh eõg 6??:+( ldmgr|venlg utd g|vgr rdb|gvdr ctdvgn pvkgvkyelgr *khtr|vebkòn 5<+.

Btelvg 62  ‒ Aer|g dn rehtl dr|e|eh dn $ ldh aer|g pùfhkbg |g|eh( Fghkske( 6??2-6??:

Aer|g dn rehtldn $ ldh aer|g dr|e|eh

6??2 6??< 6??4 6??3 6??1 6??: *p+

Aer|g Dr|e|eh rehtldn $ ldh aer|g pùfhkbg ;(5$ ;(:$ 5?(;$ ;(1$ 1(3$ 3(:$

Rtfrdb|gv pùfhkbg <(3$ <(;$ 3(5$ 4(<$ <(4$ <(5$

Rtfrdb|gv R. Rgbkeh <(4$ <(;$ <(:$ <(2$ 2(5$ 6(:$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Åskhe d| eh. 6?550 MDC_ { FBF 6?5?  

Dn he khtr|vebkòn 5<( rd ptdld bgnr|e|ev dh lkcdvdnbkeh dn|vd dh knbvdmdn|g ldh aer|g dr|e|eh dn rehtl {

dh knbvdmdn|g ldh aer|g pùfhkbg |g|eh e pev|kv ldh eõg 6??4( utd dzphkbe dn pev|d he lkrmkntbkòn ldhve|kg ld aer|g dn rehtl vdrpdb|g eh aer|g pùfhkbg |g|eh9 mkdn|ver utd dh bvdbkmkdn|g ngmknehebtmthelg ldh aer|g dr|e|eh dve ld 2?(4$ dn|vd 6??2 { 6??:( dh bvdbkmkdn|g ldh vdr|g ldh aer|gpùfhkbg ctd ld 55:(<$ *ld 62.6<2 mkhhgndr ld fghkskengr dn dh eõg 6??4 e 4?.131 mkhhgndr ldfghkskengr dn dh eõg 6??:+( ldmgr|venlg utd g|vgr rdb|gvdr ctdvgn pvkgvkyelgr *khtr|vebkòn 5<+.

Khtr|vebkòn 5<  ‒ Bvdbkmkdn|g ngmkneh ebtmthelg ldh aer|g dr|e|eh dnrehtl { ldh vdr|g ldh aer|g pùfhkbg( Fghkske( 6??2-6??:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Åskhe d| eh. 6?550 MDC_ { FBF 6?5?  

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 47/110

 Dn bten|g eh ve|kg ld aer|g dn rehtl dn $ ldh aer|g ldh Agfkdvng Adndveh( dr|d |emfkën lkrmknt{ò(pdvg dn mdngvdr pvgpgvbkgndr utd peve dh ve|kg ld aer|g pùfhkbg( {e utd tne pev|d kmpgv|en|d ldhknbvdmdn|g ldh aer|g pùfhkbg rd jkyg( ldrld dh eõg 6??3( e pev|kv ld her dmpvdrer pùfhkber *herbtehdr ng dn|ven dn dh aer|g ldh Agfkdvng Adndveh+. Erí( dh ve|kg ld aer|g dn rehtl dn $ ldh aer|gldh Agfkdvng Adndveh però ld 5?(3$ dn 6??2 e ;(<$ dn 6??:( e pdrev ld jefdv mgr|velg tnknbvdmdn|g dn dh eõg 6??4 { utd rd men|tsg dh ve|kg dn dh eõg 6??3 *btelvg 6<+. Drg rkankckbe utd epev|kv ldh eõg 6??1( feiò he pvkgvkyebkòn ld he rehtl ldn|vg ldh aer|g ldh Agfkdvng Adndveh.

Btelvg 6<  ‒ Aer|g dn rehtl dr|e|eh dn $ ldh aer|g ldh Agfkdvng Adndveh( Fghkske( 6??2-6??:

Aer|g dn rehtldn $ ldh aer|g dr|e|eh

6??2 6??< 6??4 6??3 6??1 6??: *p+

Aer|g Dr|e|eh rehtldn $ ldh aer|g pùfhkbg 5?(3$ 5?(<$ 55(2$ 55(4$ 5?(4$ ;(<$

Rtfrdb|gv pùfhkbg 4(2$ 4(6$ 3(2$ 3(<$ 3(6$ 4(3$

Rtfrdb|gv R. Rgbkeh 4(6$ 4(6$ 4(?$ 4(5$ <(2$ 2(:$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Åskhe d| eh. 6?550 MDC_ { FBF 6?5?  

He lkrmkntbkòn ldh ve|kg ld aer|g dr|e|eh dn rehtl dn $ ldh aer|g ldh Agfkdvng Adndveh rd ldfd ehrtfrdb|gv ld he Rdatvklel Rgbkeh ld bgv|g pheyg( utd però ld 4(6$ ldh aer|g ldh Agfkdvng Adndvehdn 6??2 e 2(:$ dn 6??:. Dn bemfkg( he pev|kbkpebkòn ldh aer|g dn rehtl ldh rtfrdb|gv pùfhkbg rdknbvdmdn|ò( ld 4(2$ ldh aer|g ldh Agfkdvng Adndveh dn 6??2 e 4(3$ dn 6??:. Dh rtfrdb|gv pùfhkbghgavò men|dndv dr|d ve|kg dn mår ldh 3$ ld 6??4 e 6??1( pdvg dn dh eõg 6??: feiò dn nksdhdrrkmkhevdr e hg utd rd pglíe gfrdvsev dn hgr eõgr 6??2 { 6??< *btelvg 6< d khtr|vebkòn 54+.

Khtr|vebkòn 54  ‒ Aer|g dn rehtl dr|e|eh dn $ ldh aer|g ldh Agfkdvng Adndveh( Fghkske( 6??2-?:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Åskhe d| eh. 6?550 MDC_ { FBF 6?5?  

RDATVKLELRGBKEH 

RTFRDB\GV_ÙFHKBG 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 48/110

 

<:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Bgmpevenlg bgn le|gr kn|dvnebkgnehdr( dh aer|g dr|e|eh dn rehtl dn $ ldh aer|g ldh AgfkdvngAdndveh dn Fghkske dr rkankckbe|ksemdn|d kncdvkgv eh sehgv ld hgr avtpgr ld peírdr bgmpevelgr(knbhtrksd hgr peírdr bgn mkrmg nksdh ld knavdrg dr|e|eh *khtr|vebkòn 53+. Erí( dn dh eõg 6??:( dh aer|gdr|e|eh dn rehtl vdpvdrdn|e dh 52(4$ ldh aer|g ldh Agfkdvng adndveh dn hgr peírdr bgn bgfdv|tvetnksdvreh( { dh 56(3$ bgmg pvgmdlkg dn hgr peírdr ld Rtlemëvkbe. _eve ehbenyev dn 6??: dh nksdhld hgr peírdr bgn bgfdv|tve tnksdvreh( dh rdb|gv dr|e|eh ld Fghkske jefvíe ndbdrk|elg tn aer|g dnrehtl elkbkgneh ld epvgzkmelemdn|d 5.35:(4 mkhhgndr ld fghkskengr *666(5 mkhhgndr ld TR,+(vdpvdrdn|enlg tn <2(3$ ld aer|g dr|e|eh elkbkgneh peve dh eõg 6??:. _eve ehbenyev dh nksdhpvgmdlkg ld Rtlemëvkbe( jefvíe ndbdrk|elg epvgzkmelemdn|d Fr. 5.616(4 mkhhgndr elkbkgnehdr.

Khtr|vebkòn 53  ‒ Bgmpevebkòn kn|dvnebkgneh ldh ve|kg ld aer|g dr|e|eh dn rehtl dn $ldh aer|g |g|eh ldh Agfkdvng Adndveh peve hgr eõgr 6??2 { 6??: *sehgv ngmkneh+

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Åskhe d| eh. 6?550 MDC_ { FBF 6?5?0 GMR 6?5? 

E nksdh ld peírdr( <6 mtdr|ven tn nksdh ld aer|g dr|e|eh rtpdvkgv g kateh eh 54$ ldh aer|g ldh

Agfkdvng Adndveh *AAA+ peve dh eõg 6??:( bgmg pgv didmphg Bjkhd( Bghgmfke( Bgr|e Vkbe( Btfe(_dvù( Mëzkbg( Cvenbke( d knbhtrksd Dr|elgr Tnklgr( utd e pdrev ld |dndv tn rkr|dme ld rehtleh|emdn|d pvkse|kyelg( |kdnd tn aer|g dr|e|eh dn rehtl utd vdpvdrdn|e dh 5:(1$ ldh aer|g ldhAgfkdvng Adndveh ld dr|d peír peve dh eõg 6??: *GMR 6?5?+. _eve dh eõg 6??:( Bgr|e Vkbe dr dh peírldh mtnlg dn dh bteh rd gfrdvse dh me{gv ve|kg ld aer|g dr|e|eh dn $ ld AAA( bgn 63$ * GMR 6?5?+.

Dn bten|g e he dsghtbkòn ldh ve|kg ld aer|g dr|e|eh dn rehtl dn $ ldh Aer|g ldh Agfkdvng Adndveh(dzkr|dn :4 g|vgr peírdr ld 5:; utd |tskdvgn lkrmkntbkòn ld dr|d ve|kg dn|vd 6??2 { 6??:( mgr|venlgher lkckbth|eldr dzkr|dn|dr dn men|dndv g knbvdmdn|ev dh aer|g dn rehtl dn vdhebkòn bgn dh AAA. Rkn

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 49/110

 dmfevag( 5?< peírdr hgavevgn men|dndv g knbvdmdn|ev dr|d ve|kg { dh pvgmdlkg ld dr|d knlkbelgvpeve hgr avtpgr ld bgmpevebkòn mtdr|ve tne dsghtbkòn pgrk|kse *khtr|vebkòn 53+. Dh berg btfeng rdldr|ebe e nksdh kn|dvnebkgneh peve rt pvkgvkyebkòn ld he rehtl( {e utd dh ve|kg ld aer|g dr|e|eh dnrehtl dn $ ldh AAA però ld 5?(;$ dn 6??2 e 54(4$ dn 6??:. E nksdh bgn|kndn|eh( rd ptdld bk|ev dhberg ldh At{ene( peve dh bteh dr|d ve|kg rd knbvdmdn|ò( ld ;(;$ dn 6??2 e 5<(4$ dn 6??:(ldmgr|venlg utd dr ceb|kfhd pvkgvkyev he rehtl ldn|vg ld hgr pvdrtptdr|gr pùfhkbgr rk dzkr|d tne vdehsghtn|el pghí|kbe e nksdh nebkgneh.

KKK.<. Enåhkrkr ldh Aer|g dn rehtl rdaùn ctdn|dr ld cknenbkemkdn|g 

KKK.<.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn ctdn|d

Ld ebtdvlg bgn he dr|vtb|tve ld aer|g 6??1 pgv ctdn|dr ld cknenbkemkdn|g behbthelg peve dhpvdrdn|d enåhkrkr e pev|kv ld hgr lgr dr|tlkgr lkrpgnkfhdr *Sehlër { _dõehgye 6?5?0 Åskhe d| eh . 6?55+( herctdn|dr ld cknenbkemkdn|g rgn mkz|er( dn|vd her ctdn|dr pùfhkber( utd vdpvdrdn|en dh <<(5$ ldhaer|g |g|eh dn rehtl( her ctdn|dr pvkseler nebkgnehdr *<1(4$ ldh aer|g+ { her ctdn|dr dz|dvner( utd

vdpvdrdn|en dh :(<$ ldh aer|g |g|eh dn rehtl peve he adr|kòn 6??1. Her ctdn|dr nebkgnehdr *pùfhkber{ pvkseler+ vdpvdrdn|en dn|gnbdr dh ;5(3$ ldh aer|g dn rehtl 6??1( ld cknenbkemkdn|g pùfhkbernebkgnehdr vdpvdrdn|en dn|gnbdr mdngr ld he mk|el ldh aer|g dn rehtl peve he adr|kòn 6??1( { tnekmpgv|en|d pev|d ldh cknenbkemkdn|g ldh rkr|dme ld rehtl ldpdnld ld ctdn|dr pvkseler bgmg hgrjgaevdr { hgr dmphdelgvdr pvkselgr *Khtr|vebkòn 51+.

Khtr|vebkòn 51  ‒ Dr|vtb|tve ld Aer|g pgv ctdn|d ld cknenbkemkdn|g( Fghkske( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

Dmphdelgvdrpvkselgr

51(6$

Dmphdelgvdr

pùfhkbgr52(:$

\drgvg Adndvehld he Nebkòn

64(6$

Vdr|g ldh Mtnlg*GNAr+ 5(<$

4(<$Lgnebkgndrdz|dvner

Jgaevdr

2?(2$

Bvëlk|grDz|dvngr

5(3$

VdbtvrgrDrpdbíckbgr

4(5$

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 50/110

 

4?

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Ld ebtdvlg bgn he bherkckbebkòn t|khkyele dn hgr lgr dr|tlkgr ld btdn|er ld rehtl( her ctdn|dr ldcknenbkemkdn|g pùfhkber knbht{dn dh \drgvg Adndveh ld he Nebkòn *bgmptdr|g pgv dh gvaenkrmgcknenbkelgv \AN( he bgpev|kbkpebkòn |vkft|evke( dh Kmptdr|g Lkvdb|g e Jklvgbevftvgr( d|b.+( hgrvdbtvrgr drpdbíckbgr *vdaehíer { vdbtvrgr pvgsdnkdn|dr ld he sdn|e ld rdvskbkgr ld rehtl dn dhrtfrdb|gv pùfhkbg( dn|vd g|vgr+ { hgr dmphdelgvdr pùfhkbgr *bg|kyebkgndr ld rdatvklel rgbkeh dr|e|ehpeaeler peve dmphdelgr ldh Agfkdvng Adndveh g ld dmpvdrer pùfhkber+.

Her ctdn|dr pvkseler dr|ån bgmptdr|er pgv hgr dmphdelgvdr pvkselgr *bg|kyebkgndr ld rdatvklelrgbkeh g rdatvgr pvkselgr peaelgr pgv dmphdelgvdr pvkselgr+ { hgr jgaevdr *bg|kyebkgndr ldrdatvklel rgbkeh( rdatvgr pvkselgr { aer|g ld fghrkhhg+. Cknehmdn|d( her ctdn|dr dz|dvner knbht{dnlgnebkgndr { bvëlk|gr dz|dvngr *mendielgr pgv hgr eadn|dr ld cknenbkemkdn|g dr|e|ehdr+ { herldmår ctdn|dr dz|dvner *aer|g ld her GNAr( peve her btehdr dr lkrbt|kfhd he mdnbkòn ldcknenbkemkdn|g dz|dvng+.

Her ctdn|dr ld cknenbkemkdn|g pùfhkber vdpvdrdn|en dn|gnbdr mdngr ld he mk|el ldh aer|g dn rehtl*<<(5$ dn 6??1( pvdskrkòn ld <4(:$ peve 6??:+( pdvg rt pdrg e dsghtbkgnelg ld cgvme pgrk|kse epev|kv ldh eõg 6??4( {e utd her ctdn|dr pùfhkber vdpvdrdn|efen rghemdn|d dh 2:(5$ ldh aer|g dnrehtl dn dh eõg 6??<( { dh <?(;$ dn dh eõg 6??2 *khtr|vebkòn 5: { btelvg 64+.

Khtr|vebkòn 5: ‒

Dsghtbkòn ld he dr|vtb|tve ld aer|g pgv ctdn|d( Fghkske( 6??2-?1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55 

6??1

6??3

6??4

6??<

6??2

G|ver ctdn|drdz|dvner *GNAr+ 

\drgvg Adndvehld he Nebkòn 

Vdbtvrgrdrpdbíckbgr 

Dmphdelgvdrpvkselgr 

Jgaevdr 

Lgnebkòndz|dvne 

Bvëlk|gdz|dvng 

Dmphdelgvdr pùfhkbgr

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 51/110

 Dn pev|kbthev( rd ldfd ldr|ebev dh knbvdmdn|g ld he pev|kbkpebkòn ldh \drgvg Adndveh ld he Nebkòn dndh aer|g |g|eh e pev|kv ldh eõg 6??4( hhdaenlg dr|d eõg e cknenbkev dh 62(4$ ldh aer|g |g|eh dn rehtlmkdn|ver utd dn dh 6??<( rghg cknenbkefe dh 51(1$ ldh aer|g. Dn 6??1( dh \drgvg Adndveh ld heNebkòn cknenbkefe lkvdb|emdn|d d knlkvdb|emdn|d *e |vesër ld |venrcdvdnbker+ dh 64(6$ ldh aer|g|g|eh dn rehtl { rd pvg{db|e peve dh eõg 6??: tne pev|kbkpebkòn ldh 63(1$. Ld he mkrme mendve( rdknbvdmdn|g he pvgpgvbkòn ldh aer|g dn rehtl cknenbkelg pgv vdbtvrgr drpdbíckbgr *pvknbkpehmdn|d ldhgr Mtnkbkpkgr { ld her _vdcdb|tver+( ldh 2(5$ dn 6??2 eh 4(5$ dn 6??1 { 6??:.

Rkn dmfevag( dh pgvbdn|eid ld aer|g dn rehtl cknenbkelg bgn ctdn|dr pùfhkber ng rd knbvdmdn|ò dnpvgpgvbkgndr rkmkhevdr eh \drgvg Adndveh ld he Nebkòn( ldfklg e tne lkrmkntbkòn ldh cknenbkemkdn|gld hgr dmphdelgvdr pùfhkbgr9 dn dh eõg 6??2( her bg|kyebkgndr rgbkehdr ld hgr dmphdelgvdr pùfhkbgrcknenbkefen dh 5:(<$ ldh aer|g |g|eh dn rehtl( mkdn|ver utd peve 6??1 { 6??:( cknenbkefenrghemdn|d dh 52(:$ ldh aer|g |g|eh dn rehtl.

Dn bten|g e hgr jgaevdr( rt pev|kbkpebkòn dn dh aer|g |g|eh dn rehtl( e pev|kv ldh peag ld fghrkhhg(pvkmer ld rdatvgr pvkselgr { bg|kyebkgndr sghtn|evker ld rdatvklel rgbkeh( lkrmknt{ò ltven|d dhpdvkglg9 dn dh eõg 6??2( hgr jgaevdr cknenbkefen dh 22(:$ ldh aer|g |g|eh dn rehtl( mkdn|ver utdpeve 6??1( dr|d pgvbdn|eid jefíe lkrmkntklg e 2?(2$.

Btelvg 64 ‒

Dsghtbkòn ld he dr|vtb|tve ld aer|g pgv |kpg ld ctdn|d( Fghkske( 6??2-?:Knlkbelgv 6??2 6??< 6??4 6??3 6??1 6??: *p+

Ctdn|dr nebkgnehdr ;?(1$ ::(<$ ;?(2$ ;?(1$ ;5(3$ ;5(;$

Ctdn|dr pùfhkber <?(;$ 2:(5$ <<(2$ <<(6$ <<(5$ <4(:$

Ctdn|dr pvkseler <;(:$ 4?(2$ <3(5$ <3(4$ <1(4$ <3(6$

Ctdn|dr dz|dvner ;(2$ 55(3$ ;(1$ ;(2$ :(<$ :(5$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

Bgmpevenlg e nksdh kn|dvnebkgneh he dr|vtb|tve ld ctdn|dr ld cknenbkemkdn|g nebkgnehdr { dz|dvner(rd bgnr|e|e utd Fghkske mtdr|ve tne pvgpgvbkòn ld cknenbkemkdn|g bgn ctdn|dr dz|dvner ldn|vg ld hgpvgmdlkg peve hgr peírdr ld knavdrg mdlkg-feig( rkn utd dh cknenbkemkdn|g dz|dvng rd stdhsectnlemdn|eh bgmg dn ehatngr peírdr ld Åcvkbe9 ld 5:; peírdr bgn le|gr lkrpgnkfhdr( 41 |kdndn tncknenbkemkdn|g dz|dvng utd vdpvdrdn|e mår ldh 5?$ ldh aer|g |g|eh dn rehtl( ld hgr btehdr 22 rgnldh bgn|kndn|d ecvkbeng *khtr|vebkòn 5;+.

Rkn dmfevag( e nksdh he|kngemdvkbeng( dh pvgmdlkg ld cknenbkemkdn|g dz|dvng dr ld 2(2$ ldh aer|g|g|eh dn rehtl *6(:$ peve Rtlemëvkbe+( { rghemdn|d At{ene( Jek|í( Jgnltver { Nkbeveate |kdndntne me{gv ldpdnldnbke eh cknenbkemkdn|g dz|dvng utd Fghkske peve dh eõg 6??:( bgn 62(1$( 2<(1$(5?(<$ { 5?(2$ vdrpdb|ksemdn|d. Rghg e nksdh ld Rtlemëvkbe( rd ptdld gfrdvsev utd Evadn|kne(Fverkh( Bjkhd( Bghgmfke( _dvù( Tvtate{ { Sdndytdhe pvåb|kbemdn|d ng |kdndn cknenbkemkdn|g dz|dvng*mdngr ldh ?(5$ ldh aer|g |g|eh+ { utd hgr ldmår peírdr( e he dzbdpbkòn ld At{ene( |kdndn tne mt{

feie ldpdnldnbke eh cknenbkemkdn|g dz|dvng.

Ld ebtdvlg bgn dr|gr le|gr( rd bgnr|e|e dn|gnbdr utd Fghkske |kdnd me{gv pvgpgvbkòn ldcknenbkemkdn|g dz|dvng utd rtr sdbkngr( hg utd rkankckbe utd |emfkën |kdnd me{gv ldpdnldnbke ehcknenbkemkdn|g dz|dvng( peve dh bteh dr e sdbdr mår lkcíbkh jebdv bgknbklkv bgn her pvkgvkleldrnebkgnehdr dn rehtl. Enehkyenlg pgv eadn|d ld cknenbkemkdn|g( rd bgnr|e|e utd ehatngr( bgmg dhMknkr|dvkg ld rehtl { her Knr|k|tbkgndr ldrbdn|vehkyeler |kdndn tne eh|e ldpdnldnbke ehcknenbkemkdn|g dz|dvng *sdv ebåpk|d KKK.<.6+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 52/110

 

46

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Khtr|vebkòn 5;  ‒ Bgmpevebkòn kn|dvnebkgneh ldh $ ld cknenbkemkdn|gdz|dvng ldn|vg ldh aer|g |g|eh dn rehtl( 6??:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Åskhe d| eh. 6?550 GMR 6?5? 

KKK.<.6. Ldr|kng ldh aer|g dn rehtl pgv ctdn|dr ld cknenbkemkdn|g

Enehkyenlg dh ldr|kng ld her lkcdvdn|dr ctdn|dr ld cknenbkemkdn|g peve |glg dh pdvkglg 6??2-6??:*khtr|vebkòn 6? { btelvg 63 peve her ctdn|dr ld|ehheler+( rd bgnr|e|e utd hgr cgnlgr pùfhkbgrcknenbken rghemdn|d dh rdb|gv dr|e|eh( pvknbkpehmdn|d dh rtfrdb|gv pùfhkbg *32(:$+( hg vdr|en|dcknenbke he Rdatvklel Rgbkeh dr|e|eh.

Dn bemfkg( her ctdn|dr pvkseler nebkgnehdr ng bgn|vkft{dn rghemdn|d eh cknenbkemkdn|g ldh rdb|gvpvkselg( rkng |emfkën ldh rdb|gv dr|e|eh e |vesër ldh peag ld bg|kyebkgndr rgbkehdr e Knr|k|tbkgndr ldhe Rdatvklel Rgbkeh Dr|e|eh pgv pev|d ld hgr dmphdelgvdr pvkselgr { dn mdngv pvgpgvbkòn( ld hgrjgaevdr. Erí( rd ptdld bgnr|e|ev utd he Beie _d|vghdve ld Rehtl { he Beie ld Bemkngr { VemerEndzer rgn dn|kleldr ld rdatvklel rgbkeh dr|e|ehdr( pdvg utd |kdndn tn cknenbkemkdn|gpvknbkpehmdn|d pvkselg. Ld he mkrme cgvme( he Beie Nebkgneh ld Rehtl |kdnd tne kmpgv|en|dpvgpgvbkòn ld rt cknenbkemkdn|g ld gvkadn pvkselg *<6(4$ dn 6??1 ld ebtdvlg bgn dh dr|tlkg ld Q.Sehlër { V. _dõehgye+ { rghemdn|d hgr rdatvgr tnksdvrk|evkgr( he Beie ld he Fenbe Dr|e|eh { dhBGRRMKH |kdndn tn cknenbkemkdn|g berk dzbhtrksemdn|d pùfhkbg.

_gv g|ve pev|d( hgr jgaevdr |emfkën pev|kbkpen eh cknenbkemkdn|g ldh rtf-rdb|gv pùfhkbg( pdvg dr|ddn|ve ldn|vg ld her btdn|er nebkgnehdr bgmg vdbtvrgr drpdbíckbgr *bgnrkldvelg bgmg ctdn|dpùfhkbe+ rkn pgldv lkcdvdnbkev hg utd epgv|en hgr jgaevdr bgmg peag ld fghrkhhg dn dh rtfrdb|gvpùfhkbg { hg utd rgn g|vgr vdbtvrgr drpdbíckbgr ld hgr agfkdvngr Mtnkbkpehdr. Rí( rd ptdld bgnr|e|evdn dh btelvg 62 utd he me{gv pev|d ld he ctdn|d jgaev dr|å lkvkakle eh aer|g ld fghrkhhg *;2(:$+( {utd rghemdn|d dh 3(6$ ld dr|e ctdn|d rd ldr|kne e rdatvgr( dr|e|ehdr g pvkselgr.

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 53/110

 Khtr|vebkòn 6?  ‒ Ldr|kng ld her lkcdvdn|dr ctdn|dr ld cknenbkemkdn|g( Fghkske( 6??2-?:

Ctdn|dEadn|d

Cgnlgr_ùfhkbgr

Cgnlgr_vkselgr

CgnlgrDz|dvngr

Elmknkr|vebkòn Bdn|veh :(;$  ?$  2<(4$ 

_vdcdb|tver 22(4$  ?$  5<(:$ 

Agfkdvngr Mtnkbkpehdr 6?(;$  ?$  61(;$ 

Knr|. Ldrbdn|vehkyeler ?(4$  ?$  :(2$ Rdatvklel Rgbkeh dr|e|eh 23(6$  63(3$  ?$ 

Rdatvklel Rgbkeh pvksele  ?$  <(1$  ?$ 

Rdatvgr _vkselgr  ?$  ;(2$  ?$ 

Jgaevdr  ?$  4;(<$  ?$ 

GNAr  ?$  ?$  5<(4$ 

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

Btelvg 63  ‒ Ldr|kng ld her lkcdvdn|dr ctdn|dr ld cknenbkemkdn|g( Fghkske( 6??2-?:

Ctdn|d

Eadn|d 

CGNLGR _ÙFHKBGR CGNLGR _VKSELGR CGNLGR DZ\DVNGR

\AN { V.drpdbíckbgr

Dmphdelgv_ùfhkbg

Dmphdelgvpvkselg Jgaev Bvëlk|g

Dz|dvngLgnebkònDz|dvne

Vdr|g ldhMtnlg*GNA+

RDB\GV DR\E\EH 5??(?$ 5??(?$ 15(5$ ?(:$ 5??(?$ 5??(?$ ?(?$

Elmknkr|vebkòn Bdn|veh 5<(?$ ?$ ?$ ?$ 12(3$ 62(;$ ?$

_vdcdb|tver 46(4$ ?$ ?$ ?$ ?$ 64(;$ ?$

Agfkdvngr Mtnkbkpehdr 26(1$ ?$ ?$ ?$ 55(1$ <6(;$ ?$

Knr|. Ldrbdn|vehkyeler ?(1$ ?$ ?$ ?$ 5<(3$ 1(2$ ?$

R.Rgbkeh dr|e|eh ?$ 5??(?$ 15(5$ ?(:$ ?$ ?$ ?$

RDB\GV _VKSELG ?(?$ ?(?$ 6:(;$ ;;(6$ ?(?$ ?(?$ 5??(?$R.Rgbkeh pvksele ?$ ?$ 56(<$ ?(6$ ?$ ?$ ?$

Rdatvgr _vkselgr ?$ ?$ 53(4$ 4(6$ ?$ ?$ ?$

Jgaevdr ?$ ?$ ?$ ;2(:$ ?$ ?$ ?$

GNAr ?$ ?$ ?$ ?$ ?$ ?$ 5??(?$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

CGNLGR _ÙFHKBGR*\drgvg Adndveh ld he Nebkòn(

Vdbtvrgr drpdbíckbgr( { epgv|drdmphdelgvdr pùfhkbgr+

CGNLGR _VKSELGR*Jgaevdr { epgv|dr ldDmphdelgvdr pvkselgr+

CGNLGR DZ\DVNGR*Bvëlk|gr dz|dvngr( lgnebkgndr{ ctdn|dr dz|dvner ld GNAr+

RDB\GV _VKSELGRDB\GV DR\E\EH

5??$63(3$ 12(<$ :4(4$ 5<(4$

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 54/110

 

4<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Cknehmdn|d( rd ptdld bgnr|e|ev utd ltven|d dh pdvkglg 6??2-6??:( her ctdn|dr dz|dvner cknenbkevgnpvknbkpehmdn|d dh rtfrdb|gv pùfhkbg { dn pev|kbthev dh Mknkr|dvkg ld Rehtl { Ldpgv|dr9 dn dh pdvkglg6??2-?:( dh 12(3$ ldh aer|g dn rehtl cknenbkelg pgv bvëlk|gr dz|dvngr { dh 62(;$ ldh aer|gcknenbkelg pgv lgnebkgndr ctdvgn elmknkr|velgr pgv dh Mknkr|dvkg ld Rehtl { Ldpgv|dr *btelvg 63+.Hgr Agfkdvngr Mtnkbkpehdr bgnr|k|t{dn dh rdatnlg eadn|d utd mår rd fdndckbke ld hgr cgnlgrdz|dvngr( {e utd dh 61(;$ ldh aer|g cknenbkelg pgv vdbtvrgr dz|dvngr rd lkvkad e dr|d eadn|d ldcknenbkemkdn|g *khtr|vebkòn 6?+.

Ldfklg e dr|e lkr|vkftbkòn ld her ctdn|dr ld cknenbkemkdn|g( hgr lkcdvdn|dr eadn|dr utd bgmpgndneh rkr|dme ld rehtl |kdndn tne dr|vtb|tve ld aer|g dn rehtl rdaùn ctdn|dr ld cknenbkemkdn|g|g|ehmdn|d lkcdvdn|d( { dn pev|kbthev tn lkcdvdn|d avelg ld ldpdnldnbke eh cknenbkemkdn|g dz|dvng g ectdn|dr pvkseler nebkgnehdr9 erí( peve |glg dh pdvkglg 6??2-6??:( rghemdn|d dh 4<(:$ ldh aer|g dnrehtl ld he Elmknkr|vebkòn Bdn|veh { dh 6?(:$ ldh aer|g dn rehtl ld her Knr|k|tbkgndrLdrbdn|vehkyeler ctd cknenbkelg bgn vdbtvrgr pùfhkbgr nebkgnehdr. Dn bemfkg( her _vdcdb|tverLdpev|emdn|ehdr |kdndn feie ldpdnldnbke jebke hgr vdbtvrgr dz|dvngr( {e utd dh ;5(<$ ld rt aer|gdn rehtl dn dh pdvkglg 6??2-6??: ctd cknenbkelg bgn vdbtvrgr pùfhkbgr *pvknbkpehmdn|d ldh \drgvgAdndveh ld he Nebkòn peve dh peag ld vdbtvrgr jtmengr dn rehtl+. Dn bten|g e hgr AgfkdvngrMtnkbkpehdr( dh 11(:$ ld rt aer|g dn dh pdvkglg 6??2-6??: ctd cknenbkelg bgn vdbtvrgr pùfhkbgrnebkgnehdr( pdvg |kdndn tne kmpgv|en|d pvgpgvbkòn ld cknenbkemkdn|g pgv lgnebkòn dz|dvne(pvknbkpehmdn|d peve kncvedr|vtb|tver *btelvg 61+.

_gv g|ve pev|d( he Rdatvklel Rgbkeh dr|e|eh ng vdbkfd cgnlgr dz|dvngr( pdvg rt cknenbkemkdn|gldpdnld dn aven meank|tl ld her ctdn|dr pvkseler( utd cknenbkevgn dh <<(1$ ld rt aer|g dn rehtlltven|d dh pdvkglg 6??2-6??:. Her ctdn|dr pvkseler utd cknenbken her Knr|k|tbkgndr ld he RdatvklelRgbkeh rgn pvknbkpehmdn|d hgr dmphdelgvdr pvkselgr( {e utd her bgn|vkftbkgndr sghtn|evker ld hgrjgaevdr rgn berk knrkankckben|dr( { vdpvdrdn|en mdngr ldh 5$ ld her ctdn|dr ld cknenbkemkdn|g ld heRdatvklel Rgbkeh dr|e|eh *btelvg 61+.

Btelvg 61  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g ld hgreadn|dr rdaùn ctdn|d ld cknenbkemkdn|g( Fghkske( 6??2-?:

Knlkbelgv

CGNLGR _ÙFHKBGR CGNLGR _VKSELGR CGNLGR DZ\DVNGR

AgfkdvngAdndveh

Dmphdelgv_ùfhkbg

Dmphdelgvpvkselg Jgaev Bvëlk|g

Dz|dvngLgnebkònDz|dvne

Vdr|g ldhMtnlg*GNA+

RDB\GV DR\E\EH <2(2$ 6<(4$ 5;(<$ ?(<$ <(5$ :(2$ ?(?$

Elmknkr|vebkòn Bdn|veh 4<(:$ ?(?$ ?(?$ ?(?$ 61(2$ 51(;$ ?(?$

_vdcdb|tver ;5(<$ ?(?$ ?(?$ ?(?$ ?(?$ :(3$ ?(?$

Agfkdvngr Mtnkbkpehdr 11(:$ ?(?$ ?(?$ ?(?$ 6(3$ 5;(3$ ?(?$

Knr|. Ldrbdn|vehkyeler 6?(:$ ?(?$ ?(?$ ?(?$ 2;(<$ 2;(:$ ?(?$

R.Rgbkeh dr|e|eh ?(?$ 44(2$ <2(:$ ?(;$ ?(?$ ?(?$ ?(?$

RDB\GV _VKSELG ?(?$ ?(?$ 52(;$ :6(<$ ?(?$ ?(?$ 2(1$

R.Rgbkeh pvksele ?(?$ ?(?$ ;1(4$ 6(4$ ?(?$ ?(?$ ?(?$

Rdatvgr _vkselgr ?(?$ ?(?$ 34(?$ 24(?$ ?(?$ ?(?$ ?(?$

Jgaevdr ?(?$ ?(?$ ?(?$ 5??(?$ ?(?$ ?(?$ ?(?$

GNAr ?(?$ ?(?$ ?(?$ ?(?$ ?(?$ ?(?$ 5??(?$

\G\EH EADN\DR 61(3$ 54(3$ 51(<$ 2?(5$ 6(3$ 4(2$ 5(2$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 55/110

 KKK.<.2. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn ctdn|d ld cknenbkemkdn|g

Dn bten|g e mgn|gr aer|elgr e pev|kv ld her lkcdvdn|dr ctdn|dr ld cknenbkemkdn|g( |gler her ctdn|drknbvdmdn|evgn rt epgv|d eh aer|g dn rehtl( e he dzbdpbkòn ld hgr bvëlk|gr dz|dvngr( utdlkrmknt{dvgn dn|vd 6??2 { 6??:. Her ctdn|dr utd |tskdvgn dh me{gv knbvdmdn|g dn|vd 6??2 { 6??:ctdvgn hgr vdbtvrgr drpdbíckbgr( her lgnebkgndr dz|dvner { dh \drgvg Adndveh ld he Nebkòn bgn tne|ere ld bvdbkmkdn|g 6??2-6??: ld vdrpdb|ksemdn|d 513(2$( 5<3(1$ { 564(<$.

E nksdh eavdaelg( her ctdn|dr ld cknenbkemkdn|g pùfhkber rgn her utd |tskdvgn me{gv knbvdmdn|g enksdh ld aer|g( bgn tne |ere ld bvdbkmkdn|g ebtmthele ld :2(3$ peve dh pdvkglg 6??2-6??:. Dnbten|g e her ctdn|dr dz|dvner( dr|er |tskdvgn tn bvdbkmkdn|g kmpgv|en|d dn dh eõg 6??<( peve htdagmgr|vev tne dr|enbebkòn dn sehgv ngmkneh *btelvg 6:+. _gv g|ve pev|d( her ctdn|dr nebkgnehdrpvkseler( bgnr|k|tkler pvknbkpehmdn|d pgv hgr peagr ld fghrkhhg ld hgr jgaevdr { pgv her bg|kyebkgndrld rdatvklel rgbkeh ld hgr dmphdelgvdr pvkselgr( jen mgr|velg tn bvdbkmkdn|g ngmkneh dn|vd 6??2{ 6??1 ld <2(5$( { ld 46(<$ rk rd bgnrkldve her dr|kmebkgndr peve dh eõg 6??:( peve ehbenyev tnaer|g ld 6.364.: mkhhgndr ld fghkskengr dn 6??: *btelvg 6:+.

Btelvg 6:  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv |kpg ld ctdn|d( Fghkske( 6??2-?:

Aer|g dn rehtl pgvctdn|d *eavdaelg+ 6??2 6??< 6??4 6??3 6??1 6??: *p+

Ctdn|drnebkgnehdr

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+

2.5<5(?

-  

2.261(5

4(;$ 

4(;$  

2.;63(2

5:(?$ 

64(?$  

<.636(1

:(3$ 

24(1$  

<.14;(?

55(3$ 

45(4$  

4.66;(5

;(;$ 

33(4$  

Ctdn|dr nebkgnehdr pùfhkber 

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

5.<51(3

-  

5.<22(1

5(5$ 

5(5$  

5.;62(3

2<(6$ 

24(1$  

6.?1:(;

:(5$ 

<3(3$  

6.6;6(<

5?(2$ 

35(1$  

6.3?2(2

52(3$ 

:2(3$  

Ctdn|dr nebkgnehdr pvkseler 

Dn mkhhgndr

ld fghkskengr*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

5.162(<- 

-  

5.:;2(<;(;$ 

;(;$  

6.??6(14(:$ 

53(6$  

6.5:2(:;(?$ 

63(1$  

6.<33(456(;$ 

<2(5$  

6.364(:3(4$ 

46(<$  

Ctdn|drdz|dvner

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

266(5

-  

<24(;

24(2$ 

24(2$  

<6?(<

-2(3$ 

2?(4$  

<23(<

2(:$ 

24(4$  

<2;(5

?(3$ 

23(2$  

<4:(2

<(<$ 

<6(2$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

_ev|kdnlg ld tn nksdh ld aer|g dn rehtl mdngv( her ctdn|dr ld cknenbkemkdn|g pùfhkber( bgn tncknenbkemkdn|g ld Fr. 6.3?2(2 mkhhgndr( hhdaevgn dn|gnbdr eh 6??: e epvgzkmelemdn|d dh mkrmgnksdh aer|g dn rehtl utd her ctdn|dr pvkseler *Fr. 6.364(: mkhhgndr+( avebker e tn bvdbkmkdn|g entehpvgmdlkg ld 52(<$ dn dh pdvkglg 6??2-6??:( mkdn|ver utd dh bvdbkmkdn|g pvgmdlkg enteh ld herctdn|dr pvkseler ctd ld :(:$. Drg rd ldfd pvknbkpehmdn|d eh knbvdmdn|g ldh aer|g cknenbkelg pgv dh\drgvg Adndveh ld he Nebkòn { pgv vdbtvrgr drpdbíckbgr( utd |tskdvgn tne |ere ld bvdbkmkdn|g entehpvgmdlkg ld 5;$ { 62(1$ vdrpdb|ksemdn|d( pev|kbthevmdn|d mevbele dn dh eõg 6??4 *42(3$ {46(<$ ld knbvdmdn|g dr|d eõg vdrpdb|ksemdn|d+ *btelvg 6: d khtr|vebkòn 65+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 56/110

 

43

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Khtr|vebkòn 65  ‒ Aer|g dn sehgv ngmkneh rdaùn ctdn|d nebkgneh *Fr. Mkhhgndr+( Fghkske( 6??2-?:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

Enehkyenlg mår e ld|ehhd dh cknenbkemkdn|g ldh aer|g dn rehtl dn sehgv ngmkneh rdaùn her lkcdvdn|drctdn|dr ld cknenbkemkdn|g( rd bgnr|e|e utd dh bvdbkmkdn|g ldh aer|g cknenbkelg pgv dh Rdb|gv pùfhkbgrd ldfd rgfvd |glg eh bvdbkmkdn|g ldh cknenbkemkdn|g ldh \drgvg Adndveh ld he Nebkòn *utd knbht{d

\AN( bgpev|kbkpebkòn( KLJ( d|b.+ { ld hgr vdbtvrgr drpdbíckbgr( utd |tskdvgn tn knbvdmdn|gebtmthelg dn dh pdvkglg 6??2-6??: ld 564(<$ *ld Fr. 312(2 mkhhgndr e Fr. 5.451(2 mkhhgndr+ {513(2$ *ld Fr. 5?:(3 mkhhgndr e Fr. 2??(6 mkhhgndr+ vdrpdb|ksemdn|d *btelvg 6;+.

Btelvg 6;  ‒ Aer|g ngmkneh rdaùn ctdn|dr ld cknenbkemkdn|g pùfhkber( Fghkske( 6??2-?:

Aer|g dn rehtl pgvctdn|d ld cknenbkemkdn|g 6??2 6??< 6??4 6??3 6??1 6??: *p+

\drgvgAdndveh ld he

Nebkòn

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

312(2

-  

334(1

-5(5$  

5.?66(<

45(;$  

5.?;;(2

32(2$  

5.255(2

;<(:$  

5.451(2

564(<$  

Vdbtvrgrdrpdbíckbgr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

5?:(3

-  

553(;

1(3$  

51:(5

3<(?$  

6<6(2

562(5$  

63<(1

5<2(1$  

2??(6

513(2$  

Dmphdelgvdr_ùfhkbgr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

324(1

-  

345(5

6(<$  

162(?

52(1$  

121(<

53(?$  

153(<

56(1$  

1:4(:

62(3$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 57/110

 Her ldmår ctdn|dr ld cknenbkemkdn|g utd mgr|vevgn tn bvdbkmkdn|g ng|efhd rgn her lgnebkgndrdz|dvner *5<3(1$ dn dh pdvkglg 6??2-?:+( bgn tn knbvdmdn|g ldh aer|g dn rehtl ld Fr. 52;(2mkhhgndr dn dh eõg 6??2 jer|e Fr. 2<2(1 mkhhgndr dn dh 6??:0 dn dh mkrmg pdvkglg( dh aer|g dn rehtlcknenbkelg pgv hgr dmphdelgvdr pvkselgr |tsg tn bvdbkmkdn|g ld :5(<$( ld Fr. 445(1 mkhhgndr dn dheõg 6??2 e Fr. 5.???(; dn dh eõg 6??: *btelvg 2?+.

Dn bten|g e mgn|gr aer|elgr( hgr jgaevdr rkatdn rkdnlg he pvknbkpeh ctdn|d ld cknenbkemkdn|g ldrlddh eõg 6??2 *Fr. 5.41<(1 mkhhgndr peve he adr|kòn 6??1+( e pdrev ldh ctdv|d bvdbkmkdn|g ldhcknenbkemkdn|g ldh \drgvg Adndveh ld he Nebkòn( utd bgnr|k|t{d he rdatnle ctdn|d ldcknenbkemkdn|g. Rkn dmfevag( rk rd eavdae dmphdelgvdr pùfhkbgr { dmphdelgvdr pvkselgr( dr|grbgnr|k|t{dn he pvknbkpeh ctdn|d ld cknenbkemkdn|g dn rehtl ldhen|d ldh \AN { ld hgr jgaevdr( bgn tncknenbkemkdn|g |g|eh ld 5.1:3(: mkhhgndr ld fghkskengr peve he adr|kòn 6??: *btelvgr 6; { 2?+.

Btelvg 2?  ‒ Dsghtbkòn ldh aer|g ngmkneh rdaùn ctdn|dr ldcknenbkemkdn|g pvkseler { dz|dvner( Fghkske( 6??2-?:

Aer|g dn rehtl pgvctdn|d ld cknenbkemkdn|g 6??2 6??< 6??4 6??3 6??1 6??: *p+

Dmphdelgvdr

_vkselgr

Dn mkhhgndrld fghkskengr

*bvdbkmkdn|g ebtmthelg+ 

445(1

-  

3:5(5

62(4$  

121(;

22(:$  

:33(;

41(5$  

:;5(:

35(1$  

5.???(;

:5(<$  

Jgaevdr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

5.515(1

-  

5.656(2

2(4$  

5.63<(:

1(;$  

5.251(?

56(<$  

5.41<(1

2<(<$  

5.36<(;

2:(1$  

Bvëlk|grDz|dvngr

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

56<(4

-  

526(5

3(5$  

5:1(3

4?(1$  

52<(;

:(<$  

:4(4

-25(2$  

<4(:

-32(6$  

LgnebkgndrDz|dvner

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

52;(2-  

6<:(1

1:(4$  

5;6(:

2:(<$  

66;(5

3<(4$  

6:2(2

5?2(<$  

2<2(1

5<3(1$  

Vdr|g ldhMtnlg*GNAr+

Dn mkhhgndrld fghkskengr*bvdbkmkdn|g ebtmthelg+ 

4:(2

-  

44(5

-4(4$  

<?(5

-25(2$  

16(<

6<(5$  

1?(2

6?(4$  

3:(;

5:(5$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55 

KKK.<.<. Nksdh { dsghtbkòn ldh aer|g dn sehgv vdeh rdaùn ctdn|d ld cknenbkemkdn|g

Dh knbvdmdn|g ldh aer|g rdaùn ctdn|d ld cknenbkemkdn|g |emfkën rd ldfd enehkyev dn sehgv vdeh( {eutd dn dh pdvkglg 6??2  ‒ 6??1( he mk|el ldh knbvdmdn|g ldh aer|g |g|eh dn rehtl rd ldfd e heknchebkòn *knbvdmdn|g ld hgr pvdbkgr+. Erí( dh bvdbkmkdn|g vdeh ld her ctdn|dr ld cknenbkemkdn|gpùfhkber ctd ld rghemdn|d 24(5$ dn |glg dh pdvkglg 6??2-6??:( pvknbkpehmdn|d avebker ehknbvdmdn|g gfrdvselg dn dh eõg 6??4( {e utd dh bvdbkmkdn|g vdeh enteh dn hgr rkatkdn|dr eõgr( ld6??3 e 6??:( ctd rkdmpvd kncdvkgv e 4$ *btelvg 25+. Dr|d bvdbkmkdn|g rd ldfd pgndv dn pevehdhg bgndh bvdbkmkdn|g ngmkneh ldh cknenbkemkdn|g pùfhkbg ld :3(2$( ldmgr|venlg utd aven pev|d ldhknbvdmdn|g ldh aer|g cknenbkelg pgv ctdn|dr pùfhkber ctd ldfklg rghemdn|d e he knchebkòn.

Dn bten|g e her ctdn|dr pvkseler( dr|er mtdr|ven tn bvdbkmkdn|g vdeh ebtmthelg ld 65(3$ dn|vd6??2 { 6??1( pvknbkpehmdn|d ldfklg eh knbvdmdn|g ldh cknenbkemkdn|g ld hgr dmphdelgvdr pvkselgr.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 58/110

 

4:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

E nksdh eavdaelg( her ctdn|dr pùfhkber { pvkseler nebkgnehdr |tskdvgn dn dh pdvkglg 6??2-6??: tnbvdbkmkdn|g vdeh ld 63(<$( mtbjg me{gv eh bvdbkmkdn|g ldh cknenbkemkdn|g dz|dvng *rghemdn|d :(6$dn dh pdvkglg 6??2-6??:+. Dr|er( ctdn|dr( dz|dvner( rk fkdn jen pdvmk|klg dn dh eõg 6??: dhcknenbkemkdn|g ld tn aer|g vdeh rtpdvkgv e rt aer|g dn rehtl ldh eõg 6??2( dr|g rd ldfd ùnkbemdn|deh ctdv|d bvdbkmkdn|g vdeh gfrdvselg dn dh eõg 6??< * 25(1$+( {e utd dh aer|g dn sehgv vdehcknenbkelg pgv ctdn|dr dz|dvner dr|å lkrmknt{dnlg bgn|kntemdn|d ldrld dh 6??4 *btelvg 25+.

Btelvg 25  ‒ Dsghtbkòn ldh aer|g dn sehgv vdeh pgv ctdn|d ld cknenbkemkdn|g( Fghkske( 6??2-?:

Aer|g dn rehtl pgvctdn|d *eavdaelg+

6??2 6??< 6??4 6??3 6??1 6??: *p+

Ctdn|drnebkgnehdr

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

2.?26(<

-  

-  

2.55<(6

6(1$  

6(1$  

2.46<(4

52(6$  

53(6$  

2.364(:

6(;$  

5;(3$  

2.1::(5

<(4$  

6<(;$  

2.:22(?

5(6$  

63(<$  

Ctdn|dr nebkgnehdr 

pùfhkber 

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

5.2?;(?

-  

-  

5.61?(6

-2(?$  

-2(?$  

5.3<?(;

6;(6$  

64(<$  

5.3<<(4

?(6$  

64(3$  

5.3;2(5

2(?$  

6;(2$  

5.13:(;

<(4$  

24(5$  

Ctdn|dr nebkgnehdr pvkseler 

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

5.162(<

-  

-  

5.:<<(?

1(?$  

1(?$  

5.::2(3

6(5$  

;(2$  

5.;:5(2

4(6$  

54(?$  

6.?;4(5

4(1$  

65(3$  

6.?3<(5

-5(4$  

5;(:$  

Ctdn|drdz|dvner

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

266(5

-  

<6<(2

25(1$ 

25(1$  

2:;(4

-:(6$ 

6?(;$  

2::(2

-?(2$ 

6?(3$  

23?(:

-1(5$ 

56(?$  

2<:(4

-2(<$ 

:(6$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

Enehkyenlg mår e ld|ehhd dh bvdbkmkdn|g vdeh ldh cknenbkemkdn|g pvgsdnkdn|d ld her lkcdvdn|drctdn|dr( rd ptdld gfrdvsev utd rghemdn|d dh cknenbkemkdn|g pgv vdbtvrgr drpdbíckbgr je rklg ehmdngr lgfhelg dn dh pdvkglg 6??2-6??:( avebker e lgr ctdv|dr knbvdmdn|gr bgnrdbt|ksgr dn hgreõgr 6??4 { 6??3 peve htdag men|dndvrd *btelvg 26+. _gv rt pev|d( dh cknenbkemkdn|g ldh \drgvgAdndveh ld he Nebkòn |tsg tn knbvdmdn|g vdeh ld 12(;$ dn|vd 6??2 { 6??:( { dh bvdbkmkdn|g vdehvdhe|ksemdn|d mdlkg ldh bgnrghklelg ld her ctdn|dr pùfhkber *btelvg 25+ rd ldfd e he lkrmkntbkònldh aer|g vdeh ld hgr dmphdelgvdr pùfhkbgr( ld 3$ dn|vd 6??2 { 6??: *btelvg 26+.

Dn bten|g e her ctdn|dr pvkseler( dh knbvdmdn|g vdeh ldh aer|g dn rehtl rd ldfd pev|kbthevmdn|d ehbvdbkmkdn|g ldh cknenbkemkdn|g ld hgr dmphdelgvdr pvkselgr *<?(;$ dn dh pdvkglg 6??2-6??:+( {e

utd dh bvdbkmkdn|g vdeh ldh cknenbkemkdn|g ld hgr jgaevdr ctd ld rghemdn|d ;(:$ dn dh pdvkglgbgnrkldvelg *btelvg 26+.

Cknehmdn|d( rd ptdld enehkyev utd dh bvdbkmkdn|g ldh aer|g dn rehtl cknenbkelg mdlken|d ctdn|drdz|dvner rd ldfd dzbhtrksemdn|d eh knbvdmdn|g vdeh ld her lgnebkgndr dz|dvner *bvdbkmkdn|g vdeh ld;5$ dn dh pdvkglg 6??2-6??:+( {e utd dh aer|g dn rehtl cknenbkelg pgv bvëlk|gr dz|dvngr { pgvGNAr mgr|vò tn ldrbdnrg vdeh dn|vd 6??2 { 6??: ld 11(5$ { 1(3$ vdrpdb|ksemdn|d *btelvg 26+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 59/110

 Btelvg 26  ‒ \ere ld bvdbkmkdn|g vdeh ebtmthele ldh aer|g dn rehtl

rdaùn ctdn|dr ld cknenbkemkdn|g( Fghkske( 6??2-?:

Ctdn|d ldCknenbkemkdn|g

6??2 6??< 6??4 6??3 6??1 6??: *p+

5. CTDN\DR _ÙFHKBER 

\drgvg Adndvehld he Nebkòn 

- -<(;$ <6(2$ <3(<$ 32(2$ 12(;$

Vdbtvrgrdrpdbíckbgr  - <(?$ 4<(6$ 5?6(?$ 5?<(1$ 556(;$

Dmphdelgvdr_ùfhkbgr  - -?(;$ 1(<$ 2(3$ -3(3$ -3(?$

6. CTDN\DR _VKSELER NEBKGNEHDR 

Dmphdelgvdr_vkselgr - 6?(2$ 63(3$ <6(<$ 23(6$ <?(;$

Jgaevdr - ?(1$ 5(6$ 6(5$ 5<(1$ ;(:$

2. CTDN\DR DZ\DVNER 

Bvëlk|grDz|dvngr - 6(2$ <?(5$ -<(:$ -<1(1$ -11(5$

LgnebkgndrDz|dvner - 1<(3$ 6:(6$ <3(:$ 3;(;$ ;5(?$

Vdr|g ldhMtnlg *GNAr+ - -1(;$ -21(6$ 56(5$ 5(6$ -1(3$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55 

KKK.<.4. Aer|g dn rehtl pdv båpk|e( rdaùn ctdn|d ld cknenbkemkdn|g

Dh aer|g |g|eh dn rehtl pdv båpk|e *dn sehgv ngmkneh+( utd sevíe ld Fr. 2:2(1 pgv jefk|en|d dn 6??2 eFr. 431(6 dn 6??: *btelvg 1+ ptdld rdv vdpev|klg dn|vd her lkcdvdn|dr ctdn|dr ld cknenbkemkdn|g(vdrth|enlg peve he adr|kòn 6??: dn tn aer|g pgv jefk|en|d ld Fr. 64;(3 cknenbkelg mdlken|d herctdn|dr pùfhkber( Fr. 635(; cknenbkelg pgv ctdn|dr pvkseler { Fr. <4(1 cknenbkelg pgv ctdn|dr ldcknenbkemkdn|g dz|dvner. Dn cgvme eavdaele( her ctdn|dr ld cknenbkemkdn|g nebkgnehdr( pùfhkber {pvkseler bgvvdrpgnldn peve he adr|kòn 6??1 e tn aer|g pgv jefk|en|d ld Fr. <:<(2 { ld 465(4 rdaùndr|kmebkgndr peve he adr|kòn 6??: *khtr|vebkòn 66+.

Ltven|d dh pdvkglg 6??2-6??:( rd vdltidvgn her lkcdvdnbker dn|vd dh cknenbkemkdn|g pùfhkbg { dhcknenbkemkdn|g pvkselg( {e utd he lkcdvdnbke ld aer|g pdv båpk|e dn|vd emfgr |kpgr ld ctdn|dr dve ldFr. 22(; pgv jefk|en|d dn dh eõg 6??2 { ld Fr. 6(6 dn dh eõg 6??:( ldfklg e tn me{gv knbvdmdn|g

ldh aer|g pdv båpk|e cknenbkelg mdlken|dr ctdn|dr pùfhkber.

Enehkyenlg bele ctdn|d *btelvg 22+( rd bgnr|e|e utd peve he adr|kòn 6??1( dh cknenbkemkdn|g ld hgrjgaevdr bgvvdrpgnld e Fr. 53? pgv jefk|en|d( vdpvdrdn|enlg Fr. ::5 pgv cemkhke |gmenlg dn btdn|ehe |ere ahgfeh ld cdbtnlklel peve 6??: *MR{L d KND 6??;+( dr ldbkv 5(3: rehevkgr mínkmgr nebkgnehdrrdaùn he drbehe skadn|d dr|d eõg *Aebd|e gckbkeh ld Fghkske 6??1+. Dn dh eõg 6??2( dr|e vdhebkòn dve ldFr. 142 pgv cemkhke |gmenlg dn btdn|e he |ere ahgfeh ld cdbtnlklel peve 6??2 * MR{L d KND 6??;+( drldbkv 5(15 rehevkgr mínkmgr nebkgnehdr rdaùn he drbehe skadn|d dr|d eõg * Aebd|e gckbkeh ld Fghkske 6??2+. 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 60/110

 

3?

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Khtr|vebkòn 66  ‒ Aer|g pdv båpk|e *Fr.+ dn sehgv ngmkneh rdaùn |kpg ld ctdn|d( Fghkske( 6??2-?:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??40  

Befd rdõehev utd rd dr|å t|khkyenlg peve dh båhbthg ldh cknenbkemkdn|g pdv båpk|e dh mkrmgldngmknelgv peve |gler her ctdn|dr9 he pgfhebkòn |g|eh ld Fghkske dr|kmele pgv dh Knr|k|t|g Nebkgneh

ld Dr|elír|kber {e utd ng rd ptdldn rdpevev hgr fdndckbkevkgr rdaùn ctdn|d ld cknenbkemkdn|g.

Dn he adr|kòn 6??1( he rdatnle ctdn|d ld cknenbkemkdn|g dve dh \drgvg Adndveh ld he Nebkòn bgn Fr.522(< pgv jefk|en|d. Eavdaenlg dmphdelgvdr pvkselgr { pùfhkbgr( dr|gr cknenbkefen dn he adr|kòn6??1 tn pvgmdlkg ld Fr. 532(3 pgv jefk|en|d { ld Fr. 51:(6 dn dh 6??: *btelvg 22+.

Btelvg 22  ‒ Aer|g pdv båpk|e *Fr.+ dn sehgv ngmkneh rdaùn ctdn|d( Fghkske( 6??2-?:

Aer|g dn rehtl pgvctdn|d ld cknenbkemkdn|g 6??2 6??< 6??4 6??3 6??1 6??: *p+

\drgvgAdndveh ld he

Nebkòn

Fr. ' jefk|en|d*bvdbkmkdn|g ebtmthelg+ 

1<(3

-  

16(6

-2(2$  

5?:(4

<4(<$  

55<(6

42(5$  

522(<

1:(;$  

545(2

5?6(:$  

Vdbtvrgrdrpdbíckbgr

Fr. ' jefk|en|d*bvdbkmkdn|g ebtmthelg+ 

56(?

-  

56(1

4(2$  

5:(;

41(?$  

64(6

5?;(5$  

63(;

562(:$  

6;(;

5<:(1$  

Dmphdelgvdr_ùfhkbgr

Fr. ' jefk|en|d*bvdbkmkdn|g ebtmthelg+ 

1?(<

-  

1?(3

?(6$  

13(1

:(;$  

13(3

:(1$  

16(;

2(4$  

1:(<

55(2$  

CTDN\DR_VKSELER

NEBKGNEHDR 

CTDN\DRDZ\DVNER 

CTDN\DR_ÙFHKBER 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 61/110

 Btelvg 22 - Aer|g pdv båpk|e dn sehgv ngmkneh rdaùn ctdn|d( Fghkske( 6??2-?: *bgn|kntebkòn+

Aer|g dn rehtl pgvctdn|d ld cknenbkemkdn|g 6??2 6??< 6??4 6??3 6??1 6??: *p+

Dmphdelgvdr_vkselgr

Fr. ' jefk|en|d*bvdbkmkdn|g ebtmthelg+ 

35(5

-  

12(:

6?(:$  

1:(2

6:(5$  

;?(?

<1(2$  

;?(1

<:(4$  

;;(:

32(2$  

JgaevdrFr. ' jefk|en|d

*bvdbkmkdn|g ebtmthelg+ 

56;(:

-  

525(<

5(6$  

52<(6

2(2$  

523(:

4(<$  

53?(6

62(<$  

536(?

6<(:$  

Bvëlk|grDz|dvngr

Fr. ' jefk|en|d*bvdbkmkdn|g ebtmthelg+ 

52(:

-  

5<(2

2(:$  

5;(;

<<(2$  

5<(?

5(3$  

:(1

-23(;$  

<(3

-33(;$  

LgnebkgndrDz|dvner

Fr. ' jefk|en|d*bvdbkmkdn|g ebtmthelg+ 

54(<

-  

61(?

1<(3$  

6?(<

26(4$  

62(:

4<(6$  

6:(:

:3(1$  

2<(2

566(?$  

Vdr|g ldhMtnlg*GNAr+

Fr. ' jefk|en|d*bvdbkmkdn|g ebtmthelg+ 

3(4

-  

3(?

-1(3$  

<(6

-2<(2$  

1(4

53(2$  

1(6

5?(3$  

3(;

3(2$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??40  

Bgmpevenlg kn|dvnebkgnehmdn|d dh aer|g pdv båpk|e rdaùn |kpg ld ctdn|d( rd bgnr|e|e utd Fghkske|kdnd tn mdngv aer|g pdv båpk|e cknenbkelg pgv ctdn|dr dz|dvner utd peírdr bgn mkrmg nksdh ldínlkbd ld ldrevvghhg jtmeng { mkrmg nksdh ld knavdrg dr|e|eh( hg utd pglvíe knlkbev utd Fghkske ngvdbkfd |en|g epg{g dz|dvng bgmg rd ptdld gfrdvsev dn sevkgr peírdr dn ldrevvghhg *btelvg 2<+9 erí(dh aer|g bgn cknenbkemkdn|g dz|dvng dr( dn pvgmdlkg ld hgr peírdr bgn mkrmg nksdh ld ínlkbd ldldrevvghhg jtmeng utd Fghkske( ld TR, 55(: pgv jefk|en|d peve he adr|kòn 6??:( mkdn|ver utd dve ldrghemdn|d TR, 3(2 dn Fghkske *btelvg 2<+.

Btelvg 2<  ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g pdv båpk|e rdaùn |kpg ld ctdn|d( 6??:

Aer|g dn rehtl pdvbåpk|e *dn TR, { __E+

FGHKSKE Mtnlg Avtpg 5Rtlemëvkbe  Avtpg 6Ldrevvghhg

jtmeng Avtpg 2Knavdrg

dr|e|eh Avtpg <Bgfdv|tve

tnksdvreh 

Ctdn|drNebkgnehdr

Dn TR,  15(3 ;:5(: <<<(4 625(3 54:(; 6.351(1

Dn __E 5::(3 ;33(2 3<;(3 2:5(4 63;(3 6.6:;(3

Ctdn|drDz|dvner

Dn TR,  3(2 5:(? <(4 55(: 5?(3 4(;

Dn __E 53(4 64(< :(5 5:(4 5:(1 4(5

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??40 GMR 6?5? 

E nksdh he|kngemdvkbeng { Bevkfd( At{ene( Jgnltver( Nkbeveate( Jek|í { Fevfelgr rgn hgr peírdrutd vdbkfdn dh me{gv mgn|g ld cknenbkemkdn|g dz|dvng vdrpdb|g e rt pgfhebkòn( bgn tn aer|g pdvbåpk|e *dn __E+ cknenbkelg bgn ctdn|dr dz|dvner ld , 4:(4( , 64(;( , 64(;( , 62(: { , 65(1vdrpdb|ksemdn|d peve he adr|kòn 6??: ld ebtdvlg e dr|kmebkgndr ld he GMR * GMR 6?5?+. Fghkskeskdnd dn|gnbdr dn rdz|g htaev bgn tn aer|g pdv båpk|e ld , 53(4 dn pevklel ld pgldv elutkrk|ksgcknenbkelg pgv ctdn|dr dz|dvner *btelvg 2<+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 62/110

 

36

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Eldmår ld mgr|vev nksdhdr ld aer|g pdv båpk|e kncdvkgvdr e hgr avtpgr ld peírdr bgmpevelgr( her|erer ld bvdbkmkdn|g ld her ctdn|dr nebkgnehdr { dz|dvner dn Fghkske rgn |emfkën kncdvkgvdr e hg utdrd ptdld gfrdvsev dn dh mtnlg. _gv didmphg( mkdn|ver utd dh cknenbkemkdn|g bgn ctdn|dr nebkgnehdrpdv båpk|e rd knbvdmdn|efe dn Fghkske ld 2;(5$ dn|vd 6??2 { 6??1( dr|d knbvdmdn|g dve dnpvgmdlkg ld :6(6$ dn Rtlemëvkbe { ld 14$ dn hgr peírdr bgn mkrmg nksdh ld ínlkbd ld ldrevvghhgjtmeng. Dh knbvdmdn|g ldh cknenbkemkdn|g dz|dvng pdv båpk|e dr eùn mår avenld( bgn tnbvdbkmkdn|g pvgmdlkg ld 5?<(2$ dn hgr peírdr ld mkrmg nksdh ld knavdrg dr|e|eh *khtr|vebkòn 62+. 

Khtr|vebkòn 62  ‒ Bgmpevebkòn kn|dvnebkgneh ld he |ere ld bvdbkmkdn|g 6??2-6??1 ldhaer|g dn rehtl pdv båpk|e dn sehgv ngmkneh *TMN+( rdaùn |kpg ld ctdn|d

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6??40 GMR 6?5? 

Enehkyenlg dh bvdbkmkdn|g vdeh ldh aer|g pdv båpk|e ld her lkcdvdn|dr ctdn|dr ld cknenbkemkdn|g( rdptdld gfrdvsev utd jtfg tn ldrbdnrg dn sehgv vdeh ldh cknenbkemkdn|g dz|dvng pgv jefk|en|d*lkrmkntbkòn ld 6(3$ dn|vd 6??2 { 6??:+ { tne hkadve etmdn|ebkòn ldh cknenbkemkdn|g ld her ctdn|drpvkseler nebkgnehdr * 1(:$ dn|vd 6??2 { 6??:+. Dn bemfkg( her ctdn|dr pùfhkber mgr|vevgn tn

knbvdmdn|g me{gv( ld 61$ dn dh mkrmg pdvkglg( perenlg ld tn aer|g pdv båpk|e( dn fghkskengr ld6??2( ld Fr. 541(5 dn dh eõg 6??2 e Fr 5;;(4 dn dh eõg 6??: *khtr|vebkòn 6<+.

Rkn dmfevag( rd ptdld gfrdvsev dn he khtr|vebkòn 6< utd dh knbvdmdn|g ldh aer|g vdeh pdv båpk|ecknenbkelg bgn ctdn|dr pùfhkber rd ldfd drdnbkehmdn|d eh bvdbkmkdn|g gfrdvselg dn dh eõg 6??4*bvdbkmkdn|g vdeh ld 6:$ dn vdhebkòn eh eõg 6??<+( {e utd dn hgr eõgr rkatkdn|dr( ld 6??3 e 6??:( dhbvdbkmkdn|g enteh ctd ld rghemdn|d 5(2$ bgmg pvgmdlkg.

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 63/110

 Khtr|vebkòn 6<  ‒ Aer|g vdeh pdv båpk|e rdaùn ctdn|d nebkgneh *Fr.+( Fghkske( 6??2-?:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?55

KKK.<.3. Ve|kgr mebvgdbgnòmkbgr ldh aer|g rdaùn ctdn|d ld cknenbkemkdn|g

KKK.<.3.e. Aer|g dn rehtl rdaùn ctdn|d ld cknenbkemkdn|g dn $ ldh _KF

Dn bten|g eh ve|kg mebvgdbgnòmkbg ld aer|g dn rehtl dn $ ldh pvgltb|g kn|dvng fvt|g( rd ptdldgfrdvsev utd he lkrmkntbkòn ld dr|d ld 4(3$ dn 6??2 e <(1$ dn 6??: rd ldfd pvknbkpehmdn|d e herctdn|dr pvkseler nebkgnehdr( utd mtdr|ven tne lkrmkntbkòn ld rt aer|g dn vdhebkòn eh pvgltb|gkn|dvng fvt|g( ld 6(:$ dn 6??2 jer|e 6(6$ dn dh eõg 6??:. Dn bemfkg( her ctdn|dr pùfhkber |kdndntn ve|kg ld aer|g dn $ ldh _KF vdhe|ksemdn|d dr|efhd( perenlg ld 6(2$ ldh _KF dn dh eõg 6??2 e6(6$ dn hgr eõgr 6??1 { 6??:( bgn tn pkbg ld 6(4$ dn dh eõg 6??4. Vdrpdb|g e her ctdn|drdz|dvner( lkrmknt{dvgn ld ?(4$ ldh _KF dn dh eõg 6??2 e ?(<$ dn dh eõg 6??: *khtr|vebkòn 64+.

Mår drpdbíckbemdn|d( he ctdn|d ld cknenbkemkdn|g utd |tsg me{gv knbvdmdn|g rkankckbe|ksg dnvdhebkòn eh pvgltb|g kn|dvng fvt|g dr dh \drgvg Adndveh ld he Nebkòn( bteh cknenbkemkdn|g ldh aer|gdn rehtl vdpvdrdn|efe 5(2$ ldh _KF dn dh eõg 6??: bgn|ve 5(5$ dn dh eõg 6??2. Dn bemfkg( dhcknenbkemkdn|g ldh aer|g dn rehtl pgv pev|d ld hgr jgaevdr lkrmknt{ò dn vdhebkòn eh _KF( ld 5(;$ dndh eõg 6??2 e 5(2$ dn dh eõg 6??:.

Cknehmdn|d( hgr dmphdelgvdr lkrmknt{dvgn rt ve|kg ld cknenbkemkdn|g dn $ ldh _KF ld 5(;$ dn dheõg 6??2 e 5(4$ dn dh eõg 6??:9 hgr dmphdelgvdr pùfhkbgr perevgn ld tn ve|kg ld 5$ ldh _KF dn dheõg 6??2 e ?(1$ dn dh 6??:( mkdn|ver utd hgr dmphdelgvdr pvkselgr perevgn ld tn ve|kg ld ?(;$dn dh eõg 6??2 e ?(:$ dn dh eõg 6??:.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 64/110

 

3<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Khtr|vebkòn 64  ‒ Aer|g dn rehtl pgv |kpg ld ctdn|d dn $ ldh _KF( Fghkske( 6??2-6??:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 KND 6?5?  

KKK.<.3.f. Aer|g dr|e|eh dn rehtl dn $ ldh aer|g pùfhkbg { ldh aer|g ldh agfkdvng adndveh

_eve behbthev dh ve|kg ld cknenbkemkdn|g rdaùn ctdn|dr dn $ ldh aer|g pùfhkbg |g|eh( rd bgnrkldven

|gler her ctdn|dr mdngr hgr epgv|dr ld dmphdelgvdr pvkselgr { jgaevdr eh rdb|gv pvkselg *pdvg rk ehrdb|gv dr|e|eh+ { mdngr dh cknenbkemkdn|g dz|dvng ld GNAr.

Dn |g|ehklel( dh aer|g dn rehtl dr|e|eh lkrmknt{ò rkankckbe|ksemdn|d rt pev|kbkpebkòn ldn|vg ldh aer|gpùfhkbg e pev|kv ldh eõg 6??4( perenlg ld ;(5$ dn 6??2 e 3(:$ dn 6??:. _gv ctdn|d( her pùfhkberrgn dskldn|dmdn|d her utd |kdndn me{gv pdrg ldn|vg ldh aer|g pùfhkbg |g|eh( vdpvdrdn|enlg peve headr|kòn 6??: <(:$ ldh aer|g pùfhkbg |g|eh( mkdn|ver utd her ldmår ctdn|dr vdpvdrdn|efen dh 6$ ldhaer|g pùfhkbg |g|eh *5(2$ peve ctdn|dr pvkseler { ?(1$ peve ctdn|dr dz|dvner+ *khtr|vebkòn 63+.

Dn bten|g e he dsghtbkòn pgv |kpg ld ctdn|d( |en|g her pùfhkber bgmg dz|dvner { pvkseler mtdr|ventn ctdv|d ldrbdnrg dn vdhebkòn eh aer|g pùfhkbg |g|eh dn dh pdvkglg ld enåhkrkr bgnrkldvelg9 erí( herctdn|dr pùfhkber dn rehtl vdpvdrdn|efen dh 3(6$ ldh aer|g pùfhkbg |g|eh dn dh eõg 6??2 { hhdaevgn e1(<$ dn dh eõg 6??4( peve htdag ldrbdnldv e rghemdn|d <(:$ dn dh eõg 6??:. Hg pvgpkg gbtvvd bgnher ldmår ctdn|dr ld cknenbkemkdn|g9 her ctdn|dr dz|dvner dn rehtl vdpvdrdn|efen dh 5(6$ ldh aer|gpùfhkbg |g|eh dn dh eõg 6??2 { rghemdn|d ?(1$ dn dh eõg 6??:0 her ctdn|dr pvkseler bgnrkldvelerbgmg aer|g pùfhkbg *dn he rdatvklel rgbkeh dr|e|eh+ vdpvdrdn|efen dh 5(1$ ldh aer|g pùfhkbg |g|eh dndh eõg 6??2 { ehbenyevgn dh 6(5$ dn dh 6??< { 6??4( peve ehbenyev 5(2$ dn dh 6??: *khtr|vebkòn 63+.

Rk fkdn dh aer|g pùfhkbg |g|eh dn sehgv ngmkneh rd knbvdmdn|ò dn tn 5?;$ dn|vd 6??4 { 6??:(dzphkbenlg erí pev|d ld he lkrmkntbkòn ld dr|gr ve|kgr( he lkrmkntbkòn ldh cknenbkemkdn|g ld he rehtlldn|vg ldh aer|g dn rehtl dr pvdgbtpen|d( dn pev|kbthev dn bten|g e ctdn|dr pùfhkber( ldmgr|venlgtne ldrsehgvkyebkòn ld he rehtl ldn|vg ldh aer|g pùfhkbg e pev|kv ldh eõg 6??3.

CTDN\DR_VKSELER

NEBKGNEHDR 

CTDN\DRDZ\DVNER 

CTDN\DR_ÙFHKBER 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 65/110

 Khtr|vebkòn 63  ‒ Aer|g dn rehtl rdaùn ctdn|d dn $ ldh aer|g pùfhkbg |g|eh( Fghkske( 6??2-6??:

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 MDC_ { FBF 6?5?  

Dn bten|g eh ve|kg ld aer|g dn rehtl dn $ ldh aer|g ldh Agfkdvng Adndveh( dr|d |emfkën lkrmknt{ò(pdvg dn mdngvdr pvgpgvbkgndr utd peve dh ve|kg ld aer|g pùfhkbg. Erí( dh ve|kg ld aer|g dn rehtldr|e|eh cknenbkelg pgv ctdn|dr pùfhkber dn $ ldh aer|g ldh Agfkdvng Adndveh però ld 1(6$ dn 6??2e 3(3$ dn 6??:( e pdrev ld jefdv mgr|velg tn knbvdmdn|g dn hgr eõg 6??4 { 6??3 *btelvg 24+. Dn

eavdaelg( her ctdn|dr nebkgnehdr dn rehtl vdpvdrdn|efen dh ;(6$ ldh aer|g |g|eh ldh AgfkdvngAdndveh dn dh eõg 6??2( peve feiev e :(<$ dn dh 6??:( perenlg pgv tn pkbg e 5?(5$ dn dh eõg 6??3(rkankckbenlg tne feie ld he pvkgvkyebkòn ld he rehtl ldn|vg ldh aer|g ldh Agfkdvng Adndveh.

Cknehmdn|d( dh cknenbkemkdn|g dz|dvng ldh aer|g ldh Agfkdvng Adndveh dn rehtl vdpvdrdn|efe dh 5(1$ldh aer|g |g|eh ldh Agfkdvng Adndveh peve dh eõg 6??<( ve|kg utd htdag lkrmknt{ò jer|e vdpvdrdn|ev5$ dn dh eõg 6??: *btelvg 24+.

Btelvg 24  ‒ Aer|g dn rehtl pgv ctdn|d dn $ ldh aer|g ldh Agfkdvng adndveh( Fghkske( 6??2-6??:

Aer|g dn rehtl dn $ ldhaer|g ldh A.adndveh

6??2 6??< 6??4 6??3 6??1 6??: *p+

Ctdn|dr Nebkgnehdr ;(6$ :(1$ ;(:$ 5?(5$ ;(2$ :(<$Ctdn|dr pùfhkber 1(6$ 3(<$ 1(3$ 1(:$ 1(2$ 3(3$

Ctdn|dr _vkseler 6(?$ 6(2$ 6(5$ 6(<$ 6(?$ 5(:$

Ctdn|dr Dz|dvner 5(2$ 5(1$ 5(4$ 5(<$ 5(6$ 5(?$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 Åskhe d| eh. 6?550 MDC_ { FBF 6?5?  

C. _VKSELER

C. DZ\DVNER

CTDN\DR

_ÙFHKBER 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 66/110

 

33

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

KKK.4. Enåhkrkr ldh Aer|g dn rehtl rdaùn gfid|g ldh aer|g 

KKK.4.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn gfid|g

Vdrpdb|g eh aer|g dn rehtl rdaùn gfid|g( befd vdk|dvev utd her dr|kmebkgndr pvgskdndn

dzbhtrksemdn|d ldh pvkmdv dr|tlkg *Sehlër { _dõehgye 6?5?+ {e utd ng dzkr|d tne ldreavdaebkònrtckbkdn|d dn dh rdatnlg dr|tlkg peve pvgbdldv e tn enåhkrkr. Dh sehgv ldh aer|g |g|eh ng bgvvdrpgnlddn|gnbdr e hgr mgn|gr enehkyelgr dn hgr ebåpk|dr en|dvkgvdr( { rk fkdn rd pvdrdn|en hgr mgn|grdr|kmelgr ld aer|g pgv gfid|g( dr|gr rghg |kdndn tn sehgv knlkbe|ksg9 dh sdvleldvg bdn|vg ldh enåhkrkrld hgr mgn|gr ld aer|g pgv gfid|g rgn her |erer ld bvdbkmkdn|g { he dr|vtb|tve pgvbdn|teh.

Ld ebtdvlg bgn he dr|vtb|tve ld aer|g 6??1 pgv gfid|g ldh aer|g behbthelg peve dh pvdrdn|d enåhkrkre pev|kv ld her dr|kmebkgndr ldh pvkmdv dr|tlkg ld btdn|er ld rehtl 6??2-6??1 *Sehlër { _dõehgye 6?5?+(hgr rdvskbkgr pdvrgnehdr bgnr|k|t{dn dh pvknbkpeh gfid|g ldh aer|g( vdpvdrdn|enlg dh 25(2$ ldh aer|g|g|eh dn rehtl *bgnrkldvenlg utd pgv md|glghgaíe( dh aer|g dn rdvskbkgr pdvrgnehdr ng knbht{derkanebkgndr cemkhkevdr( epgv|dr ld bgv|g pheyg peve rehtl  ‒mdngr peve hgr dmphdelgr ld heRdatvklel Rgbkeh ‒( epgv|dr ld hevag pheyg peve pdnrkgndr { epgv|d pe|vgneh peve skskdnle+.

Khtr|vebkòn 61  ‒ Dr|vtb|tve ld Aer|g dn rehtl rdaùn gfid|g( Fghkske( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

_gv g|ve pev|d( dh aer|g dn mdlkbemdn|gr vdpvdrdn|efe dh 64(4$ ldh aer|g |g|eh dn rehtl { dh 66(<$ctd ldr|knelg e rdvskbkgr ng pdvrgnehdr *rdvskbkgr fårkbgr( |venrpgv|d( ehutkhdvdr( men|dnkmkdn|g {vdpevebkgndr( rdvskbkgr pvgcdrkgnehdr mëlkbgr( renk|evkgr { rgbkehdr( d|b.+. Dh aer|g dn rtmknkr|vgrng mdlkbemdn|grgr( bgmg ehkmdn|gr( |dz|khdr( bgmftr|kfhdr( pepdh g knr|vtmdn|gr mdngvdr mëlkbgrvdpvdrdn|efe dh <(5$ ldh aer|g |g|eh dn rehtl( dh aer|g ld knsdvrkòn *bgnr|vtbbkòn { dutkpemkdn|g+(

Aer|gr ldknsdvrkòn

5?$

Mdlkbemdn|gr64(4$ 66(<$

Rdvskbkgr ngpdvrgnehdr

Rdvskbkgrpdvrgnehdr

25(2$

G|vgrme|dvkehdr {rtmknkr|vgr*ng mdlkbe-

mdn|gr+

<(5$

G|vgr aer|gr *rdvskbkgr ld he ldtle(|venrcdvdnbker( kmptdr|gr( d|b.+ 5(3$

Ng erk-anefhd

4(5$

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 67/110

 vdpvdrdn|efe dh 5?$ { hgr ldmår aer|gr( bgmg rdvskbkg ld he ldtle pùfhkbe( |venrcdvdnbker(kmptdr|gr { g|vgr( vdpvdrdn|efen dh 5(3$ ldh aer|g |g|eh dn rehtl *khtr|vebkòn 61+.

Cknehmdn|d( pev|d ldh aer|g ng ptlg rdv erkanelg pgv gfid|g dn dh pvkmdv dr|tlkg ld btdn|er ldrehtl 6??2-?1 *Sehlër { _dõehgye 6?5?+ ldfklg e he ceh|e ld kncgvmebkòn9 dr|d aer|g ng erkanefhdvdpvdrdn|e peve he adr|kòn 6??1 dh 4(5$ ldh aer|g |g|eh dn rehtl { dr|å bgnr|k|tklg pgv he |g|ehklelldh aer|g ld hgr rdatvgr pvkselgr { pev|d ldh aer|g ld her GNAr *khtr|vebkòn 61+.

He dsghtbkòn ld he dr|vtb|tve ldh aer|g dn rehtl rdaùn gfid|g ng dr mt{ mevbele dn dh pdvkglg6??2-6??1( dzbdp|g peve dh aer|g ld knsdvrkòn { hgr rdvskbkgr ng pdvrgnehdr9 erí( mkdn|ver utd hgraer|g ld knsdvrkòn vdpvdrdn|efen rghemdn|d dh <(:$ ldh aer|g |g|eh dn rehtl dn dh eõg 6??2(rtpdvevgn hgr 5?$ e pev|kv ldh eõg 6??< *khtr|vebkòn 6: { btelvg 23+9 ldn|vg ldh aer|g ld knsdvrkòn(dh aer|g dn bgnr|vtbbkgndr je perelg ld 6(<$ ldh aer|g |g|eh dn rehtl dn dh eõg 6??2 e <(:$ dn dheõg 6??1( mkdn|ver utd dh aer|g dn meutknevke { dutkpg je perelg ld 6(6$ e <$ dn dr|d pdvkglg.

Khtr|vebkòn 6:  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn gfid|g( Fghkske( 6??2-?1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Dn bten|g e rdvskbkgr ng pdvrgnehdr( he dsghtbkòn dr knsdvre( perenlg ld 6;(4$ ldh aer|g |g|eh dnrehtl dn dh eõg 6??2 e 66(<$ dn dh eõg 6??1. He pvgpgvbkòn ldh aer|g dn rehtl bgvvdrpgnlkdnlg e

6??1

6??3

6??4

6??<

6??2

Aer|g ngerkanefhd 

Rdvskbkgr_dvrgnehdr 

Mdlkbemdn|gr 

G|vgraer|gr 

Aer|gr ldknsdvrkòn 

Rdvskbkgrng pdvrgnehdr

G|vgrme|dvkehdr {rtmknkr|vgr*ng mdlkbe-

mdn|gr+

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 68/110

 

3:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

mdlkbemdn|gr { vdeb|ksgr |emfkën |tsg tn knbvdmdn|g( ld 62(2$ dn dh eõg 6??2 e 64(4$ dn dh6??1( mkdn|ver utd peve hgr ldmår gfid|g ld aer|g( dh pgvbdn|eid ldh aer|g |g|eh rd men|tsg dn|vd6??2 { 6??1 *khtr|vebkòn 6: { btelvg 23+.

Btelvg 23  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn gfid|g( Fghkske( 6??2-?1

Gfid|g ld aer|g 6??2 6??< 6??4 6??3 6??1Rdvskbkgr _dvrgnehdr 25(6$ 6;(1$ 2?(?$ 25(<$ 25(2$

Rdvskbkgr Ng _dvrgnehdr 6;(4$ 63(2$ 65(3$ 6?(1$ 66(<$

Mdlkbemdn|gr 62(2$ 65(1$ 63(;$ 64(:$ 64(4$

G|vgr Me|dvkehdr { rtmknkr|vgr 2(;$ <(5$ 2(;$ <(?$ <(5$

Aer|gr ld knsdvrkòn <(:$ 55(2$ ;(;$ 55(5$ 5?(?$

G|vgr Aer|gr 6(5$ 6(?$ 6(;$ 6(5$ 5(3$

Aer|g ng erkanefhd 4(6$ 4(?$ <(:$ <(;$ 4(5$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Rk rd enehkye he dr|vtb|tve pgv gfid|g ldh aer|g rdaùn rtfrdb|gv( hgr vdrth|elgr rgn |g|ehmdn|dlkcdvdn|dr( bgnr|e|enlg pgv didmphg utd dh aer|g dn mdlkbemdn|gr vdpvdrdn|e tne mt{ feiepvgpgvbkòn ldh aer|g ldh rtfrdb|gv pùfhkbg *3(2$ peve he adr|kòn 6??1+( mkdn|ver utd vdpvdrdn|e dh52(4$ ldh aer|g dn rehtl ld he Rdatvklel Rgbkeh { dh 43(1$ ldh aer|g pvkselg *btelvg 21+( ldfklg ehkmpgv|en|d aer|g ld fghrkhhg utd vdehkyen hgr jgaevdr dn mdlkbemdn|gr9 ld ebtdvlg bgn herdr|kmebkgndr ld Sehlër { _dõehgye *6?5?+ peve he adr|kòn 6??1( dh 3:(6$ ldh aer|g ld fghrkhhg ldhgr jgaevdr dr|å ldr|knelg e he bgmpve ld mdlkbemdn|gr.

Btelvg 21  ‒ Dr|vtb|tve ld aer|g dn rehtl pgv gfid|g ldh aer|g { pgv rtfrdb|gv( Fghkske( 6??1

Gfid|g ld aer|g Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh

Rdb|gv

Dr|e|eh

Rdb|gv

pvkselgRdvskbkgr _dvrgnehdr <6(?$ 4<(3$  <1(2$ ?(3$

Rdvskbkgr Ng _dvrgnehdr 62(?$ 54(1$  5;(;$ 61(6$

Mdlkbemdn|gr 3(2$ 52(4$  ;(2$ 43(1$

G|vgr Me|dvkehdr { rtmknkr|vgr <(:$ 1(:$  3(?$ ?(2$

Aer|gr ld knsdvrkòn 6?(:$ 1(5$  54(5$ ?(6$

G|vgr Aer|gr 2(5$ 5(<$  6(<$ ?(5$

Aer|g ng erkanefhd ?(?$ ?(?$  ?(?$ 5<(;$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Dn bemfkg( dh rtfrdb|gv pùfhkbg ldr|kne tne pvgpgvbkòn mår kmpgv|en|d ld rt aer|g e he knsdvrkòn({e utd dn dh eõg 6??1( dh 6?(:$ ldh aer|g ldh rtfrdb|gv pùfhkbg ctd ldr|knelg e dr|d vtfvg(pvknbkpehmdn|d dn bgnr|vtbbkgndr *41(4$ ldh aer|g ld knsdvrkòn ld eadn|dr cknenbkdvgr pùfhkbg+ { dndutkpemkdn|g *2?(5$ ldh aer|g ld knsdvrkòn+. E |í|thg ld bgmpevebkòn( rd t|khkyò dn he adr|kòn 6??1rghg dh 1(5$ ldh aer|g dn rehtl ld he Rdatvklel Rgbkeh peve knsdvrkòn *btelvg 21+. Dn dh rtfrdb|gvpvkselg( dh aer|g ld knsdvrkòn dr knrkankckben|d( pdvg rd dzphkbe hòakbemdn|d pgv rdv vdakr|velg dn herbtdn|er ld rehtl rghemdn|d dh aer|g ld knsdvrkòn ld her Gvaenkyebkgndr ng Atfdvnemdn|ehdr(mkdn|ver utd ng dzkr|dn kncgvmebkgndr ldh rtfrdb|gv pvkselg bgn ckndr ld htbvg.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 69/110

 Dr|å dr|vtb|tve je bemfkelg vdhe|ksemdn|d pgbg dn dh pdvkglg 6??2-6??1( rehsg ehatnerdzbdpbkgndr( ldn|vg ld her btehdr rd ptdld mdnbkgnev dh bvdbkmkdn|g ld he pvgpgvbkòn ldh aer|g ldknsdvrkòn ldh rtfrdb|gv pùfhkbg( ld 5?(6$ ldh aer|g dn dh 6??2 e 6?(:$ dn dh 6??10 dh bvdbkmkdn|gld he pvgpgvbkòn ldh aer|g ld fghrkhhg ld jgaevdr ldr|knelg e mdlkbemdn|gr( ld 45(;$ dn dh eõg6??2 e 3:(6$ dn dh 6??10 dh ldrbdnrg ld he pvgpgvbkòn ldh aer|g ldh rtfrdb|gv pùfhkbg ldr|knelg erdvskbkgr pdvrgnehdr *ld <3(<$ dn dh eõg 6??2 e <6$ dn dh 6??1+ { e rdvskbkgr ng pdvrgnehdr *ld6:(;$ dn dh eõg 6??2 e 62$ dn dh 6??1+0 dh ldrbdnrg ld he pvgpgvbkòn ldh aer|g ld he RdatvklelRgbkeh ldr|knelg e mdlkbemdn|gr( ld 5:(:$ dn dh 6??2 e 52(4$ dn dh eõg 6??1.

KKK.4.6. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn gfid|g ldh aer|g

He dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn gfid|g ldh aer|g mtdr|ve lkcdvdnbker kmpgv|en|dr(bgmg rd ptdld gfrdvsev dn dh btelvg 2:9 mkdn|ver utd ehatngr avtpgr bgmg dh aer|g dn rdvskbkgrpdvrgnehdr t g|vgr aer|gr mgr|vefen tn knbvdmdn|g hkmk|elg *bvdbkmkdn|g ebtmthelg dn dh pdvkglg6??2-?1 ld 56(:$ { 5<(;$ vdrpdb|ksemdn|d+( dh aer|g ld knsdvrkòn ctd mth|kphkbelg pgv |vdr.

Btelvg 2:  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv gfid|g( Fghkske( 6??2-?1

Aer|g dn rehtl pgv gfid|gldh aer|g *eavdaelg+

6??2 6??< 6??4 6??3 6??1

Rdvskbkgr_dvrgnehdr

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+

5.5?6(3

-  

-  

5.516(2

3(2$  

3(2$  

5.6:?(6

;(6$  

53(5$  

5.<:5(6

54(1$  

2<(2$  

5.3<4(?

55(5$  

<;(6$  

Rdvskbkgr Ng_dvrgnehdr

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

5.?<2(;

-  

-  

5.?2;(;

-?(<$  

-?(<$  

;5;(2

-55(3$  

-55(;$  

;13(3

3(6$  

-3(<$  

5.511(<

6?(3$  

56(:$  

Mdlkbemdn|gr

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

:64(?

-  

:44(;

2(1$ 

2(1$  

5.5<1(2

2<(?$ 

2;(5$  

5.65<(5

4(:$ 

<1(6$  

5.22:(;

5?(2$ 

36(2$  

G|vgr Me|dvkehdr{ rtmknkr|vgr

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

523(2

-  

-  

53?(5

51(4$  

51(4$  

531(1

<(1$  

62(?$  

5:;(:

52(6$  

2;(2$  

656(:

56(5$  

43(5$  

Aer|gr ld

knsdvrkòn

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

53;(:

-  

-  

<<1(6

532(<$  

532(<$  

<6?(3

-4(;$  

5<1(1$  

466(2

6<(6$  

6?1(3$  

46<(6

?(<$  

6?:(:$  

G|vgr Aer|gr

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

1<(4

-  

1:(:

4(:$ 

4(:$  

566(6

44(5$ 

3<(5$  

5?5(5

-51(2$ 

24(1$  

:4(3

-54(<$ 

5<(;$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 70/110

 

1?

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Gfrdvsenlg dh bvdbkmkdn|g ld hgr pvknbkpehdr gfid|g ld aer|g *rdvskbkgr pdvrgnehdr( mdlkbemdn|gr {rdvskbkgr ng pdvrgnehdr+ dn sehgv ngmkneh( rd bgnr|e|e utd dh aer|g dn rdvskbkgr pdvrgnehdr drvdathev ldfklg eh knbvdmdn|g rehevkeh { eh bvdbkmkdn|g sdad|e|ksg. He |ere ld bvdbkmkdn|g enteh drme{gv dn he adr|kòn 6??3( {e utd dn dr|d eõg rd pvdrdn|e dh me{gv knbvdmdn|g rehevkeh dn rehtl ldhpdvkglg 6??2-6??1 bgn 1$ *dh bvdbkmkdn|g rehevkeh ctd ld <$ dn dh 6??2( 2$ dn dh 6??< { 6??4 { 3,dn dh eõg 6??1+. Dh aer|g dn mdlkbemdn|gr mgr|vò tn bvdbkmkdn|g pev|kbthevmdn|d kmpgv|en|d dn dheõg 6??4( pvknbkpehmdn|d e|vkftkfhd e hgr jgaevdr ld ebtdvlg bgn her dr|kmebkgndr ld Sehlër {_dõehgye *6?5?+. Dn bten|g eh aer|g dn rdvskbkgr ng pdvrgnehdr( dr|d lkrmknt{ò ldrld dh eõg 6??2peve sghsdv e knbvdmdn|evrd e pev|kv ldh eõg 6??3 *btelvg 2: d khtr|vebkòn 6;+.

Khtr|vebkòn 6;  ‒ Dsghtbkòn ldh aer|g dn rehtl rdaùn pvknbkpehdr gfid|gr( Fghkske( 6??2-?1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Dr|tlkenlg he dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv rtfrdb|gv( rd ptdld ldr|ebev utd dh aer|gld knsdvrkòn je mår utd |vkphkbelg dn dh rtfrdb|gv pùfhkbg ltven|d dh pdvkglg 6??2-6??1 *knbvdmdn|gebtmthelg ld 64?(3$+. Dh rtfrdb|gv pùfhkbg |emfkën knbvdmdn|ò rt aer|g ngmkneh dnmdlkbemdn|gr dn tn 5<1(1$ ltven|d dr|d pdvkglg( mkdn|ver utd dh aer|g ld he Rdatvklel Rgbkeh ldbgv|g pheyg dn dr|e pev|kle lkrmkntíe ld 6(<$. E pdrev ld dr|d knbvdmdn|g( hgr jgaevdr rkatdnrkdnlg dh me{gv eadn|d cknenbkelgv peve mdlkbemdn|gr( {e utd rt aer|g dn dr|d vtfvg vdpvdrdn|e :sdbdr dh aer|g ldh rtfrdb|gv pùfhkbg *btelvg 2;+. Rkn dmfevag( pgv pvgfhdmer ld bgn|efkhklel( drbkdv|g utd dh aer|g ckneh dn mdlkbemdn|gr ldh rtfrdb|gv pùfhkbg ng rd vdchdie eutí( {e utd pev|d lddr|er bgmpver dn|ven dn pev|kler ld |venrcdvdnbker { rdvskbkgr mëlkbgr( dn|vd g|vgr.Ldn|vg ld hgr g|vgr jehheyagr( |emfkën rd bgnr|e|e utd dh rtfrdb|gv pùfhkbg |tsg tn bvdbkmkdn|gme{gv ld rt aer|g dn vdbtvrgr jtmengr *44(<$ dn|vd 6??2 { 6??1+ utd dn he Rdatvklel Rgbkeh*<6(4$+( hg pvgpkg gbtvvd peve g|vgr rtmknkr|vgr *1;(5$ { 24(:$ vdrpdb|ksemdn|d+ *btelvg 2;+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 71/110

 Btelvg 2;  ‒Aer|g dn sehgv ngmkneh pgv gfid|g { rtfrdb|gv( Fghkske( 6??1

Aer|g dn rehtl pgv gfid|gldh aer|g *eavdaelg+

Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh

Rdb|gvDr|e|eh

Rdb|gvpvkselg

Rdvskbkgr_dvrgnehdr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.

6??2-6??1+

:<3(<

44(<$  

1::(4

<6(4$  

5.32<(:

<:(;$  

5?(6

56?(2$  

Rdvskbkgr Ng_dvrgnehdr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

<32(;

23(;$  

663(6

22(:$  

3;?(5

24(;$  

<:1(<

-;(5$  

Mdlkbemdn|gr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

563(;

5<1(1$  

5;4(6

-6(<$  

266(5

6:(6$  

5.?53(1

11(6$  

G|vgr Me|dvkehdr{ rtmknkr|vgr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

;3(?

1;(5$  

556(2

24(:$  

6?:(2

46(:$  

<(4

<<6<(<$ 

Aer|gr ldknsdvrkòn

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

<5;(5

64?(3$  

5?6(?

5?2(3$  

465(5

6?1(6$  

2(5

6256(<$  

G|vgr Aer|gr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

36(:

-2(1$  

6?(<

562(3$  

:2(6

55(;$  

6(<

5<4:(6$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

KKK.4.2. Nksdh { dsghtbkòn ldh aer|g vdeh rdaùn gfid|g ldh aer|g

He dsghtbkòn ldh aer|g dn sehgv vdeh rdaùn gfid|g ldh aer|g mtdr|ve lkrmkntbkòn vdeh dn|vd 6??2 {6??1 rghemdn|d peve hgr rdvskbkgr ng pdvrgnehdr( bgn tn ldrbdnrg vdeh ld 5(6$ dn|vd 6??2 { 6??1.Hgr gfid|gr ld aer|g utd pvdrdn|en hgr me{gvdr knbvdmdn|gr vdehdr rgn dh aer|g ld knsdvrkòn*5<?$ dn|vd 6??2 { 6??1+ { dh aer|g dn mdlkbemdn|gr *22(2$+ *btelvg <?+.

Btelvg <?  ‒ Dsghtbkòn ldh aer|g vdeh rdaùn gfid|g ldh aer|g( Fghkske( 6??2-?1

Aer|g dn rehtl pgv gfid|gldh aer|g *eavdaelg+

6??2 6??< 6??4 6??3 6??1

Rdvskbkgr_dvrgnehdr

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

5.5?6(3

-  -  

5.52;(6

2(2$  2(2$  

5.6?;(;

3(6$  ;(1$  

5.254(6

:(1$  5;(2$  

5.2:5(1

4(5$  64(2$  

Rdvskbkgr Ng_dvrgnehdr

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

5.?<2(;

-  

-  

5.??1(3

-2(4$  

-2(4$  

:35(<

-5<(4$  

-51(4$  

:;6(2

2(3$  

-5<(4$  

5.?25(:

54(3$  

-5(6$  

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 72/110

 

16

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg <?  ‒ Dsghtbkòn ldh aer|g vdeh rdaùn gfid|g ldh aer|g( Fghkske( 6??2-?1 *bgn|kntebkòn+

Aer|g dn rehtl pgv gfid|gldh aer|g *eavdaelg+

6??2 6??< 6??4 6??3 6??1

Mdlkbemdn|gr

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

:64(?

-  

-  

:2:(?

5(3$  

5(3$  

5.?4;(<

63(<$  

6:(<$  

5.?;1(4

2(3$  

22(?$  

5.?;;(4

?(6$  

22(2$  

G|vgr Me|dvkehdr{ rtmknkr|vgr

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

523(2

-  

-  

542(:

56(:$  

56(:$  

54<(:

?(1$  

52(3$  

531(:

:(<$  

62(5$  

531(3

-?(5$  

62(?$  

Aer|gr ldknsdvrkòn

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

53;(:

-  

-  

<21(;

541(;$  

541(;$  

2:3(2

-55(:$  

561(4$  

<43(<

5:(5$  

53:(:$  

<?1(<

-5?(1$  

5<?(?$  

G|vgr Aer|gr

Dn mkhhgndrld Fr. ld 6??2

*bvdbkm. vdeh+

*bvdbkmkdn|g ebtmthelg+

1<(4-  

-  

1:(44(<$  

4(<$  

56?(142(:$  

36(5$  

;;(<-51(1$  

22(<$  

:2(?-53(4$  

55(<$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Dr|tlkenlg he dsghtbkòn ldh aer|g vdeh pgv rtfrdb|gv( rd ptdld ldr|ebev utd dh aer|g ld knsdvrkòn|tsg tn bvdbkmkdn|g vdeh ld 511(5$ dn|vd 6??2 { 6??1. Dh rtfrdb|gv pùfhkbg |emfkën knbvdmdn|ò rtaer|g vdeh dn mdlkbemdn|gr dn tn 5?;(:$ ltven|d dr|d pdvkglg( mkdn|ver utd dh aer|g vdeh ld heRdatvklel Rgbkeh ld bgv|g pheyg dn dr|e pev|kle lkrmkntíe ld 62(5$. Dn he Rdatvklel Rgbkeh ld bgv|gpheyg( rd knbvdmdn|ò dh aer|g vdeh dn g|vgr aer|gr *55:$+ mkdn|ver utd dr|d vtfvg mtdr|ve tnldrbdnrg dn dh rtfrdb|gv pùfhkbg. Dn dh rdb|gv pvkselg( rd ldr|ebe he lkrmkntbkòn dn sehgv vdeh ldhgr rdvskbkgr pdvrgnehdr { dh knbvdmdn|g ldh aer|g dn mdlkbemdn|gr( kmpthrelg pvknbkpehmdn|d pgvdh bemfkg ld he dr|vtb|tve ld aer|g ld hgr jgaevdr. Her eh|er |erer ld bvdbkmkdn|g dn hgr ldmåravtpgr ldh rdb|gv pvkselg ng rgn rkankckbe|kser( {e utd bgnbkdvndn mgn|gr pdutdõgr *btelvg <5+.

Btelvg <5  ‒ \ere ld bvdbkmkdn|g vdeh ebtmthele 6??2-?1 pgv rtfrdb|gv( Fghkske( 6??2-?1

Gfid|g ldh Aer|g Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh

Rdb|gvDr|e|eh

Rdb|gvpvkselg

Rdvskbkgr _dvrgnehdr 2?(;$ 5;(2$ 64(5$ :1(?$

Rdvskbkgr Ng_dvrgnehdr

6?(<$ 51(1$ 5;(4$ -6?(:$

Mdlkbemdn|gr 5?;(:$ -62(5$ <(?$ <3(5$G|vgr Me|dvkehdr

{ rtmknkr|vgr<5(4$ 3(<$ 6?(6$ 2416(3$

Aer|gr ld knsdvrkòn 511(5$ <1(1$ 52:(;$ 51<;(?$

G|vgr Aer|gr -3(:$ 55:(?$ :(4$ 5<?:(2$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 73/110

 KKK.3. Enåhkrkr ldh Aer|g dn rehtl rdaùn ctnbkòn 

KKK.3.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn ctnbkòn

Her dr|kmebkgndr ld aer|g pgv ctnbkòn pvgskdndn dzbhtrksemdn|d ldh pvkmdv dr|tlkg *Sehlër { _dõehgye

6?5?+ {e utd ng dzkr|d dr|e me|vky dn dh rdatnlg dr|tlkg. Dh sehgv ldh aer|g |g|eh ng bgvvdrpgnlddn|gnbdr e hgr mgn|gr enehkyelgr dn hgr ebåpk|dr en|dvkgvdr( { rk fkdn rd pvdrdn|en hgr mgn|grdr|kmelgr ld aer|g pgv ctnbkòn( dr|gr rghg |kdndn tn sehgv knlkbe|ksg9 dh sdvleldvg bdn|vg ldh enåhkrkrld hgr mgn|gr ld aer|g pgv ctnbkòn rgn her |erer ld bvdbkmkdn|g { he dr|vtb|tve pgvbdn|teh.

Rdaùn he bherkckbebkòn t|khkyele dn dh pvkmdv dr|tlkg ld btdn|er ld rehtl 6??2-6??1 *Sehlër { _dõehgye6?5?+( her lkcdvdn|dr be|dagvíer ctnbkgnehdr knbht{dn her rkatkdn|dr eb|kskleldr9

  E|dnbkòn emfthe|gvke9 knbht{d rdvskbkgr mëlkbgr( glgn|ghòakbgr { pevemëlkbgr *bgnrth|edz|dvne g ld dmdvadnbke+ fvknlelgr e pebkdn|dr emfthe|gvkgr( dr ldbkv hgr utd ng rgnkn|dvnelgr dn dh dr|efhdbkmkdn|g ld rehtl.

  E|dnbkòn jgrpk|ehevke9 knbht{d rdvskbkgr ld rehtl eh pebkdn|d g pdvrgne utd dr cgvmehmdn|djgrpk|ehkyelg { utd rd utdle pgv tn mínkmg ld tne ngbjd dn tn dr|efhdbkmkdn|g ld rehtl.

  E|dnbkòn ld hevae ltvebkòn9 bgmpvdnld e|dnbkgndr dn rehtl fvknleler e pebkdn|dr utdndbdrk|en erkr|dnbke bgn|knte e betre ld kmpdlkmdn|gr bvònkbgr { tn avelg vdltbklg ldknldpdnldnbke *erkhgr peve enbkengr( bdn|vgr ld vdjefkhk|ebkòn ld lvgaelkbbkòn( d|b.+.

  Rdvskbkgr etzkhkevdr ld e|dnbkòn ld he rehtl9 bgnrkr|d dn tne sevkdlel ld rdvskbkgr ld epg{g(pvknbkpehmdn|d dcdb|teler pgv pevemëlkbgr g pdvrgneh |ëbnkbg mëlkbg( |ehdr bgmg hefgve|gvkg(kmeadnghgaíe( mdlkbkne ntbhdev( |venrpgv|d ld pebkdn|dr( fenbgr ld renavd.

  _vgltb|gr( ù|khdr { dutkpgr mëlkbgr ctdve ld hgr dr|efhdbkmkdn|gr9 bgnrkr|d dn pvgltb|grlkrpdnrelgr e pebkdn|dr emfthe|gvkgr |ehdr bgmg sdn|er eh ld|ehhd { ehutkhdv ld pvgltb|grmëlkbgr. Btfvd mdlkbemdn|gr( pvò|drkr( epeve|gr mëlkbgr { g|vgr fvknlelgr e knlkskltgr(ngvmehmdn|d ld lkrpdnrelgvdr cevmebët|kbgr g rtv|klgvdr ld dutkpgr mëlkbgr bgn he kn|dnbkònld trg pgv tn rghg knlkskltg t jgaev g ctdve ld tne knr|k|tbkòn g dr|efhdbkmkdn|g ld rehtl.

  _vdsdnbkòn { rehtl pùfhkbe9 rgn rdvskbkgr lkrdõelgr peve mdigvev dh dr|elg ld rehtl ld hepgfhebkòn( lkr|knatklgr ld rdvskbkgr btve|ksgr( hgr btehdr vdpeven he lkrctnbkòn ld rehtl.Knbht{dn( dn|vd g|vgr( pvgmgbkòn ld he rehtl( pvgavemer ld sebtnebkòn( mgnk|gvdg ldhbvdbkmkdn|g kncen|kh( e|dnbkòn pvdne|eh { pgr| ne|eh( phenkckbebkòn cemkhkev( rtphdmdn|grnt|vkbkgnehdr( dltbebkòn dn rehtl( mdlkbkne drbghev( pvdsdnbkòn ld dncdvmdleldr |venrmkrkfhdr{ ng |venrmkrkfhdr( mdlkbkne ldh |vefeig( skakhenbke { bgn|vgh ld dncdvmdleldr( d|b.

  Vdb|gvíe { elmknkr|vebkòn9 knbht{dn eb|kskleldr ld elmknkr|vebkòn ld cgnlgr( pvgavemebkònpvdrtptdr|evke( bggvlknebkòn ld pghí|kber( phenkckbebkòn( vdathebkòn( dn|vd g|vgr.

  Ctnbkgndr vdhebkgneler bgn he rehtl9 knbht{d ctnbkgndr endzer( bgmg he cgvmebkòn fvt|e ldbepk|eh ckig( he cgvmebkòn ld pdvrgneh dn rehtl { hgr pvgavemer ld knsdr|kaebkòn dn rehtl.

  Aer|g ld |kpg ng drpdbkckbelg9 bgvvdrpgnld eh aer|g utd ng ptlg rdv bherkckbelg dn hedr|vtb|tve ldrbvk|e en|dvkgvmdn|d *pvknbkpehmdn|d dh aer|g ld hgr rdatvgr pvkselgr+.

Ld ebtdvlg bgn he dr|vtb|tve ld aer|g 6??1 pgv ctnbkòn behbthelg peve dh pvdrdn|d enåhkrkr e pev|kvld her dr|kmebkgndr ldh pvkmdv dr|tlkg ld btdn|er ld rehtl 6??2-6??1 *Sehlër { _dõehgye 6?5?+( hgrrdvskbkgr ld e|dnbkòn emfthe|gvke bgnr|k|t{dn he ctnbkòn utd |kdnd me{gv aer|g( {e utd vdpvdrdn|edh 6;(2$ ldh aer|g |g|eh dn rehtl *ld hgr btehdr dh 55(4$ rgn e|dnbkgndr glgn|ghòakber(bgvvdrpgnlkdnlg eh 2(2$ ldh aer|g |g|eh dn rehtl+. Dn bemfkg( he e|dnbkòn jgrpk|ehevke( fkdn utd rtbgr|g pgv pebkdn|d rde me{gv( rghg vdpvdrdn|e dh 53(6$ ldh aer|g |g|eh dn rehtl *khtr|vebkòn 2?+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 74/110

 

1<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

He rdatnle ctnbkòn bgn me{gv aer|g dr ‘_vgltb|gr( ù|khdr { dutkpgr mëlkbgr ctdve ld hgrdr|efhdbkmkdn|gr” *bgvvdrpgnlkdnlg me{gvmdn|d e lkrpdnrelgvdr cevmebët|kbgr+( utd vdpvdrdn|e dh5;(3$ ldh aer|g |g|eh dn rehtl peve he adr|kòn 6??1. Her ctnbkgndr vdhebkgneler bgn he rehtl*knsdvrkòn( cgvmebkòn d knsdr|kaebkòn+ bgvvdrpgnldn eh 55$ ldh aer|g |g|eh dn rehtl *khtr|vebkòn 2?+9ld dr|gr( dh ;6$ bgvvdrpgnldn e kncvedr|vtb|tve { dutkpemkdn|g( mkdn|ver utd rghemdn|d dh 4$ { dh2$ bgvvdrpgnldn e knsdr|kaebkòn { cgvmebkòn vdrpdb|ksemdn|d.

Hgr rdvskbkgr ld pvdsdnbkòn { rehtl pùfhkbe vdpvdrdn|en dh 5?(5$ ldh aer|g |g|eh dn rehtl*khtr|vebkòn 2?+9 dh <5$ ldh aer|g ldn|vg ld dr|e ctnbkòn rd lkvkad e he pvdsdnbkòn ld dncdvmdleldr|venrmkrkfhdr *5;$ dn sebtner { 66$ dn g|vgr+ { dh 25$ e rehtl me|dvng-kncen|kh { phenkckbebkòncemkhkev( mkdn|ver utd rghemdn|d dh 4$ se e pvgmgbkòn ld he rehtl { dh 5$ e mdlkbkne drbghev.

Khtr|vebkòn 2?  ‒ Dr|vtb|tve ld Aer|g dn rehtl rdaùn ctnbkòn( Fghkske( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

_gv g|ve pev|d( hgr rdvskbkgr etzkhkevdr ld e|dnbkòn ld rehtl bgvvdrpgnldn eh 5(1$ ldh aer|g |g|eh dnrehtl9 ld dr|gr rdvskbkgr( he me{gv pvgpgvbkòn ldh aer|g bgnbkdvnd hgr rdvskbkgr ld hefgve|gvkg *45$ldh aer|g ld he ctnbkòn ld rdvskbkgr etzkhkevdr+ { ld kmeadnghgaíe *55$ ldh aer|g ld he ctnbkòn+.

Ldn|vg ld he ctnbkòn ld vdb|gvíe { elmknkr|vebkòn( utd vdpvdrdn|e peve dh eõg 6??1 dh 1$ ldh aer|g|g|eh dn rehtl( dh aer|g pvknbkpeh bgnbkdvnd her elmknkr|vebkgndr ldh rtfrdb|gv pùfhkbg *1?$ ldh aer|gld dr|e ctnbkòn+( mkdn|ver utd dh 6:$ bgnbkdvnd he Rdatvklel Rgbkeh { dh 6$ dh rdb|gv pvkselg. Rkndmfevag( rd |gmò dn btdn|e dn dh dr|tlkg dh aer|g ld Fr. 2;(5 mkhhgndr peve he vdbgnr|vtbbkòn ld heBDERR ldn|vg ld he ctnbkòn ld vdb|gvíe( mkdn|ver utd bgvvdrpgnld víe e ‘ctnbkgndr vdhebkgneler”.

Ctnbkgndrvdhebkgnelerbgn he rehtl 

55$

53(6$E|dnbkòn

jgrpk|ehevke

E|dnbkònemfthe|gvke

6;(2$

Vdb|gvíe {elmknkr|vebkòn

E|dnbkòn ld hevaeltvebkòn ?(2$Rdvskbkgr etzkhkevdr ld e|dnbkòn ld rehtl 5(1$

5;(3$_vgltb|gr( ù|khdr {dutkpgr mëlkbgr

ctdve ld hgrdr|efhdbkmkdn|gr

5?(5$_vdsdnbkòn {rehtl pùfhkbe

1$

Aer|g ld |kpg ng drpdbkckbelg <(1$

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 75/110

 Enehkyenlg he dr|vtb|tve ld aer|g pgv ctnbkòn ld hgr eõgr en|dvkgvdr( rd bgnr|e|e utd he dsghtbkònld dr|e dr|vtb|tve rghg bgnbkdvnd rghemdn|d e|dnbkòn jgrpk|ehevke( hgr pvgltb|gr( ù|khdr { dutkpgrmëlkbgr ctdve ld hgr dr|efhdbkmkdn|gr { her ctnbkgndr vdhebkgneler bgn he rehtl0 her ldmårctnbkgndr vdpvdrdn|en bele tne epvgzkmelemdn|d dh mkrmg pgvbdn|eid ldh aer|g |g|eh dn rehtl dndh eõg 6??2 utd dn dh eõg 6??1 *khtr|vebkòn 25 { btelvg <6+.

Khtr|vebkòn 25  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn ctnbkòn( Fghkske( 6??2-?1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Erí( rd ptdld bgnr|e|ev utd dh aer|g dn e|dnbkòn emfthe|gvke lkrmknt{ò rt pev|kbkpebkòn ldn|vg ldhaer|g |g|eh dn rehtl( perenlg ld 24(2$ dn dh eõg 6??2 e 6:$ ldh aer|g |g|eh dn rehtl dn dh 6??3 {6;(2$ dn dh 6??1. Dn bten|g e hgr pvgltb|gr( ù|khdr { dutkpgr mëlkbgr ctdve ld hgr dr|efhdbkmkdn|grrt pev|kbkpebkòn ldn|vg ldh aer|g |g|eh dn rehtl rd knbvdmdn|ò e pev|kv ldh eõg 6??49 dn dh eõg 6??<(vdpvdrdn|efe dh 54(5$ ldh aer|g |g|eh dn rehtl( { htdag( dr|e pvgpgvbkòn etmdn|ò jer|e vdpvdrdn|evdh 5;(3$ ldh aer|g |g|eh dn rehtl dn dh eõg 6??1. Cknehmdn|d( her ctnbkgndr vdhebkgneler bgn herehtl knbvdmdn|evgn rt pev|kbkpebkòn e pev|kv ldh eõg 6??<( perenlg ld 4(1$ e 56(1$ ldh aer|g |g|ehdn rehtl dr|d eõg( ldfklg eh bvdbkmkdn|g ldh aer|g ld knsdvrkòn *khtr|vebkòn 25 { btelvg <6+.

6??1

6??3

6??4

6??<

6??2

Aer|g ngerkanefhd 

E|dnbkònemfthe|gvke 

_vgltb|gr( ù|khdr {dutkpgr mëlkbgr ctdveld hgr dr|efhdbkmkdn|gr 

Ctnbkgndrvdhebkgnelerbgn he rehtl 

E|dnbkònjgrpk|ehevke

Vdb|gvíe {elmknkr|vebkòn

_vdsdnbkòn{ rehtlpùfhkbe

Rdvskbkgr etzkhkevdrld e|dnbkòn ld rehtl 

E|dnbkòn ldhevae ltvebkòn 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 76/110

 

13

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg <6  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn ctnbkòn( Fghkske( 6??2-?1

Ctnbkòn 6??2 6??< 6??4 6??3 6??1

E|dnbkòn emfthe|gvke 24(2$ 22(?$ 2?(5$ 6:(?$ 6;(2$

E|dnbkòn jgrpk|ehevke 51(5$ 53(1$ 53(4$ 53(3$ 53(6$

E|dnbkòn ld hevae ltvebkòn ?(6$ ?(6$ ?(6$ ?(6$ ?(2$Rdvskbkgr etzkhkevdr dn rehtl 5(:$ 5(3$ 5(3$ 5(1$ 5(1$

_vgltb|gr( ù|khdr { dutkpgr mëlkbgrctdve ld hgr dr|efhdbkmkdn|gr 53(4$ 54(5$ 5:(3$ 5;(5$ 5;(3$

_vdsdnbkòn { rehtl pùfhkbe 55(5$ ;(4$ 5?(4$ ;(4$ 5?(5$

Vdb|gvíe { elmknkr|vebkòn 1(4$ 3(3$ 3(3$ 1(3$ 1(?$

Ctnbkgndr vdhebkgneler bgn he rehtl 4(1$ 56(1$ 55(5$ 56(4$ 55(?$

Aer|g ld |kpg ng drpdbkckbelg <(:$ <(3$ <(:$ <(;$ <(1$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

_eve he bgmpevebkòn kn|dvnebkgneh( dzkr|dn pgbgr le|gr lkrpgnkfhdr dn cgvme knmdlke|e rgfvd aer|gdn rehtl pgv ctnbkòn. Rkn dmfevag( he Gvaenkyebkòn Mtnlkeh ld he Rehtl |kdnd lkrpgnkfhd |vdrknlkbelgvdr utd pdvmk|dn vdehkyev bgmpevebkgndr9 dh aer|g dn rdvskbkgr ld pvdsdnbkòn { rehtlpùfhkbe dn $ ldh aer|g |g|eh dn rehtl *khtr|vebkòn 26+( mkdn|ver utd dn he khtr|vebkòn 22 rd ptdldgfrdvsev dh aer|g dn e|dnbkòn jgrpk|ehevke dn $ ldh aer|g |g|eh dn rehtl { dh aer|g dn e|dnbkònjgrpk|ehevke dn $ ldh aer|g dr|e|eh dn rehtl { * GMR 6?55+. Bele tng ld dr|gr knlkbelgvdr dr|ålkrpgnkfhd peve tn pgbg mår ld 1? peírdr( pdvg ng rkdmpvd peve bele eõg0 pgv dr|e veyòn( rd dr|åbgmpevenlg eutí hgr pvgmdlkgr peve dh pdvkglg 6??2-?1.

Khtr|vebkòn 26  ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g dn he ctnbkòn ldpvdsdnbkòn { rehtl pùfhkbe dn $ ldh aer|g |g|eh dn rehtl( pdvkglg 6??2-6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 GMR 6?55

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 77/110

 Dh aer|g dn pvdsdnbkòn { rehtl pùfhkbe dn vdhebkòn bgn dh aer|g |g|eh dn rehtl dr e nksdh kn|dvnebkgnehkncdvkgv eh ve|kg utd rd ptdld gfrdvsev dn Fghkske *khtr|vebkòn 26+9 dn dcdb|g( ldn|vg ld hgr 1; peírdrpeve hgr btehdr dzkr|dn le|gr lkrpgnkfhdr dn her ferdr ld le|gr ld btdn|er ld rehtl ld heGvaenkyebkòn Mtnlkeh ld he Rehtl *GMR 6?55+( rghg 51 |dníe tn ve|kg ld aer|g dn pvdsdnbkòn ' rehtlpùfhkbe dn $ ldh aer|g |g|eh dn rehtl rtpdvkgv eh pvgmdlkg 6??2-6??1 peve Fghkske( utd dve ld5?(5$. Ldn|vg ld dr|gr 51 peírdr( rd ldr|ebe Krvedh( utd lkvkad dh <6$ ld rt aer|g |g|eh dn rehtl ehe pvdsdnbkòn { rehtl pùfhkbe( bgnr|k|t{dnlg erí tne dzbdpbkòn e nksdh mtnlkeh.

E nksdh ld Emëvkbe He|kne { Bevkfd( ld hgr 5? peírdr peve hgr btehdr je{ le|gr lkrpgnkfhdr( rghgJek|í( bgn 5:(6$( pvdrdn|e tn ve|kg ld aer|g dn pvdsdnbkòn { rehtl pùfhkbe rtpdvkgv e Fghkske(mkdn|ver utd g|vgr( bgmg pgv didmphg Bgr|e Vkbe( Nkbeveate( Ate|dmehe( Mëzkbg { Bjkhd( pvdrdn|enve|kgr kncdvkgvdr( ld 3(4$( 4(:$( <(:$( 2(?$ { 6(5$ vdrpdb|ksemdn|d.

Dn bemfkg( Fghkske |kdnd tne mdngv pvgpgvbkòn ld aer|g dn e|dnbkòn jgrpk|ehevke utd hg utd rdptdld gfrdvsev e nksdh kn|dvnebkgneh9 mkdn|ver utd e nksdh mtnlkeh( dh aer|g dn e|dnbkòn jgrpk|ehevkevdpvdrdn|e dn pvgmdlkg 6:(3$ ldh aer|g |g|eh dn rehtl { <?$ ldh aer|g dr|e|eh dn rehtl peve dhpdvkglg 6??2-6??1( dr|gr ve|kgr dn Fghkske dven ld 53(3$ { 62(5$ vdrpdb|ksemdn|d *khtr|vebkòn 22+.Erí( e nksdh he|kngemdvkbeng( sevkgr peírdr |kdndn tne mt{ kmpgv|en|d pvgpgvbkòn ld rt aer|gldr|knelg e e|dnbkòn jgrpk|ehevke9 dn Bjkhd( dh aer|g dn dr|e ctnbkòn vdpvdrdn|e dh 1<$ ldh aer|gdr|e|eh dn rehtl( mkdn|ver utd ldn|vg ld hgr peírdr he|kngemdvkbengr bgn le|gr lkrpgnkfhdr(

rghemdn|d Nkbeveate { _eveate{ mtdr|ven ve|kgr ld aer|g dn e|dnbkòn jgrpk|ehevke kncdvkgvdr eFghkske( bgn vdrpdb|ksemdn|d 54$ { 53(2$ ld rt aer|g dr|e|eh dn rehtl.

Khtr|vebkòn 22  ‒ Bgmpevebkòn kn|dvnebkgneh ldh aer|g dn e|dnbkòn jgrpk|ehevke dn $ ldh aer|g|g|eh dn rehtl { dn $ ldh aer|g dr|e|eh dn rehtl( pdvkglg 6??2-6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?0 GMR 6?55

Fghkske Mtnlg Avtpg 5Rtlemëvkbe

Avtpg 6LdrevvghhgJtmeng

Avtpg 2Knavdrgdr|e|eh

Avtpg <Bgfdv|tveTnksdvreh 

RknLe|gr

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 78/110

 

1:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Bgmpevenlg he dr|vtb|tve ld aer|g pgv ctnbkòn rdaùn rtfrdb|gv *btelvg <2+( rd bgnckvme utddzkr|dn avenldr lkcdvdnbker9 mkdn|ver utd dh rtfrdb|gv pùfhkbg lkvkad rt aer|g e sevker ctnbkgndrldfklg e he phtvehklel ld rtr mkrkgndr *e|dnbkòn ld he dncdvmdlel( pvdsdnbkòn { rehtl pùfhkbe(vdb|gvíe pgv pev|d ldh Mknkr|dvkg ld Rehtl { Ldpgv|dr( d|b.+( dh drdnbkeh ldh aer|g ldh rtfrdb|gv ld heRdatvklel Rgbkeh { ldh rdb|gv pvkselg rd lkvkad e her ctnbkgndr ld e|dnbkòn ld he dncdvmdlel*e|dnbkòn emfthe|gvke( jgrpk|ehevke { pvgltb|gr( ù|khdr { dutkpgr mëlkbgr ctdve ld hgrdr|efhdbkmkdn|gr+. Tne kncgvmebkòn kn|dvdren|d dr utd dh rtfrdb|gv ld he rdatvklel rgbkeh lkvkad rtaer|g dn cgvme mtbjg mår kmpgv|en|d e he e|dnbkòn emfthe|gvke dn vdhebkòn e he e|dnbkònjgrpk|ehevke( utd hg utd rd ptdld gfrdvsev dn dh rtfrdb|gv pùfhkbg( ptlkdnlg dzphkbevrd pgv dh jdbjgld utd dn he Rdatvklel Rgbkeh( he e|dnbkòn emfthe|gvke rd vdehkye pvknbkpehmdn|d dn jgrpk|ehdr.

Rkn dmfevag( rd ptdldn bgnr|e|ev ehatner knbgjdvdnbker dn he dr|vtb|tve pgv ctnbkòn( ldfklg e heceh|e ld kncgvmebkòn9 pgv didmphg( ng rd vdpgv|e aer|g dn rdvskbkgr etzkhkevdr dn rehtl nk dn heRdatvklel Rgbkeh ld bgv|g pheyg( nk dn dh rdb|gv pvkselg *btelvg <2+.

Btelvg <2  ‒ Dr|vtb|tve ld aer|g dn rehtl pgv ctnbkòn { rtfrdb|gv( Fghkske( 6??1

Ctnbkòn Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh

Rdb|gvDr|e|eh

Rdb|gvpvkselg

E|dnbkòn emfthe|gvke 53(;$ 4<(:$  26(1$ 66(1$E|dnbkòn jgrpk|ehevke 65(3$ 6<(4$  66(:$ 2(3$

E|dnbkòn ld hevae ltvebkòn ?(1$ ?(?$  ?(<$ ?(?$

Rdvskbkgr etzkhkevdr dn rehtl <(3$ ?(?$  6(1$ ?(?$

_vgltb|gr( ù|khdr { dutkpgr mëlkbgrctdve ld hgr dr|efhdbkmkdn|gr ?(:$ ?(?$  ?(4$ 43(4$

_vdsdnbkòn { rehtl pùfhkbe 5;(?$ 4(4$  52(<$ 2(;$

Vdb|gvíe { elmknkr|vebkòn 52(5$ 3(1$  5?(<$ ?(<$

Ctnbkgndr vdhebkgneler bgn he rehtl 62(6$ 1(2$  53(3$ ?(2$

Aer|g ld |kpg ng drpdbkckbelg ?(6$ 5(?$  ?(3$ 56(3$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

KKK.3.6. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn ctnbkòn

He dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn ctnbkòn mtdr|ve lkcdvdnbker kmpgv|en|dr( bgmg rdptdld gfrdvsev dn dh btelvg <<9 he ctnbkòn bgn mdngv knbvdmdn|g ld rt aer|g dr he e|dnbkònemfthe|gvke( bgn tne |ere ld bvdbkmkdn|g ngmkneh ld 62(<$ dn|vd 6??2 { 6??1 mkdn|ver utdehatner ctnbkgndr bgmg e|dnbkgndr ld hevae ltvebkòn { ctnbkgndr vdhebkgneler bgn he rehtl|tskdvgn tn knbvdmdn|g kmpgv|en|d *;:(:$ { 5:4(5$ vdrpdb|ksemdn|d( dn|vd 6??2 { 6??1+.

Dn |g|ehklel( rd dr|kmò dn dh pvkmdv dr|tlkg ld btdn|er ld rehtl utd peve dh eõg 6??1( Fr. 2.464(;

mkhhgndr dr|evíe ldr|knelg e he e|dnbkòn ld he dncdvmdlel *knbht{dnlg her ctnbkgndr ld e|dnbkònemfthe|gvke( jgrpk|ehevke { hevae ltvebkòn( rdvskbkgr etzkhkevdr { ù|khdr { dutkpgr mëlkbgr ctdve ldhgr dr|efhdbkmkdn|gr+( dr ldbkv mår ld 3(4 sdbdr hg utd rd ldr|kne e pvdsdnbkòn { rehtl pùfhkbe.Eldmår( dr|å lkcdvdnbke dr|tsg bvdbkdnlg ltven|d dh pdvkglg 6??2-6??1( {e utd dh aer|g dn dr|erctnbkgndr ld e|dnbkòn ld he dncdvmdlel |tsg tn bvdbkmkdn|g ld <?(1$( ld Fr. 6.4?4(: mkhhgndr dn dheõg 6??2 e Fr. 2.464(; mkhhgndr dn dh eõg 6??1( mkdn|ver utd dh aer|g dn pvdsdnbkòn { rehtlpùfhkbe |tsg tn bvdbkmkdn|g dn|vd 6??2 { 6??1 ld 24(4$( ld Fr. 2;6(: mkhhgndr dn dh eõg 6??2 eFr. 426(5 mkhhgndr dn dh eõg 6??1 *btelvg <<+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 79/110

 Btelvg <<  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv ctnbkòn( Fghkske( 6??2-?1

Aer|g dn rehtl pgv ctnbkòn 6??2 6??< 6??4 6??3 6??1

E|dnbkòn

emfthe|gvke

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+

5.6<1(1

-  

-  

5.2?2(<

<(4$  

<(4$  

5.6:6(6

-5(3$  

6(:$  

5.25:(2

6(:$  

4(1$  

5.42;(3

53(:$  

62(<$  

E|dnbkònjgrpk|ehevke

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

3?3(2

-  

-  

34;(3

:(:$  

:(:$  

1?6(4

3(4$  

54(;$  

1:6(;

55(<$  

6;(5$  

:46(;

:(;$  

<?(1$  

E|dnbkòn ldhevae ltvebkòn

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

3(1

-  

-  

:(6

66(;$  

66(;$  

:(5

-5(2$  

65(2$  

5?(:

22(4$  

35(;$  

52(2

66(:$  

;:(:$  

Rdvskbkgretzkhkevdr dn

rehtl

Dn mkhhgndr

ld fghkskengr*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

36(?-  

-  

3<(3<(2$  

<(2$  

3;(::(?$  

56(4$  

:5(553(2$  

2?(;$  

;5(;52(2$  

<:(2$  

_vgltb|gr( ù|khdr{ dutkpgr

mëlkbgr ctdveld hgr

dr|efhdbkmkdn|gr

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

4:2(5

-  

-  

4;:(4

6(3$  

6(3$  

1;6(5

26(2$  

24(:$  

:;:(1

52(4$  

4<(5$  

5.?6:(2

5<(<$  

13(2$  

_vdsdnbkòn {rehtl pùfhkbe

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

2;6(:

-  

-  

21<(3

-<(3$  

-<(3$  

<<:(2

5;(1$  

5<(5$  

<<1(3

-?(6$  

5<(?$  

426(5

5:(;$  

24(4$  

Vdb|gvíe {elmknkr|vebkòn

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+

63<(5

-  

-  

64;(4

-5(1$  

-5(1$  

61;(1

1(:$  

4(;$  

243(?

61(2$  

2<(:$  

23:(;

2(3$  

2;(1$  

Ctnbkgndrvdhebkgnelerbgn he rehtl

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+

6?2(5

-  

-  

4?5(?

5<3(1$  

5<3(1$  

<1<(?

-4(<$  

522(<$  

4:1(;

6<(?$  

5:;(4$  

41;(6

-5(4$  

5:4(5$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Dr|tlkenlg he dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv rtfrdb|gv *btelvg <4+( rd ptdld ldr|ebevutd dr dn dh rdb|gv pùfhkbg utd rd gfrdvse dh me{gv bvdbkmkdn|g ldh aer|g ldr|knelg e ctnbkgndr lde|dnbkòn ld he dncdvmdlel( bgn( pgv didmphg( tn bvdbkmkdn|g ldh aer|g ngmkneh dn e|dnbkònemfthe|gvke ld 14(5$ dn|vd 6??2 { 6??1( mkdn|ver utd dr|d bvdbkmkdn|g dve ld 22(5$ peve heRdatvklel Rgbkeh dn dh mkrmg pdvkglg. Ng gfr|en|d( dh rtfrdb|gv ld he Rdatvklel Rgbkeh rkatdldr|knenlg mår lkndvg e he e|dnbkòn utd dh rtfrdb|gv pùfhkbg9 dn|vd he e|dnbkòn emfthe|gvke {jgrpk|ehevke( dh rtfrdb|gv pùfhkbg |dníe dn 6??1 tn aer|g dr|kmelg ld Fr. 11<(1 mkhhgndr( mkdn|ver

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 80/110

 

:?

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

utd dh aer|g ldr|knelg e dr|er lgr ctnbkgndr dn he Rdatvklel Rgbkeh dve ld Fr. 5.5<3(6 mkhhgndr( epdrev ld utd dr|d rtfrdb|gv |dnae tne bgfdv|tve pgfhebkgneh mdngv eh rtfrdb|gv pùfhkbg.

Dn vdhebkòn eh aer|g ld pvdsdnbkòn { rehtl pùfhkbe( rd ng|e utd dh ldrdmpdõg ld dr|e ctnbkònldpdnld dn aven meank|tl ldh rtfrdb|gv pùfhkbg( utd jefvíe aer|elg dn dh eõg 6??1 Fr. 2:6(:mkhhgndr bgn|ve Fr. 5<;(6 mkhhgndr peve dh vdr|g ldh Rdb|gv Rehtl *btelvg <4+. Drg rkankckbe utd dhrtfrdb|gv pùfhkbg cknenbke dh 16$ ldh aer|g ldn|vg ld he ctnbkòn ld pvdsdnbkòn { rehtl pùfhkbe( dknbhtrksd cknenbke dh 5??$ ldh aer|g dn ehatner rtf-ctnbkgndr ld pvdsdnbkòn { rehtl pùfhkbe( bgmgnt|vkbkòn( knmtnkyebkgndr( pvdsdnbkòn ld bjeaer( pvdsdnbkòn ld ldnatd( pvdsdnbkòn lddncdvmdleldr ng |venrmkrkfhdr { mdlkbkne drbghev( dn|vd g|vgr.

Cknehmdn|d( ldn|vg ld her ctnbkgndr vdhebkgneler bgn he rehtl( dh me{gv aer|g bgvvdrpgnld ehrtfrdb|gv pùfhkbg *btelvg <4+( {e utd dr|d |kdnd tn aer|g ld knsdvrkòn *kncvedr|vtb|tve {dutkpemkdn|g+ mtbjg me{gv e hgr ldmår rdb|gvdr { utd dr dh ùnkbg rdb|gv utd didbt|e aer|g dn hertf-ctnbkòn ld knsdr|kaebkòn { ldrevvghhg *Fr. 6;(3 mkhhgndr peve he adr|kòn 6??1+.

Btelvg <4  ‒Aer|g dn sehgv ngmkneh pgv ctnbkòn { rtfrdb|gv( Fghkske( 6??1

Aer|g dn rehtl pgv ctnbkòn Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh

Rdb|gvDr|e|eh

Rdb|gvpvkselg

E|dnbkònemfthe|gvke

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

2<?(6

14(5$  

1;6(6

22(5$  

5.526(4

<2(<$  

<?1(5

-55(6$  

E|dnbkònjgrpk|ehevke

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

<2<(<

4<(5$  

24<(?

<?(4$  

1::(<

<1(1$  

3<(4

-55(6$  

E|dnbkòn ldhevae ltvebkòn

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

52(2

;:(:$  

?(?

-  

52(2

;:(:$  

?(?

-  

Rdvskbkgretzkhkevdr dn

rehtl

Aer|g 6??1

*Fr. mkhhgndr+*bvdbkmkdn|g.6??2-6??1+

;5(;<:(2$  

?(?-  

;5(;<:(2$  

?(?-  

_vgltb|gr( ù|khdr{ dutkpgr

mëlkbgr ctdveld hgr

dr|efhdbkmkdn|gr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

53(6

16(1$  

?(?

-  

53(6

16(1$  

5.?56(?

13(<$  

_vdsdnbkòn {rehtl pùfhkbe

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

2:6(:

25(2$  

:?(?

4(3$  

<36(:

63(?$  

3;(6

516(1$  

Vdb|gvíe {elmknkr|vebkòn

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

632(3

<:(6$  

;1(2

51(3$  

23?(;

2:(4$  

1(;

52?(<$  

Ctnbkgndrvdhebkgnelerbgn he rehtl

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g.6??2-6??1+

<3:(?

651(6$  

5?3(?

;<(:$  

41<(5

5:<(6$  

4(5

245(5$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 81/110

 KKK.3.2. Dr|kmebkòn ldh bgr|g pvgmdlkg pgv |kpg ld e|dnbkòn

E pev|kv ld he dr|kmebkòn ldh aer|g dn rehtl 6??1 pgv ctnbkòn behbthelg dn dh dr|tlkg ld btdn|er ldrehtl 6??2-6??1 *Sehlër { _dõehgye 6?5?+ { ld hgr le|gr ld pvgltbbkòn ld rdvskbkgr ldh Rkr|dmeNebkgneh ld Kncgvmebkòn dn rehtl( rd ptdld dr|kmev tn bgr|g pvgmdlkg pgv |kpg ld rdvskbkg ld rehtl*jgrpk|ehkyebkòn( e|dnbkòn emfthe|gvke( d|b.+. Ldfklg e me{gv bgnckefkhklel ld he kncgvmebkònlkrpgnkfhd( rd dr|kmevå dr|d aer|g pvgmdlkg rghemdn|d dn dh rtfrdb|gv pùfhkbg { dn he RdatvklelRgbkeh ld bgv|g pheyg *dr|e|eh { pvksele+. _gv g|ve pev|d( rd eavdaò aer|g ld ehatner ctnbkgndr ldhrtfrdb|gv pùfhkbg peve pgldv bgn|ev bgn le|gr bgmpevefhdr dn|vd emfgr rtfrdb|gvdr.

Ld ebtdvlg bgn dr|er dr|kmebkgndr fårkber *btelvg <3+( rd ptdld bgnr|e|ev utd dh aer|g dn rehtlpgv |kpg ld e|dnbkòn dr mtbjg me{gv dn he Rdatvklel Rgbkeh ld bgv|g pheyg utd dn dh rtfrdb|gvpùfhkbg9 erí( dh aer|g dn rehtl pvgmdlkg pgv bele jgrpk|ehkyebkòn dr ld Fr. 5.4:5 dn dh rdb|gvpùfhkbg( mkdn|ver utd dr ld Fr. 6.<<?(4 dn he Rdatvklel Rgbkeh0 tne pev|d ld he lkcdvdnbke rd ptdlddzphkbev pgv md|glghgaíe *rd btdn|e epgv|dr rgbkehdr ld hgr |vefeielgvdr dn he Rdatvklel Rgbkeh { ngdn dh rtfrdb|gv pùfhkbg+( pdvg rd dzphkbe rgfvd |glg pgv tne dr|vtb|tve ld bgr|g me{gv dn heRdatvklel Rgbkeh( ldfklg e bgfdv|tve ld pvdr|ebkgndr ng btfkdv|er dn dh rdb|gv pùfhkbg( e me{gvvdbtvrgr jtmengr pgv pebkdn|d { e tne me{gv dr|enbke jgrpk|ehevke pvgmdlkg pgv pebkdn|dkn|dvnelg *4(3 líer bgn|ve <(3 líer dn dh rtfrdb|gv pùfhkbg+. Dn bten|g eh aer|g pgv e|dnbkònemfthe|gvke( ld ebtdvlg bgn dr|er dr|kmebkgndr( rdvíe 2(4 sdbdr mår dhdselg dn he Rdatvklel

Rgbkeh utd dn dh rtfrdb|gv pùfhkbg *btelvg <3+( hg utd pglvíe dzphkbevrd pgv he dr|vtb|tve mt{drpdbkehkyele ld he e|dnbkòn emfthe|gvke dn he Rdatvklel Rgbkeh e |vesër ld hgr _ghkbhínkbgr(mkdn|ver utd pev|d rkankckbe|kse ld he e|dnbkòn dn dh rdb|gv pùfhkbg rd vdehkye dn ptdr|gr ld rehtl.

Btelvg <3  ‒ Aer|g dn sehgv ngmkneh pgv ctnbkòn { rtfrdb|gv( dn fghkskengr( Fghkske( 6??1

Aer|g dn rehtl pgv ctnbkòn Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh Rdb|gv Dr|e|eh

Aer|g pgve|dnbkòn

glgn|ghòakbe

N¹ ld e|dnbkgndr 

Aer|g *Fr.+

Aer|g pgve|dnbkòn

5.;21.45< 

:1.:;<.;66 

<4(< 

35;.<35

:1.;34.;12 

5<6(? 

6.443.;14 

514.:3?.:;4 

3:(: 

Aer|g pgve|dnbkòn

emfthe|gvke*ng glgn|ghòakbe+

N¹ ld e|dnbkgndr 

Aer|g *Fr.+

Aer|g pgve|dnbkòn

1.;34.?:5

2?3.425.31; 

2:(4 

4.643.;;5

1?<.643.2<6 

52<(? 

52.666.?16 

5.?5?.1::.?65

13(< 

Aer|g pgv davdrgjgrpk|ehevkg

N¹ ld davdrgr 

Aer|g *Fr.+

Aer|g pgvjgrpk|ehkyebkòn

251.22? 

4?5.3:1.;25

5.4:5(? 

5<4.?<3 

242.;::.<21 

6.<<?(4 

<36.213 

:44.313.23; 

5.:4?(3 

Aer|g pgv líe ldjgrpk|ehkyebkòn

N¹ líer bemer gbtp.

Aer|g *Fr.+

Aer|g pgv líe ldjgrpk|ehkyebkòn

5.225.6:4 

4?5.3:1.;25

213(: 

14;.4:3 

242.;::.<21 

<33(? 

6.?;?.:15

:44.313.23; 

<?;(6 

Aer|g pgv bemejgrpk|ehevke

N¹ ld bemer 

Aer|g *Fr.+

Aer|g pgv bemejgrpk|ehevke

;.<:5

4?5.3:1.;25

46.;53(: 

<.;36 

242.;::.<21 

15.2<6(3 

5<.<<2 

:44.313.23; 

4;.6<1(5 

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?( RNKR 6??:  

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 82/110

 

:6

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

KKK.1. Enåhkrkr ldh Aer|g dn rehtl rdaùn pvgsddlgv ld rdvskbkgr 

KKK.1.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn pvgsddlgv

Her dr|kmebkgndr ld aer|g pgv pvgsddlgv pvgskdndn dzbhtrksemdn|d ldh pvkmdv dr|tlkg * Sehlër {

_dõehgye 6?5?+ {e utd ng dzkr|d dr|e me|vky dn dh rdatnlg dr|tlkg. Dh sehgv ldh aer|g |g|eh ngbgvvdrpgnld dn|gnbdr e hgr mgn|gr enehkyelgr dn hgr ebåpk|dr en|dvkgvdr( { rk fkdn rd pvdrdn|en hgrmgn|gr dr|kmelgr ld aer|g pgv pvgsddlgv( dr|gr rghg |kdndn tn sehgv knlkbe|ksg9 dh bdn|vg ldhenåhkrkr ld hgr mgn|gr ld aer|g pgv pvgsddlgv rgn her |erer ld bvdbkmkdn|g { he dr|vtb|tvepgvbdn|teh. Dh aer|g pgv pvgsddlgv mkld utë pvgltb|gv ld fkdndr { rdvskbkgr( pvkmevkg g rdbtnlevkg(vdehkyò dh aer|g dn rehtl( ldn|vg ldh bteh rd ptdldn vdehkyev sevker ctnbkgndr9 pgv didmphg( dhpvgsddlgv jgrpk|ehdr knbht{d e|dnbkòn emfthe|gvke( jgrpk|ehevke( rdvskbkgr etzkhkevdr( d|b.

Rdaùn he bherkckbebkòn t|khkyele dn dh pvkmdv dr|tlkg ld btdn|er ld rehtl 6??2-6??1 *Sehlër { _dõehgye6?5?+( her lkcdvdn|dr be|dagvíer eavdaeler knbht{dn e hgr rkatkdn|dr pvgsddlgvdr9

  Jgrpk|ehdr9 rgn dr|efhdbkmkdn|gr bgn hkbdnbke utd |kdndn bgmg eb|ksklel pvknbkpeh he pvgskrkònld rdvskbkgr mëlkbgr( lkeanòr|kbgr( |ve|emkdn|gr { ld ehfdvatd peve pebkdn|dr jgrpk|ehkyelgr.\emfkën ptdldn gcvdbdv rdvskbkgr emfthe|gvkgr bgmg eb|ksklel rdbtnlevke. Knbht{dn hgr

jgrpk|ehdr fårkbgr *utd gcvdbdn kn|dvnebkòn jgrpk|ehevke dn drpdbkehkleldr fårkber+0 jgrpk|ehdradndvehdr *utd gcvdbdn rdvskbkgr rtf drpdbkehkyelgr { ld eh|e |dbnghgaíe { bgmphdiklel+0jgrpk|ehdr ld rehtl mdn|eh { elkbbkgndr { jgrpk|ehdr drpdbkehkyelgr *dnbevaelgr ld pvgsddv|ve|emkdn|g e pebkdn|dr jgrpk|ehkyelgr bgn dncdvmdleldr g bgnlkbkgndr mëlkber drpdbíckberutd ng dn|ven dn he be|dagvíe ld rehtl mdn|eh g eftrg ld rtr|enbker+.

  Dr|efhdbkmkdn|gr ld e|dnbkòn mdlkbehkyele { vdrkldnbkeh9 rgn dr|efhdbkmkdn|gr utd g|gvaene|dnbkgndr vdrkldnbkehdr bgmfknelgr bgn e|dnbkgndr dn rehtl( pvknbkpehmdn|d ld dncdvmdvíe(rtpdvskrkòn t g|vgr vdutdvklgr pgv rtr vdrkldn|dr. Knbht{dn bdn|vgr ld e|dnbkòn vdrkldnbkeh pevevd|verg mdn|eh( rehtl mdn|eh { elkbbkgndr { e|dnbkòn vdrkldnbkeh e he |dvbdve dlel.

  _vgsddlgvdr ld e|dnbkòn emfthe|gvke9 rgn dr|efhdbkmkdn|gr utd gcvdbdn rdvskbkgr ld rehtllkvdb|emdn|d e pebkdn|dr emfthe|gvkgr utd ng vdutkdvdn jgrpk|ehkyebkòn. Knbht{dn e hgr ptdr|grld rehtl( bdn|vgr ld rehtl( pghkbhínkbgr( bgnrth|gvkgr mëlkbgr( tnkleldr mòskhdr ld e|dnbkòn

emfthe|gvke( hefgve|gvkgr mëlkbgr { ld lkeanòr|kbg *knbht{dnlg bdn|vgr ld kmeadnghgaíe+ {g|vgr pvgsddlgvdr ld e|dnbkòn emfthe|gvke *utd knbht{dn emfthenbke( fenbgr ld renavd {òvaengr( pvgcdrkgnehdr ld mdlkbkne |velkbkgneh dn dr|efhdbkmkdn|gr( tnkleldr nt|vkbkgnehdr+.

  Mkngvkr|er { g|vgr pvgsddlgvdr ld pvgltb|gr mëlkbgr9 rd ldlkben pvknbkpehmdn|d e he sdn|e { ehld|ehhd ld pvgltb|gr mëlkbgr eh pùfhkbg dn adndveh peve t|khkyebkòn knlksklteh g lgmkbkhkevkg.Knbht{d he BDERR( Cevmebker Knr|k|tbkgnehdr Mtnkbkpehdr { fg|kutkndr mtnkbkpehdr( dn|vd g|vgr.

  Rtmknkr|vg { elmknkr|vebkòn ld pvgavemer ld rehtl pùfhkbe9 bgmpvdnld he elmknkr|vebkòn {pvgskrkòn ld pvgavemer { pvg{db|gr ld rehtl pùfhkbe( |ehdr bgmg pvgmgbkòn( pvdsdnbkòn {pvg|dbbkòn ld he rehtl *_vgavemer ld skakhenbke { bgn|vgh ld dncdvmdleldr( dn|vd g|vgr+.

  Elmknkr|vebkòn adndveh ld he rehtl9 dr|efhdbkmkdn|gr utd rd ldlkben pvknbkpehmdn|d e hevdathebkòn ld her eb|kskleldr ld her eadnbker utd pvgpgvbkgnen e|dnbkòn e he rehtl *Mknkr|dvkgld Rehtl { Ldpgv|dr( KNERDR( RDLDR( elmknkr|vebkgndr pvkseler( d|b.+.

  Her ldmår vemer ld eb|ksklel9 bgmpvdnld e hgr jgaevdr bgmg pvgsddlgvdr ld e|dnbkònemfthe|gvke( dh bteh dr ld|dvmknelg pgv her dnbtdr|er ld jgaevdr.

  Knr|k|tbkgndr pvgsddlgver ld rdvskbkgr vdhebkgnelgr bgn rehtl9 rgn Knr|k|tbkgndr ldKnsdr|kaebkòn *bgmg pgv didmphg dh Knr|k|t|g ld Adnë|kbe Jtmene { dh Knr|k|t|g Fghkskeng ld heEh|tve+ Knr|k|tbkgndr ld dltbebkòn { bepebk|ebkòn *bgmg her Drbtdher ld Rehtl+.

  _vgsddlgvdr ld |kpg ng drpdbkckbelg9 pvgsddlgvdr ld rehtl utd ng rd ptdldn bherkckbev dn hedr|vtb|tve ldrbvk|e en|dvkgvmdn|d( adndvehmdn|d pgv ceh|e ld kncgvmebkòn.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 83/110

 Ld ebtdvlg bgn he dr|vtb|tve ld aer|g 6??1 pgv pvgsddlgv behbthelg peve dh pvdrdn|d enåhkrkr epev|kv ld her dr|kmebkgndr ldh pvkmdv dr|tlkg ld btdn|er ld rehtl 6??2-6??1 *Sehlër { _dõehgye 6?5?+(hgr jgrpk|ehdr rgn dh pvgsddlgv utd |kdnd me{gv aer|g( {e utd vdpvdrdn|e dh 25(5$ ldh aer|g |g|eh dnrehtl *ld hgr btehdr dh <4(4$ bgvvdrpgnldn e jgrpk|ehdr adndvehdr( 26(2$ e jgrpk|ehdr fårkbgr(5;(6$ e jgrpk|ehdr drpdbkehkyelgr { 2$ e jgrpk|ehdr ld rehtl mdn|eh { elkbbkgndr+. Dn |g|ehklel( hgr24 jgrpk|ehdr adndvehdr ldh peír *5? pùfhkbgr( 54 ld he rdatvklel rgbkeh( 5? pvkselgr+ bgnbdn|vevgndn dh eõg 6??1 dh 5<(6$ ldh aer|g |g|eh dn rehtl.

Hgr pvgsddlgvdr ld e|dnbkòn emfthe|gvke bgnr|k|t{dn he rdatnle be|dagvíe ld pvgsddlgvdr bgnme{gv aer|g( vdpvdrdn|enlg dh 64(1$ ldh aer|g |g|eh dn rehtl ldh eõg 6??1 *khtr|vebkòn 2<+. Lddr|gr( dh me{gv aer|g bgvvdrpgnld e pghkbhínkbgr *<<(1$ ldh aer|g ldn|vg ld hgr pvgsddlgvdr lde|dnbkòn emfthe|gvke+( rdatklgr pgv hgr bdn|vgr ld rehtl *2?(<$+ { hgr ptdr|gr ld rehtl *53(:$+.

Khtr|vebkòn 2<  ‒ Dr|vtb|tve ld Aer|g dn rehtl rdaùn pvgsddlgv( Fghkske( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

_gv rt kmpgv|enbke dn dh aer|g |g|eh dn rehtl( hgr mkngvkr|er { g|vgr pvgsddlgvdr ld pvgltb|grmëlkbgr *pvknbkpehmdn|d cevmebker+ bgnr|k|t{dn he |dvbdve be|dagvíe ld pvgsddlgv( avebker ehcknenbkemkdn|g ld hgr jgaevdr( vdpvdrdn|enlg dh 6?(6$ ldh aer|g |g|eh dn rehtl peve dh eõg 6??1. Dhbtev|g pvgsddlgv mår kmpgv|en|d rgn hgr pvgsddlgvdr ld rtmknkr|vg { elmknkr|vebkòn ld pvgavemerld rehtl pùfhkbe( utd vdpvdrdn|en dh :(5$ ldh aer|g |g|eh dn rehtl( rdatklgr pgv eherelmknkr|vebkgndr adndvehdr ld he rehtl *4(2$ ldh aer|g |g|eh dn rehtl+ { her ldmår vemer ldeb|ksklel *4(4$+. \emfkën dzkr|d 4(4$ ldh aer|g |g|eh dn rehtl utd ng rd ptlg bherkckbev(pvknbkpehmdn|d pvgsdnkdn|d ld hgr rdatvgr pvkselgr { ld he rdatvklel rgbkeh *khtr|vebkòn 2<+.

Jgrpk|ehdr 

25(5$

6?(6$Mkngvkr|er { g|vgr

pvgsddlgvdr ldpvgltb|gr mëlkbgr

_vgsddlgvdrld e|dnbkònemfthe|gvke

64(1$

Elmknkr|vebkòn adndveh ld he rehtl 

:(5$

Rtmknkr|vg {elmknkr|vebkòn

ld pvgavemerld rehtl pùfhkbe

_vgsddlgv ng drpdbkckbelg

4(4$

Dr|efhdbkmkdn|gr ld e|dnbkòn

mdlkbehkyele { vdrkldnbkeh ?(6$

Her ldmårvemer ldeb|ksklel

Knr|k|tbkgndrpvgsddlgver ld

rdvskbkgr vdhebkgnelgr

bgn rehtl ?(2$

4(2$ 

2(4$ 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 84/110

 

:<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Enehkyenlg he dr|vtb|tve ld aer|g pgv pvgsddlgv ld hgr eõgr en|dvkgvdr( rd bgnr|e|e utd hevdpev|kbkòn ldh aer|g dn rehtl dn|vd hgr lkcdvdn|dr |kpgr ld pvgsddlgvdr rd men|tsg dr|efhd dn dhpdvkglg 6??2-6??1 *btelvg <1+. Dh me{gv bemfkg gfrdvselg bgnbkdvnd tn knbvdmdn|g ld hepvgpgvbkòn ld aer|g vdehkyelg dn mkngvkr|er { g|vgr pvgsddlgvdr ld pvgltb|gr mëlkbgr9 dr|dvdpvdrdn|efe dh 53(4$ ldh aer|g |g|eh dn rehtl dn dh eõg 6??2 { 54(5$ dn dh eõg 6??< peveknbvdmdn|evrd pvgavdrksemdn|d jer|e vdpvdrdn|ev dh 6?(6$ ldh aer|g |g|eh dn dh eõg 6??1.

_gv g|ve pev|d( rd gfrdvsò tne lkrmkntbkòn ld he pvgpgvbkòn ld aer|g dn rehtl vdehkyelg ldn|vg ldhgr jgaevdr *‘her ldmår vemer ld eb|ksklel”+ { ldn|vg ld hgr jgrpk|ehdr9 mkdn|ver utd dn dh eõg6??<( hgr jgrpk|ehdr didbt|efen tn |dvbkg ldh aer|g |g|eh dn rehtl( dr|e pvgpgvbkòn lkrmknt{ò e pev|kvldh eõg 6??4( vdpvdrdn|enlg dh 25(<$ ldh aer|g |g|eh dn rehtl( pvgpgvbkòn utd rd men|tsg dn hgreõgr rkatkdn|dr *btelvg <1+. Dr|e feie rd ldfd e tne lkrmkntbkòn ld he pvgpgvbkòn ldh aer|g |g|ehvdehkyelg dn jgrpk|ehdr ld |dvbdv nksdh *adndvehdr { drpdbkehkyelgr+( utd perg ld 66(2$ ldh aer|g|g|eh dn rehtl dn dh eõg 6??< e 6?(5$ dn dh eõg 6??1.

Btelvg <1  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn pvgsddlgv( Fghkske( 6??2-?1

\kpg ld pvgsddlgv 6??2 6??< 6??4 6??3 6??1

Jgrpk|ehdr 26(6$ 22(6$ 25(<$ 25(3$ 25(5$

Dr|efhdbkmkdn|gr ld e|dnbkònmdlkbehkyele { vdrkldnbkeh ?(5$ ?(5$ ?(5$ ?(5$ ?(6$

_vgsddlgvdr ld e|dnbkòn emfthe|gvke 63(6$ 64(<$ 64(?$ 64(2$ 64(1$

Mkngvkr|er { g|vgr pvgsddlgvdr ldpvgltb|gr mëlkbgr 53(4$ 54(5$ 5:(4$ 5;(?$ 6?(6$

Rtmknkr|vg { elmknkr|vebkòn ldpvgavemer ld rehtl pùfhkbe 1(<$ :(:$ ;(:$ :(2$ :(5$

Elmknkr|vebkòn adndveh ld he rehtl 4(1$ 3(5$ 4(1$ 3(;$ 4(2$

Her ldmår vemer ld eb|ksklel 4(;$ 4(4$ 2(1$ 6(;$ 2(4$

Knr|k|tbkgndr pvgsddlgver ld rdvskbkgrvdhebkgnelgr bgn rehtl ?(<$ ?(4$ ?(2$ ?(5$ ?(2$

Aer|g ld pvgsddlgvdr ld |kpg ngdrpdbkckbelg 4(1$ 4(<$ 4(4$ 4(;$ 4(4$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Bgmpevenlg he dr|vtb|tve ld aer|g pgv pvgsddlgv ld hgr lkcdvdn|dr rtfrdb|gvdr *btelvg <:+( rdptdld bgnr|e|ev utd dzkr|dn lkcdvdnbker avenldr9 mkdn|ver utd dh rtfrdb|gv pùfhkbg lkvkad rt aer|g esevkgr pvgsddlgvdr ldfklg e he phtvehklel ld rtr mkrkgndr( dh drdnbkeh ldh aer|g ldh rtfrdb|gv ld heRdatvklel Rgbkeh rd lkvkad e jgrpk|ehdr *<1(:$+ { e pvgsddlgvdr ld e|dnbkòn emfthe|gvke *<6(2$+._gv g|ve pev|d( dh rtfrdb|gv ld he rdatvklel rgbkeh lkvkad tne pev|d mår kmpgv|en|d ld rt aer|g epvgsddlgvdr ld e|dnbkòn emfthe|gvke utd dn dh rtfrdb|gv pùfhkbg( peve dh bteh rghemdn|d dh 6;(2$ldh aer|g bgvvdrpgnld eh pvkmdv nksdh ld e|dnbkòn *btelvg <:+.

Dn|vd dh rtfrdb|gv pùfhkbg { he Rdatvklel Rgbkeh( dzkr|dn dn|gnbdr rkmkhk|tldr dn he pvgpgvbkòn mt{eh|e ldh aer|g utd rd lkvkad e jgrpk|ehdr( { |emfkën dn dh jdbjg ld lkvkakv tne pvgpgvbkòn kmpgv|en|dld rt aer|g e pvgsddlgvdr ld e|dnbkòn emfthe|gvke( etnutd bgn me{gv meank|tl dn he RdatvklelRgbkeh ld bgv|g pheyg. Rkn dmfevag( rk rd gfrdvse mår e ld|ehhd he lkr|vkftbkòn ldh aer|g pgv |kpg lddr|efhdbkmkdn|g( dzkr|dn avenldr lkcdvdnbker *khtr|vebkòn 24+9 erí( he dr|vtb|tve ld aer|g dn rehtl ldhe Rdatvklel Rgbkeh dr mt{ rkmphd { rd fere drdnbkehmdn|d dn hgr pghkbhínkbgr dn dh pvkmdv nksdh lde|dnbkòn { dn hgr jgrpk|ehdr adndvehdr bgmg vdcdvdnbke( mkdn|ver utd dn dh rtfrdb|gv pùfhkbg( hedr|vtb|tve dr mår jgmgaënde( dn|vd bdn|vgr ld rehtl( jgrpk|ehdr fårkbgr( adndvehdr( d|b.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 85/110

 Btelvg <:  ‒ Dr|vtb|tve ld aer|g dn rehtl pgv pvgsddlgv { rtfrdb|gv( Fghkske( 6??1

\kpg ld pvgsddlgv Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh

Rdb|gvDr|e|eh

Rdb|gvpvkselg

Jgrpk|ehdr <?(?$ <1(:$  <2(2$ 1(3$

Dr|efhdbkmkdn|gr ld e|dnbkòn

mdlkbehkyele { vdrkldnbkeh

?(4$ ?(?$  ?(2$ ?(?$

_vgsddlgvdr ld e|dnbkòn emfthe|gvke 6;(2$ <6(2$  2<(1$ :(<$

Mkngvkr|er { g|vgr pvgsddlgvdr ldpvgltb|gr mëlkbgr 6(4$ ?(?$  5(<$ 43(4$

Rtmknkr|vg { elmknkr|vebkòn ldpvgavemer ld rehtl pùfhkbe 51(<$ ?(?$  5?(5$ <(?$

Elmknkr|vebkòn adndveh ld he rehtl :(?$ 1(4$  1(:$ ?(3$

Her ldmår vemer ld eb|ksklel ?(?$ ?(?$  ?(?$ 5?(2$

Knr|k|tbkgndr pvgsddlgver ld rdvskbkgrvdhebkgnelgr bgn rehtl ?(;$ ?(?$  ?(4$ ?(?$

Aer|g ld pvgsddlgvdr ld |kpg ng

drpdbkckbelg

5(2$ 6(4$  5(:$ 56(3$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Khtr|vebkòn 24  ‒ Aer|g dn rehtl pgv |kpg ld dr|efhdbkmkdn|g dn $ ldh aer|g |g|ehdn rehtl dn hgr rtfrdb|gvdr pùfhkbg { ld he Rdatvklel Rgbkeh( Fghkske( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?( KND 6??4  

Jgrpk|ehdr _vgsddlgvdr ld e|dnbkòn emfthe|gvke

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 86/110

 

:3

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Erí( dn dh rtfrdb|gv pùfhkbg( dh aer|g dn jgrpk|ehdr rd vdpev|d dn|vd jgrpk|ehdr fårkbgr( adndvehdr {drpdbkehkyelgr *vdpvdrdn|enlg vdrpdb|ksemdn|d 51(2$( 5?(<$ { 55(1$ ldh aer|g pùfhkbg |g|eh+( dhaer|g jgrpk|ehevkg ld he Rdatvklel Rgbkeh ld bgv|g pheyg rd lkvkad berk dzbhtrksemdn|d e jgrpk|ehdradndvehdr *khtr|vebkòn 24+. Her lkcdvdnbker ld dr|vtb|tve ld aer|g rdaùn |kpg ld dr|efhdbkmkdn|gdn|vd dh rtfrdb|gv pùfhkbg { he Rdatvklel Rgbkeh |emfkën rgn avenldr ldn|vg ldh pvkmdv nksdh lde|dnbkòn9 mkdn|ver utd he berk-|g|ehklel ldh aer|g ld he Rdatvklel Rgbkeh dn dh pvkmdv nksdh rd lkvkade hgr _ghkbhínkbgr( jer|e vdpvdrdn|ev dh 2;(6$ ldh aer|g |g|eh dn rehtl ld he Rdatvklel Rgbkeh( dr|d|kpg ld dr|efhdbkmkdn|g( bgn bgnrth|gvkgr ld drpdbkehkleldr( dr berk kndzkr|dn|d dn dh rtfrdb|gvpùfhkbg( dn dh bteh rd knskdv|d pvknbkpehmdn|d dn bdn|vgr ld rehtl( utd vdpvdrdn|en dh 51(6$ ldhaer|g dn rehtl |g|eh ldh rtfrdb|gv pùfhkbg *khtr|vebkòn 24+.

Cknehmdn|d( vdrpdb|g eh rdb|gv pvkselg( he me{gv pev|d ldh aer|g rd lkvkad e he be|dagvíe ldpvgsddlgv ‘mkngvkr|er { g|vgr pvgsddlgvdr ld pvgltb|gr mëlkbgr” ldfklg eh kmpgv|en|d aer|g ldfghrkhhg peaelg pgv hgr jgaevdr dn cevmebker. Dn pvgpgvbkòn( dh aer|g pvkselg dn jgrpk|ehdr { dnpvgsddlgvdr ld e|dnbkòn emfthe|gvke dr dn|gnbdr vdhe|ksemdn|d feig( vdpvdrdn|enlgvdrpdb|ksemdn|d 1(3$ { :(<$ ldh aer|g pvkselg |g|eh peve he adr|kòn 6??1 *btelvg <:+.

KKK.1.6. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn pvgsddlgvDh aer|g dn rehtl dn sehgv ngmkneh rdaùn |kpg ld pvgsddlgv mtdr|ve jd|dvgadndklel( bgn |erer ldknbvdmdn|g 6??2-6??1 mt{ lkcdvdn|dr rdaùn pvgsddlgv *btelvg <;+9 dh aer|g vdehkyelg ldn|vg ld hgrjgaevdr *her ‘ldmår vemer ld eb|ksklel”+( dr|kmelg e pev|kv ld her Dnbtdr|er ld Jgaevdr ldh KND(dr dh ùnkbg utd mtdr|ve tn ldrbdnrg dn|vd 6??2 { 6??1 *-55(6$+ ldfklg e tne lkrmkntbkòn ld dr|daer|g dn hgr eõgr 6??4 { 6??3. Hgr lgr pvgsddlgvdr rkatkdn|dr bgn mdngr bvdbkmkdn|g dn dhpdvkglg 6??2-6??1 rgn her knr|k|tbkgndr ld elmknkr|vebkòn adndveh ld he rehtl { her knr|k|tbkgndrpvgsddlgver ld rdvskbkgr vdhebkgnelgr bgn rehtl( bgn tn bvdbkmkdn|g dn|vd hgr eõgr 6??2 { 6??1 ld2:(<$ { 2;(3$ vdrpdb|ksemdn|d.

Dn cgvme gptdr|e( dh |kpg ld pvgsddlgv utd |tsg me{gv knbvdmdn|g ld rt aer|g ctdvgn hgrdr|efhdbkmkdn|gr ld e|dnbkòn mdlkbehkyele { vdrkldnbkeh * 65<(:$ dn|vd 6??2 { 6??1+0 rkndmfevag( dr|d pvgsddlgv vdpvdrdn|e tne pvgpgvbkòn mt{ feie ldh aer|g |g|eh dn rehtl( bgn tn aer|gdr|kmelg peve dh eõg 6??1 ld rghemdn|d Fr. 55(5 mkhhgndr *btelvg <;+( etnutd dr|d drpvgfefhdmdn|d rtfdr|kmelg ldfklg e he etrdnbke ld kncgvmebkòn ldh rdb|gv pvkselg. Dh rdatnlgpvgsddlgv bgn me{gv knbvdmdn|g ld aer|g dn rehtl dn|vd 6??2 { 6??1 ctdvgn hgr mkngvkr|er { g|vgrpvgsddlgvdr ld pvgltb|gr mëlkbgr( bgn tne |ere ld bvdbkmkdn|g ld :6(4$( perenlg ld tn aer|g ldFr. 4:6 mkhhgndr dn dh eõg 6??2 e Fr. 5.?36 mkhhgndr dn dh eõg 6??1.

Dn bten|g e mgn|gr aer|elgr( hgr jgrpk|ehdr bgnr|k|t{dn dh |kpg ld pvgsddlgv bgn me{gv aer|g dnrehtl9 rd dr|kmò dn dh pvkmdv dr|tlkg ld btdn|er ld rehtl * Sehlër { _dõehgye 6?5?+ utd dr|dvdpvdrdn|evíe Fr. 5.326(1 mkhhgndr dn dh eõg 6??1 *btelvg <;+( vdpev|klg dn|vd jgrpk|ehdr adndvehdr*Fr. 1<2(2 mkhhgndr+( jgrpk|ehdr fårkbgr *Fr. 461(2 mkhhgndr+( jgrpk|ehdr drpdbkehkyelgr *Fr. 252(4mkhhgndr+ { jgrpk|ehdr ld rehtl mdn|eh { elkbbkgndr *Fr. <:(3 mkhhgndr+. Dh aer|g dn pvgsddlgvdr lde|dnbkòn emfthe|gvke rkdmpvd ctd mdngv eh aer|g dn jgrpk|ehdr( ldmgr|venlg he lëfkh pvkgvkyebkòn ldhe e|dnbkòn pvkmevke dn dh rdb|gv rehtl fghkskeng9 dr|gr |dníen dn dh 6??1 tn aer|g dr|kmelg ld 5.246

mkhhgndr ld fghkskengr *btelvg <:+( vdpev|klg dn|vd pghkbhínkbgr *Fr. 3?<(5 mkhhgndr+( bdn|vgr ld rehtl*Fr. <5?(: mkhhgndr+( ptdr|gr ld rehtl *Fr. 663(4 mkhhgndr+( bgnrth|gvkgr mëlkbgr *Fr. 22(1mkhhgndr+( tnkleldr mòskhdr ld e|dnbkòn emfthe|gvke *Fr. 61(< mkhhgndr+( ldn|vg ld hgr pvknbkpehdr.

Dr|gr lgr pvknbkpehdr |kpgr ld pvgsddlgvdr( jgrpk|ehdr { pvgsddlgvdr ld e|dnbkòn emfthe|gvke(|tskdvgn tn bvdbkmkdn|g enteh pvgmdlkg ld rt aer|g ngmkneh ld ;(4$ { 5?$ vdrpdb|ksemdn|d(ldmgr|venlg tn knbvdmdn|g enteh vdhe|ksemdn|d vdathev( mdngr peve dh eõg 6??4( utd rd itr|kckbepgv dh knbvdmdn|g ld pvdbkgr { dh knbvdmdn|g vdathev ld her e|dnbkgndr dn rehtl.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 87/110

 Btelvg <;  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv |kpg ld pvgsddlgv( Fghkske( 6??2-?1

Aer|g dn rehtl pgv|kpg ld pvgsddlgv

6??2 6??< 6??4 6??3 6??1

Jgrpk|ehdr

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+

5.52;(5

-  

-  

5.25?(6

54(?$  

54(?$  

5.22:(<

6(6$  

51(4$  

5.<:;(6

55(2$  

2?(1$  

5.326(1

;(3$  

<2(2$  

Dr|efhdbkmkdn|grld e|dnbkòn

mdlkbehkyele {vdrkldnbkeh

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

2(4

-  

-  

<(5

51(:$  

51(:$  

2(4

-5<(<$  

?(;$  

1(5

;;(<$  

5?5(5$  

55(5

43(4$  

65<(:$  

_vgsddlgvdr lde|dnbkòn

emfthe|gvke

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

;64(?

-  

-  

5.??2(:

:(4$  

:(4$  

5.?33(4

3(6$  

54(2$  

5.5;?(;

55(1$  

6:(1$  

5.246(?

52(4$  

<3(6$  

Mkngvkr|er { g|vgrpvgsddlgvdr ldpvgltb|grmëlkbgr

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

4:6(?-  

-  

4;4(56(2$  

6(2$  

1;?(626(:$  

24(:$  

:;3(152(4$  

4<(5$  

5.?36(?5:(<$  

:6(4$  

Rtmknkr|vg {elmknkr|vebkònld pvgavemer

ld rehtl pùfhkbe

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

63?(<

-  

-  

2<:(<

22(:$  

22(:$  

<5:(;

6?(6$  

3?(;$  

2;?(;

-3(1$  

4?(5$  

<62(?

:(6$  

36(<$  

Elmknkr|vebkònadndveh ld he

rehtl

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+ 

6?6(2

-  

-  

6<?(2

5:(:$  

5:(:$  

6<6(4

?(;$  

5;(;$  

26<(2

22(1$  

3?(2$  

61;(;

-52(1$  

2:(<$  

Her ldmårvemer ldeb|ksklel

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+

6?:(3

-  

653(5

2(3$ 

2(3$  

543(;

-61(<$ 

-6<(:$  

52<(<

-5<(<$ 

-24(3$  

5:4(2

21(;$ 

-55(6$  

Knr|k|tbkgndrpvgsddlgver ld

rdvskbkgrvdhebkgnelgr

bgn rehtl

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkmkdn|g ebtmthelg+

56(<

-  

-  

6?(<

3<(4$  

3<(4$  

56(2

-2;(3$  

-?(1$  

<(6

-34(1$  

-34(;$  

51(2

2?;(1$  

2;(3$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Dr|tlkenlg dh aer|g dn sehgv ngmkneh pgv rtfrdb|gv { rt dsghtbkòn *btelvg 4?+( rd ptdld ldr|ebevutd dr dn dh rdb|gv pùfhkbg utd rd gfrdvse dh me{gv knbvdmdn|g ldh aer|g ldr|knelg e hgrjgrpk|ehdr( bgn tne |ere ld bvdbkmkdn|g ld 1?(<$ dn|vd hgr eõgr 6??2 { 6??1( ld |eh mendve utd dhaer|g dn jgrpk|ehdr ldh rdb|gv pùfhkbg( utd dn dh eõg 6??2 dve kncdvkgv eh ld he Rdatvklel Rgbkeh*Fr. <12(2 mkhhgndr bgn|ve Fr. 456(< mkhhgndr dn he Rdatvklel Rgbkeh+ rd knbvdmdn|ò dn rtckbkdn|dmeank|tl peve utd e pev|kv ldh eõg 6??3( dr|d dn rtpdvd dh aer|g jgrpk|ehevkg ld he Rdatvklel Rgbkehld bgv|g pheyg9 dn dh eõg 6??1( dh aer|g dn hgr 555 Jgrpk|ehdr ldh Rdb|gv pùfhkbg * MR{L 6??1+ dve ld

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 88/110

 

::

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Fr. :?3(3 mkhhgndr( mkdn|ver utd dn hgr jgrpk|ehdr { bhínkber ldh rtfrdb|gv ld he Rdatvklel Rgbkehdr|e|eh { pvksele( utd rtmefen 552 dr|efhdbkmkdn|gr dn dh eõg 6??3 * KNERDR 6??1+( dh aer|g dn rehtl6??1 dve ld Fr. 3:;(: mkhhgndr( dr ldbkv kncdvkgv ld 553(: mkhhgndr ld fghkskengr eh aer|g dnjgrpk|ehdr ldh rtfrdb|gv pùfhkbg( e pdrev ld utd emfgr rtfrdb|gvdr pvdrdn|en epvgzkmelemdn|d dhmkrmg nùmdvg ld dr|efhdbkmkdn|gr jgrpk|ehevkgr ld ebtdvlg bgn le|gr ldh RNKR peve dh rtfrdb|gvpùfhkbg { ldh KNERDR peve dh rtfrdb|gv ld he Rdatvklel Rgbkeh.

Dn bten|g eh aer|g dn pvgsddlgvdr ld e|dnbkòn emfthe|gvke( |emfkën dr dh rtfrdb|gv pùfhkbg utdmtdr|ve he me{gv |ere ld bvdbkmkdn|g *::(:$ dn|vd hgr eõgr 6??2 { 6??1+( perenlg ld tn aer|gdr|kmelg ld Fr. 252(2 mkhhgndr dn dh eõg 6??2 e Fr. 4;5(< mkhhgndr dn dh eõg 6??1. Dn bemfkg( dhaer|g dn e|dnbkòn emfthe|gvke dn he Rdatvklel Rgbkeh rd knbvdmdn|ò ld rghemdn|d 21(;$ ltven|d dhmkrmg pdvkglg( pdvg dr|d rkatd rkdnlg dn 6??1 me{gv eh aer|g pùfhkbg( ldfklg pvknbkpehmdn|d eh eh|gaer|g ld her knr|k|tbkgndr ld rdatvklel rgbkeh dn hgr pghkbhínkbgr9 mkdn|ver utd dn dh eõg 6??1 dhaer|g pùfhkbg dr|kmelg dn pvgsddlgvdr ld e|dnbkòn emfthe|gvke dve ld Fr. 4;5(< mkhhgndr( dh aer|gld he rdatvklel rgbkeh dn dr|d |kpg ld pvgsddlgvdr dve ld Fr. 35?(4 mkhhgndr *btelvg 4?+.

Btelvg 4?  ‒ Aer|g dn sehgv ngmkneh pgv |kpg ld pvgsddlgv { rtfrdb|gv( Fghkske( 6??1

Aer|g dn rehtl pgv|kpg ld pvgsddlgv

Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh

Rdb|gvDr|e|eh

Rdb|gvpvkselg

Jgrpk|ehdrAer|g 6??1

*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

:?3(3

1?(<$  

3:;(:

2<(3$  

5.<;3(4

45(:$  

523(6

-55(6$  

Dr|efhdbkmkdn|grld e|dnbkòn

mdlkbehkyele {vdrkldnbkeh

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

55(5

65<(:$  

?(?

-  

55(5

65<(:$  

?(?

-  

_vgsddlgvdr lde|dnbkòn

emfthe|gvke

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

4;5(<

::(:$  

35?(4

21(;$  

5.6?5(;

4;(?$  

54?(5

-55(6$  

Mkngvkr|er { g|vgr

pvgsddlgvdr ldpvgltb|grmëlkbgr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

4?(?

4?5(2$  

?(?

-  

4?(?

4?5(2$  

5.?56(?

13(<$  

Rtmknkr|vg {elmknkr|vebkònld pvgavemer

ld rehtl pùfhkbe

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

24?(;

<;(<$  

?(?

-  

24?(;

<;(<$  

16(5

5:6(:$  

Elmknkr|vebkònadndveh ld he

rehtl

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

536(?

6;(1$  

5?1(;

<3(?$  

63;(;

24(1$  

5?(5

5;5(1$  

Her ldmårvemer ld

eb|ksklel

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

?(?

-  

?(?

-  

?(?

-  

5:4(2

-55(6$  Knr|k|tbkgndr

pvgsddlgver ldrdvskbkgr

vdhebkgnelgrbgn rehtl

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

51(6

45(5$  

?(?

-  

51(6

45(5$  

?(5

-::(<$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?  

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 89/110

 Enehkyenlg mår e ld|ehhd he lkr|vkftbkòn ldh aer|g pgv |kpg ld dr|efhdbkmkdn|g dn dh rtfrdb|gv pùfhkbg{ dn he Rdatvklel Rgbkeh ld bgv|g pheyg( dzkr|dn lkcdvdnbker kmpgv|en|dr *btelvg 45+9 mkdn|ver utddn he Rdatvklel Rgbkeh dh aer|g dn jgrpk|ehdr dr|å lkvkaklg berk dzbhtrksemdn|d e jgrpk|ehdradndvehdr( bgn tn aer|g 6??1 dr|kmelg ld Fr. 422(< mkhhgndr *bgn|ve Fr. 13(3 mkhhgndr pevejgrpk|ehdr ld rdatnlg nksdh+( dh rtfrdb|gv pùfhkbg |kdnd tn aer|g mår kmpgv|en|d dn jgrpk|ehdrfårkbgr { drpdbkehkyelgr( mkdn|ver utd dh aer|g dn jgrpk|ehdr adndvehdr vdpvdrdn|e Fr. 6?;(;mkhhgndr( dr ldbkv tn pvgmdlkg ld Fr. 65 mkhhgndr pgv jgrpk|eh( {e utd dzkr|dn 5? jgrpk|ehdradndvehdr dn dr|d rtfrdb|gv ld ebtdvlg bgn le|gr ldh RNKR. Dn bemfkg( dr|d aer|g pvgmdlkg dn heRdatvklel Rgbkeh rdvíe ld Fr. 24(3 mkhhgndr pgv jgrpk|eh adndveh *54 jgrpk|ehdr adndvehdr ldebtdvlg bgn dh RNKR dn dh eõg 6??1+ *MR{L 6??1+.

Ldn|vg ld hgr pvgsddlgvdr ld e|dnbkòn emfthe|gvke( dh aer|g ld he Rdatvklel Rgbkeh rd lkvkadpvknbkpehmdn|d e pghkbhínkbgr( bgn tn aer|g knbhtrksd me{gv utd btehutkdv g|vg |kpg lddr|efhdbkmkdn|g. Erí( dh aer|g dn bdn|vgr { ptdr|gr ld rehtl( utd vdpvdrdn|en bgnitn|emdn|d Fr. <4mkhhgndr dn he Rdatvklel Rgbkeh ld bgv|g pheyg( dr 5?(: sdbdr kncdvkgv eh aer|g dn dh rtfrdb|gvpùfhkbg( utd vdpvdrdn|evíe Fr. <:4(1 mkhhgndr dn dh eõg 6??1 *btelvg 45+. _gv g|ve pev|d( dhrtfrdb|gv pùfhkbg dr dh ùnkbg utd lkrpgnd ld tnkleldr mòskhdr peve e|dnbkòn dn dh åvde vtveh dn dhpdvkglg 6??2-?1 *_vgaveme Dz|dnre+( bgn tn aer|g 6??1 dr|kmelg ld Fr. 61(< mkhhgndr *btelvg 45+.

Btelvg 45 ‒

Aer|g ngmkneh dn rehtl pgv |kpg ld dr|efhdbkmkdn|g dn hgrrtfrdb|gvdr _ùfhkbg { ld he Rdatvklel Rgbkeh( Fghkske( 6??1

Aer|g dn rehtl pgv|kpg ld dr|efhdbkmkdn|g

Rtfrdb|gv _ùfhkbg Rtfrdb|gv ld heRdatvklel Rgbkeh

   J  g  r  p   k   |  e   h  d  r

Jgrpk|ehdrFårkbgr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

2<:(:

;3(1$  

13(3

61(3$  

Jgrpk|ehdrAdndvehdr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

6?;(;

<:(6$  

422(<

24(3$  

Jgrpk|ehdrDrpdbkehkyelgr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

623(6

3?(3$  

11(2

24(<$  

   _  v  g  s  d  d   l  g  v  d  r   l  d

  e   |  d  n  b   k   ò  n  e  m   f  t   h  e   |  g  v   k  e

_tdr|grld Rehtl

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

52:(:

524(3$  

2:(?

2<(:$  

Bdn|vgrld Rehtl

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

2<3(;

:1(4$  

1(?

<:(1$  

_ghkbhínkbgr

Aer|g 6??1

*Fr. mkhhgndr+*bvdbkmkdn|g 6??2-6??1+

2:(4

66;(;$  

434(3

2:(?$  

Tnkleldrmòskhdr

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

61(<

1(2$  

?(?

-  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?  

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 90/110

 

;?

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

KKK.:. Enåhkrkr ldh Aer|g dn rehtl rdaùn Ldpev|emdn|g 

KKK.:.5. Dsghtbkòn ld he dr|vtb|tve ld aer|g dn rehtl rdaùn Ldpev|emdn|g

Her dr|kmebkgndr ld aer|g pgv ldpev|emdn|g pvgskdndn ldh pvkmdv dr|tlkg *Sehlër { _dõehgye 6?5?+ {e

utd ng dzkr|d dr|e me|vky dn dh rdatnlg dr|tlkg( { bgmg bgnrdbtdnbke( dh sehgv ldh aer|g |g|eh ngbgvvdrpgnld e hgr mgn|gr enehkyelgr dn hgr ebåpk|dr en|dvkgvdr. Dh aer|g vdpgv|elg bgvvdrpgnld ehaer|g didbt|elg ldn|vg ldh Ldpev|emdn|g bgnrkldvelg( ptlkdnlg rdv pgv pev|d ld btehutkdv |kpg ldeadn|d( dzbdp|g hgr jgaevdr. _gv g|ve pev|d( bele eõg( epvgzkmelemdn|d tn |dvbkg ldh aer|g |g|eh dnrehtl ng ptdld rdv e|vkftklg e nknaùn Ldpev|emdn|g *be|dagvíe ‘nksdh nebkgneh”+ {e utd bgvvdrpgnlde elmknkr|vebkgndr bdn|vehdr ldh Mknkr|dvkg ld Rehtl( ld he Rdatvklel Rgbkeh g ld Gvaenkyebkgndr ngAtfdvnemdn|ehdr( pdvg rgfvd |glg bgvvdrpgnld eh aer|g ld fghrkhhg ld hgr jgaevdr( ldfklg e utd herdnbtdr|er ld jgaevdr vdehkyeler pgv dh KND ng rgn vdpvdrdn|e|kser e nksdh ldpev|emdn|eh( pgv hg utdhe |g|ehklel ld dr|d aer|g ctd eavdaelg e nksdh nebkgneh dn dh dr|tlkg ld btdn|er ld rehtl enehkyelg.Erí( dn dh rdb|gv dr|e|eh *pùfhkbg rdatvklel rgbkeh+( dh aer|g nebkgneh vdpvdrdn|e dh 1$ ldh aer|grdb|gvkeh dn dh eõg 6??1( mkdn|ver utd dn dh rdb|gv pvkselg( vdpvdrdn|e dh :3$ ldfklg e dr|ekmpgrkfkhklel ld ldreavdaev dh aer|g ld fghrkhhg pgv Ldpev|emdn|g.

Gfrdvsenlg he lkr|vkftbkòn ldh aer|g dn rehtl utd ptlg rdv ldreavdaelg pgv Ldpev|emdn|g ldebtdvlg bgn dr|gr bvk|dvkgr md|glghòakbgr( rd bgnr|e|e utd ld mendve adndveh( he lkr|vkftbkòn ldhaer|g dn rehtl ng dr mt{ lkcdvdn|d ld he lkr|vkftbkòn pgfhebkgneh peve 3 ld hgr ; Ldpev|emdn|gr ldFghkske( bgn he dzbdpbkòn ld \evkie { _enlg( peve hgr btehdr he pvgpgvbkòn ldh aer|g dn rehtl drrtpdvkgv e he pvgpgvbkòn ld he pgfhebkòn ldpev|emdn|eh ldn|vg ld he pgfhebkòn nebkgneh *pgv didmphg

Khtr|vebkòn 23  ‒ Dr|vtb|tve ld Aer|g dn rehtl { ldpgfhebkòn rdaùn Ldpev|emdn|g( Fghkske( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5?( KND 6??4  

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 91/110

 dn dh Ldpev|emdn|g ld \evkie( dh aer|g dn rehtl vdpvdrdn|e dh :$ ldh aer|g ld hgr ; Ldpev|emdn|gr(mkdn|ver utd he pgfhebkòn |evkidõe rghg vdpvdrdn|e dh <(;$ ld he pgfhebkòn nebkgneh+. DhLdpev|emdn|g ld Bgbjefemfe bgnr|k|t{d he |dvbdve dzbdpbkòn( pdvg dn cgvme ndae|kse9 mkdn|verutd he pgfhebkòn ldpev|emdn|eh vdpvdrdn|efe dn dh eõg 6??1 dh 51(:$ ld he pgfhebkòn fghkskene ldebtdvlg bgn pvg{dbbkgndr ldh KND * KND 6??4+( dh aer|g dn rehtl ldpev|emdn|eh rghg vdpvdrdn|efe dh52(3$ ldh aer|g ld hgr ; Ldpev|emdn|gr *khtr|vebkòn 23+.

Hgr ldpev|emdn|gr utd vdpvdrdn|en he me{gv pvgpgvbkòn ld aer|g dn rehtl rgn dn|gnbdr hgr utd|kdndn me{gv pgfhebkòn9 dh aer|g dn rehtl ldh ldpev|emdn|g ld He _ey vdpvdrdn|e dh 61(4$ ldhaer|g dn rehtl ld hgr ; Ldpev|emdn|gr( { dh Ldpev|emdn|g ld Ren|e Bvty vdpvdrdn|e dh 63(3$. Dngpgrkbkòn( hgr Ldpev|emdn|gr mdngr pgfhelgr( Gvtvg { _enlg( |kdndn he mdngv pvgpgvbkòn ld aer|gdn rehtl( bgn vdrpdb|ksemdn|d <$ { 6(2$ ldh aer|g ld hgr ; Ldpev|emdn|gr *khtr|vebkòn 23+.

Dn dh pdvkglg 6??2-6??1( dr|å lkr|vkftbkòn ldh aer|g dn rehtl pgv Ldpev|emdn|g dsghtbkgnòvdhe|ksemdn|d pgbg9 he me{gv lkcdvdnbke rd gfrdvse dn dh Ldpev|emdn|g ld He _ey( dn dh bteh hepvgpgvbkòn ldh aer|g dn rehtl bherkckbefhd pgv Ldpev|emdn|g dve ld 2?(;$ dn dh eõg 6??2( pevehtdag lkrmkntkv aveltehmdn|d jer|e ehbenyev 61(4$ dn dh eõg 6??1. Ren|e Bvty( dh g|vgLdpev|emdn|g bgn me{gv aer|g( |emfkën lkrmknt{ò rt pev|kbkpebkòn dn dh aer|g dn rehtl( ld 6:$dn 6??2 e 63(3$ dn 6??1. Dn gpgrkbkòn( dh ldpev|emdn|g ld \evkie skg rt pev|kbkpebkòn dn dh aer|gdn rehtl ld hgr ; Ldpev|emdn|gr knbvdmdn|evrd( ld <(;$ dn dh eõg 6??2 e :$ dn dh 6??1. Dn

mdngvdr pvgpgvbkgndr( he pvgpgvbkòn ld aer|g dn rehtl bgvvdrpgnlkdnlg eh Ldpev|emdn|g ld _g|gríperò ld 4(1$ dn dh eõg 6??2 e 1(5$ dn dh eõg 6??1 *btelvg 46+.

Btelvg 46  ‒ Dsghtbkòn ld he dr|vtb|tve ld aer|g rdaùn Ldpev|emdn|g( Fghkske( 6??2-?1

Ldpev|emdn|g 6??2 6??< 6??4 6??3 6??1

Bjtutkrebe 3(3$ 3(?$ 3(6$ 4(1$ 4(;$

He _ey 2?(;$ 6;(4$ 6:(<$ 61(;$ 61(4$

Bgbjefemfe 52(4$ 54(<$ 56(;$ 56(:$ 52(3$

Gvtvg <(?$ 2(:$ <(5$ 2(1$ <(?$

_g|grí  4(1$ 3(5$ 3(:$ 3(4$ 1(5$

\evkie <(;$ 4(3$ 4(;$ 1(4$ :(?$

Ren|e Bvty 6:(?$ 64(:$ 6:(2$ 6;(2$ 63(3$

Fdnk 4(5$ 3(2$ <(1$ 4(?$ 4(?$

_enlg 5(<$ 5(3$ 6(4$ 5(1$ 6(2$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Bgmpevenlg he dr|vtb|tve ld aer|g pgv Ldpev|emdn|g ld hgr lkcdvdn|dr rtfrdb|gvdr *btelvg 42+( rd

ptdld bgnr|e|ev utd dzkr|dn lkcdvdnbker avenldr9 mkdn|ver utd dh rtfrdb|gv pùfhkbg lkvkad rt aer|gdn cgvme vdhe|ksemdn|d dutk|e|kse dn bgmpevebkòn bgn he lkr|vkftbkòn pgfhebkgneh( bgn he ng|efhddzbdpbkòn ld \evkie( he lkr|vkftbkòn pgv ldpev|emdn|gr ld he Rdatvklel Rgbkeh { ldh rdb|gv pvkselgrgn mt{ kndutk|e|kser( fdndckbkenlg pvknbkpehmdn|d e hgr ldpev|emdn|gr ld He _ey { Ren|e Bvty9 dndh 6??1( dh rtfrdb|gv pùfhkbg lkvkad dh <6(1$ ld rt aer|g ldreavdaelg pgv Ldpev|emdn|gr *ngbdn|veh+ e dr|gr lgr ldpev|emdn|gr0 dn bemfkg( dh rtfrdb|gv ld he Rdatvklel Rgbkeh lkvkad dh 3<(3$ld rt aer|g e He _ey { Ren|e Bvty *btelvg 42+( e pdrev ld utd dr|gr vdpvdrdn|en rghemdn|d dh4<(5$ ld he pgfhebkòn eckhkele dn he Rdatvklel Rgbkeh *KNERDR 6??;+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 92/110

 

;6

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Dn dh rdb|gv pvkselg( he lkcdvdnbke dr eùn mår avenld( {e utd dn dh eõg 6??1( dh :1(2$ ldh aer|g lddr|d rdb|gv rd lkvkad e hgr Ldpev|emdn|gr ld Ren|e Bvty { He _ey *vdrpdb|ksemdn|d 42(:$ {6:(;$+( pvknbkpehmdn|d pgv dh aer|g ld hgr rdatvgr pvkselgr( {e utd dr|gr vdpvdrdn|en dh ;?$ ldhaer|g pvkselg utd ptlg rdv ldreavdaelg pgv Ldpev|emdn|g *btelvg 42+.

Rk rd enehkye mår e ld|ehhd he lkr|vkftbkòn ldh aer|g dn rehtl ldh rtfrdb|gv pùfhkbg( rd gfrdvse utddh rtfrdb|gv pùfhkbg cesgvdbd mdngr hgr Ldpev|emdn|gr ld He _ey { Ren|e Bvty dn vdhebkòn e rtpgfhebkòn9 mkdn|ver utd he lkr|vkftbkòn ldh aer|g |g|eh bgvvdrpgnld epvgzkmelemdn|d e helkr|vkftbkòn pgfhebkgneh dn dr|gr lgr ldpev|emdn|gr *khtr|vebkòn 23+( he pvgpgvbkòn ld aer|g pùfhkbgdidbt|elg dn dr|gr lgr Ldpev|emdn|gr dr kncdvkgv e he lkr|vkftbkòn pgfhebkgneh9 dh rtfrdb|gv pùfhkbglkvkad dh <6(1$ ld rt aer|g e dr|gr lgr ldpev|emdn|gr mkdn|ver utd vdpvdrdn|en bgnitn|emdn|d dh42(4$ ld he pgfhebkòn nebkgneh *btelvg 42+.

Dn bemfkg( dh Ldpev|emdn|g ld \evkie dr dh mår cesgvdbklg pgv dh rtfrdb|gv pùfhkbg dn bten|g eaer|g dn rehtl( {e utd hd bgvvdrpgnlíe dn 6??1 dh 55(<$ ldh aer|g pùfhkbg ldreavdaelg pgvLdpev|emdn|g *btelvg 42+( mkdn|ver utd rt pgfhebkòn rghg vdpvdrdn|efe dh <(;$ ld he pgfhebkònfghkskene. Dr|e kndutklel adgavåckbe rd ldfd pvknbkpehmdn|d e hgr drctdvygr e cesgv ldh aer|g dn dhRdb|gv Rehtl vdehkyelgr pgv he _vdcdb|tve { pgv hgr Mtnkbkpkgr ld \evkie e pev|kv ldh eõg 6??3(pdvmk|klgr pgv tn ctdv|d knbvdmdn|g ld hgr knavdrgr pgv bgnbdp|g ld jklvgbevftvgr *KLJ { vdaehíer+9erí( dn dh eõg 6??3( hgr Agfkdvngr mtnkbkpehdr ldh ldpev|emdn|g mth|kphkbevgn rt aer|g dn rehtl pgv

6(5 vdrpdb|g eh eõg 6??4( mkdn|ver utd he _vdcdb|tve ld \evkie mth|kphkbò dh rt{g pgv 5(;. Dr|dknbvdmdn|g ldh aer|g bgn|kntò dn dh eõg 6??1( bgn he kmphdmdn|ebkòn( dn|vd g|vgr( ldh RdatvgTnksdvreh ld Rehtl Et|òngmg ld \evkie( utd |tsg tn aer|g dn rehtl peve dh eõg 6??1 ld mår ld :mkhhgndr ld fghkskengr *Sehlër { _dõehgye 6?5?+.

Btelvg 42  ‒ Dr|vtb|tve ld aer|g dn rehtl pgv Ldpev|emdn|g { rtfrdb|gv( Fghkske( 6??1

Ldpev|emdn|g Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh

Rdb|gvDr|e|eh

Rdb|gvpvkselg

Bjtutkrebe 1(;$ <(5$  3(2$ 5(<$

He _ey 65(<$ 24(3$  61(<$ 6:(;$

Bgbjefemfe 5<(2$ 52(4$  5<(?$ :(<$Gvtvg <(6$ <(5$  <(5$ 5(:$

_g|grí  ;(?$ 4(3$  1(3$ 5(5$

\evkie 55(<$ <(5$  :(2$ 2(4$

Ren|e Bvty 65(6$ 6;(?$  6<(4$ 42(:$

Fdnk 3(:$ 2(2$  4(2$ ?(:$

_enlg 2(:$ ?(3$  6(<$ ?(<$

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Hgr ldmår ldpev|emdn|gr mår cesgvdbklgr pgv dh rtfrdb|gv pùfhkbg rgn _enlg( Fdnk( Bjtutkrebe {_g|grí9 bgnitn|emdn|d( dr|gr Ldpev|emdn|gr vdpvdrdn|en mdngr ld 6?$ ld he pgfhebkòn |g|eh*5;(2$ dn 6??1 ld ebtdvlg bgn pvg{dbbkgndr ldh KND+( pdvg didbt|en dh 61(4$ ldh aer|g dn rehtlldh rtfrdb|gv pùfhkbg9 eh Ldpev|emdn|g ld _enlg( hd bgvvdrpgnld 2(:$ ldh aer|g dn rehtl pùfhkbg*peve rghemdn|d dh ?(1$ ld he pgfhebkòn fghkskene+( Fdnk didbt|e dh 3(:$ ldh aer|g *<(2$ ld hepgfhebkòn+( Bjtutkrebe 1(;$ ldh aer|g *3(2$ ld he pgfhebkòn+ { dh Ldpev|emdn|g ld _g|grí didbt|edh ;$ ldh aer|g pùfhkbg *peve dh 1(;$ ld he pgfhebkòn+ *btelvg 42 d khtr|vebkòn 23+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 93/110

 KKK.:.6. Dr|vtb|tve ldpev|emdn|eh ld aer|g dn rehtl rdaùn rtfrdb|gv

Bgmg bgnrdbtdnbke ld her kndutkleldr ld lkr|vkftbkòn ldh aer|g ldmgr|veler dn dh ebåpk|d en|dvkgv*:.5+( hgr ntdsd ldpev|emdn|gr ldh peír |kdndn dn|vd rí mkrmgr kmpgv|en|dr lkcdvdnbker dn hedr|vtb|tve ld rt aer|g pgv rtfrdb|gv *khtr|vebkòn 21+. Hgr Ldpev|emdn|gr ld _enlg( \evkie( Fdnk(Bjtutkrebe { _g|grí |kdndn |glgr tn cknenbkemkdn|g pùfhkbg utd vdpvdrdn|e mår ld lgr |dvbkgr ldhaer|g |g|eh dn rehtl ldreavdaelg e nksdh ldpev|emdn|eh( bgn vdrpdb|ksemdn|d ::(3$ ldh aer|g(13(<$( 12$( 15$ { 31(:$. _evehdhemdn|d( dr|gr bknbg Ldpev|emdn|gr |kdndn tne pvgpgvbkòn ld rtaer|g dn rehtl cknenbkelg pgv he Rdatvklel Rgbkeh { pgv dh rdb|gv pvkselg *rdatvgr pvkselgr { GNAr+vdhe|ksemdn|d feig9 dn dh Ldpev|emdn|g ld _enlg( rghemdn|d dh 5?(6$ ldh aer|g dn rehtlbgvvdrpgnld e he Rdatvklel Rgbkeh ld bgv|g pheyg( dh 6?(<$ dn dh Ldpev|emdn|g ld \evkie. E |k|thg ldbgmpevebkòn he lkr|vkftbkòn pvgmdlkg dn|vd hgr ; Ldpev|emdn|gr *pvgmdlkg ld $ { ng ld mgn|gr+dr ld 32(:$ peve dh rtfrdb|gv pùfhkbg( 26$ peve he Rdatvklel Rgbkeh { <(6$ peve dh rdb|gv pvkselg.

Khtr|vebkòn 21  ‒ Dr|vtb|tve ld aer|g dn rehtl pgv rtfrdb|gv rdaùn Ldpev|emdn|g( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Dn bemfkg( hgr Ldpev|emdn|gr ld Bgbjefemfe { Gvtvg pvdrdn|en dn pvgpgvbkòn ld rt aer|g |g|ehtn aer|g pùfhkbg mdngv utd dn hgr bknbg Ldpev|emdn|gr mdnbkgnelgr en|dvkgvmdn|d. Dr|gr lgrLdpev|emdn|gr pvdrdn|en tne dr|vtb|tve rkmkhev( bgn tn aer|g pùfhkbg utd vdpvdrdn|e epvgzkme-

lemdn|d dh 43$ ldh aer|g( { tne pvgpgvbkòn ld aer|g ld he Rdatvklel Rgbkeh { pvkselg me{gv e hgutd rd ptdld gfrdvsev dn _enlg( \evkie( Fdnk( Bjtutkrebe { _g|grí9 he Rdatvklel Rgbkeh vdpvdrdn|eepvgzkmelemdn|d dh <?$ ldh aer|g dn rehtl { dh rdb|gv pvkselg dh <$ *khtr|vebkòn 21+.

Hgr Ldpev|emdn|gr ld He _ey { Ren|e Bvty rgn hgr utd pvdrdn|en me{gv cveamdn|ebkòn ld rtcknenbkemkdn|g9 dn dr|gr( dh rtfrdb|gv pùfhkbg vdpvdrdn|e mdngr ld he mk|el ldh aer|g dn rehtl0 dndh Ldpev|emdn|g ld He _ey( dh cknenbkemkdn|g ld he Rdatvklel Rgbkeh vdpvdrdn|e mår ld he mk|el ldhaer|g dn rehtl *ùnkbg Ldpev|emdn|g dn dr|d berg+ { |kdnd tn aer|g ld rdatvgr pvkselg ' GNArme{gv dn pvgpgvbkòn vdrpdb|g e hgr ldmår Ldpev|emdn|gr( dzbdp|g Ren|e Bvty.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 94/110

 

;<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Dn dh Ldpev|emdn|g ld Ren|e Bvty( rd gfrdvse utd dh rtfrdb|gv pùfhkbg { dh rtfrdb|gv ld heRdatvklel Rgbkeh cknenbken he mkrme pvgpgvbkòn ldh aer|g dn rehtl *<6(1$+( { drg e pdrev ld utdRen|e Bvty dr dh Ldpev|emdn|g bgn mdngr bgfdv|tve ld he Rdatvklel Rgbkeh9 dn dh eõg 6??:( hgreckhkelgr e he Rdatvklel Rgbkeh ld bgv|g pheyg *rkn bgn|ev hgr eckhkelgr eh RR_EM+ vdpvdrdn|efen dh5:$ ld he pgfhebkòn ldpev|emdn|eh( mkdn|ver utd e nksdh nebkgneh( he bgfdv|tve dve ld 6:(6$.Ren|e Bvty dr |emfkën dh Ldpev|emdn|g bgn me{gv pvgpgvbkòn ld aer|g pvkselg *berkdzbhtrksemdn|d rdatvgr pvkselgr+ {e utd dr|d vdpvdrdn|e dh 5<(3$ ld rt aer|g dn rehtl *khtr|vebkòn21+. Ng rd ldfd ghsklev utd dh aer|g ld fghrkhhg ng dr|å knbhtklg ldn|vg ldh aer|g pvkselg( ldfklg e heng vdpvdrdn|e|ksklel ld dr|d le|g e nksdh ldpev|emdn|eh dn her dnbtdr|er ld jgaevdr ldh KND. Rkndmfevag( ldfklg e he gcdv|e ld rdvskbkgr pvkselgr lkrpgnkfhd( dr pgrkfhd utd dn pvgpgvbkòn ldh aer|gldpev|emdn|eh |g|eh( hgr Ldpev|emdn|gr ld He _ey( Ren|e Bvty { Bgbjefemfe |dnaen tn aer|g ldfghrkhhg me{gv e hgr ldmår Ldpev|emdn|gr.

Dr|tlkenlg mår e ld|ehhd he vdpev|kbkòn ldh aer|g pùfhkbg dn|vd hgr lkcdvdn|dr eadn|dr cknenbkelgvdrldh rtfrdb|gv bgvvdrpgnlkdn|d( rd bgnr|e|e utd her _vdcdb|tver rgn dn dh eõg 6??1 dh pvknbkpeheadn|d cknenbkelgv dn |glgr hgr Ldpev|emdn|gr *khtr|vebkòn 2:+( ldfklg pvknbkpehmdn|d eh jdbjg utd

Khtr|vebkòn 2:  ‒ Dr|vtb|tve ld aer|g pgv dn|klel pùfhkbe rdaùn Ldpev|emdn|g( 6??2 { 6??1

Ldpev|emdn|g Eõg

Bjtutkrebe6??1

6??2

He _ey6??1

6??2

Bgbjefemfe6??1

6??2

Gvtvg6??1

6??2

_g|grí 6??1

6??2

\evkie6??1

6??2

Ren|e Bvty6??1

6??2

Fdnk

6??1

6??2

_enlg6??1

6??2

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 95/110

 e her _vdcdb|tver hdr bgvvdrpgnldn dh aer|g dn vdbtvrgr jtmengr cknenbkelg pgv dh \drgvg Adndvehld he Nebkòn *utd vdpvdrdn|en mår ldh :?$ ldh aer|g pvdcdb|gveh+. Dh Ldpev|emdn|g ld _enlgpvdrdn|e he me{gv pvgpgvbkòn ld aer|g pùfhkbg bgn cknenbkemkdn|g pvdcdb|gveh( bgn 3?(1$ dn dh eõg6??1. Dn gpgrkbkòn( He _ey { Bgbjefemfe rgn hgr Ldpev|emdn|gr dn hgr btehdr he pvgpgvbkòn ldaer|g pùfhkbg cknenbkelg pgv he _vdcdb|tve dr mdngv( <<(6$ { <4(2$ vdrpdb|ksemdn|d. Dn hgrldpev|emdn|gr ld Ren|e Bvty { \evkie( dr|e pvgpgvbkòn dr ld <:(3$ { <;(:$( mkdn|ver utd dn hgrldmår ldpev|emdn|gr( he _vdcdb|tve cknenbke mår ld he mk|el ldh aer|g pùfhkbg *khtr|vebkòn 2:+.

Dn bten|g e cknenbkemkdn|g mtnkbkpeh( dh me{gv dn vdhebkòn eh aer|g pùfhkbg |g|eh rd dnbtdn|ve dn dhLdpev|emdn|g ld \evkie( lònld hgr Agfkdvngr Mtnkbkpehdr cknenbken dh <<(4$ ldh aer|g pùfhkbg*khtr|vebkòn 2:+. Dn He _ey( Bgbjefemfe { Ren|e Bvty( dr|d pgvbdn|eid dr ld ehvdldlgv ld <6$(mkdn|ver utd dr Bjtutkrebe { _enlg utd dh cknenbkemkdn|g mtnkbkpeh |kdnd mdngv kmpgv|enbke(vdpvdrdn|enlg vdrpdb|ksemdn|d 2<(3$ { 25(;$ ldh aer|g ldpev|emdn|eh dn rehtl *khtr|vebkòn 2:+.

Cknehmdn|d( dh cknenbkemkdn|g ldh Mknkr|dvkg ld Rehtl { Ldpgv|dr peve 6??1 dr vdhe|ksemdn|d feig dnvdhebkòn bgn dh aer|g pùfhkbg |g|eh( vdpvdrdn|enlg dn|vd 4 { 5? $ ldh aer|g pùfhkbg rdaùn dhLdpev|emdn|g9 dn He _ey { Bgbjefemfe( vdpvdrdn|e mår ldh 5?$ ldh aer|g pùfhkbg |g|eh peve dheõg 6??1( mkdn|ver utd |kdndn mdngv kmpgv|enbke dn _enlg { \evkie *1$ { 4(:$ vdrpdb|ksemdn|d+.

Rk rd gfrdvse he dsghtbkòn ld he dr|vtb|tve ldpev|emdn|eh ldh aer|g pùfhkbg rdaùn eadn|d ld

cknenbkemkdn|g( rd ptdld bgnr|e|ev utd he pvgpgvbkòn ldh aer|g pùfhkbg cknenbkelg pgv dh Mknkr|dvkgld Rehtl { Ldpgv|dr rd je vdltbklg pvgavdrksemdn|d dn |glgr hgr Ldpev|emdn|gr9 dn dh eõg 6??2(dh Mknkr|dvkg ld Rehtl cknenbkefe dh 5;(6$ ldh aer|g pùfhkbg bgmg pvgmdlkg dn|vd hgr ;Ldpev|emdn|gr( mkdn|ver utd dn dh 6??1( dr|d pvgmdlkg dve ld rghemdn|d :(1$. Erí( rd bgnr|e|eutd dn dh eõg 6??2( dh Mknkr|dvkg ld Rehtl { Ldpgv|dr |dníe tn vgh ctnlemdn|eh dn dh cknenbkemkdn|gldh aer|g pùfhkbg dn hgr Ldpev|emdn|gr ld _enlg( _g|grí( \evkie { Bjtutkrebe( {e utd vdpvdrdn|efedn dr|gr Ldpev|emdn|gr dh 23$( 62(5$( 66(;$ { 5:(2$ ldh aer|g pùfhkbg vdrpdb|ksemdn|d. Dn dheõg 6??1( he pvgpgvbkòn ldh aer|g cknenbkelg pgv dh Mknkr|dvkg ld Rehtl dve kncdvkgv e 5?$ dn dr|grbte|vg Ldpev|emdn|gr. Dr|d bemfkg ld dr|vtb|tve rd jkyg e cesgv ld hgr Agfkdvngr Mtnkbkpehdr( utdskdvgn rt pev|kbkpebkòn dn dh aer|g pùfhkbg ldpev|emdn|eh perev ld 2?(4$ e 2;(<$ bgmg pvgmdlkgdn|vd hgr ; Ldpev|emdn|gr. Dh knbvdmdn|g me{gv ldh pgvbdn|eid ld aer|g cknenbkelg pgv hgrMtnkbkpkgr rd gfrdvse dn dh Ldpev|emdn|g ld \evkie9 mkdn|ver utd dn dh eõg 6??2( hgr AgfkdvngrMtnkbkpehdr ld dr|d Ldpev|emdn|g cknenbkefen rghemdn|d dh 6?(;$ ldh aer|g pùfhkbg ldpev|emdn|eh

*mdngr utd dh mknkr|dvkg ld Rehtl+( dn dh eõg 6??1( elmknkr|vefen dh <<(4$ *khtr|vebkòn 2:+.

KKK.:.2. Nksdh { dsghtbkòn ldh aer|g dn sehgv ngmkneh rdaùn Ldpev|emdn|g

Ld ebtdvlg bgn he dr|vtb|tve ld aer|g dn rehtl pgv Ldpev|emdn|g( dh me{gv aer|g dn rehtl rddnbtdn|ve dn hgr Ldpev|emdn|gr ld He _ey { Ren|e Bvty( dn hgr btehdr dh aer|g dr|e|eh { ld hgrrdatvgr pvkselgr rd ebdvbe dn bgnitn|g e hgr mkh mkhhgndr ld fghkskengr0 dh ldpev|emdn|g bgn mdngvaer|g dr dh ld _enlg( bgn Fr. 1;(4 mkhhgndr *btelvg 4<+.

Vdrpdb|g eh knbvdmdn|g ldh aer|g dn rehtl dn dh pdvkglg 6??2-6??1 *btelvg 4< d khtr|vebkòn 2;+( rgnhgr Ldpev|emdn|gr ld _enlg { \evkie utd mgr|vevgn he me{gv |ere ld bvdbkmkdn|g dn|vd hgr eõgr

6??2 { 6??1( 53?(5$ { 541(4$ vdrpdb|ksemdn|d( rkankckbenlg utd dn dr|gr Ldpev|emdn|gr( dh aer|gdn rehtl ctd mth|kphkbelg pgv 6(3 dn dr|d pdvkglg. Ng gfr|en|d( dr|gr knbvdmdn|gr |tskdvgn htaev dnmgmdn|gr lkcdvdn|dr9 mkdn|ver utd dh me{gv knbvdmdn|g ldh aer|g dn rehtl dn _enlg dr|tsg dn hgreõgr 6??4 { 6??1( dh bvdbkmkdn|g dn \evkie rd ldfd pvknbkpehmdn|d e hgr eõgr 6??< { 6??3.

_gv g|ve pev|d( dh mdngv bvdbkmkdn|g rd gfrdvse dn hgr Ldpev|emdn|gr ld He _ey { Bjtutkrebe( bgntne |ere ld bvdbkmkdn|g dn|vd hgr eõgr 6??2 { 6??1 ld 2;(1$ { <5(1$ vdrpdb|ksemdn|d. Ren|e Bvty|emfkën |tsg tn bvdbkmkdn|g kncdvkgv e 4?$ *btelvg 4< d khtr|vebkòn 2;+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 96/110

 

;3

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Btelvg 4<  ‒ Dsghtbkòn ldh aer|g dn sehgv ngmkneh pgv Ldpev|emdn|g( Fghkske( 6??2-?1

Aer|g dn rehtlpgv Ldpev|emdn|g

6??2 6??< 6??4 6??3 6??1

Bjtutkrebe

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+*bvdbkm. ebtmt- helg 6??2-?1+

5<4(2

-  -  

54<(3

3(<$  3(<$  

51<(1

52(?$  6?(6$  

5:6(?

<(6$  64(2$  

6?3(?

52(5$  <5(1$  

He _ey

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkm. ebtmt- helg 6??2-?1+

3:2(4

-  

-  

14;(2

55(5$  

55(5$  

1;1(2

4(?$  

53(1$  

:;?(?

55(3$  

2?(6$  

;44(5

1(2$  

2;(1$  

Bgbjefemfe

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkm. ebtmt- helg 6??2-?1+

6;;(6

-  

-  

2;3(?

26(2$  

26(2$  

232(<

-:(6$  

65(<$  

<?1(<

56(5$  

23(6$  

<15(5

54(3$  

41(<$  

Gvtvg

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkm. ebtmt- helg 6??2-?1+

:1(<

-  

;1(6

55(6$ 

55(6$  

554(5

5:(<$ 

25(1$  

553(;

5(3$ 

22(;$  

521(<

51(4$ 

41(2$  

_g|grí 

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkm. ebtmt- helg 6??2-?1+

564(3

-  

541(<

64(2$ 

64(2$  

5;5(4

65(3$ 

46(<$  

6?:(6

:(:$ 

34(:$  

6<4(;

5:(5$ 

;4(:$  

\evkie

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkm. ebtmt- helg 6??2-?1+

5?1(2

-  

5<2(1

2<(?$ 

2<(?$  

533(6

54(1$ 

44(?$  

62:(:

<2(1$ 

566(3$  

613(6

54(1$ 

541(4$  

Ren|e Bvty

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkm. ebtmt- helg 6??2-?1+

35:(;

-  

33<(?

1(2$ 

1(2$  

1;3(?

5;(;$ 

6:(3$  

;23(4

51(3$ 

45(2$  

;62(?

-5(<$ 

<;(6$  

Fdnk

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkm. ebtmt- 

helg 6??2-?1+

556(6

-  

532(2

<4(3$ 

<4(3$  

526(<

-5:(;$ 

5:(5$  

53?(:

65(<$ 

<2(<$  

512(:

:(5$ 

44(?$  

_enlg

Dn mkhhgndrld fghkskengr

*bvdbkm. enteh+

*bvdbkm. ebtmt- helg 6??2-?1+

2?(3

-  

<?(4

26(<$ 

26(<$  

15(4

13(;$ 

52<(5$  

42(3

-64(5$ 

14(4$  

1;(4

<:(2$ 

53?(5$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 97/110

 Khtr|vebkòn 2;  ‒ \ere ld bvdbkmkdn|g 6??2-6??1 ldh aer|g dn rehtl pgv Ldpev|emdn|g( Fghkske

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Enehkyenlg dh aer|g ldpev|emdn|eh dn sehgv ngmkneh pgv rtfrdb|gv { rt dsghtbkòn *btelvg 44+( rdptdld bgnckvmev utd dh knbvdmdn|g ldh aer|g |g|eh dn rehtl rd ldfd pvknbkpehmdn|d eh knbvdmdn|g ldhaer|g pùfhkbg9 erí( hgr |vdr Ldpev|emdn|gr bgn me{gv knbvdmdn|g ldh aer|g dn rehtl dn dh pdvkglg6??2-6??1( _enlg( \evkie { _g|grí( |emfkën rgn hgr utd |tskdvgn me{gv knbvdmdn|g ld rt aer|gpùfhkbg( bgn |erer ld bvdbkmkdn|g dn|vd hgr eõgr 6??2 { 6??1 ld 6?3(<$ peve \evkie( 5:4(:$ peve_enlg { 556(;$ peve _g|grí. Dh btev|g Ldpev|emdn|g bgn me{gv bvdbkmkdn|g ldh aer|g ctd dh ldGvtvg *;<(6$ dn|vd 6??2 { 6??1+ mkdn|ver utd dh Ldpev|emdn|g ld Ren|e Bvty ctd dh utd mgr|vòdh mdngv knbvdmdn|g *4?(<$ dn|vd 6??2 { 6??1+( rdatklg pgv He _ey { Bjtutkrebe( bgn tne |ereld bvdbkmkdn|g ld 4:(;$ peve emfgr Ldpev|emdn|gr. Erí( rk fkdn hgr Ldpev|emdn|gr ld He _ey {

Ren|e Bvty |kdndn dh me{gv aer|g dn rehtl pùfhkbg( bgn epvgzkmelemdn|d Fr. <?? mkhhgndr beletng dn dh eõg 6??1( |emfkën rgn hgr utd mdngr knbvdmdn|evgn dr|d aer|g *btelvg 44+.

Dn bten|g e he Rdatvklel Rgbkeh( dh Ldpev|emdn|g ld He _ey dr dh utd vdpvdrdn|e dh me{gv aer|g(bgn Fr. <:<(4 mkhhgndr peve he adr|kòn 6??1( dr ldbkv tn aer|g rtpdvkgv e hg utd rd aer|ò dn dhrtfrdb|gv pùfhkbg dn dr|d Ldpev|emdn|g *Fr. 2;:(6 mkhhgndr+. Rkn dmfevag( he |ere ld bvdbkmkdn|gldh aer|g ld he Rdatvklel Rgbkeh ctd vdhe|ksemdn|d feie dn dr|d Ldpev|emdn|g( vdpvdrdn|enlg tn61(4$ dn|vd hgr eõgr 6??2 { 6??1 *btelvg 44+.

Ren|e Bvty 

<;(6$

Bjtutkrebe _g|grí  

;4(:$

Fdnk 

44(?$

Bgbje-femfe 

41(<$

Gvtvg 

41(2$

He _ey 

2;(1$

_enlg 

53?(5$

\evkie  541(4$ 

<5(1$ 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 98/110

 

;:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

_g|grí bgnr|k|t{d dh Ldpev|emdn|g dn dh bteh rd gfrdvse he me{gv |ere ld bvdbkmkdn|g ldh aer|g dnrehtl ld he Rdatvklel Rgbkeh dn|vd 6??2 { 6??1 *36(3$+. Htdag( rghemdn|d hgr Ldpev|emdn|gr ld\evkie { Ren|e Bvty mgr|vevgn tne |ere ld bvdbkmkdn|g rtpdvkgv eh 4?$ dn|vd 6??2 { 6??1( mkdn|verutd hgr Ldpev|emdn|gr ld Bjtutkrebe { Gvtvg mtdr|ven tn bvdbkmkdn|g mt{ feig ld rt aer|g ld heRdatvklel Rgbkeh dn sehgv ngmkneh( ld :$ { 51(;$ vdrpdb|ksemdn|d( rkankckbenlg bgn |glepvgfefkhklel tne lkrmkntbkòn ldh aer|g vdeh dn dr|gr lgr Ldpev|emdn|gr. Rkn dmfevag( ldfklg e heceh|e ld le|gr pvdbkrgr ld knchebkòn { aer|g pgv gfid|g ld|ehhelgr pgv Ldpev|emdn|g( ng rd behbthe dndh pvdrdn|d dr|tlkg dh bvdbkmkdn|g vdeh ldh aer|g ldpev|emdn|eh *btelvg 44+.

Vdrpdb|g eh aer|g ldh rdb|gv pvkselg( dr|d mtdr|ve |erer ld bvdbkmkdn|g mt{ ctdv|dr dn hgrLdpev|emdn|gr ctdve ldh Did Bdn|veh9 Bjtutkrebe( Gvtvg( _g|grí( \evkie( Fdnk { _enlg. Dn dr|gr( dhaer|g pvkselg bgnrkldvelg dn dh dr|tlkg ctd mth|kphkbelg pgv 1(6 dn|vd 6??2 { 6??1. E pdrev ld dr|dctdv|d bvdbkmkdn|g( dh aer|g pvkselg behbthelg dn dh dr|tlkg peve dr|gr Ldpev|emdn|gr rkatd rkdnlgpdutdõg( vdpvdrdn|enlg Fr. 66(2 mkhhgndr dn dh eõg 6??1( dr ldbkv 5? sdbdr mdngv e hgr Fr. 66:(6mkhhgndr aer|elgr dn hgr |vdr Ldpev|emdn|gr ldh Did Bdn|veh *btelvg 44+.

Btelvg 44  ‒ Aer|g dn sehgv ngmkneh pgv Ldpev|emdn|g { rtfrdb|gv( Fghkske( 6??1

Aer|g dn rehtlpgv Ldpev|emdn|g

Rtfrdb|gvpùfhkbg

Rtfrdb|gvRda.Rgbkeh

Rdb|gvDr|e|eh

Rdb|gvpvkselg

BjtutkrebeAer|g 6??1

*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

5<3(6

4:(;$  

43(<

:(?$  

6?6(3

<?(4$  

2(<

6?2(;$  

He _ey

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

2;:(6

4:(;$  

<:<(4

61(4$  

::6(3

<?(?$  

16(4

23(:$  

Bgbjefemfe

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

633(5

11(<$  

5:<(?

21(2$  

<4?(5

4:(4$  

65(?

21(1$  

Gvtvg

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

11(4

;<(6$  

44(2

51(;$  

526(1

42(?$  

<(3

3:4(3$  

_g|grí 

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

533(3

556(;$  

13(3

36(3$  

6<2(6

;<(?$  

6(1

5662(3$  

\evkie

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

655(?

6?3(<$  

43(<

4?(4$  

631(4

545(4$  

:(1

:46(1$  

Ren|e Bvty

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

2;2(;

4?(<$  

2;<(2

4?(<$  

1::(6

4?(<$  

52<(:

<6(<$  

FdnkAer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

563(:

3:(5$  

<4(?

62(3$  

515(:

42(3$  

5(;

41;(6$  

_enlg

Aer|g 6??1*Fr. mkhhgndr+

*bvdbkmkdn|g 6??2-6??1+

1?(4

5:4(:$  

:(5

21(4$  

1:(3

541(5$  

?(;

-  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 99/110

 KKK.:.<. Aer|g dn rehtl pdv båpk|e( rdaùn Ldpev|emdn|g

Dh aer|g |g|eh dn rehtl pdv båpk|e *dn sehgv ngmkneh+ utd ptlg rdv ldreavdaelg pgv Ldpev|emdn|g*ng rd knbht{d dh aer|g ld fghrkhhg nk hgr aer|gr vdehkyelgr peve dh nksdh nebkgneh+ dr dn bgnrghklelgnebkgneh ld Fr. 246(; pgv jefk|en|d dn dh eõg 6??1( pdvg bgn avenldr kndutkleldr kn|dv-ldpev|emdn|ehdr9 _enlg dr dh Ldpev|emdn|g bgn me{gv aer|g pdv båpk|e( bgn Fr. 5.?;1(1( mkdn|verutd Bgbjefemfe |kdndn tn aer|g pdv båpk|e bte|vg sdbdr mår feig( bgn Fr. 63;(4 pgv jefk|en|d0Gvtvg { _g|grí |emfkën mtdr|ven tn feig aer|g dn rehtl pdv båpk|e( bgn Fr. 255(1 { Fr. 253(1vdrpdb|ksemdn|d( mkdn|ver utd \evkie bgnr|k|t{d dh rdatnlg Ldpev|emdn|g bgn me{gv aer|g pdvbåpk|e *Fr. 41?(<+( etnutd dr|d dr 5(; sdbdr mdngv e hg utd rd gfrdvse dn _enlg *khtr|vebkòn <?+.

Dn hgr ld mår Ldpev|emdn|gr( dh aer|g pdv båpk|e behbthelg peve dh pvdrdn|d dr|tlkg e pev|kv ld hgrle|gr ld aer|g ld Sehlër { _dõehgye *6?5?+ { le|gr ld pgfhebkòn ldh KND *6??4+( dr ld Fr. 225(4pgv jefk|en|d dn Bjtutkrebe( Fr. 245(: dn He _ey( Fr. 236(< dn Ren|e Bvty { Fr. <55(< pgvjefk|en|d dn dh Ldpev|emdn|g ldh Fdnk *khtr|vebkòn <?+.

Khtr|vebkòn <?  ‒ Aer|g dn rehtl pdv båpk|e rdaùn Ldpev|emdn|g( dn fghkskengr( Fghkske( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Dh aer|g pgv jefk|en|d je dsghtbkgnelg ld mendve mt{ lkcdvdn|d rdaùn dh Ldpev|emdn|g9 erí( hgrLdpev|emdn|gr utd dn 6??1 |kdndn dh me{gv aer|g pdv båpk|e *_enlg { \evkie+ |emfkën rgn hgr utd|tskdvgn me{gv knbvdmdn|g( {( rk fkdn dh Ldpev|emdn|g ld _enlg rkdmpvd ctd dh utd |tsg me{gvaer|g pdv båpk|e( dh Ldpev|emdn|g ld \evkie |dníe dn dh eõg 6??2 tn aer|g pdv båpk|e kncdvkgv e hg utdrd pglíe gfrdvsev dn He _ey( Ren|e Bvty( Bjtutkrebe { Fdnk( pdvg dr|d rd knbvdmdn|gpvgavdrksemdn|d { ctd mth|kphkbelg pgv lgr dn rghemdn|d 2 eõgr *btelvg 43+.

Hgr Ldpev|emdn|gr ld He _ey( Ren|e Bvty { Bjtutkrebe rgn hgr utd mgr|vevgn her mdngvdr |ererld bvdbkmkdn|g ld rt aer|g pdv båpk|e( vdrpdb|ksemdn|d 25$( 2?(1$ { 26(1$ *btelvg 43+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 100/110

 

5??

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Dn bten|g eh Ldpev|emdn|g ld _g|grí( rt aer|g pdv båpk|e |tsg tn knbvdmdn|g ld ;5(6$ dn|vd 6??2{ 6??1( ld |eh cgvme utd rkdnlg dh mdngv aer|g pdv båpk|e dn dh eõg 6??2( bgn Fr. 534(3 pgvjefk|en|d( |kdnd dn dh eõg 6??1 tn aer|g pdv båpk|e me{gv utd dn hgr Ldpev|emdn|gr ldBgbjefemfe { ld Gvtvg. Ld jdbjg( e pev|kv ldh eõg 6??4( dr dn dh Ldpev|emdn|g ld Bgbjefemfeutd rd gfrdvse dh mdngv aer|g dn rehtl pdv båpk|e *btelvg 43+.

_gv g|ve pev|d( rd ptdld gfrdvsev tn knbvdmdn|g ld her ldrkatehleldr kn|dvldpev|emdn|ehdr dn dhaer|g dn rehtl pdv båpk|e dn|vd hgr eõgr 6??2 { 6??19 mkdn|ver utd dn dh eõg 6??2( dh aer|g pdvbåpk|e ldpev|emdn|eh me{gv *_enlg bgn Fr. 4?5(5 pgv jefk|en|d+ dve 2 sdbdr mår dhdselg utd dn dhLdpev|emdn|g bgn mdngv aer|g *_g|grí bgn Fr. 534(3 pgv jefk|en|d+( dn dh eõg 6??1 dr|d ve|kg dveld <9 dh aer|g pdv båpk|e dn _enlg *Fr. 5.?;1(1 pgv jefk|en|d+ dve <(5 sdbdr mår dhdselg utd dn dhLdpev|emdn|g bgn mdngv aer|g *Bgbjefemfe bgn Fr. 63;(4 pgv jefk|en|d+. Dn dh eõg 6??4( dhaer|g pdv båpk|e dn _enlg *Fr. 5.?16(; pgv jefk|en|d+ dve <(; sdbdr mår dhdselg utd dn dhLdpev|emdn|g ld Bgbjefemfe( dh bteh dve ld Fr. 651(2 pgv jefk|en|d *btelvg 43+.

Btelvg 43  ‒ Dsghtbkòn ldh aer|g pdv båpk|e pgv Ldpev|emdn|g( Fghkske( 6??2-?1

Aer|g pdv båpk|epgv Ldpev|emdn|g

6??2 6??< 6??4 6??3 6??1

BjtutkrebeFr. ' jefk|en|d

*bvdbkmkdn|g ebtmthelg+ 

6<;(:-  

635(6<(3$  

6;?(253(6$  

6;1(35;(5$  

225(426(1$  

He _eyFr. ' jefk|en|d

*bvdbkmkdn|g ebtmthelg+ 

63:(3

-  

6;2(<

;(6$  

2?2(5

56(;$  

222(?

6<(?$  

245(:

25(?$  

BgbjefemfeFr. ' jefk|en|d

*bvdbkmkdn|g ebtmthelg+ 

5:1(4

-  

6<6(2

6;(2$  

651(2

54(;$  

62:(2

61(5$  

63;(4

<2(:$  

GvtvgFr. ' jefk|en|d

*bvdbkmkdn|g ebtmthelg+ 

6?4(5

-  

663(5

5?(6$  

634(<

6;(<$  

631(4

2?(<$  

255(1

46(?$  

_g|grí  Fr. ' jefk|en|d*bvdbkmkdn|g ebtmthelg+ 

534(3-  

6?3(66<(4$  

6<;(64?(4$  

63;(436(1$  

253(1;5(6$  

\evkieFr. ' jefk|en|d

*bvdbkmkdn|g ebtmthelg+ 

6<1(6

-  

265(:

2?(6$  

236(6

<3(4$  

4?3(<

5?<(;$  

41?(<

52?(:$  

Ren|e BvtyFr. ' jefk|en|d

*bvdbkmkdn|g ebtmthelg+ 

611(2

-  

6:1(<

2(1$  

222(6

6?(6$  

21;(3

23(;$  

236(<

2?(1$  

FdnkFr. ' jefk|en|d

*bvdbkmkdn|g ebtmthelg+ 

6:3(:

-  

<?;(2

<6(1$  

264(2

52(<$  

2:1(1

24(6$  

<55(<

<2(<$  

_enlgFr. ' jefk|en|d

*bvdbkmkdn|g ebtmthelg+ 

4?5(5-  

322(163(<$  

5.?16(;55<(5$  

115(542(;$  

5.?;1(155;(?$  

Bgnrghklelg ;Ldpev|emdn|gr

Fr. ' jefk|en|d*bvdbkmkdn|g ebtmthelg+ 

6<<(;

-  

61;(6

5<(?$  

6;1(;

65(1$  

225(:

24(4$  

246(;

<<(5$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 101/110

 E pev|kv ld he ldreavdaebkòn ldh aer|g ldpev|emdn|eh pdv båpk|e pgv rtfrdb|gv( rd ptdld bgnr|e|eveùn mår her ldrkatehleldr gfrdvseler dn dh aer|g |g|eh pdv båpk|e9 dn dh rtfrdb|gv pùfhkbg( _enlgdr dh Ldpev|emdn|g bgn me{gv aer|g pdv båpk|e dn dh eõg 6??1( bgn Fr. 5.62<(6 pgv jefk|en|d ngeckhkelg e he Rdatvklel Rgbkeh( mkdn|ver utd hgr ve|kgr pdv båpk|e mdngvdr rd gfrdvsen dn hgrLdpev|emdn|gr ldh Did Bdn|veh9 Fr. 5:;(; pgv jefk|en|d ng eckhkelg dn he Rdatvklel Rgbkeh dn Ren|eBvty( Fr. 6?5 dn Bgbjefemfe { Fr. 66;(: dn He _ey *khtr|vebkòn <5 { btelvg 41+.

Dzkr|dn dn|gnbdr ldrkatehleldr kn|dv-ldpev|emdn|ehdr mt{ pvgntnbkeler dn he lkr|vkftbkòn ldhaer|g pùfhkbg( {e utd me{gv aer|g pùfhkbg ldpev|emdn|eh pdv båpk|e *_enlg+ dr 3(4 sdbdr me{gv ehmdngv *_enlg+. Dn dh rtfrdb|gv ld he Rdatvklel Rgbkeh( dr|er kndutkleldr rgn mdngr mevbeler( {eutd dn dh eõg 6??1( dh aer|g pdv båpk|e ldpev|emdn|eh me{gv *Ren|e Bvty bgn Fr. 161(; pgv eckhkelg+dve 2(4 sdbdr mår dhdselg utd dn dh Ldpev|emdn|g bgn mdngv aer|g pdv båpk|e dn he RdatvklelRgbkeh *Gvtvg bgn Fr. 6?5(; pgv eckhkelg+ *khtr|vebkòn <5 { btelvg 41+.

Khtr|vebkòn <5  ‒ Aer|g dn rehtl pdv båpk|e rdaùn Ldpev|emdn|g { rtfrdb|gv( Fghkske( 6??1

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Rk rd gfrdvse her lkcdvdnbker dn|vd hgr rtfrdb|gvdr pùfhkbg { ld he Rdatvklel Rgbkeh( rd bgnr|e|e utde nksdh nebkgneh( dh aer|g pgv eckhkelg dn he Rdatvklel Rgbkeh dr rtpdvkgv eh aer|g pdv båpk|e ldhrtfrdb|gv pùfhkbg *pgv jefk|en|d ng eckhkelg+. Rkn dmfevag( hg bgn|vevkg gbtvvd dn hgr Ldpev|emdn|grld Gvtvg( _g|grí( \evkie { _enlg( rkdnlg dh aer|g pdv båpk|e dn dh rtfrdb|gv pùfhkbg me{gv utd dhaer|g pdv båpk|e ld he Rdatvklel Rgbkeh. Erí( dn dh Ldpev|emdn|g ld _enlg( dh aer|g pdv båpk|e ldhrtfrdb|gv pùfhkbg *Fr. 5.62<(6+ dr 6(4 sdbdr mår dhdselg utd dh aer|g pdv båpk|e ld he RdatvklelRgbkeh *Fr. <:3(2 pgv eckhkelg+. Dn _g|grí( dh aer|g pdv båpk|e pùfhkbg dr 5(; sdbdr mår dhdselg utddh aer|g pgv eckhkelg dn he Rdatvklel Rgbkeh *khtr|vebkòn <5 { btelvg 41+.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 102/110

 

5?6

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

Rkn dmfevag( dn hgr Ldpev|emdn|gr ld Bjtutkrebe( He _ey( Bgbjefemfe( Ren|e Bvty { Fdnk( hecveamdn|ebkòn ldh rdb|gv rehtl dr ldrcesgvefhd e he pgfhebkòn utd ebtld eh rtfrdb|gv pùfhkbg dnbten|g e aer|g pdv båpk|e9 erí( dn dh Ldpev|emdn|g ld Ren|e Bvty( dh aer|g pdv båpk|e dn heRdatvklel Rgbkeh dr 2(: sdbdr mår dhdselg utd dn dh rtfrdb|gv pùfhkbg. Dn hgr Ldpev|emdn|gr ldHe _ey { Bgbjefemfe( dh aer|g pdv båpk|e ld he Rdatvklel Rgbkeh dr lgr sdbdr mår dhdselg utd dhaer|g pdv båpk|e ldh rtfrdb|gv pùfhkbg *khtr|vebkòn <5 { btelvg 41+.

Cknehmdn|d( dh aer|g pdv båpk|e dn dh rdb|gv pvkselg dr vdhe|ksemdn|d pdutdõg dn bgmpevebkòn bgnhgr ldmår rtfrdb|gvdr. Rkn dmfevag( ng rd ldfd ghsklev utd dr|d aer|g pvkselg rghg bgnbkdvnd hgrrdatvgr pvkselgr { pev|d ldh aer|g ld GNAr. Dh ldpev|emdn|g bgn me{gv aer|g pvkselg pdv båpk|edr dh ld Ren|e Bvty( bgn Fr. 46(; pgv jefk|en|d( mkdn|ver utd dh mdngv ve|kg pdv båpk|e rd gfrdvsedn hgr Ldpev|emdn|gr ld _g|grí( Fdnk { Bjtutkrebe( bgn tn aer|g pvkselg pdv båpk|e ld Fr. 2(<(Fr. <(3 { Fr. 4(< vdrpdb|ksemdn|d *btelvg 41+. .

Btelvg 41  ‒ Aer|g pdv båpk|e pgv Ldpev|emdn|g { rtfrdb|gv( dn fghkskengr( Fghkske( 6??1

Aer|g pdv båpk|epgv Ldpev|emdn|g 6??1

Rtfrdb|gvpùfhkbg

*rgfvd pgfhebkònng eckhkele e

Rda. Rgbkeh+

Rtfrdb|gvRda.Rgbkeh

*rgfvd pgfhebkònng eckhkele e

Rda. Rgbkeh+ 

Rdb|gvDr|e|eh

*rgfvd pgfhebkòn|g|eh+ 

Rdb|gvpvkselg

*rgfvd pgfhebkòn|g|eh+ 

BjtutkrebeFr. ' jefk|en|d

*bvdbkmkdn|g 6??2-6??1+ 

6;<(<

4<(?$  

<?4(2

-54(5$  

263(?

25(4$  

4(<

5:<(4$  

He _eyFr. ' jefk|en|d

*bvdbkmkdn|g 6??2-6??1+ 

66;(:

<:(5$  

<4;(<

5:(5$  

264(5

25(6$  

63(1

6:(6$  

BgbjefemfeFr. ' jefk|en|d

*bvdbkmkdn|g 6??2-6??1+ 

6?5(?

3:(<$  

<??(:

:(6$  

641(4

<<(1$  

56(?

64(1$  

GvtvgFr. ' jefk|en|d

*bvdbkmkdn|g 6??2-6??1+ 

<?6(:

536(;$  

65?(;

-65(3$  

2?5(2

<1(:$  

5?(4

34;(6$  

_g|grí Fr. ' jefk|en|d

*bvdbkmkdn|g 6??2-6??1+ 

24<(:

54?(<$  

6<6(3

;(?$  

252(6

:;(<$  

2(<

55;6(4$  

\evkieFr. ' jefk|en|d

*bvdbkmkdn|g 6??2-6??1+ 

4<;(3

5:3(<$  

<4:(3

;(1$  

446(2

564(<$  

5:(?

142(;$  

Ren|e BvtyFr. ' jefk|en|d

*bvdbkmkdn|g 6??2-6??1+ 

5:;(;

22(3$  

161(;

6?(?$  

2?;(4

25(:$  

46(;

6<(:$  

FdnkFr. ' jefk|en|d

*bvdbkmkdn|g 6??2-6??1+ 

2:6(5

32(5$  

<62(1

-:(6$  

<?3(:

<6(6$  

<(3

46:(3$  

_enlgFr. ' jefk|en|d

*bvdbkmkdn|g 6??2-6??1+ 

5.62<(6546(?$  

<:3(2-4(6$  

5.?:4(?553(4$  

56(1-  

Bgnrghklelg ;Ldpev|emdn|gr

Fr. ' jefk|en|d*bvdbkmkdn|g 6??2-6??1+ 

636(;

1?(5$  

<4?(:

5?(?$  

261(<

<<(3$  

64(4

2:(3$  

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 103/110

 Vdrpdb|g eh drctdvyg peve knbvdmdn|ev dh aer|g dn rehtl ldpev|emdn|eh rdaùn rtfrdb|gv( rdgfrdvse utd her |erer ld bvdbkmkdn|g me{gvdr rd dnbtdn|ven dn dh rtfrdb|gv pùfhkbg( bgn hedzbdpbkòn ldh knbvdmdn|g ldh aer|g pvkselg pdv båpk|e dn hgr Ldpev|emdn|gr ld Bjtutkrebe( Gvtvg(_g|grí( \evkie( Fdnk { _enlg *dn dr|d ùh|kmg ng rd pvdrdn|e |ere ld bvdbkmkdn|g {e utd dh aer|gbehbthelg peve 6??2 dve nthg+( utd |tsg tn bvdbkmkdn|g dzpgndnbkeh pdvg rgfvd mgn|gr pdutdõgr*btelvg 41+9 bgnitn|emdn|d( dr|gr rdkr Ldpev|emdn|gr perevgn ld tn aer|g pvkselg *rdatvgrpvkselgr { GNAr+ pdv båpk|e ld Fr. 5(6 dn dh eõg 6??2 e Fr. 1(; peve dh eõg 6??1.

Dh Ldpev|emdn|g bgn me{gv bvdbkmkdn|g ld rt aer|g pùfhkbg pdv båpk|e ctd dh ld \evkie *5:3(<$dn|vd 6??2 { 6??1+( rdatklg pgv Gvtvg *536(;$+( _enlg *546$+ { _g|grí *54?(<$+. Dn bemfkg(dr dn dh Ldpev|emdn|g ld Ren|e Bvty utd rd gfrdvse dh mdngv bvdbkmkdn|g *22(3$+( ld |eh mendveutd dn dh eõg 6??1( dh aer|g pùfhkbg pdv båpk|e dn dr|d Ldpev|emdn|g dr dh mdngv ldh peír( mkdn|verutd dn dh eõg 6??2( dve me{gv eh aer|g pdv båpk|e ld hgr Ldpev|emdn|gr ld Bgbjefemfe { _g|grí.Dh Ldpev|emdn|g ld He _ey |emfkën mtdr|ve tn bvdbkmkdn|g vdhe|ksemdn|d feig ld rt aer|g pùfhkbgpdv båpk|e( <:(5$ dn|vd 6??2 { 6??1 *btelvg 41 d khtr|vebkòn <6+.

Khtr|vebkòn <6  ‒ \ere ld bvdbkmkdn|g 6??2-6??1 ldh aer|gpùfhkbg pdv båpk|e rdaùn Ldpev|emdn|g( Fghkske

Ctdn|d9 dhefgvebkòn pvgpke dn ferd e le|gr ld9 Sehlër { _dõehgye 6?5? 

Cknehmdn|d( dh bvdbkmkdn|g ldh aer|g ld he Rdatvklel Rgbkeh mtdr|ve vdrth|elgr bgn|ver|elgr rdaùnLdpev|emdn|gr9 dn dcdb|g( rd ptdld gfrdvsev tne lkrmkntbkòn ldh aer|g pgv eckhkelg dn|vd hgr eõgr6??2 { 6??1 dn hgr Ldpev|emdn|gr ld Bjtutkrebe( Gvtvg( Fdnk { _enlg *btelvg 41+ peve fdndckbkeve hgr Ldpev|emdn|gr ld He _ey { Ren|e Bvty pvknbkpehmdn|d( ldng|enlg tn knbvdmdn|g ld herkndutkleldr dn|vd eckhkelgr rdaùn Ldpev|emdn|g( { tn vkdrag avenld ld lkrmkntbkòn ld he behklel lde|dnbkòn dn dr|gr bte|vg Ldpev|emdn|gr.

Ren|e Bvty 

22(3$

_g|grí  

54?(<$

Fdnk 

32(5$

Bgbje-femfe 

3:(<$Gvtvg 

536(;$

He _ey 

<:(5$

_enlg 

546(?$

\evkie  5:3(<$ 

4<$ 

Bjtutkrebe 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 104/110

 

5?<

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 105/110

 Bgnbhtrkgndr { vdbgmdnlebkgndr 

Enehkyenlg he kncgvmebkòn ld aer|g { cknenbkemkdn|g dn rehtl pvgpgvbkgnele dn hgr lgr dr|tlkgr ld

btdn|er lkrpgnkfhdr *Sehlër { _dõehgye 6?5?0 Åskhe d| eh . 6?55+( rd ptlg dr|efhdbdv utd dh aer|g |g|eh dnrehtl dn sehgv ngmkneh rd jefvíe knbvdmdn|elg dn tn 4?$ dn|vd 6??2 { 6??1( vdpvdrdn|enlg tnaer|g pdv båpk|e 6??1 ld Fr. 46:(;. Rkn dmfevag( |emfkën rd ldmgr|vò utd dh knbvdmdn|g vdeh ctdld rghemdn|d 64(1$ dn|vd 6??2 { 6??1( rkankckbenlg utd he mk|el ldh knbvdmdn|g ldh aer|g |g|eh dnrehtl dn dh pdvkglg 6??2-?1 rd ldfd e he knchebkòn *knbvdmdn|g ld hgr pvdbkgr+.

E pdrev ld tn me{gv knbvdmdn|g ldh aer|g dn rehtl dn dh rtfrdb|gv pùfhkbg utd dn he RdatvklelRgbkeh { dh rdb|gv pvkselg( rd ldmgr|vò utd dh aer|g dr|e|eh dn rehtl dn Fghkske dr ng|efhdmdn|dknrtckbkdn|d peve mkvev jebke tn bgfdv|tve tnksdvreh dn rehtl( e pdrev ld utd dr|d dr|å pvdskr|e dn heBgnr|k|tbkòn _ghí|kbe ldh Dr|elg _htvknebkgneh ld Fghkske9 rk fkdn he dzpdvkdnbke kn|dvnebkgneh mtdr|veutd dr pgrkfhd |dndv tn me{gv aer|g dn rehtl e pev|kv ld tne me{gv pvkgvkyebkòn ld he rehtl ldn|vgld hgr pvdrtptdr|gr pùfhkbgr { pvkselgr( hg bgn|vevkg gbtvvkò dn Fghkske dn dh pdvkglg enehkyelg(mgr|venlg tn lkrmkntbkòn dn vdhebkòn eh _KF { dn vdhebkòn eh aer|g dr|e|eh |g|eh( ldfklg e tn feig

knbvdmdn|g ldh aer|g dn rehtl9 erí( ldrld dh knkbkg dn 6??3 ld he eb|teh adr|kòn ld Agfkdvng jer|e dheõg 6??:( dh aer|g dr|e|eh dn rehtl *rtfrdb|gvdr pùfhkbg { ld he rdatvklel rgbkeh+ rd knbvdmdn|ò dnrghemdn|d 2?(4$( mkdn|ver utd dh vdr|g ldh aer|g pùfhkbg rd knbvdmdn|ò dn 55:(<$ ldmgr|venlg heceh|e ld pvkgvklel ebgvlele eh rdb|gv rehtl ldrld dh eõg 6??3. Bgmg vdrth|elg( rghemdn|d dh ;(<$ldh aer|g ldh Agfkdvng Adndveh dn 6??: bgvvdrpgnld e aer|g dn rehtl( mkdn|ver utd dn peírdr bgnbgfdv|tve tnksdvreh dn rehtl( dr|d ve|kg hhdae eh 52(4$.

Dr|e ceh|e ld cknenbkemkdn|g peve dh rdb|gv rehtl ldfd pgndvrd ld pevehdhg bgn he lkrmkntbkòn ld hekmpgv|enbke ldh cknenbkemkdn|g dz|dvng ldn|vg ldh aer|g |g|eh dn rehtl( ldmgr|venlg he ndbdrklel lddnbgn|vev mdbenkrmgr ld cknenbkemkdn|g nebkgnehdr peve erdatvev he bgfdv|tve tnksdvreh dn Fghkske{ dn pev|kbthev ctdn|dr pùfhkber {e utd dn he eb|tehklel( he mk|el ld her ctdn|dr ld cknenbkemkdn|g ldhe rehtl nebkgnehdr rgn pvkseler { rghemdn|d he mk|el rgn pùfhkber9 dn pev|kbthev( dh aer|g dnmdlkbemdn|gr ldh rdb|gv dr|e|eh dr ng|efhdmdn|d knrtckbkdn|d( {e utd dh aer|g dn mdlkbemdn|grbgvvdrpgnld dn 13$ eh rdb|gv pvkselg( pvknbkpehmdn|d hgr jgaevdr.

Eldmår ld rdv knrtckbkdn|d( dh aer|g dn rehtl dr|å meh vdpev|klg9 erí( dh aer|g dn eb|kskleldr bgr|g-dckbkdn|dr( bgmg he pvdsdnbkòn { he rehtl pùfhkbe dr ng|efhdmdn|d knrtckbkdn|d( hhdaenlg evdpvdrdn|ev rghemdn|d 5?(5$ ldh aer|g |g|eh dn rehtl dn he adr|kòn 6??1 e pdrev ld utd rd ldfdpvkgvkyev he pvdsdnbkòn { pvgmgbkòn ld ebtdvlg bgn he Bgnr|k|tbkòn pghí|kbe ldh Dr|elg { her pghí|kberskadn|dr dn dh rdb|gv rehtl. Ld jdbjg( ldmerkelg aer|g dn rehtl rd lkvkad e jgrpk|ehdr *25(5$ ldhaer|g |g|eh dn rehtl+ peve e|dnbkòn ld dncdvmdleldr dsk|efhdr bgn me{gv drctdvyg cknenbkdvg e cesgvld he pvdsdnbkòn ld dncdvmdleldr { pvgmgbkòn ld he rehtl.

Cknehmdn|d( rd vdbgmkdnle utd dr|d |kpg ld enåhkrkr( rk fkdn pglvíe rdv mtbjg mår ld|ehhelg( ldfevdpd|kvrd e bele dr|tlkg ld btdn|er ld rehtl( peve utd dr|gr ng rd stdhsen dn tn rkmphd vdpgv|d ldaer|g rkn t|khklel knmdlke|e( rkng dn tn didvbkbkg enehí|kbg utd ptdle rdv t|khkyelg peve mdigvev herpghí|kber ld rehtl. Rkn dmfevag( dn dh bgn|dz|g eb|teh( dh pvdrdn|d enåhkrkr ldfd pvknbkpehmdn|d

rdvskv ld evatmdn|ebkòn e cesgv ld he kmphdmdn|ebkòn ldh Rkr|dme Ùnkbg ld Rehtl { mårpev|kbthevmdn|d ld rt bgmpgndn|d ld bgfdv|tve tnksdvreh9 mgr|venlg he knrtckbkdnbke ldh aer|g dnrehtl( rd ldfd bvdev tne bgnrbkdnbke bghdb|kse ld utë dh knbvdmdn|g rgr|dnklg ldh aer|g dn rehtl ngdr ehag kmpgrkfhd( {e utd dh Dr|elg Fghkskeng |kdnd tne bepebklel dbgnòmkbe dskldn|d peveknbvdmdn|ev dh aer|g pùfhkbg dn pvgpgvbkgndr mtbjg me{gvdr e hg utd je jdbjg ldrld dh eõg 6??2(pdvg rd ndbdrk|e peve dhhg tne sdvleldvg bgmpvgmkrg pghí|kbg ldh Dr|elg _htvknebkgneh ld Fghkske dnrt bgnitn|g( e nksdh bdn|veh { rtfnebkgneh( e cesgv ld he rehtl( peve erí erdatvev dcdb|ksemdn|d dhldvdbjg e he rehtl ld |glgr hgr fghkskengr { fghkskener.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 106/110

 

5?3

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 107/110

 Fkfhkgavecíe 

  Eskhe V.( Skhhdne M.( Åhsevdy J. { Båvldner N. *6?55+( Rdvkd ld Aer|g dn Rehtl 6??2-6??: (Mknkr|dvkg ld Rehtl { Ldpgv|dr { Rgbkgr peve dh Ldrevvghhg( ng ptfhkbelg.

  Fenbg Bdn|veh ld Fghkske FBF *6?5?+( Bg|kyebkòn gckbkeh e ckn ld mdr ldh Lòhev ngv|demdvkbeng (dn Tnklel ld Enåhkrkr ld _ghí|kber Rgbkehdr { Dbgnòmkber TLE_D *6?5?+( Lgrrkdv ld Dr|elír|kber Rgbkehdr { Dbgnòmkber Sgh.6? ( lkrpgnkfhd dn qqq.tlepd.agf.fg.

  Båvldner M. { Levvår B. *5;;3+( Aer|g Nebkgneh { Cknenbkemkdn|g ldh Rdb|gv Rehtl dn Fghkske (Gvaenkyebkòn Mtnlkeh ld he Rehtl- Rdvkd ‘Mebvgdbgngmíe( Rehtl { Ldrevvghhg” Nvg. 51( Dndvg ld5;;3( Akndfve Rtkye.

  Båvldner M.( Bjeqhe M. { Mtõgy I. *5;;1+( Mgskhkyebkòn ld Vdbtvrgr peve dh Rdb|gv Rehtl dn Fghkske ( TLE_RG( Lgbtmdn|g ld \vefeig 4:';1( Eagr|g 5;;1( He _ey Fghkske. _tfhkbelgknkbkehmdn|d dn Båvldner M.( Bjeqhe M. { Mtõgy I. *5;;1+ Vdrgtvbd Mgfkhkye|kgn cgv |jd Jdeh|j Rdb|gv kn Fghkske ( LLM'L_KJ( Jevsevl Rbjggh gc _tfhkb Jdeh|j( Ithkg 5;;3( Fgr|gnMerrebjtrd||r( lkrpgnkfhd dn qqq.jrpj.jevsevl.dlt.

  Båvldner M. *6???+( Btdn|er Nebkgnehdr ld Cknenbkemkdn|g { Aer|g dn Rehtl - Fghkske ( He _ey(Gvaenkyebkòn _enemdvkbene ld he Rehtl( Dndvg 6???.

  Båvldner M. *6??<+( Btdn|er Nebkgnehdr ld Cknenbkemkdn|g { Aer|g dn Rehtl  ‒ Rdatnle Dlkbkòn ( He _ey( Mknkr|dvkg ld Rehtl { Ldpgv|dr( _vg{db|g Vdcgvme ld Rehtl( Lkbkdmfvd 6??<.

  Bevvkn A. { Iemdr B. *6??2+( Ld|dvmknen|r gc ebjkdskna tnksdvreh bgsdvead gc jdeh|j bevd 9 en dmpkvkbeh eneh{rkr ( dn Etlkfdv|( Me|jgnne| { Ld Vggldnfd`d *6??2+( Cknenbdmdn| ld he ren|ë lenr hdr pe{r l‛Ecvkutd d| l‛Erkd ï cekfhd vdsdnt ( @ev|jehe dl( _evkr( 6??2( pp 6;;-265.

  Ltpt{ I. *6?55+( Dr|tlkg ld rk|tebkòn { dzpdvkdnbker dn peírdr bgn bgfdv|tve tnksdvreh dn rehtl (Mknkr|dvkg ld Rehtl { Ldpgv|dr( ng ptfhkbelg.

  Cgnlg Mgnd|evkg Kn|dvnebkgneh *6?55+( Qgvhl Dbgngmkb Gt|hgg` Le|eferd( Epvkh 6?55(lkrpgnkfhd dn qqq.kmc.gva.

  Aebd|e Gckbkeh ld Fghkske *6??2+( Ldbvd|g Rtpvdmg N¹ 61?<;( me{g 63 ld 6??2 ( lkrpgnkfhd dnqqq.aebd|egckbkehldfghkske.agf.fg.

  Aebd|e Gckbkeh ld Fghkske *6??1+( Ldbvd|g Rtpvdmg N¹ 6;553( me{g ?5 ld 6??1 ( lkrpgnkfhd dnqqq.aebd|egckbkehldfghkske.agf.fg.

  Advl|jem T.A. { Iónrrgn M. *6???+( Kn|dvne|kneh bgmpevkrgnr gc jdeh|j dzpdnlk|tvd 9 |jdgv{(le|e enl dbgngmd|vkb eneh{rkr ( dn Bth{dv E.I. { Ndqjgtrd I._. *6???+( Jenlfgg` gc Jdeh|j Dbgngmkbr ( Sghtmd 5.

  Knr|k|t|g Nebkgneh ld Dr|elír|kber KND *6??4+( _vg{dbbkgndr Adndvehdr ld he pgfhebkòn 6??6- 6?5? ( lkrpgnkfhd dn qqq.knd.agf.fg.

  Knr|k|t|g Nebkgneh ld Dr|elír|kber KND *6??:+( Ínlkbd ld _vdbkgr eh Bgnrtmklgv Fghkske9 

Sevkebkòn Ebtmthele _gvbdn|teh ldh Ínlkbd ld _vdbkgr eh Bgnrtmklgv pgv Eõg rdaùn Bepí|thg { Avtpg *5;;5=5??+(Rdvkd9 5;:; - 6??: ( lkrpgnkfhd dn qqq.knd.agf.fg.

  Knr|k|t|g Nebkgneh ld Dr|elír|kber KND *6?5?+( Rdvkd jkr|òvkbe ldh _vgltb|g Kn|dvng Fvt|g (lkrpgnkfhd dn qqq.knd.agf.fg.

  Knr|k|t|g Nebkgneh ld Rdatvgr ld Rehtl KNERDR *6??1+( Entevkg advdnbkeh 6??3 ( Mknkr|dvkg ldRehtl { Ldpgv|dr( Fghkske( 6??1.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 108/110

 

5?:

   E  n   å   h   k  r   k  r   l  d   h   a  e  r   |  g

  d  n

  r  e   h  t   l

  d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :

  Knr|k|t|g Nebkgneh ld Rdatvgr ld Rehtl KNERDR *6??;+( entevkgr dr|elír|kbgr ld he adr|kòn 6??: ( Mknkr|dvkg ld Rehtl { Ldpgv|dr( Fghkske( 6??;.

  Mknkr|dvkg ld Dbgngmíe { Cknenyer _ùfhkber MDC_ { Fenbg Bdn|veh ld Fghkske FBF *6?5?+(Gpdvebkgndr bgnrghkleler ldh Rdb|gv _ùfhkbg ( lkrpgnkfhd dn qqq.fbf.agf.fg.

  Mknkr|dvkg ld Rehtl { Ldpgv|dr MR{L *6??1+( Dr|vtb|tve ld dr|efhdbkmkdn|gr ld rehtl (

Rkr|dme Nebkgneh ld Kncgvmebkòn dn Rehtl RNKR-SD( lkrpgnkfhd dn qqq.rnr.agf.fg.  Mknkr|dvkg ld Rehtl { Ldpgv|dr MR{L d Knr|k|t|g Nebkgneh ld Dr|elír|kber KND *6??;+(

Dnbtdr|e Nebkgneh ld Ldmgavecíe { Rehtl 6??: - FGHKSKE( lkrpgnkfhd dn qqq.rnr.agf.fg.

  Mknkr|dvkg ld Rehtl { Ldpgv|dr MR{L *6?5?+( _hen Rdb|gvkeh ld Ldrevvghhg 6?5?-6?54  ‒ Mgskhkyelgr pgv dh Ldvdbjg e he Rehtl { e he Skle ( Lkvdbbkòn Adndveh ld _henkckbebkòn *lkvdbbkòn {bggvlknebkòn9 M.Rb. Ithkdn Ltpt{+( ng ptfhkbelg.

  Gvaenkyebkòn ld her Nebkgndr Tnkler GNT *6?5?+( Qgvhl _gpthe|kgn _vgrpdb|r9 \jd 6?5? Vdskrkgn( _gpthe|kgn Lkskrkgn gc |jd Ldpev|mdn| gc Dbgngmkb enl Rgbkeh Eccekvr gc |jd Tnk|dlNe|kgnr Rdbvd|evke|( lkrpgnkfhd dn j||p9''dre.tn.gva'tnpl'qpp'knldz.j|m.

  Gvaenkyebkòn Mtnlkeh ld he Rehtl GMR *6?5?+( Dr|elír|kber Renk|evker Mtnlkehdr 6?5? (lkrpgnkfhd dn qqq.qjg.kn|.

  Gvaenkyebkòn Mtnlkeh ld he Rehtl GMR *6?55+( Ahgfeh Jdeh|j Dzpdnlk|tvd Le|eferd (lkrpgnkfhd dn j||p9''eppr.qjg.kn|'nje'le|eferd.

  Gvaenkyebkòn peve he Bggpdvebkòn { dh Ldrevvghhg Dbgnòmkbg GBLD *6???+( E R{r|dm gcJdeh|j Ebbgtn|r Sdvrkgn 5.?( lkrpgnkfhd dn qqq.gdbl.gva.

  Gvaenkyebkòn Mtnlkeh ld he Rehtl *6??4+( Atíe ldh _vgltb|gv ld Btdn|er Nebkgnehdr ld Rehtl bgn ephkbebkgndr drpdbkehdr peve hgr peírdr ld knavdrgr feigr { mdlkgr ( lkrpgnkfhd dnqqq.qjg.kn|.

  _ev|ndvrjkpr cgv Jdeh|j Vdcgvm _JV *5;;:+( Btdn|er Nebkgnehdr ld Rehtl9 Fghkske ( lkrpgnkfhddn qqq.gpr.gva.fg.

  _vgaveme ld her Nebkgndr Tnkler peve dh Ldrevvghhg _NTL  *6?5?+( Jtmen Ldsdhgpmdn| Vdpgv| 6?5? 6?|j Ennksdvrev{ Dlk|kgn( \jd Vdeh Qdeh|j gc Ne|kgnr9 _e|jqe{r |g Jtmen 

Ldsdhgpmdn| ( lkrpgnkfhd dn qqq.tnlp.gva.  Rgbkeh Rdbtvk|{ Elmknkr|ve|kgn *6??:+( Rgbkeh Rdbtvk|{ _vgavemr \jvgtajgt| |jd Qgvhl9 Erke 

enl |jd _ebkckb 6??: ( lkrpgnkfhd dn qqq.rgbkehrdbtvk|{.ags.

  Rgbkeh Rdbtvk|{ Elmknkr|ve|kgn *6??;e+( Rgbkeh Rdbtvk|{ _vgavemr \jvgtajgt| |jd Qgvhl9 Ecvkbe 6??; ( lkrpgnkfhd dn qqq.rgbkehrdbtvk|{.ags.

  Rgbkeh Rdbtvk|{ Elmknkr|ve|kgn *6??;f+( Rgbkeh Rdbtvk|{ _vgavemr \jvgtajgt| |jd Qgvhl9 Emdvkbe 6??; ( lkrpgnkfhd dn qqq.rgbkehrdbtvk|{.ags.

  Rgbkeh Rdbtvk|{ Elmknkr|ve|kgn *6?5?+( Rgbkeh Rdbtvk|{ _vgavemr \jvgtajgt| |jd Qgvhl9 Dtvgpd 6?5? ( lkrpgnkfhd dn qqq.rgbkehrdbtvk|{.ags.

  Tnklel ld Enåhkrkr ld _ghí|kber Dbgnòmkber TLE_D { Gvaenkyebkòn _enemdvkbene ld heRehtl G_R *6??<+( Beveb|dvkyebkòn ld he dzbhtrkòn dn rehtl dn Fghkske .

  Sehlër Q. { _dõehgye V. *6?5?+( Btdn|er Nebkgnehdr ld Rehtl dn Fghkske ( Mknkr|dvkg ld Rehtl {Ldpgv|dr { TLE_D( ng ptfhkbelg.

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 109/110

 

8/3/2019 Julien Dupuy - Estudio de Gasto en Salud en Bolivia 2003-2008

http://slidepdf.com/reader/full/julien-dupuy-estudio-de-gasto-en-salud-en-bolivia-2003-2008 110/110

 

d  n

   F  g   h   k  s   k  e

   6   ?   ?   2

 -   6   ?   ?   :