Hospital trends in latin America

World Health • 47th Year, No. 5, September-october 1994 15 Hospital trends in latin America Humberto M. Novaes with fewer than ten beds, which are probably of low clinical efficiency and will surely be replaced by hospi- tals of greater complexity in the future . The Directory will be useful not only for authorities in the various countries and specialists in the area but also for the three million or so hospital workers in Latin America and the Caribbean. Patient and health workers at a hospital in Tegucigalpa, Honduras. The basic data on hospital services provided in the Region will be available to all concerned public or private institutions. We hope this complex international project will serve to strengthen the relations among the Region 's hospitals and to promote, in the near future, a network of Latin American and Caribbean hospitals for the exchange of experts, services and technology for all the countries. Given the entry of private health insurance companies into various Latin American health care markets, public and private hospitals could become integrated into a network of services, thereby facilitating the exchange of patients between community health services and hospitals. The Pan American Health Organization (PAHO), WHO's Regional Office of the Americas, is in the process of draw- ing up a register of some 15 000 hospitals in Latin America and the Caribbean. The principal objective of the Latin American and Caribbean Hospital Directory is to foster a Latin American network of related institu- tions that will facilitate communica- tion between medical specialties or disciplines for the future exchange of information. The Directory will help the various subregions to share knowledge about common problems and public health subjects, and will also promote more detailed research on specific aspects of the functioning of hospitals. Collecting information on the Region's hospitals called for total support from ministries of health, social security institutions, associa- tions of hospitals and private clinics, and members of the Latin American Hospital Federation, as well as mili- tary and charitable organizations. Instead of a lengthy question- naire, we opted for a simple document that sought to collect only basic data. To date, 10 000 questionnaires have already been returned, and these give us a good general picture of the Region. The case ·of Brazil With an estimated population of over 150 million, Brazil has suffered from rapid urbanization, and this has led to a shortfall in urban services - in particular a lack of basic sanitation in Of particular interest is the high number of private clinics A malaria patient in Brazil. Private and public hospitals are to be integra- ted in a broader network . 16 World Health • 47th Year, No. 5, September-october 1994 A cholera patient at an outpatient facility in Guatemala. Hospitals take up the ma;ority of health budgets in many countries. Can they be better run? {see box). the favelas or urban slums surround- ing large cities. In 1987, Brazil had 501 600 hospital beds, of which 125 215 were public and 376 385 private. There were 2034 public and 5240 private hospitals, a total of 7274. Of the sample of 2554 hospitals analysed for the purposes of the Directory, 1488 (58.3%) currently have some kind of computerized information system. High technology equipment was reported in 15.9% of the hospitals, while 129 institutions had computerized tomography (13%) and 15 had magnetic resonance imaging equipment (0.6% ). Brazil particularly, and Latin America as a whole, are going through a transitional phase at the present time. Moves toward democ- Towards better-run hospitals ratization mean that public or gov- ernment-subsidized hospitals are more subject to criticism from the mass media, while the population is much better informed of its social rights, including those pertaining to health. Advantage for patients Given the current trend towards privatization and the entry of private health insurance companies into various Latin American health care markets, and in view of the growing requirement for quality hospital care to compete for better service con- tracts with private industry, the Region is likely to see small hospi- tals being replaced by larger facili- ties, in urban areas, with at least 300 beds each. There will be a tendency for public and private hospitals to be integrated into a network of services, thereby facilitating the exchange of patients between community health services and hospitals. Outpatient consultations will be provided not only in the hospitals but also in satellite clinics managed by them, located in distant communities. Token payments may well be needed to limit the number of consultations at hospital emergency departments for patients who did not first visit their local clinics. • Dr Humberto M. Novaes is Regional Advisor in Hospital and Health Systems Administration, Pan American Health Organization (PAHO), From 50% to 80% of all health expenditures in countries go to the hospitals. Public hospitals usually absorb more than 50% of government spending on health . The bigger the hospital , the harder it seems to keep the costs under control. So their role in the health system needs to be re-examined to make sure that they are more effective and better adapted to changing health situations . The role of the big teaching hospitals in particular needs to be reassessed , since the poorer sectors of the population have always had only limited access to basic and intermediate care, and very rarely benefit from the technology and high-level competence of these institutions. Better management is call ed fo r in every domain. The present trend towards privatization does not resolve all the problems. Hospitals should , in fact, be an integral part of the national health systems and their role and fu nctions clearly stated and monitored , allow ing firm control to be exercised on investments in high-tech medicine and on imports of costly drugs by countries . Hospitals should provide a w ell-defined number of interventions and an agreed level of performance and quality, and adhere to a list of essential pharmaceutical substances. Courses in management should be included in th e training of all health personnel , and the hospitals themselves could call in financial experts- two measures that would serve to avoid the risks of unnecessary waste. As for hospital staff, their role in health care needs to be much more fu lly recognized and they should be rewarded accordingly. These were the conclusions of experts participating in a WHO consultation on the role of hospitals held last April. Experts w ill meet again early next year.