Colombia and Cuba, contrasting models in Latin America's health sector reform

Summary Latin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far‐reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful – and radical – example of ‘market‐oriented’ health care reform, and Cuba, which followed a highly ‘conservative’ path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign – especially North American – corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies. Keywords Latin America , Cuba , Colombia , health sector reform , privatization , national health system Les systèmes de santé nationaux d'Amérique Latine ont été révisés de façon drastique par des réformes du secteur de santé depuis les années 1990. Les gouvernements, poussés par les donateurs et les institutions financières internationales, devaient mettre en place des changements institutionnels majeurs, incluant la séparation des fonctions de financement et de prestation de services et des privatisations. Cet article analyse premièrement un paradoxe frappant dans les mesures de réforme de grande envergure: contrairement à ce qui est imposé aux services de santé publique, après la privatisation les fonctions de financement et de prestation de services sont réunies. Deuxièmement, nous comparons deux exemples opposés: la Colombie, qui est promu internationalement comme un exemple radical de succès sur la réforme des soins de santé«orientée sur le marché», et Cuba, qui s