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The protests in Chile in October 2019 raised the issue of health reform to the public agenda again. This article reviews some of the explanations for why there was a widespread protest, including the expectations of continued progress, the emergence of a "fear-based populism" and the decline in legitimacy of most social and political actors. Using the theories of Kingdon to explain how reforms are placed on the political agenda, we describe how the protests raised health reform as a problem to be addressed, discuss the tendency toward consensus on policy options by technical health reform advocates, and examine the uncertain political processes that would be necessary for a consensus reform to be adopted and implemented. A lesson for reformers is the need to pay attention to growing signs of popular resentment over failures of health reforms to address accumulating problems and to try to address them with urgency to avoid populist crises.

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Mexico's health system is undergoing major restructuring by the administration of President Andrés Manuel López Obrador (known as AMLO) starting in December 2018. The government has eliminated the 2003 health reform (Seguro Popular) from national laws and government agencies and is returning Mexico to a centralized health system with integrated public financing and delivery and reduced private participation. This article looks at the political drivers of Mexico's restructuring reform. Three main ethical principles are identified as the foundation for the government's health system vision: universality, free services, and anti-corruption. The article then compares what existed under Seguro Popular with the new system under the Instituto de Salud para el Bienestar (INSABI), which began on 1 January 2020. The analysis uses the five policy levers that shape health system performance: financing, payment, organization, regulation, and persuasion. The article concludes with five lessons about the reform process in Mexico. First, undoing past reforms is much easier than implementing a new system. Second, the AMLO government's restructuring emerged more from broad ethical principles than detailed technical analyses, with limited plans for evaluation. Third, the overarching values of the AMLO government reflect a pro-statist and anti-market bias, swimming against the global flow of health policy trends to include the private sector in reforming health systems. Fourth, the experiences in Mexico show that path dependence does not always work as expected in policy reform. Finally, the debate of Seguro Popular versus INSABI shows the influence of personality politics and polarization.

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The US healthcare systems is struggling to keep pace with increasing demand, as the burden faced by providers and healthcare organizations expands. While care delivery models continue to evolve in the post-reform era, many barriers stemming from capacity constraints, regulation, shortages of manpower and, misallocation of resources persist. In this paper, we provide an analysis of unmet demand in the US system healthcare system. We contribute a deep dive of the literature to elucidate the reasons for which imbalanced and unmet demand, including the heavy use of the emergency department for non-emergent conditions, continues to burden healthcare organizations. We use these findings to motivate recommendations about how to address critical shortcomings in order to better address the needs of patients with both emergent and non-emergent conditions.

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Healthcare Human Resources (HHR) are key for the success of any health system; its development and performance are fundamental to ensure quality care. Despite this reality, HHR are often absent from health reform processes. In Peru, in the last 30 years, there have been several reforms that have included, to a greater or lesser extent, improvements in HHR policies aimed at providing a better quality of care to the population. This article seeks to make a brief analysis of the advances in the field of management and development of human resources in the healthcare sector in recent years, highlighting their importance in the quality of care. Through considerable effort, we would achieve competent, equitably-distributed HHR committed to delivering quality care to all individuals.

Los Recursos Humanos en Salud (RHUS) son pilar clave en el éxito de todo sistema de salud, su desarrollo y desempeño son fundamental para garantizar una atención de calidad. A pesar de esta realidad, los RHUS suelen estar ausentes en procesos de reforma sanitaria. En el Perú, en los últimos 30 años, se han dado diversas reformas que han incluido en mayor o menor medida, mejoras en las políticas de RHUS con la finalidad de brindar una mejor calidad de atención a la población. Este artículo busca hacer un breve análisis de los avances en el campo de la gestión y desarrollo de los Recursos humanos en el Sector Salud en los últimos años, destacando su importancia en la calidad de atención. De hacer esfuerzos suficientes en este campo, lograríamos RHUS competentes, distribuidos de forma equitativa y comprometidos con entregar atención de calidad a todos los individuos.

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RESUMEN Los Recursos Humanos en Salud (RHUS) son pilar clave en el éxito de todo sistema de salud, su desarrollo y desempeño son fundamental para garantizar una atención de calidad. A pesar de esta realidad, los RHUS suelen estar ausentes en procesos de reforma sanitaria. En el Perú, en los últimos 30 años, se han dado diversas reformas que han incluido en mayor o menor medida, mejoras en las políticas de RHUS con la finalidad de brindar una mejor calidad de atención a la población. Este artículo busca hacer un breve análisis de los avances en el campo de la gestión y desarrollo de los Recursos humanos en el Sector Salud en los últimos años, destacando su importancia en la calidad de atención. De hacer esfuerzos suficientes en este campo, lograríamos RHUS competentes, distribuidos de forma equitativa y comprometidos con entregar atención de calidad a todos los individuos.

ABSTRACT Healthcare Human Resources (HHR) are key for the success of any health system; its development and performance are fundamental to ensure quality care. Despite this reality, HHR are often absent from health reform processes. In Peru, in the last 30 years, there have been several reforms that have included, to a greater or lesser extent, improvements in HHR policies aimed at providing a better quality of care to the population. This article seeks to make a brief analysis of the advances in the field of management and development of human resources in the healthcare sector in recent years, highlighting their importance in the quality of care. Through considerable effort, we would achieve competent, equitably-distributed HHR committed to delivering quality care to all individuals.

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Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.

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Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.

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While health policies are a major focus in disciplines such as public health and public policy, there is a dearth of work on the histories, social contexts, and personalities behind the development of these policies. This article takes an anthropological approach to the study of a health policy's origins, based on ethnographic research conducted in Bolivia between 2010 and 2012. Bolivia began a process of health care reform in 2006, following the election of Evo Morales Ayma, the country's first indigenous president, and leader of the Movement Toward Socialism (Movimiento al Socialism). Brought into power through the momentum of indigenous social movements, the MAS government platform addressed racism, colonialism, and human rights in a number of major reforms, with a focus on cultural identity and indigeneity. One of the MAS's projects was the design of a new national health policy in 2008 called The Family Community Intercultural Health Policy (Salud Familiar Comunitaria Intercultural). This policy aimed to address major health inequities through primary care in a country that is over 60% indigenous. Methods used were interviews with Bolivian policymakers and other stakeholders, participant observation at health policy conferences and in rural community health programs that served as models for aspects of the policy, and document analysis to identify core premises and ideological areas. I argue that health policies are historical both in their relationship to national contexts and events on a timeline, but also because of the ways they intertwine with participants' personal histories, theoretical frameworks, and reflections on national historical events. By studying the Bolivian policymaking process, and particularly those who helped design the policy, it is possible to understand how and why particular progressive ideas were able to translate into policy. More broadly, this work also suggests how a uniquely anthropological approach to the study of health policy can contribute to other disciplines that focus on policy analysis and policy processes.

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