The papers and comments of Drs. Infante and Arango present a documented study of the role of the State and the ways of reform in Latin American health systems. Although most constitutions in these countries state that health is a basic right of every citizen and that health care is an obligation of the State, only a short number of countries guarantee common access for all citizens to health care. Indeed, budget restrictions and a shortage of resources in the health sector are more obvious here than in Western Europe.
Readjustments and changes in health carried out or begun during the last ten years have been greatly influenced, according to Dr. Infante and other experts, by recommendations from the World Bank. These emphasize a limited role for the State and the public sector in health benefits, users' fees and copayments to enlarge financing sources and a greater role for insurance plans and the private sector. This strategy, adopted to some extent by the Interamerican Development Bank (IDB), is very questionable, as acknowledged by the World Bank experts themselves in their 1993 Report: Investing in health. The outlook of this report and the joint report by CEPAL and the Panamerican Health Organization (PAHO) on Health, equity and productive change in Latin America and the Caribbean, may contribute to creating a new reference point for future health reforms in Latin America.