Uruguay HEALTH AND WELFARE
Unavailable
Water line at an elementary school in a barrio of Colonia
Courtesy Inter-American Development Bank
Children playing in a barrio of Artigas
Courtesy Charles Guy Gillespie
Delivering milk in Treinta y Tres
Courtesy Inter-American Development Bank
Uruguay has been described as South America's "first
welfare
state" as a result of its pioneering efforts in the fields
of
public education, health care, and social security. The
steady
rise in public employment, often by the creation of jobs
that
fulfilled no particular function, served to keep the
unemployment
level down, particularly in election years. However, the
stagnation of the economy starting in the 1950s put
increasing
strains on this system. In particular, declining tax
revenues and
increased spending produced large government deficits and
accelerating rates of inflation. Foreign advisers began to
recommend severe budget cuts as the only solution to the
chronic
fiscal crisis.
During the first half of the twentieth century,
Uruguay,
along with Argentina, led Latin America in its advanced
standards
of medical care. Even in 1990, the University of the
Republic's
medical school had a high international reputation and
continued
to attract students from other countries in South America.
Starting with the progressive reforms of the early part of
the
twentieth century, the state has taken a leading role in
the
provision of health care, particularly for the lower
classes.
Private medicine remained the preferred option of the
middle and
upper classes, however. Under military rule from 1973 to
1985,
standards of care in public hospitals and clinics were
adversely
affected by budget restrictions.
By the 1970s, Uruguay's welfare state had declined
sharply in
the standards of protection that it afforded to the mass
of the
population. The government bureaucracy, however, continued
to
swell. Total health care spending in 1984 represented 8.1
percent
of GDP, a proportion similar to that of the developed
world. In
the same year, about 7.5 percent of household spending
went to
health care, but 400,000 Uruguayans were without state or
private
health care coverage.
Under the civilian administration inaugurated in 1985,
progress was made in redirecting the budget away from
spending on
the military and toward social welfare. Defense spending
fell
from 13.0 percent of government outlays in 1984 to 11.8
percent
in 1986. Over the same period, social security decreased
from
31.5 percent to 27.6 percent, but education grew from 7.4
percent
to 10.1 percent and sanitation from 4.3 percent to 6.7
percent of
public expenditure.
In 1987 Montevideo had over sixty public health
facilities,
including seven major public hospitals. About half the
interior
departments had their own hospital; the rest had only a
centro
auxiliar (auxiliary center). Altogether, Uruguay's
public
health system had about 9,505 hospital rooms available.
In 1985 the number of inhabitants per physician was
466,
about the same rate as in the developed world. However,
the
distribution of health care services was highly skewed.
Outside
Montevideo the ratio was a much less favorable 1,234
citizens per
physician; by contrast, there were only 262 inhabitants of
Montevideo for every doctor.
Data as of December 1990
|