[Structure of medical care services].

This paper analyzes in detail the principal patterns of the organization or structure of medical care observed in Latin American countries. It reviews the salient features of their structures and examines the major strategies adopted for reorganizing them to respond to new operating requirements. The authors state the conceptual basis and the components of the structure of medical care services and their nature, and then discuss different organizational models both of health systems as a whole and of operating units within them. The four organizational models considered are public or government service, social security, group medicine, and private medicine. The aspects selected for review in these four models are financing, remunerations, the investment in technology, the local service units, the formal structure of the services, the user's participation, information for decision-making, equity and economic efficiency, and the capacity to deliver benefits. The paper emphasizes throughout the patent need for change at all levels of the structure of the services so as to attain the goals of coverage expansion and health for all by the year 2000. These changes must take account of factors deriving from population growth and the changes in the systems made necessary by the present state of the services. A few considerations are also presented on the principal problems that will confront health services in the process and, lastly, there is emphasis on the importance of health services research to establish the facts in each particular situation, and on the need to redirect the training of the manpower needed to attain the established goals.