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Desigualdad y protección social en Centroamérica

Por: Werner Peña

Recientemente, la socióloga y economista Ana Sojo ha publicado el libro Protección Social en América Latina: La desigualdad en el banquillo. El libro plantea que los sistemas de protección social de América Latina y el Caribe atraviesan una crisis de legitimidad derivada de su incapacidad para asegurar el derecho ciudadano a la protección social. Más aun, las reformas orientadas a promover la participación privada en la provisión de servicios sociales no cumplieron con sus promesas de elevar la suficiencia, eficiencia y maximización de los beneficios para los ciudadanos de la región. Así, estos sistemas enfrentan el reto de promover la igualdad por medio de mecanismos redistributivos y solidarios que superen los diseños actuales. Los esquemas de aseguramiento cuando son públicos, universales y solidarios permiten la articulación de los beneficios económicos y sociales que facilitan la lucha contra la desigualdad socioeconómica que experimentan los países de América Latina y en particular los países de Centroamérica.

El libro ofrece una mirada reveladora sobre el estado actual de los sistemas de salud y pensiones de Centroamérica. En la región, el acceso a servicios de salud públicos de calidad es limitado para una parte importante de los hogares, los cuales deben recurrir al gasto de bolsillo para hacer frente a eventos de salud. Este gasto se caracteriza por realizarse de forma fragmentada, respondiendo a una lógica que se aleja de la solidaridad y la diversificación social del riesgo. Asimismo, este gasto es realizado por los hogares que tienen los recursos para permitírselo –reflejando la condición socioeconómica de los mismos– y tiene la capacidad de hacer que hogares vulnerables económicamente empeoren su situación.

Como se observa en el cuadro 1, la incidencia de la pobreza es mayor en hogares que no registran gastos de bolsillo en salud, lo que podría reflejar el hecho de que estos hogares –por su condición económica– no tienen posibilidad de realizar este tipo de gasto. Por otra parte, el porcentaje de hogares que se empobrecen como consecuencia de afrontar un gasto en salud es mayor en Honduras (4.7%) y en Nicaragua (3.2%). También se presentan indicadores de los hogares que realizan un gasto catastrófico en salud[1]. En Honduras y Nicaragua la proporción de hogares con este tipo de gasto es mayor con relación al resto de la región, al mismo tiempo, en estos países la incidencia de la pobreza es mayor entre los hogares que realizan un gasto de bolsillo denominado como catastrófico. La última columna del cuadro 1 presenta la proporción de hogares que se empobrecen al afrontar un gasto de este tipo. Nuevamente, Honduras y Nicaragua son los países en los que el empobrecimiento de los hogares es mayor como consecuencia de un gasto catastrófico en salud.

 

 

Por su parte, el cuadro 2 presenta la cobertura de pensiones por quintiles de ingreso en personas de 65 años y más. Como se observa, la cobertura de pensiones contributiva es mayor en Costa Rica (65.1%) y Panamá (46%), países con sistemas de protección social más institucionalizados. En el otro extremo, en 2006 únicamente 5 de cada 100 personas de 65 años y más contaban con acceso a pensión contributiva en Honduras. Asimismo, se tiene que a medida se desciende por la distribución del ingreso la cobertura provista por las pensiones contributivas es menor. Por ejemplo, en 2013 en El Salvador y Costa Rica la cobertura de pensiones contributivas de personas en el quintil de mayores ingresos era mayor en aproximadamente 29 puntos porcentuales a la registrada en el fondo de la distribución del ingreso. Más aún, en países como Guatemala –año 2006– la cobertura de pensiones contributivas que registra el quintil de mayores ingresos es mayor en 20 veces a la registrada en el 25% de los hogares más pobres del país.

El cuadro también muestra la importancia de los pilares no contributivos en Costa Rica y Panamá. En el primer país, un 17.7% de las personas de 65 años y más tienen acceso a una pensión proveniente de un régimen no contributivo, por un 26.3% en Panamá. Al sumar la cobertura contributiva y no contributiva se tiene que 8 de cada 10 personas en la última etapa del ciclo de vida tienen acceso a una pensión en Costa Rica, mientras que en Panamá 7 de cada 10 personas. Asimismo, el pilar no contributivo muestra una lógica progresiva en ambos países, ya que el porcentaje de cobertura disminuye a medida se escala en la distribución del ingreso.

 

 

Los datos muestran un panorama complicado para los hogares con menores recursos de la región. Por un lado, la incidencia de la pobreza en hogares que no realizan gastos de bolsillo en salud es mayor comparada con aquellos hogares que sí lo realiza, indicando que los hogares con menores recursos podrían no contar con acceso a servicios de salud por su condición socioeconómica. Al mismo tiempo, el carácter fragmentado de este gasto hace que los hogares que afronten un gasto catastrófico en salud incrementen las probabilidades de empeorar de forma sustancial su situación económica. Por su parte, el porcentaje de personas de 65 años con acceso a pensiones es bajo, sobre todo en países pertenecientes al triángulo norte de la región, evidenciando el fracaso de los sistemas de pensiones y mercados laborales en asegurar una vejez digna a las personas mayores. Al mismo tiempo, son las personas de los hogares con mayores recursos quienes registran un mayor acceso a una pensión contributiva.

Ante este panorama, Ana Sojo resalta la importancia de las coaliciones políticas amplias entre distintos estratos sociales y grupos de interés para superar los actuales esquemas de protección social, que en general se caracterizan por su fragmentación, segmentación y baja calidad de servicios. Estas coaliciones deben tener como principal objetivo la construcción de sistemas de protección social públicos de calidad que tengan como lógica orientadora la redistribución y la solidaridad, y que al mismo tiempo ofrezcan cobertura universal, reconociendo a las personas como sujetos de derechos. Sin duda alguna, el libro Protección Social en América Latina: La desigualdad en el banquillo es una gran contribución para que los países centroamericanos avancen hacia este horizonte.

 

Referencias bibliográficas
[1] Un gasto de bolsillo en salud se denomina catastrófico si el mismo representa 30% o más de la capacidad de gasto de los hogares –gasto total una vez descontado el valor de la línea de subsistencia destinada a alimentos–.

Sojo, A. (2017). Protección social en América Latina. La desigualdad en el banquillo. Libros de la CEPAL, N° 143 (LC/PUB.2017/7-P). Comisión Económica para América Latina y el Caribe (CEPAL), Santiago.

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