Among the most serious challenges facing health systems in lower and middle income countries is establishing efficient, fair, and sustainable financing mechanisms that offer universal protection. Lack of financial protection forces families to suffer the burden not only of illness but also of economic ruin and impoverishment. In Latin America, financial protection for health continues to be segmented and fragmented; health is mainly financed through out-of-pocket payments.

Financing Health in Latin America presents new and important insight into the crucial issue of financial protection in health systems. The book analyzes the level and determinants of catastrophic health expenditures among households in Argentina, Brazil, Chile, Colombia, Costa Rica, the Dominican Republic, Mexico, and Peru, applying both descriptive and econometric analyses. The results demonstrate that out-of-pocket health spending is pushing large segments of the population into impoverishment and that the poorest and most vulnerable segments of the population are most at risk of financial catastrophe. This work is a product of the collaboration between more than 25 researchers and 18 institutions associated with the Research for Health Financing in Latin America and the Caribbean Network, with support from the International Development Research Centre of Canada.

So many women who do everything right to stay healthy still wind up with breast cancer, heart disease, or osteoporosis. In The Fragile Wisdom, Grazyna Jasienska provides an evolutionary perspective on the puzzle of why disease prevention among women is so frustratingly difficult. Modern women, she shows, are the unlucky victims of their own bodies’ conflict of interest between reproductive fitness and life-long health.

The crux of the problem is that women’s physiology has evolved to facilitate reproduction, not to reduce disease risk. Any trait—no matter how detrimental to health in the post-reproductive period—is more likely to be preserved in the next generation if it increases the chance of giving birth to offspring who will themselves survive to reproductive age. To take just one example, genes that produce high levels of estrogen are a boon to fertility, even as they raise the risk of breast cancer in mothers and their daughters.

Jasienska argues that a mismatch between modern lifestyles and the Stone Age physiology that evolution has bequeathed to every woman exacerbates health problems. She looks at women’s mechanisms for coping with genetic inheritance and at the impact of environment on health. Warning against the false hope gene therapy inspires, Jasienska makes a compelling case that our only avenue to a healthy life is prevention programs informed by evolutionary understanding and custom-fitted to each woman’s developmental and reproductive history.

Americans are understandably concerned about the runaway costs of medical care and the fact that one citizen out of seven is without health insurance coverage. Solving these problems is a top priority for the Clinton administration, but as Victor Fuchs shows, the task is enormously complex. In this book Fuchs, America's foremost health economist, provides the reader with the necessary concepts, facts, and analyses to comprehend the complicated issues of health policy. He shows why health care reform that benefits society as a whole will unavoidably burden certain individuals and groups.

Fuchs addresses such central questions as cost containment, managed competition, technology assessment, poverty and health, children's health, and national health insurance. The future of U.S. health policy, he argues, is tightly linked to three basic questions; First, how can we disengage health insurance from employment? Second, how can we tame technological change in health care? And finally how can we cope with the runaway medical costs of an aging society?