PABLO PULIDO ROBERTO RONDÓN
According to the 1991 census, the population of Venezuela was 18,105,265, with 80 percent of the population living in cities. It is estimated that by the year 2000, the urban population will have reached 93 percent of the total.
Article 76 of the national constitution guarantees the right to health for all citizens. Health services are organized into three levels of care: primary--general urban and rural ambulatory care; secondary--specialized ambulatory services and general hospitalization; and tertiary--subspecialized ambulatory clinics and specialty hospitals. Theoretically, roughly 85 percent of the population receives medical services, including medical consultations, laboratory examinations and medications from the following public institutions: (1) the Ministry of Health and Social Service (MSAS), provides 49 percent of the care for this 85 percent of the population through a network of 277 hospitals, 526 outpatient clinics, 646 rural ambulatory services, and 2,819 simple rural dispensaries; (2) the Venezuelan Institute of Social Security (IVSS) (to which the worker contributes 4 percent of his or her salary and the private or public employer contributes 8 percent) provides 31.5 percent; (3) the Institute of Social Security and Health Care of the Ministry of Education (IPASME) is responsible for 3 percent; (4) the Armed Forces Institute of Social Security (IPSFA) is responsible for 1.6 percent; (5) and the National Geriatric Institute (NAGER) is responsible for 0.28 percent.
The remaining 15 percent of the population is, theoretically, attended by the private sector through direct payment or commercial insurance. This is the sector of the most growth, increasing from seven hospitals in 1950 to 256 in 1982.
The health system is characterized by diffuseness, ineffectiveness, and high costs, and in reality 30 percent of the population is not adequately covered. For this reason, a National Health System law was passed in 1987 to put under one