<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1816-8949</journal-id>
<journal-title><![CDATA[Anales de la Facultad de Ciencias Médicas (Asunción)]]></journal-title>
<abbrev-journal-title><![CDATA[An. Fac. Cienc. Méd. (Asunción)]]></abbrev-journal-title>
<issn>1816-8949</issn>
<publisher>
<publisher-name><![CDATA[EFACIM. Editorial de la Facultad de Ciencias Médicas - Universidad Nacional de Asunción]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1816-89492019000100033</article-id>
<article-id pub-id-type="doi">10.18004/anales/2019.052(01)33-042</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Gastos empobrecedores de salud: un desafío para la cobertura universal de salud en el Paraguay]]></article-title>
<article-title xml:lang="en"><![CDATA[Impoverishing health expenditure: a challenge for universal health coverage in Paraguay]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Giménez Caballero]]></surname>
<given-names><![CDATA[Edgar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ocampos]]></surname>
<given-names><![CDATA[Gladys]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[José Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Araujo]]></surname>
<given-names><![CDATA[José Modesto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peralta]]></surname>
<given-names><![CDATA[Néstor]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Concepción Facultad de Medicina ]]></institution>
<addr-line><![CDATA[Concepción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Investigación para el Desarrollo (ID)  ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Dirección General de Estadísticas, Encuestas y Censos (DGEEC)  ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2019</year>
</pub-date>
<volume>52</volume>
<numero>1</numero>
<fpage>33</fpage>
<lpage>42</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S1816-89492019000100033&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S1816-89492019000100033&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S1816-89492019000100033&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN El gasto de bolsillo es la principal fuente de financiamiento del sistema de salud en Paraguay. Es necesario revertir esta situación para que la Cobertura Universal de Salud sea efectiva en 2030, un logro que forma parte de los Objetivos de Desarrollo Sostenible. El objetivo de este estudio fue determinar la incidencia del Gasto Empobrecedor en Salud en los hogares paraguayos. Tomó en cuenta aquellos hogares cuyos gastos de bolsillo causaron una caída por debajo de la línea de pobreza, así como los hogares que profundizaron su pobreza a causa de estos gastos de salud. Como material y método, el estudio analizó la Encuesta Permanente de Hogares 2014; tomó la definición de los gastos de bolsillo de la Organización Mundial de la Salud y la definición oficial de pobreza monetaria del país de la Dirección General de Estadísticas, Encuestas y Censos de la STP. El resultado es que 23,387 hogares fueron empujados por debajo de la línea de pobreza debido a gastos de bolsillo en caso de enfermedad. Esto representó el 1,8% de los hogares no pobres y el 1,4% del total de hogares. Además, el 61.9% de los hogares que ya se encontraban en situación de pobreza la empeoraron debido a los gastos de bolsillo en salud. La conclusión es que los hogares paraguayos están expuestos a gastos de salud excesivos y que se requieren políticas específicas para protegerlos. Las estrategias para combatir la pobreza pueden ser más efectivas cuando se consideran los gastos de salud en caso de una enfermedad o accidente.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Out-of-pocket spending is the main financing of the health system in Paraguay. Reversing this situation is necessary for the Universal Health Coverage to be effective in 2030, an achievement that is part of the Sustainable Development Goals. The objective of this study was to determine the incidence of Impoverishment health expenditure in Paraguayan households. I take into account those households whose out-of-pocket expenses caused a fall below the poverty line, as well as households that deepened their poverty as a cause of these health expenditures. As a material and method, the study analyzed the Permanent Household Survey 2014; took the definition of the out-of-pocket expenses of the World Health Organization and the official definition of monetary poverty of the country of the General Directorate of Statistics, Surveys and Census of the STP. The result is that 23,387 households were pushed below the poverty line due to out-of-pocket expenses in case of illness. This represented 1.8% of non-poor households and 1.4% of total households. In addition, 61.9% of households already in poverty worsened their poverty due to out-of-pocket health expenditures. The conclusion is that Paraguayan households are exposed to excessive health expenditures and that specific policies are required to protect the population in the area. Strategies to combat poverty can be more effective when considering health expenditures in case of the event of an illness or accident.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[financiamiento de salud]]></kwd>
<kwd lng="es"><![CDATA[protección financiera de salud]]></kwd>
<kwd lng="es"><![CDATA[gasto de bolsillo de salud]]></kwd>
<kwd lng="es"><![CDATA[gasto empobrecedor de salud]]></kwd>
<kwd lng="es"><![CDATA[cobertura universal de salud.]]></kwd>
<kwd lng="en"><![CDATA[health financing]]></kwd>
<kwd lng="en"><![CDATA[health financial protection]]></kwd>
<kwd lng="en"><![CDATA[out-of-pocket health expenditure]]></kwd>
<kwd lng="en"><![CDATA[impoverishing health expenditure]]></kwd>
<kwd lng="en"><![CDATA[universal health coverage.]]></kwd>
</kwd-group>
</article-meta>
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