Health Policy and Finance Challenges in Latin America and the Caribbean: An Economic Perspective

Abstract

Latin American and Caribbean (LAC) countries have experienced a long-term process of improvement in populational health conditions, shifting their health priorities from child–mother care and transmissible diseases to non-communicable diseases (NCDs). However, persistent socioeconomic inequalities create barriers to achieve universal health coverage (UHC). Despite a high level of governmental commitment to UHC, and rising coverage, approximately 25% of the population does not have access to healthcare, particularly in rural and outlying areas. Health system quality issues have been largely ignored, and inefficiency, from health financing to health delivery, is not on the policy agenda. The use of incentives to improve performance are rare in LAC health systems and there are political barriers to introduce reforms in payment systems in the public sector, though the private sector has opportunity to adapt change. Fragmentation in the financing of healthcare is a common theme in the region. Most systems retain social health insurance (SHI) schemes, mostly for the formal sector, and in some cases have more than one; and parallel National Health System (NHS)-type arrangements for the poor and those in the informal labor market. The cost and inefficiency in delivery and financing is considerable. Regional health economics literature stresses inadequate funding—despite the fact that the region has the highest inequality in access and spends the most on healthcare across the regions—and analyzes multiple aspects of health equity. The agenda needs to move from these debates to designing and leveraging delivery and payment systems that target performance and efficiency. The absence of research on payment arrangements and performance is a symptom of a health management culture based on processes rather than results. Indeed, health services in the region remain rooted in a culture of fee-for-service and supply-driven models, where expenditures are independent of outcomes. Health policy reforms in LAC need to address efficiency rather than equity, integrate healthcare delivery, and tackle provider payment reforms. The integration of medical records, adherence to protocols and clinical pathways, establishment of health networks built around primary healthcare, along with harmonized incentives and payment systems, offer a direction for reforms that allow adapting to existing circumstances and institutions. This offers the best path for sustainable UHC in the region.

Integrated approach for noncommunicable disease management in the Americas

“…For the estimated 242 million people (24% of the population) in the Americas that have at least one underlying chronic condition ( 17 ), such fragmentation has led to underdiagnosis, unnecessary procedures, or care provided at more complex levels and use of costly services ( 18 ). In fact, as an indicator of fragmentation, the hospitalization rate for chronic conditions that could be better managed at the first level of care ranged from 10.8% to 21.6% in countries in the Americas ( 19 ).…”

Assessing pharmaceutical consultations: Comparing pharmacy-recommended medications for minor ailments and regulatory compliance in a Latin American healthcare network

“… 1 , 11 , 12 , 13 In particular, approximately 25% of the population residing in rural and remote areas confronts insufficiencies in accessing essential healthcare services. 14 The region contends with an array of challenges, including socioeconomic disparities that affect health outcomes, discrepancies in the quality of healthcare provisions between the public and private sectors, and inequitable financing mechanisms, among other pressing concerns. 13 In addition, compared to other regions, there are more medicines available without a prescription in Latin American countries, which encourages patients to seek advice on medications and illnesses from pharmacists in communal pharmacies.…”

An Ounce of Prevention for a Pound of Cure: Efficiency of Community-Based Healthcare

“…In in low-and middle-income countries (LMICs) hospital care accounts for the highest percentage of government health care expenditure (around 60%) (Pinto et al, 2018). Indeed, a common feature of health systems in LMICs is the underuse of primary care, which results in undue reliance on hospital services to treat illnesses which could have been better prevented or managed through primary care (Medici and Lewis, 2019;Wagstaff et al, 2015). Preventive care can improve health outcomes (Soares, 2007;Cesur et al, 2017;Carrillo and Feres, 2019), but less is known about how it can improve efficiency, which is relevant for a thorough welfare assessment.…”