The inefficiency of health systems in Latin America | Health | SAHIFAT ASSALAM QATAR 

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Saúde / 24/06/2020

The inefficiency of health systems in Latin America

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The inefficiency of health systems in Latin America


Since 2000, health systems have been fundamental to health progress in Latin America and the Caribbean. The improvement in assistance coverage is explained by the expansion of citizens' access to health services, with an increase in life expectancy or a decrease in mortality rates among children under five years of age.

According to the World Health Organization (WHO), most countries in the region are implementing policies and programs that aim to provide universal health coverage. Even so, despite the advances of the last decades, there are great and unresolved needs in the region, and great inequalities in terms of access to health.

In Latin America, public spending on health in 2004 was equivalent to 3.7% of the Gross Domestic Product (GDP), a percentage considerably less than the minimum of 5% recommended to guarantee minimum standards in health services. Investments varied widely between countries, 1.5% of GDP in the case of Venezuela to 6.7% and 10.5% in the cases of Costa Rica and Cuba, respectively.

To overcome the shortages and establish feasible access to quality services for all citizens, different governments are faced with the need to mobilize additional resources or restructure current levels of investment in order to obtain universal coverage.

In the region, total spending on health increased 6.3% to 7.2%, 1995 to 2004. But in the current regional and global economic context, most Latin American countries face budget constraints. For this reason, according to the report “Better Spending for Better Lives: How Latin America and the Caribbean can do more with less”, by the Inter-American Development Bank (IDB), “policies should focus on improving the efficiency of health care, with investment in interventions that obtain the best health results and proper implementation of these interventions ”.

In Latin America, data are lacking to explain the inefficiency of health spending, which represents a limitation when it comes to reordering efforts to define policies. Still, according to the IDB study, of the 27 countries in Latin America and the Caribbean, 22 are in the bottom half of the world average efficiency ranking, and 12 of them are among the 25% of most inefficient countries. This is due to an incorrect allocation of resources to human resources, infrastructure, medicines, staff and information.

Countries in the region are also highly heterogeneous in terms of spending efficiency. Chile is the most efficient country, and the only one in the region that is among the 25% of countries best placed in the ranking, along with most of the countries of the Organization for Economic Cooperation and Development (OECD), and its high efficiency explains the good results of the country in several indicators, such as life expectancy at birth.

Barbados, Costa Rica, Cuba and Uruguay are just below Chile in terms of efficiency. At the opposite extreme, the countries most inefficient in their health investments are Bolivia, Ecuador, Guatemala, Guyana, Panama and Suriname.

And one of the categories in which countries in the region have particularly negative results is the provision of equitable access to health services. In this context, in which the increase in health budgets is unlikely, according to the IDB study, a large part of countries in the region could significantly improve their indicators if efficiency were achieved.

To do this, governments would have to “improve institutions and governance; regulate drug prices; and offer comprehensive primary treatment ”. These changes are essential in view of the aging of the population, the increasing incidence of chronic diseases, and socioeconomic advances that translate into a greater demand for universal and quality health services.

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