A bitter pill to swallow

Healthcare inequality needs addressing across Latin America.

The Pan American Health Organization (PAHO), the Americas regional office for the World Health Organization (WHO) has warned that 30% of the population of Latin America does not have access to basic health services for economic reasons.

According to the WHO, Chile, Argentina and Brazil invest below 5% of GDP in public health, compared with 8% in the UK and Spain and almost 10% in France and Germany. Meanwhile, Venezuela, Haiti, Bolivia and Guatemala are below 2% of public spending, while Honduras and the Dominican Republic do not exceed 3%.

Although some countries, including Brazil and Costa Rica, have a universal healthcare system, most Latin American countries have large gaps in accessibility caused mainly by out-of-pocket health expenditure, which is 34% of total health spending.

Colombia has a universal social security system, divided into two regions: subsidised and contributory. A public health official in Colombia comments, “The government has made efforts to make the subsidised systems more like the contributory system but there are still large gaps in access and quality.”

“The government has made efforts to make the subsidised systems more like the contributory system but there are still large gaps in access and quality.”

Public health official, Colombia

The COVID-19 pandemic has placed more pressure on the system, as the Chief Operating Officer for a healthcare company in Colombia observes, “Most of the State’s resources have been used to strengthen intensive care, emergency support, etc. This caused people to postpone medical appointments and ongoing treatments. This will have a strong impact on the cost of health in the medium term.”

This will be compounded by the economic fall-out from the pandemic, the healthcare executive predicts, “Due to the loss of employment, many people will not be able to pay their health insurance, causing a further debt in the system. Added to this, many people will migrate from the contributory systems to the subsidised system.”

“Due to the loss of employment, many people will not be able to pay their health insurance, causing a further debt in the system.”

Healthcare executive, Colombia

In terms of access, there is a large gap between urban and rural areas across much of Latin America. The public health official confirms, “The system does not reach the entire population uniformly but the rise of teleconsultations has helped. Despite this, healthcare facilities in rural settings are lacking, there are no specialists or new technologies, sometimes outpatient and primary care coverage is also poor.”

Healthcare inequality has been a major issue in many of the protests that have been sweeping across Latin America. Perhaps in the aftermath of the pandemic, governments across the region will push the quality and accessibility of healthcare up their agenda – especially with many elections looming.

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