Fragmentation and inequalities in Latin American healthcare systems

Study on health coverage in Peru, Mexico, Colombia, and Uruguay shows problems caused by the lack of a unified system

Healthcare in Latin America has made significant advances since the 1990s, when governments in the region began taking seriously efforts to provide universal health coverage. It is still marked by severe inequalities and deficiencies, however, such as fragmentation of care. This is the conclusion of a study carried out in four countries: Peru, Mexico, Colombia, and Uruguay.

The study, described in a paper published in Lancet Global Health, asked people questions about their level of satisfaction with the healthcare systems they used, whether public, private, or mixed.

The survey was carried out by telephone between July 2022 and January 2023. Between 1,000 and 1,250 adults were interviewed in each country.

The topics covered included health system coverage, user experience, system competence, and confidence in the system. An inequality index was also calculated based on the income and education of the interviewees.

Access to healthcare as a whole was good, but only a third said they received high-quality services, and only 25% of people with mental health diagnoses said they received adequate care.

Two-thirds of respondents reported that they had access to relevant preventative care and 42% of older adults were screened for cardiovascular disease.

In relation to more specific topics, such as access to telemedicine, communication and autonomy during their most recent consultation, waiting times, and preventive examinations, the survey revealed inequalities that favor people with higher incomes in all four countries.

The socioeconomic inequalities between and within the four countries were taken into account, as well as issues specific to each one, such as corruption and political upheaval.

In Peru, where 61% of the population is covered by the Ministry of Health’s program (which is only offered to the poorest, those from the informal economy, and the unemployed and their families), the political upheavals of the last five years have had a major impact on investment in healthcare infrastructure.

Quantity vs. quality

Among the four countries analyzed, Uruguay has the highest income, the most stable political environment, and a well-funded and equipped healthcare system.

Several results were better in Uruguay, including coverage, user experience, system competence, and management of the COVID-19 pandemic—but this does not mean that there are no inequalities in the country.

Although the approaches taken in these four countries do not represent Latin America as a whole, the results of the study could prove useful across the region. One example is the influence that health system fragmentation has on perpetuating inequalities, both in care quality and access.

In all of the countries analyzed, there are multiple agencies responsible for public health, in addition to the private system—which is very small in some countries, such as Peru, where only 3% of the population has health insurance.

None of them has a unified system like Brazil’s SUS.

“Our results suggest that access to general health services is high in these countries, although access did not equate to high-quality access, needs for mental healthcare access being met, or preventive care and screenings being provided,” the researchers stated in the article.

They also highlight that the region’s long-standing shortage of mental health funding has been further accentuated by the pandemic.

The authors also note that innovations such as telemedicine offer promise for improving access to primary care, but present a risk of exacerbating inequalities, given the disproportionate access to primary care by higher-income individuals.

The analysis of health systems in the four countries may also serve as a guide for governments and public policymakers, providing information on quality and helping to identify priorities.

“Overall, our study underscores the importance of continued efforts to address the challenges facing the healthcare systems in Latin America to ensure equitable access to high-quality care for all,” the researchers say.

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