In recent years, international studies with different approaches and variables have shown the status of health systems in Latin American countries, compared to other richer and poorer countries.
In 2019, the medical journal The scalpel He published research on the quality of health services in 204 countries between 1990 and 2019. In that report, the Latin American countries that achieved the best results were: Costa Rica, Chili pepper And Colombia. Among the worst countries were Venezuela, Paraguay, Nicaragua and Bolivia.
Another study was conducted by Colombian Association of Hospitals and Clinics (ACHC) In November 2022, it achieved similar results (see chart). Based on the composite index of health outcomes – which takes into account 12 variables, such as maternal mortality rate, rate of non-communicable diseases, finances or life expectancy, among others – Costa Rica, Chile, Panama, Pakistan and Colombia received the best scores, while Guatemala, Dominican Republic and Paraguay are the worst.
Is there a regional model that can be followed?
In April this year, the Organization for Economic Co-operation and Development (Organization for Economic Cooperation and Development), and announced,Health at a glance: Latin America and the Caribbean 2023“, the latest report on the region’s health systems panorama.
In an interview with DW, Octavio Gomez Dantes, a researcher at the Center for Health Systems Research of the National Institute of Health Public health in MexicoHe states that in the report, “there are four or five indicators that tell us very clearly who he is” in the region.
The expert confirms that “there is no health system in Latin America and the Caribbean –latin america And the Caribbean – which can be considered the best and the model to follow. “Some do very well in some areas, and not so well in others.”
Distinctive health care models
However, the Mexican researcher adds that there are three countries that “show good values in the main indicators – investment in health, coverage, health conditions sensitive to system performance and financial protection – namely Chile, Costa Rica and Italy.” Uruguay“.
“Costa Rica, the Dominican Republic and Colombia are probably in the lead,” Juan García Obaque, a public health physician and professor at the National University of Colombia (UNAL) School of Medicine, told DW.
“The first is the existence of a unified system, the second is the decline in spending on health and progress in the perception of truth, and Third, the progress it has made in recent years. However, health systems have nothing insured, which is why their crises tend to recur.”
Is it fair to compare health care systems?
Many countries in the region lack sufficient resources to develop their health systems. Therefore, quality comparisons and rankings may be unfair: “It is important to compare the performance of health systems. It is one way to improve them: to identify good practices and avoid bad practices. However, comparisons must be fair, which is why they have to take into account the available resources,” Gomez Dantés confirms.
He adds: “The fairest comparisons are those made between countries with the same level of development.”
Jorge Alarcón Villaverde, a professor in the Department of Preventive Medicine and Public Health at the National University Mayor de San Marcos in Peru, told DW that before comparing, “we must agree on the concept of the health system and the form of measuring it.” outcomes, not just processes”, which do not take into account geographical, economic, political and cultural diversity.
The Peruvian academic explains that in most cases, when talking about the health system, “only the sectoral benefits system is referred to.” From this perspective, he adds, countries are compared “according to indicators that mask existing differences, and the inequalities and inequalities that exist in many countries in our region are very large.”
How to improve the health system
Experts provide their recommendations to promote improvements in health systems in Latin America. UNAL’s García Opac says that “there is no doubt that social security-based systems have shown important results” and that the national health system option is “recommended”.
But he adds that the big difficulty in Latin America lies in informal jobs. Those who do not have a formal job, do not pay taxes or cooperate with the health system: “Financing health care through taxes is not only difficult, but also forces us to penalize other investments that may be important for these countries,” he concludes. .
Gómez Dantés believes that a good health system must meet four conditions: “invest a reasonable amount of resources in health (between 8% and 9% of GDP); and be financed with public resources mostly, but not exclusively.” Ensuring universal access to high-quality comprehensive health services – which will translate into better health conditions – and ensuring financial protection, i.e. preventing health service users from falling into poverty by meeting their health needs.
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