Toward Universal Health Coverage and Equity in Latin America and the Caribbean

ebook Evidence from Selected Countries · Directions in Development: Human Development

By Tania Dmytraczenko

cover image of Toward Universal Health Coverage and Equity in Latin America and the Caribbean

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Over the past three decades, many countries in Latin America and the Caribbean have recognized health asa human right. Since the early 2000s, 46 million more people in the countries studied are covered by healthprograms with explicit entitlements to care. Reforms have been accompanied by a rise in public spending forhealth, financed largely by general revenues that prioritize or explicitly target the population withoutcapacity to pay. Political commitment has generally translated into larger budgets as well as passage oflegislation that ring-fenced funding for health. Most countries have prioritized cost-effective primary careand have adopted purchasing methods that incentivize efficiency and accountability for results and thatgive stewards of the health sector greater leverage to steer providers to deliver on public health priorities.Despite progress, disparities remain in financing and quality of services provision across health subsystems.Delivering on the commitment to universal health coverage will require concerted efforts to improverevenue generation in a fiscally sustainable manner and to increase the productivity of expenditures.In Toward Universal Health Coverage and Equity in Latin America and the Caribbean: Evidence from SelectCountries, the authors show that evidence from an analysis of 54 household surveys corroborates thatinvestments in extending coverage are yielding results. Although the poor still have worse health outcomesthan do the rich, disparities have narrowed considerably — particularly in the early stages of life. Countrieshave reached high levels of coverage and equity in utilization of maternal and child health services.The picture is more nuanced, and not nearly as positive, regarding adult health status and prevalence ofchronic conditions and illnesses. Coverage of noncommunicable disease interventions is not as high, andservice utilization is still skewed toward those who are better off. Prevalence of noncommunicable diseaseshas not behaved as expected given the drop in mortality; better access to diagnosis among wealthierindividuals may be masking changes in actual prevalence.Catastrophic health expenditures have declined in most countries. The picture regarding equity, however,is mixed, pointing to limitations in the measure. Although the rate of impoverishment owing to healthexpenditures is low and generally declining, 2–4 million people in the countries studied still fall below thepoverty line after health spending.Efforts to systematically monitor quality of care in the region are still in their infancy. Nonetheless, a reviewof the literature reveals important shortcomings in quality of care, as well as substantial differences acrosssubsystems. Improving quality of care and ensuring sustainability of investments in health remain anunfinished agenda.
Toward Universal Health Coverage and Equity in Latin America and the Caribbean