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The Economist - Access to Healthcare in Latin America 2017

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ACCESS TO
HEALTHCARE
IN LATIN AMERICA
Sponsored by:
ACCE S S TO H E A LT H C A R E I N L ATI N A M E R I C A
CONTENTS
2
About this report
3
INTRODUCTION
5
CHAPTER 1: Inequities persist
9
CHAPTER 2: Corruption and insufficient political will undermine
progress
1
11
CHAPTER 3: Fertile ground for innovation and improvement
12
CONCLUSION
© The Economist Intelligence Unit Limited 2017
ACCE S S TO H E A LT H C A R E I N L ATI N A M E R I C A
ABOUT THIS REPORT
Access to healthcare in Latin America is an Economist Intelligence Unit report, commissioned by
Gilead, which examines the challenges and opportunities health systems in the region face as they
attempt to improve access to high-quality care that meets the needs of their populations. This report
is based on the findings of a global index measuring how healthcare systems across 60 countries
are working to fulfil the health needs of their populations. It is part of a regional series of a wider
programme, which includes a global report that summarises the overall results and implications.1
The 13 countries in Central and South America (hereafter referred to as Latin America) included in
the index are Argentina, Bolivia, Brazil, Chile, Colombia, Cuba, the Dominican Republic, Ecuador,
Guatemala, Honduras, Mexico, Peru and Venezuela. In addition to the index findings, this report
includes insights from additional desk research and five in-depth interviews with senior healthcare
practitioners, academics and policymakers.
Our thanks are due to the following for their time and insight (listed alphabetically):
 Ricardo Bitrán, economist and founding partner and president, Bitrán & Associates, Santiago,
Chile
 Tania Dmytraczenko, programme leader for human development, Latin America, World Bank
 Julio Frenk, former secretary of health, Mexico, and president, University of Miami, US
 Jorge Alejandro García Ramírez, CEO and co-founder, Bive, Colombia
 Cesar Gattini, assistant professor, School of Public Health, University of Chile, and executive
director, Chilean Observatory of Public Health
The report was written by Andrea Chipman and edited by Martin Koehring of The Economist
Intelligence Unit.
June 2017
The Economist Intelligence Unit, Global
Access to Healthcare. Available at: www.
accesstohealthcare.eiu.com
1
2
© The Economist Intelligence Unit Limited 2017
ACCE S S TO H E A LT H C A R E I N L ATI N A M E R I C A
INTRODUCTION
The two domains that comprise The Economist Intelligence Unit’s Global Access to Healthcare
Index—accessibility and healthcare systems—include a number of sub-categories, all of which
contribute to the ranking of the 60 countries included in the index (see chart 1). The index ranks
15 countries from each of the four broad regions of the world: Africa/Middle East, the Americas,
Asia-Pacific and Europe. Within each region, countries with the largest populations were selected,
representing a diversity of income levels. Population and income criteria were established in order
to compare countries facing similar organisational challenges owing to their size, and to highlight
achievements across income levels.2
The accessibility domain provides a country-level snapshot of current access to prevention and
treatment services across a set of disease areas: child and maternal health services; infectious
diseases, such as malaria, HIV/AIDS, tuberculosis and viral hepatitis; and non-communicable
diseases, such as cardiovascular diseases (CVDs), cancer and mental health. The index evaluates
these areas according to a series of key performance indicators, focusing on health outcomes, and
assesses progress within these sub-indices considering current global policy agendas, such as the
Sustainable Development Goals (SDGs).
In the case of the healthcare systems domain, the index measures the conditions that allow for good
access to effective and relevant healthcare services, such as policy, institutions and infrastructure.
The index takes a forward-looking approach to the category, namely, is the country implementing
the right mechanisms today for optimal access tomorrow?
Chart 1
The components of the Global Access to Healthcare Index
Access to healthcare
For a detailed description of the
methodology, please refer to the
accompanying methodology paper:
The Economist Intelligence Unit,
Global Access to Healthcare Index:
Methodology, May 2017. Available at:
http://accesstohealthcare.eiu.com /
methodology/
2
3
Accessibility
Healthcare system
Child and maternal health
Coverage
Infectious diseases
Political will
Non-communicable diseases
Reach of infrastructure
Access to medicines
Efficiency and innovation
Equity of access
Source: The Economist Intelligence Unit, Global Access to Healthcare Index.
Latin American countries have made some of the greatest advances in improving the health of their
people over the past couple of decades, driven by improved development, health and political will,
which have increased the political and financial commitment to providing healthcare in the region.
© The Economist Intelligence Unit Limited 2017
ACCE S S TO H E A LT H C A R E I N L ATI N A M E R I C A
This focus has led to impressive improvements in health outcomes in the region, such as a 69% fall
in the mortality rate for children under the age of five between 1990 and 2015.3
As a result, countries such as Cuba, Brazil, Colombia and Chile rank within the top one-third of
countries in the Global Access to Healthcare Index (see chart 2).
Chart 2
Ranking of countries from the Americas in the Global Access to Healthcare Index
(score out of 10)
Rank in
Americas
(of 15)
1
Global rank
(of 60)
6
Canada
8.6
Cuba
2
7
3
=10
US
4
=12
Brazil
5
=16
Colombia
6
=20
Chile
7
28
Argentina
8
28
Mexico
9
=30
Ecuador
10
=33
Peru
11
37
8.5
8.3
8.0
7.5
7.3
6.9
6.7
6.5
6.4
Dominican Republic
12
=40
Venezuela
=13
=46
Bolivia
=13
=46
Honduras
15
48
Guatemala
6.0
5.6
5.1
5.1
4.7
Note: The index includes 60 countries from each of the four broad regions of the world—Africa/Middle East, the Americas,
Asia-Pacific and Europe—representing a diversity of income levels.
Source: The Economist Intelligence Unit, Global Access to Healthcare Index.
“There has been considerable progress in Latin America and the Caribbean over the past 20 years,
and especially in the past ten years, expanding the provision of primary healthcare and hospitalbased health services,” observes Ricardo Bitrán, an economist and founding partner and president
of Santiago-based Bitrán & Associates, which designs and implements public-health projects. “As a
consequence, countries in the region have made substantial gains in health status with a longer life
expectancy at birth and lower infant, child and maternal mortality ratios.”
But progress has been uneven in the region, and significant disparities still exist both within and
between many countries (see Chapter 1). In addition, persistent corruption, vested interests and a
lack of political will in some countries in the region are undermining efforts to extend access (see
Chapter 2). However, the region is home to a number of best practices in primary care as well as
innovative healthcare experiments (see Chapter 3).
“Latin America, and especially South America, has made a transition towards implementing health
systems based on a free-market approach,” notes Jorge Alejandro García Ramírez, CEO and coUN, The Millennium Development Goals
Report 2015. Available at: http://www.
un.org/millenniumgoals/reports.shtml
3
4
founder of Bive, a social enterprise in Colombia. “When you have a national health system, you
don’t have the problems of the private entities or insurance companies.”
© The Economist Intelligence Unit Limited 2017
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CHAPTER 1: INEQUITIES PERSIST
The Latin American and Caribbean regions face a number of inequities between their populations
with regard to access to healthcare services. First and foremost is the gap between the countries of
South America and those in Central America and the Caribbean. There are also significant inequities
between urban and rural areas, some of which are so remote that they may lack any measurable
access to healthcare at all. Finally, there is the growth of a “two-tiered” healthcare system in many
countries, where public and private healthcare have either flourished side by side or the services
offered by the latter are increasingly more generous than those provided by the former.
Geographical inequities between countries in the region are most pronounced between the
wealthiest countries in Latin America and the poorest countries in the Andean, Central American
and Caribbean regions. Brazil, Colombia and Chile rank in the top 20 of the Global Access to
Healthcare Index, well ahead of their regional peers such as Guatemala, Honduras and Bolivia.
Most countries in the region fail to rank in the top 20 when it comes to the domains relating to
the development of health systems, most notably population coverage of the healthcare system,
political will for increased access, and reach of the healthcare infrastructure.
A notable exception to this pattern is Cuba, which ranks in seventh place overall in the index and
second globally in population coverage of the healthcare system (see chart 3). However, experts
note that it is a unique example in many ways, including the political legacy of its socialist system
and its commitment to funding primary care and training medical providers. “Cuba has plenty of
doctors, a big university in Havana, and they are exporting doctors,” says Cesar Gattini, assistant
professor at the School of Public Health at the University of Chile, and executive director of the
Chilean Observatory of Public Health.
Elsewhere in the Caribbean, basic indicators remain weaker. The UN report on Millennium
Development Goals (MDGs) found that the maternal mortality rate remained stubbornly high in
the Caribbean at 190 maternal deaths per 100,000 live births in 2013, compared with 77 deaths per
100,000 in the rest of Latin America.4
Intra-country inequities
There are also numerous inequities within populations. In countries such as Bolivia and Haiti, which
face continued problems with rural development, urban populations have easier access to a full
range of health services, while rural areas may have only a bare-bones clinic, which is frequently
understaffed. Even in Mexico, which has made significant progress in extending access over the
last couple of decades, the existence of many small villages makes even vaccination programmes
challenging.
Larger countries have as wide a range of topography as demography. “Brazil is so big that they have
tropical areas, jungles and big areas of inequality,” says Professor Gattini. “They have to do verbal
autopsies [in some areas].” Countries that rank lower in some of the public health areas, such as Peru
and Bolivia, are likely to suffer from a lack of human resources, he adds, a factor that also explains
Ibid.
4
5
the paucity of health data for many of these countries. “If there are no healthcare centres in rural
© The Economist Intelligence Unit Limited 2017
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Chart 3
Ranking of countries from the Americas in the area of population coverage of the
healthcare system
(score out of 10)
Rank in
Americas
(of 15)
1
Global rank
(of 60)
=2
Cuba
2
5
Canada
3
6
US
4
=15
Colombia
5
=18
Bolivia
6
=18
Dominican Republic
7
23
Brazil
8
=27
Peru
9
=29
Chile
10
31
Argentina
11
34
Mexico
12
=41
Ecuador
=13
43
Guatemala
=13
44
Honduras
15
=47
Venezuela
9.2
8.9
8.8
8.1
7.9
7.9
7.5
7.1
7.0
6.9
6.2
5.6
5.1
4.9
4.4
Note: The index includes 60 countries from each of the four broad regions of the world—Africa/Middle East, the Americas,
Asia-Pacific and Europe—representing a diversity of income levels. The metrics evaluated in this sub-domain include: sustainable
financial protection, and prevention and public health services as a percentage of total health expenditure.
Source: The Economist Intelligence Unit, Global Access to Healthcare Index.
Peru or Bolivia, it’s not possible to have access, and you have no health records.” He says that one
way to study access is through community surveys, especially when no local facilities are available
(in poor and rural areas).
Professor Bitrán notes that several Central American countries have relied on public contracting of
private healthcare providers to expand access to healthcare for low-income populations living in
rural areas where public healthcare providers are not present.
Gaps in access to care are also likely to be found in cities. A 2009 study of four South American cities
(Buenos Aires, São Paulo, Montevideo and Santiago) found that “access to preventive care was low
in general in all cities”, an obstacle that many countries are still working to rectify.5
Meanwhile, there is a growing gap within countries between populations with access to private
care and those forced by their low income to rely on the public healthcare system. Julio Frenk,
a former secretary of health for Mexico and president of the University of Miami, identifies four
basic functions of the health system: stewardship, including regulation, policy development,
evaluation and assessment; financing; delivery of services; and generation of human, facility and
information-technology resources. The key is how to achieve a mix of public-sector and privateA Balsa et al, “Horizontal Inequity in
Access to Health Care in Four South
American Cities”, Revista de Economía del
Rosario, 2011;14(1):31–56.
5
6
sector involvement. According to Dr Frenk, segregating populations by access to private or public
healthcare may be the wrong way to do this—it is much better to organise the public-private mix
© The Economist Intelligence Unit Limited 2017
ACCE S S TO H E A LT H C A R E I N L ATI N A M E R I C A
by functions. Stewardship and financing require governmental involvement, while direct service
delivery and resource generation offer opportunities for private participation, he notes.
Significant variations in health systems
The history of health systems in the region is one of significant variations. Chile has long had a twotiered social health insurance system, which covers 97% of the population through both public and
private insurers, according to Professor Bitrán. He adds that just 17% are covered by better-quality
private insurers, while the remaining 80% have “comparatively mediocre coverage”, including lowerquality care and longer waiting times.
“Chile has achieved very strong health indicators, nearly as good as those of much richer countries,
such as the US,” Professor Bitrán adds. “However, equity in access and in financing health services is
not as good in Chile as in many other OECD countries.”
In Colombia and Brazil, ambitious governments have extended access to healthcare over the past
couple of decades in an effort to provide universal coverage. In Colombia, this has led to an increase
in coverage to 96% in the past few years, from less than 40% in the 1990s, Dr García notes.
Brazil’s Sistema Único de Saúde (SUS) has been particularly successful as an example of a
national health system based on “decentralised universal access”, in which municipalities provide
comprehensive free healthcare to all citizens, financed by the states and the federal government.6
Primary healthcare has been a key pillar of the programme, with all levels of government
encouraging the country’s poorest citizens to make use of initiatives such as the Family Health
Programme and auxiliary health workers to work with the poorest families in their homes, as well as
in clinics and hospitals.7
“Cuba, Brazil and Chile are some of the higher-performing countries in the region, looking at
measures of coverage, financial protection and service utilisation,” says Tania Dmytraczenko,
programme leader for Human Development, Latin America, at the World Bank. Although inequities
within systems are a reality for many developing countries, “when you have 95% coverage, the
“Flawed but fair: Brazil’s health system
reaches out to the poor”, Bulletin
of the World Health Organization,
Vol. 86, No. 4, April 2008, pp. 241-320.
Available at: http://www.who.int/bulletin/
volumes/86/4/08-030408/en/
likelihood is that most segments [of the country] have pretty high coverage,” she says.
6
Ibid.
7
Varying finance models and funding gaps
While many Latin American countries have worked hard to invest in health and eliminate
fragmentation in financing and segmentation in service delivery, the region as a whole still lags
behind OECD countries in terms of healthcare spending per capita and investment as a percentage
of GDP. For example, in 2014 Latin American countries spent on average US$714 per capita on
World Bank, Global Health Expenditure
database, Health expenditure per capita
(current US$). Available at: http://data.
worldbank.org/indicator/SH.XPD.PCAP
health. Although this was up from US$240 in 1995, it was still much lower than the OECD average
World Bank, Global Health Expenditure
database, Health expenditure, total (% of
GDP). Available at: http://data.worldbank.
org/indicator/SH.XPD.TOTL.ZS
cases exacerbated inequities, those interviewed for this report say. Its impact is evident even in
8
9
7
of US$4,735.8 Likewise, Latin American countries spent on average 7.3% of GDP on health in 2014
(up from 6.3% in 1995), well below the OECD average of 12.3%.9 This factor, compared with the
existence in many countries in the region of different systems of health coverage, has in some
comparatively wealthy countries such as Brazil, whose healthcare system has struggled to cope with
the recent Zika virus epidemic and its aftermath.
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This funding disparity, which has been exacerbated in recent years by the global economic crisis and
volatile commodities markets, has had an adverse effect on many Latin American countries, which
remain heavily dependent on natural resources.
Following pressure from international institutions such as the World Bank and the International
Monetary Fund, several countries in the region have introduced more market-oriented systems,
especially in the area of health insurance. Thus, while countries such as Colombia and Chile pool
employer and employee contributions with general taxation subsidies to pay for healthcare,
providers can be public or private, and are financed through a range of provider payment
mechanisms.
Dr García notes that publicly funded healthcare sometimes fails to provide adequate services. This
is particularly true in the case of access to medicines, although in some countries even access to
basic primary care and diagnosis of potentially urgent health conditions can be severely delayed.
Ms Dmytraczenko notes, however, that more recent reforms since the 1990s have reduced gaps
in spending between insurance schemes for those who contribute and those who are subsidised.
Gaps in spending remain, particularly in countries that have not reformed payroll tax-financed social
health insurance schemes, such as Mexico, Peru and Argentina, she adds.
“If you have the persistence of two systems, you need to make sure that you are spending the same
amount across the system, or have guarantees of quality of care,” says Ms Dmytraczenko. She
notes that Chile and Colombia have had more success with ensuring an even distribution in the
provision of healthcare than countries such as Mexico and Argentina, whose healthcare reforms
have placed more emphasis on subsidising health services for the poor, who used to have little
access to healthcare, while leaving the existing employer-based system untouched. The result has
been a reduction in—but not the elimination of—inequities in the quality of services provided, Ms
Dmytraczenko observes.
In addition, the lack of regulation in the private sector can actually contribute to higher out-ofpocket spending and greater inefficiencies, as patients demand medicines that are not scientifically
proven or cost-effective, Ms Dmytraczenko says.
A 2009 study from the Universidad de la República found that “there is evidence that national
progressive-tax-based health systems with universal coverage achieve better levels of health in the
population and reduce inequalities in health and in use of healthcare services”.10 However, the study
went on to state that “due to the lower resources available at the public level, those with private
coverage are likely to benefit from better access and be less subject to rationing queues”.11
Payment models can also vary significantly between private and public healthcare. For example,
Balsa et al, “Horizontal Inequity in Access
to Health Care in Four South American
Cities”.
10
Brazil has a split payment model, with the public health system using a capitation system in which
providers receive a fixed payment for treatment, based on the disease, while the private system is
maintained on a fee-for-service basis.12
Ibid.
11
GTB Araújo et al, “Is Equity of Access to
Healthcare Achievable in Latin America?”,
Value in Health, Vol. 14 (2011), p. S9.
12
8
Although the financing basis and set-up of the health system are important to provide the basis for
widening access to healthcare, political will and transparency are crucial too—and corruption in the
political system often undermines progress, as the next chapter will highlight.
© The Economist Intelligence Unit Limited 2017
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CHAPTER 2: CORRUPTION AND
INSUFFICIENT POLITICAL WILL
UNDERMINE PROGRESS
Insufficient investment in healthcare services, particularly in preventative care, contributes to
limited access and is often attributable to a failure of political will, those interviewed say. Indeed,
Cuba is the only country in the region which gets the top score for political will in the Global Access
to Healthcare Index, measured in terms of ten-year growth of both out-of-pocket expenditure as
a percentage of total expenditure on health and general government expenditure on health as a
percentage of total government expenditure. Other countries in the region lag significantly behind,
with Venezuela and Argentina near the bottom of the ranking (see chart 4).
Chart 4
Ranking of countries from the Americas in the area of political will for increased
access to healthcare
(score out of 10)
Rank in
Americas
(of 15)
1
Global rank
(of 60)
=1
Canada
=1
Cuba
3
=1
US
4
=15
Colombia
5
19
Ecuador
6
=22
Bolivia
7
30
8
=31
9
33
Brazil
10
=34
Mexico
11
=37
Peru
Honduras
2
10.0
10.0
10.0
7.9
7.3
6.1
Chile
5.8
Guatemala
12
=39
=13
41
=13
58
Venezuela
15
59
Argentina 1.7
5.7
5.6
5.5
5.2
5.1
Dominican Republic
4.9
2.0
Note: The index includes 60 countries from each of the four broad regions of the world—Africa/Middle East, the Americas,
Asia-Pacific and Europe—representing a diversity of income levels. The metrics evaluated in this sub-domain include: out-of-pocket
expenditure as a percentage of total expenditure on health (ten-year growth), and general government expenditure on health as a
percentage of total government expenditure (ten-year growth).
Source: The Economist Intelligence Unit, Global Access to Healthcare Index.
Those interviewed say that better access to healthcare in Latin American and the Caribbean will
require a greater commitment on the part of the region’s governments. “Bolivia, Peru and Ecuador
all have plenty of policies in their constitutions preserving the right to care, but there is a lack of
political will,” says Professor Gattini. These constitutions actually include the right to health, “but
there is a lack of political will” to implement feasible plans and actions with the necessary budget
and resources, he adds.
9
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There are, of course, examples in the region of what can be accomplished when political leaders
are able to marshal evidence in favour of healthcare reforms. After Mexico’s Ministry of Health
presented research documenting that most healthcare in the country was paid for out-of-pocket—
contrary to the beliefs of policymakers—health leaders were able to make an ethical case for
universal healthcare and show why it was a viable policy, Dr Frenk points out.
Similarly, the establishment of Mexico’s National Institute of Public Health has created a cadre of
researchers to provide the evidence base for further reform, while the establishment of a regulatory
agency for health risk protection has set up the upstream regulations of pharmaceutical agencies
and monitored determinants of health, according to Dr Frenk.
Vested interests
In some countries, corruption in its most obvious forms and vested interests (often in more
nuanced forms) play an important role in inequities of access, those interviewed say. Colombia
performs relatively well in terms of political will. However, although most of the population is
generally covered by one of the country’s 45 Entidades Promotoras de Salud (health maintenance
organisations, or HMOs), which are required to provide a mandated package of services, in practice
many patients find it difficult to get reimbursed for these services, according to Dr García.
The result is that Colombians regularly end up in court to sue HMOs that are not providing the
healthcare services they need. Some 120,000 of these lawsuits, known as acción de tutela after the
Spanish expression for the judicial protection of a basic right, take place annually, and 60% of these
deal with rights that are supposed to be covered by mandatory health plans. Petitioners represent
patients across the income scale, Dr García adds.
“Patients go into the judicial system to sue their HMO and the state to demand protection of their
mandatory [health] plans,” Dr García explains, noting that many HMOs have debts of “hundreds and
thousands of pesos” with Colombian hospitals, a contributing factor to the rise in such suits. “What
is happening is that access to healthcare is being provided and defended by the courts because the
system is not giving them the services they need.”
More traditional corruption is often at play, he adds, noting that Caprecom, a state-run HMO, found
itself in the midst of a scandal around payment for political favours and shut down in 2016, leaving
debts of almost US$1bn.
Dr García believes that the inefficiencies in Colombia’s health system stem from the intricate
relationship between politicians and the country’s HMOs, with many of the former having financial
and political stakes in the latter. “Insurance companies have obtained such political power that
sometimes it’s very hard to regulate them. If you had just one insurance company, centralised by the
government, it would cut those incentives. At least if you centralise insurance and payments, you
could foster competency among private healthcare providers based on results and productivity.”
The next chapter will look in more detail at the extent to which some recent innovations in the
delivery of care can bridge the gaps highlighted in this report.
10
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CHAPTER 3: FERTILE GROUND FOR
INNOVATION AND IMPROVEMENT
There are initiatives in primary care and other innovations being pioneered in Latin America which
can potentially offer lessons to other parts of the world. Outside the Caribbean, improvements in
primary care have been especially strong. In Colombia, for example, more than 98% of deliveries
now take place in a health facility, and those suffering from infectious diseases such as malaria and
HIV have access to medicine without huge cost barriers.
Yet continued problems with timely and affordable access have inspired social entrepreneurs to
come up with alternatives to the existing system. In Colombia, Dr García helped to establish Bive, a
social enterprise that aims to bridge the gap between publicly funded primary-healthcare services
and private coverage. Bive gives individual subscribers the opportunity to see private healthcare
providers faster than their HMOs would normally allow, and at around 50% of the price they would
normally pay to go private.
It is a service that many are willing to pay for, given that waiting lists are such that it can take
8-10 months to receive a diagnosis in the case of a breast lump, for example, with significant
consequences for later treatment, Dr García says. “We don’t cover surgery or complex treatment,
but if you diagnose and start treatment on time, you won’t get to the stage of high-complexity
treatment. Bive found an opportunity because of the lack of access to healthcare in Colombia, not a
lack of coverage. Our business has worked because the healthcare system is not working.”
Innovators in Healthcare network
Bive is part of a network called Innovators in Healthcare, which includes entrepreneurs working
across the region. In Brazil, where there is heavy demand on the publicly funded healthcare system,
waiting times for diagnostic services can be up to 480 days. Dr. Consulta, founded in 2011 in São
Paulo, integrates primary and secondary health services into a single location and claims to provide
patients with access to services that is 25 times faster than public options and with prices that are
70-90% lower than in the private market.13 Another Brazilian member of the network, Projeto CIES
(Centro de Integração de Educação e Saúde), uses a fleet of mobile medical centres to provide
examinations and procedures to communities in need.
Other projects include Argentina’s AccuHealth, which provides continuity of care based on a
telehealth monitoring system built on predictive analytics, and Mexico’s MedicallHome, which
provides customers with 24/7 access to medical advice over the telephone.
Innovations
in
Healthcare,
Dr.
Consulta. Available at: https://www.
innovationsinhealthcare.org/profile/dr.consulta/
13
11
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CONCLUSION
The healthcare systems of Latin America and the Caribbean have achieved significant
improvements for their populations in recent years, and in some cases the standard of the access to
care they provide is similar to that in developed countries.
However, the co-existence of public and private healthcare systems in many countries of the region,
significant disparities in infrastructure between lower- and higher-income countries and between
urban and rural areas, and issues with corruption and insufficient political will mean that the goal of
equal access will remain a distant target.
Better public funding and more innovative use of technology, such as mobile healthcare to provide
care to remoter populations, might help to create a more equitable system. In the meantime,
however, social enterprise is likely to play a larger role in finding bespoke alternatives to the
problems of unequal access.
12
© The Economist Intelligence Unit Limited 2017
While every effort has been taken to verify the
accuracy of this information, The Economist
Intelligence Unit Ltd. cannot accept any
responsibility or liability for reliance by any
person on this report or any of the information,
opinions or conclusions set out in this report.
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The Economist, journal
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