Health Reforms in Latin America: Lessons for the U.S.?

Photo credit: World Bank Photo Collection / Foter / CC BY-NC-ND

Photo credit: World Bank Photo Collection / Foter / CC BY-NC-ND

While Washington struggles to implement modest health care reforms, a number of Latin American countries over the past decade have been changing their health systems in ways that may offer encouragement to advocates of progressive change in the United States.  Reforms in Brazil, Chile, Colombia, Mexico and others strive to provide universal care in circumstances that are, in some cases, much tougher than those facing proponents of Obamacare.  Some challenges and accomplishments include:

  • In Chile, after years of investment, about 73 percent of the population now uses the public health care system.  A Family Health Plan in Brazil, which accounts for US$2 billion of the US$3.5 billion of the government’s health budget each year, has contributed to expansion of health care participation to 70 percent of the population.  When Colombia passed a health care law in 1993, only 24 percent of its citizens had coverage; in 2007, it had reached 80 percent.  Mexico has gone from 40 percent in 2004 to about 70 percent.  (In the U.S., about 83 percent had access to health insurance as of 2010.)
  • Latin American elites, like their U.S. counterparts, have long resisted providing the resources needed to cover health care costs, either through workplace insurance or through paying taxes to support state provision of health services.  But Latin American experience shows that this reticence can be overcome.  Substantial taxes have been levied in recent years – such as a 7 percent health care tax in Chile – and, according to various databases, health-related spending has grown to almost 7 percent of GDP in Mexico, about 7 percent in Colombia, about 7.5 percent of GDP in Chile, and around 8 or 9 percent in Brazil.  (Health care spending accounts for about 18 percent of the U.S. GDP – about half from public spending.)

These Latin American governments have demonstrated that, Sí, se puede when it comes to reforming health care and challenging entrenched interests wary of change.  Spending is rising as a percentage of GDP, but expenditures remain a fraction of those in the U.S. – and the gap in quality of care is narrowing.  Latin Americans have expanded coverage at a time that access to good care in the United States remains a challenge for tens of millions of people.  The U.S. economy generates more than sufficient resources to guarantee health care for the entire population, but the Obama administration seems too weak to implement its tepid reforms on schedule – recently postponing an important mandate that large employers provide insurance coverage.  Health care providers in Latin America appear to be adapting to the new playing field, but their U.S. counterparts are lagging.  If Latin American leaders had advice for their U.S. counterparts on how to slay this dragon, it would probably involve taking note that reforms in the region invariably emerged from decisive leadership from the executive branch and, with the exception of Mexico, a willingness to increase tax burdens to expand coverage.  They would also note that, much like is evident in public opinion polling of Latino populations in the U.S., citizens of Latin American countries are overwhelmingly in favor of public guarantees of health services for all.

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