Doing more with less: Defining value in Latin American health systems

March 02, 2021

Latin America

Latin American health systems

March 02, 2021

Latin America
Dr Chrissy Bishop

Former Associate, Health policy and clinical evidence

Chrissy currently serves as a Strategy and Policy Senior Manager with NHS England but was formerly an associate in Economist Impact's Health Policy and Clinical Evidence team. During her tenure at Economist Impact, Chrissy’s role involved rapid reviews of scientific papers and underlying health news reports as well as critical appraisals of scientific papers for audiences such as NHS commissioners, and the European Food Information Council. Chrissy also designed and worked on longer-term research assignments across the health market from industry to academia, regulators and payers, uniting specialist methods in both epidemiological and economic modelling.

Chrissy has an undergraduate degree in Occupational Therapy from York St John University, and two MSc degrees. The first MSc in Professional Health and Social Care from York St John University and the second in Epidemiology and Biostatistics from the University of Leeds. Chrissy was awarded a National Institute for Health Research scholarship to pursue a doctorate investigating the healthcare needs of children with chronic conditions in multi-ethnic communities. She received her doctorate in March 2019 from the University of Bradford. Chrissy worked as a Senior Occupational Therapist in the NHS and an Operations Manager for a private health care company before joining the Health Policy and Clinical Evidence team.

For most of 2020 the covid-19 pandemic has shone a stark spotlight on many health system vulnerabilities globally, and particularly in Latin America. These vulnerabilities, punctuated by huge national death tolls, have catalysed change to some extent by placing pressure on political leaders who have otherwise been slow to invest effectively in the health sector.

Prior to covid-19, continuous demand for treatment of vector-borne diseases and community-acquired infections, as well as high rates of non-communicable diseases, made it difficult for health systems to make ends meet financially. When comparing health investment designed to meet this type of increased strain to similar investments made in other regions, there are more examples of investments in Latin America which a) occur in siloes, b) receive less attention from health policy, or c) are not widely considered effective.

Such regional disparities arise because health investments largely depend on local contexts, such as existing epidemiological conditions, social aspirations, and how well investments are implemented and translate to the desired outcomes, existing prices and competing priorities.

To increase the region’s ability to meet health needs and accelerate progress toward vital health goals, there is an urgent need for Latin America to reimagine health finance, including identification of innovative financing solutions. Through a review of previous, current and ongoing health investments in Latin America, we establish a framework for understanding which investments are likely to have the biggest impact on health outcomes over time. The framework has relevance for Latin America as a whole, but in this report we take a deep dive into the health investment landscape in Argentina, Colombia, Brazil and Mexico.

Through this analysis, this report outlines several critical primary conclusions:

There is an urgent need to re-think investment strategies throughout Latin America in order to avoid losing years of progress toward key health goals, especially in the face of covid-19.

Health investment strategies need to be informed by longer-term thinking, with sustainable financing as a core objective. Short-sighted health investments have contributed to the challenges associated with creating sustainable health systems.

Alternative models of investment are needed to fund health. Innovative financing solutions include reducing inefficiencies to unlock funds, creating fiscal space via indirect and value-added tax (VAT), public-private partnerships (PPPs), and ongoing evaluation to ensure supply meets demand.

Focusing on best-buy interventions tailored to local need is the key to effective investment and fiscal sustainability. This also requires rigid, well-staffed health system infrastructure, surveillance of epidemiological trends and long-term impact assessment.

There needs to be better regulation of new technologies using HTA bodies to ensure they are both effective and financially sustainable. Governments could improve these conditions by, firstly, bolstering the readiness of health systems to assess the value of new technologies and, secondly, improving the ability of national HTA bodies to adjust to the challenges of evaluating novel technologies.

Through qualitative and quantitative analysis, thematic and country-level examples and case studies, and new insights, this report aims to unlock opportunities for renewed thinking and action around investment in health, especially as leaders seek to emerge from the covid-19 crisis.


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