16/06/2020 – Health spending in Latin America & the Caribbean (LAC) was about USD 1,000 per person in 2017, only ¼ of what was spent in OECD countries (adjusted for purchasing power). At the same time, health systems’ capacity is also considerably lower, including the ability to provide access to services of good quality to the most vulnerable groups. In addition, much is left to be done to improve efficiency, effectiveness and targeting of health spending. While the LAC region is struggling to respond to the major challenges of the COVID-19 pandemic, a serious reflection is needed not only on how to secure more funding but also on how to spend resources better, according to a new joint OECD – World Bank report, the first Health at a Glance publication entirely dedicated to the LAC region.
Health at a Glance: Latin America & the Caribbean 2020 says that total health expenditure across LAC countries is 6.6% of GDP, lower than the 8.8% in OECD countries. Spending varied from 1.1% in Venezuela to up to 11.7% in Cuba and 9.2% in Uruguay in 2017.
Government spending and compulsory health insurance represent an average of 54.3% of total health spending in LAC, significantly lower than the 73.6% in the OECD. This shows that health systems in the LAC region are heavily dependent on out-of-pocket expenditures or supplemental private insurance from households. Honduras, Haiti and Guatemala have the highest proportions of private spending, while Cuba and Costa Rica have the lowest.
Health systems in LAC have fewer resources and less capacity than OECD countries to confront the COVID-19 pandemic. The LAC region has an average of two doctors per 1,000 population, and most countries stand well below the OECD average of 3.5, with only Cuba, Argentina and Uruguay having more. The average number of hospital beds in LAC is 2.1 per 1,000 population, that is less than half of the OECD average of 4.7. Barbados, Cuba and Argentina have more hospital beds than the OECD average, whereas the stock is below one hospital bed per 1,000 population in Guatemala, Honduras, Haiti, Venezuela and Nicaragua. Moreover, according to data gathered just before the COVID-19 pandemic started, there were just 9.1 Intensive Care Unit (ICU) average beds per 100,000 population in 13 LAC countries, which is much lower than the 12 ICU average beds per 100,000 population found in OECD countries. Brazil, Uruguay and Argentina are above the LAC average, while the lowest ratios are observed in Costa Rica and El Salvador.
Health at a Glance: LAC 2020 highlights that poor allocation of health spending is slowing down, if not halting, progress towards universal health coverage in LAC. For example, weak health information systems are a major impediment. Across 22 LAC countries, an average of 10% of all deaths are never reported in public mortality databases. This means a reliable picture of population health is often missing. According to the Global Corruption Barometer, 42% of respondents across 12 LAC countries considered that there were corruption problems in the health sector. Most LAC countries have parallel health sub-systems with multiple and overlapping mechanisms of governance, financing and service provision, making it hard to steer resources to where they are most needed in an efficient way.
The report also highlights how the quality of care in LAC is often poor. Twelve out of the 33 LAC countries fall short of attaining the minimum immunisation levels recommended by the WHO to prevent the spread of diphtheria, tetanus and pertussis (90% of the target population) and 21 out of 33 fail to meet this target for measles (95% of the target population). This indicates the difficulties that countries are likely to have in making a future COVID-19 vaccine available for the whole population. Among six LAC countries with available data, women with an early diagnosis for breast cancer had a 78% probability of surviving at least five years, while in adults with colon cancer it was 52% and for rectal cancer it was 46%, which are all much lower than the 85%, 62% and 61% survival rates observed in OECD countries.
Finally, the publication identifies key critical risk factors for poor health in LAC. Eight per cent of children under the age of 5 and 28% of adolescents are overweight. This figure increases to over 53% among adult men and to more than 61% among adult women. Obesity increases the risk of chronic disease, and can also lead to complications and death in patients infected by COVID-19. Moreover, nearly one in four men and close to one in ten women aged 15 and above smoke daily. Smoking rates among children aged between 13 and 15 years old are 15% for boys and 12% for girls. Although average alcohol consumption in LAC is lower than in the OECD, it has increased by 3% between 2010 and 2016. Almost 35% and 22% of road traffic accidents among men and women, respectively, can be attributed to alcohol consumption.
Health at a Glance: Latin America & the Caribbean 2020 is available at http://www.oecd.org/health/health-at-a-glance-latin-america-and-the-caribbean-2020-6089164f-en.htm.
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