Health Systems in LATAM and ASCVD
Considering LATAM’s vast geography and population sizes, there is an
unsurprising variability in the demographics and disease indicators
within the countries. Across the region, access to healthcare is
considered a basic right for every individual. However, LATAM faces the
challenge of rising healthcare costs, resource inefficiencies, income
disparities and the epidemiological transition from infectious to
chronic diseases (61). New health care delivery models have promoted
universal health insurance coverage and introduced new financing
mechanisms that have shifted health care funding from health care supply
to health care demand (62). Additionally, most systems are dependent on
out-of-pocket payments, specifically for medications, creating an
additional barrier for access (63). For example, statins are not
universally covered by systems in the region and studies show that 78%
of these medications are paid out-of-pocket (28).
After the Declaration of Alma-Ata, many countries in LATAM introduced
reforms to improve access to health, financial protection, and increased
efficiency in health services (64). Colombia, Chile, Mexico, Peru, and
Uruguay were the first to implement these health reforms (61). Analysis
of a longitudinal community based primary health care program with
family health physician strategy in Brazil, acting through ASCVD
prevention care and follow-up contributed to decreased cardiovascular
and cerebral disease morbidity and mortality (65).
Most health systems in the region are composed of a public and
supplementary health systems, which vary vastly, cover different
services, and pay differently for medications and technologies
increasing inequalities within the population. Most public systems are
complex, composed of many agencies, and cover the vast majority of the
population with a few exceptions. The private sector includes the
insurance companies and health administrators and covers a small portion
of the population (66). These inequalities within countries further gaps
to prevention, access and adequate treatment in populations across the
region.