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.