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Health systems and health inequalities in Latin America

  • In most countries of the region, formal workers are covered by a well-funded contributory scheme with a distinct network of healthcare providers, while informal workers rely on a non-contributory scheme, leading to a segmentation of health coverage based on labor market status.


  • Cuba, Brazil, and Costa Rica have eliminated this segmentation by implementing National Health Systems, while Chile and Uruguay have given informal workers access to the same public healthcare provider network as formal ones. However, disparities might prevail due to unequal access to private healthcare providers and private insurance options.


  • Our analysis suggests that countries with a National Health System tend to exhibit lower inequality based on socio-economic factors. However, this finding comes with important caveats, including data limitations, and should not be given a causal interpretation as it might be due to characteristics of these countries other than the type of health system.


  • Differences in health outcomes between contributory and non-contributory enrolees are predominantly accounted for by socio-economic factors, with a limited influence from the type of insurance coverage. This underscores the complexity of health production, which involves multiple contributing factors.


  • While socio-economic factors partially explain the differences in healthcare utilization between contributory and non-contributory enrolees, a substantial unexplained element persists, which may be due to differences in access and quality between these two subsystems. Notably, antenatal services represent an exception, having experienced a very significant expansion in the past.

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