世界发展银行-Health-at-a-Glance---Latin-America-and-the-Caribbean-2020_156页_8mb

Summary of Health at a Glance: Latin America and the Caribbean 2020

Core Content

Health at a Glance: Latin America and the Caribbean 2020 is a joint publication by the OECD and the World Bank that presents key health indicators and analyses for 33 Latin American and Caribbean (LAC) countries. The report was prepared to provide a comprehensive overview of health status, determinants of health, health care resources and activities, health expenditure and financing, and quality of care in the region, with a special focus on the impact of the COVID-19 pandemic.

Main Views and Key Information

1. Universal Health Coverage (UHC) and Health System Challenges

• The report highlights the importance of UHC and the need for equitable and high-quality health systems.
• LAC countries face significant challenges in achieving UHC, including high out-of-pocket spending, limited health workforce and infrastructure, and fragmented health systems.
• The pandemic has exposed weaknesses in health systems, particularly in terms of financial protection, resource availability, and service coverage.

2. Health Status and Trends

• Life expectancy in LAC increased by almost four years between 2000 and 2017, with projections indicating over 18% of the population will be aged 65+ by 2050.
• Infant and under-5 mortality have declined by 35% and 46%, respectively, but some countries like Venezuela and Grenada saw increases.
• Maternal mortality has decreased by 26%, but five countries experienced an increase.
• Non-communicable diseases (NCDs) are a major cause of death, with cardiovascular diseases and cancer accounting for over 82% of all deaths. However, progress in reducing NCDs has been slower in LAC compared to OECD countries.
• Communicable diseases and injuries remain significant health challenges, with interpersonal violence showing a 33% increase between 1990 and 2017.
• HIV/AIDS and tuberculosis incidence and prevalence vary, with the region at 55% antiretroviral coverage, below the 90% target.
• Diabetes is prevalent, with over 53% of adult men and 61% of adult women affected.

3. Determinants of Health

• Overweight and obesity are major risk factors, affecting 8% of children under 5, 28% of adolescents, and over 53% of adult men and 61% of adult women.
• Unhealthy behaviors such as low physical activity, inadequate fruit and vegetable consumption, and high sugar intake are widespread.
• Smoking is common, with nearly one in four men and one in ten women aged 15+ smoking daily, slightly lower than the OECD average.
• Alcohol use is a growing concern, with high rates of alcohol-related road traffic accidents.
• Water and sanitation access is limited in some countries, with nearly 10% of deaths in LAC not reported in public databases.

4. Health Care Resources and Activities

• Health workforce: LAC has an average of 2 doctors and less than 3 nurses per 1,000 population, significantly lower than OECD averages.
• Hospital beds: The average is 2.1 per 1,000 population, with only a few countries (Argentina, Barbados, Cuba) exceeding the OECD average of 4.7.
• Critical care capacity: LAC has fewer ICU beds per 100,000 population (9.1) compared to OECD (12), and many countries lack sufficient ICU capacity.
• Mental health care: Resources are scarce, with availability of psychiatrists being almost five times lower than in OECD countries.

5. Health Expenditure and Financing

• Health spending per capita in LAC is about USD 1,000, one fourth of that in OECD countries.
• Government and compulsory insurance cover only 54.3% of total health expenditure in LAC, compared to 73.6% in OECD.
• Out-of-pocket payments account for 34% of total health spending in LAC, higher than the OECD average of 21%.
• Financial protection is weak, with 8% of the population in 16 LAC countries spending over 10% of household income on health.

6. Quality of Care

• Immunisation coverage is below WHO targets in many LAC countries, with 12 countries failing to meet the minimum level for diphtheria, tetanus, and pertussis (90%) and 21 countries failing for measles (95%).
• Hospital mortality rates for acute myocardial infarction and stroke are higher in LAC than in OECD countries.
• Cancer survival rates are lower in LAC compared to OECD, with 60% survival for cervical cancer in the region.

7. Wasteful Spending in Health Systems

• Wasteful spending is a major issue, with activities like tonsillectomies and hysterectomies in benign conditions not contributing to health improvement.
• Corruption and bribery are more prevalent in LAC, with 42% of people in 12 countries perceiving the health sector as corrupt and 11% of public health centres experiencing bribery.
• Fragmented health systems lead to inefficiencies and duplication, contributing to waste and poor resource allocation.

8. Pathways for Improvement

• The report calls for increasing public spending on health, reducing out-of-pocket payments, and improving financial protection.
• Health system integration and reduction of fragmentation are essential to improve efficiency and equity.
• Investment in public health infrastructure, including surveillance and response capabilities, is crucial for managing current and future epidemics.
• Digital solutions and data systems should be leveraged to enhance detection, prevention, and response to health crises, while ensuring transparency and accountability.
• International cooperation is needed to accelerate R&D and ensure equitable access to new diagnostics, treatments, and vaccines.

Conclusion

Health at a Glance: Latin America and the Caribbean 2020 underscores the urgent need for reform in LAC health systems to achieve UHC and improve population health outcomes. It highlights the importance of addressing financial protection, resource allocation, and governance to build more resilient and equitable health systems in the region.