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The need to build on recent progress

At the bottom of the scale are Mexico and

Brazil, which combine a relatively low average

spend (about 10% of total government

spending) with growth close to zero between

2007 and 2016. “Brazilian health financing

has been affected by the economic and

fiscal crises, imposing limitations to expand

public funding for the SUS,” explains Mr

Medici. Dr Mohar acknowledges this factor

as one key problem: “Mexico has a low

healthcare spending out of GDP. We can make

improvements in efficiency and planning,

but overall resources are needed to expand

coverage and quality.”

An important metric, although not considered

in the ICP, is government spending on

healthcare as a percentage of GDP, as it takes

into consideration the size of the economy

(instead of the size of government expenditure

only). The WHO has established that 5% is

the level of funding needed to achieve UHC.^84

Based on data from 2016, the only Latin

American countries that met this threshold

were Uruguay, Costa Rica, Argentina and Chile

(the latter is very close to 5%).^85

The ICP also measured the proportion of

out-of-pocket (OOP) spending in total health

expenditure over the past ten years, which

decreased in all but one country (Brazil).

Argentina, Peru and Costa Rica have made the

biggest progress, dropping on average by 6.6%,

4.5% and 3.6% respectively. Argentina has the

lowest level, at 13.5%, while OOP expenditure

is highest in Brazil, Ecuador and Mexico, at

around 40%; 20% is the level recommended

for reducing instances of catastrophic or

impoverishing health expenditure.^86 In the 12

Table 7: ICP assessment of selected

governance aspects

Countr y/

indicator

Health

technology

assessment

Intersectoral

action for

health and

health equity

Score 0-2 Score 0-1

Argentina 1 0

Bolivia 1 1

Brazil 2 1

Chile 2 1

Colombia 2 1

Costa Rica 0 1

Ecuador 1 1

Mexico 1 1

Panama 0 1

Paraguay 0 1

Peru 0 1

Uruguay 2 1

Note: Higher scores mean better performance.

Sources: WHO, Health Technology Assessment Country

Profiles, https://www.who.int/health-technology-

assessment/country-profile/en; EIU research.

countries examined, only Argentina, Colombia

and Uruguay meet this threshold, according to

2016 WHO data.

But increasing government spending on cancer

alone will not be sufficient, or even desirable,

if it is not used efficiently. “In my view, given

the country’s fiscal constraints, it is important

to revisit the efficiency of the current

programmes and improve cancer outcomes

with the current level of financing besides

bringing more resources when possible,” says

Mr Medici, referring to Brazil.

(^84) M Jowett et al., “Spending targets for health: no magic number”, Health Financing Working Paper No. 1, World Health Organization, 2016.
(^85) WHO, obtained from: https://data.worldbank.org/
(^86) Chatham House, “Shared Responsibilities for Health A Coherent Global Framework for Health Financing”, 2014.