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The need to build on recent progress

Coverage of essential services as measured

by the WHO’s UHC service coverage index

is highest in Uruguay, Peru and Brazil (above

75%) and lowest in Paraguay and Bolivia

(69% and 60%, respectively). Important

developments in this area are Bolivia’s first free

universal health system, inaugurated in March

2019, through promulgation of Ley del Sistema

Único de Salud. The programme will offer the

51% previously uninsured population access

to universal free healthcare.8 7, 8 8 Mexico’s first

public insurance programme, Seguro Popular,

has also been an important landmark. Between

2004 and 2013 the number of people enrolled

surpassed 55m, benefiting primarily the poor

and indigenous populations and reducing

Table 8: Health expenditure and UHC coverage

Country

Government health spending

out of total government

expenditure, 2016

OOP spending out of current

health expenditure, 2016

Coverage of essential health

ser vice s, 2015

Argentina 14% 16% 76%

Bolivia 11% 28% 60%

Brazil 10% 44% 77%

Chile 20% 35% 70%

Colombia 13% 20% 76%

Costa Rica 29% 22% 75%

Ecuador 11% 40% 75%

Mexico 10% 40% 76%

Panama 21% 27% 75%

Paraguay 16% 38% 69%

Peru 16% 28% 78%

Uruguay 19% 17% 79%

Sources: WHO, Global Health Observatory and Global Health Expenditure Database, http://apps.who.int/gho/data/node.

main.GHEDGGHEDGGESHA2011?lang=en, http://apps.who.int/nha/database, http://apps.who.int/gho/data/view.main.

INDEXOFESSENTIALSERVICECOVERAGEv

overall inequality in access and outcomes.^89

Dr Mohar notes that although this system has

been controversial, it has allowed for increased

access to cancer treatment for a segment

of the population. The Seguro Popular is in

the process of being replaced with a new

scheme,“Instituto Nacional de Salud para el

Bienestar”, which aims to increase population

coverage and reduce access barriers prevalent

in the previous scheme.^90

In terms of institutional development,

Brazil, Chile, Colombia and Uruguay have

the highest development: these countries

have an HTA agency with a requirement for

its decisions to be considered in decision-

(^87) PAHO, “Bolivia se encamina hacia la salud universal”, 2019.
(^88) Ministerio de Salud, Sistema Único de Salud - Preguntas Frecuentes, 2019.
(^89) World Bank, “Seguro Popular: Health Coverage For All in Mexico”, 2015.
(^90) Gob.mx, Inicia Parlamento Abierto, previo a la creación del Instituto Nacional de Salud para el Bienestar, 2019.