ABSTRACT
Most Latin American healthcare systems are fragmented and segmented, and involve multi-payer arrangements, featuring a prominent social security element, separate underfunded public systems for low-income groups and informal workers, and private services for the well-off. This chapter explores the historical trajectory and prospects of an array of the region’s healthcare systems and the century-long struggles and political vicissitudes shaping them. We begin with an overview of the early-Twentieth-Century emergence of social security schemes that diverged from (and sometimes dislodged) existing government institutions for the poor, charity-based initiatives, and incipient mutual aid societies. In the context of welfare state aspirations, social security efforts not only proliferated, but also splintered by sector. Next, we turn to the impact of the rise of neoliberalism on healthcare systems in key countries during the 1980s. We analyze how people’s resistance to the neoliberal model and demands for change materialized after 2000 in elected progressive governments with the potential for transforming health policies, only to be followed by reactionary governments and subsequent progressive opportunities. Finally, we examine current challenges faced by Latin American countries in building universal healthcare systems based on health justice principles: comprehensive, inclusive, participatory, single-tier (unitary/unified), publicly financed and delivered, and free from all forms of oppression.
