Regional Summary of Health and Surgical Procedures in Latin America: Chile and Colombia

Several countries in the region have increased their investments in health infrastructure in recent years, particularly as a response to the COVID-19 pandemic.

In that regard, they have made steps to reduce the gap in public health spending, which, according to a study by the Inter-American Development Bank (IDB) is USD 153.114 million in Latin America and the Caribbean.

Countries around the world are faced with inadequate budgets and growing health needs in the population. This constant, resulting from the world’s aging population pyramids, has been compounded by the huge expenses from the pandemic. It is a scenario that challenges countries to invest efficiently, and to improve their health infrastructures and capabilities for initiating and implementing disruptive health projects to respond to the health needs of their populations.

We have four examples of countries in Latin America that are at the forefront of health efficiency in the region: Chile, Colombia, Mexico, and Brazil.

In this article our analysis will focus on Chile and Colombia, to then be continued in our next article with updated analysis of Mexico and Brazil.

Chile: the country with the highest public spending on health

According to data from the World Health Organization, Chile has been progressively increasing public spending on health, rising from 39.6% in 2005 to 56.4% in 2020. Another index that shows the sector’s growth is per capita spending, which has more than doubled in fifteen years, from USD 501 in 2005 to USD 1,278 in 2020. This meant that people’s out-of-pocket spending decreased from 42.5% to 29.4%, because of better public health coverage and a more effective private insurance system.

The Chilean health system includes the public and private sectors (for-profit and non-profit). Its multiple and diverse entities perform roles of management, regulation, funding, insurance, and care-services provision. The country has virtually universal health insurance or protection coverage. Health care is close to the target of potential universal coverage as there are still limitations to timely, effective, and fair access (for example, six-month waiting lists) in some cases with pressing health conditions (such as timely referral to levels capable of resolving morbidity issues). The health system also has an informal side, with various traditional and community medicine components.

As César Gattini, an expert at the Chilean Observatory of Public Health (OCHISAP), mentions in his article “Challenges of the Heterogeneous Health System in Chile” (June 2022): “The health system is an open system and is therefore highly dependent on the country’s macro political, economic, and social context. A possible sector-wide reform would therefore benefit from (or would be more feasible) if it could actually be aligned with coherent political and economic reform of the country, especially if this is aimed at achieving a model that can bring together the country’s necessary economic advancement and an improvement in the conditions of social equity, quality of life, and well-being of its diverse inhabitants, among the country’s different groups and areas.”

In regard to its health infrastructure, data from HospiRank and SurgiScope, the analysis tools put together each year by Global Health Intelligence, demonstrate the great growth potential of the Chilean health market.

Chile has the largest hospitals in Latin America. On average, Chilean hospitals have 106 beds, compared to the regional average of 44 beds. The next country with the highest average number of beds is Brazil with 73 beds per hospital, followed by Mexico with 50, and Argentina with 48.

In terms operating rooms, Chile has an average of 1.4 per hospital, according to data drawn from HospiScope. According to the HospiRank 2022 report, it has a total of 1,064 operating rooms.

Colombia: a growing dynamic market

Per capita spending on health in Colombia grew from USD 209 in 2005 to USD 477 in 2020, according to WHO statistical data.  Despite this low figure of spending on health, we can see that the state does most of the spending, remaining practically at the same level—71% to 72%—over that period. Out-of-pocket spending on health, having fallen from 16% to 13%, is relatively low.

Although the country is facing considerable health challenges, it is among the markets that offer the best opportunities for creating dynamism in the region’s sector.

As consultant Julio Mario Orozco observes in his article “Colombian Health System: How Much State and How Much Market?”, the present Colombian health system is about to turn 30, at the same at the same time as the country has elected the first left-wing government in its history. We can therefore speculate there will be a shift in the system from a market economy model to that of a public state monopoly.

On February 14, 2023, the Colombian government put a health reform bill before Congress, with the aim, according to President Gustavo Petro, “of attending to anyone in the country” and so that a doctor can go to any sector in Colombia. He also said that the current system needs reforming because of the “millions” of claims filed by users of health promotion entities (EPS by their acronym in Spanish) seeking attention for their own treatments and those of their relatives.” This means there will be greater scrutiny of these private entities.

With the reform, the government is looking to make health a universal right in the country, rather than, in its words, a business. The initiative has led to public debates over concerns about service delivery. The government maintains that this reform is designed to bring a preventive health model to vulnerable populations, and—a key point—so that public resources will be administered by the public sector instead of private businesses, as is the case at present.

The president has said that EPSs with financial difficulties will be closed down, and that those in robust financial health will take over their patients, in a gradual, orderly fashion, so that they will not be left without health coverage.

The country’s need to provide its population with greater access to surgical care is one of the vital conversations for the transformation of the health system currently being addressed in Colombian society. One of its deficits is precisely the low ratio of operating rooms to hospitals in the country, compared to other countries in the region. This, combined with a backlog in surgical procedures resulting from the suspension of elective surgery during the pandemic, evidences the need to give the sector a boost.

As HospiRank 2022 shows, throughout the Latin American region, hospital infrastructure comprises 21,951 hospitals, 1,244,837 beds, 58,699 operating rooms, and a ratio of two doctors per thousand inhabitants. On the other hand, Colombia has a lower proportion of operating rooms per hospital compared to other countries in the region, with just 1.2 operating rooms, below Latin America’s regional average of 1.4 per hospital. Brazil leads, with an average of 4.3, followed by Mexico, with 2.2.

Information from SurgiScope, analyzed in combination with the data from HospiRank, Global Health Intelligence’s classification system highlighting the best-equipped hospitals in Latin America, reports that Colombia has 3,644 hospitals, 57% of which are private and 43% are public. The number of hospital beds is 76,915, and there are 3,976 operating rooms.

In the next article we will be looking at hospital and health infrastructure in Mexico and Brazil, as well as hospital equipment and surgical procedures in those countries, based on quantitative surveys by HospiRank and SurgiScope.