Recent decades have seen the societies in Latin America shifting their goal of focus of public awareness from the fight against oppressive regimes, lack of freedom and disputes resulting from abject poverty, exploitation and underdevelopment towards the union of democratic transitions, the conquest and defense of civil and social rights, and the emergence of a developing welfare state. This change is a typical characteristic of advanced societies and brings with it an aspirational goal. Despite there being plenty of structural weakness, the debates on healthcare systems, their universalization and accessibility have been gaining ground among the national priorities of governments and multinational agencies, local political players, human and civil rights societies, scholars, and other organized civil society players from business to the economic world. The plans of the healthcare reforms in the US have found its place in the Latin America. However, across the region, the attempts to revolutionize the health sector have left quality care still being far from reach to many, even though some countries like Chile, Cuba, and Colombia offering a different approach ( Atun et al., 2015) . The health care in Latin America is marred by a myriad of challenges that makes it inefficient, inequitable, and of low quality. Despite the fact that some people benefit from access to better health care, the majority still struggle to get primary care. This paper will look at some of the problems that face this crucial component of modern society.
Geographical position
Latin America is found in the southern part of the Western Hemisphere.
Source: World Atlas
Till the mid-twentieth century, the healthcare in Latin America has been quite similar. A typical scenario was that health care was given to the employees in the formal labor force by offering public health insurance plans catered for by a combined contribution of the employer, the government, and the worker. The wealthy had access to private services while the poor highly depended on the publicly delivered care of varied quality ( Atun et al., 2015) . The disparity saw the rise of private charity organizations with the bid to fill the gap, but the result was that the systems became inequitable and fragmented.
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Chile became the first country to disregard the traditional Latin American strategy in 1952. During the reins of Christian Democratic Party, the government organized a single-payer national health system that resembles what many countries in Europe had at that time. In such a model, the public sector financed health care, and this made all the citizens have access to free care ( Vargas & Poblete, 2007) . However, when General Augusto Pinochet rose to power in 1974, the system was replaced with a public-private approach. The national policy was disintegrated to form medical care delivery to the private sector and decentralizing it to the level of municipals. Although the system was criticized for having a favor to the wealthy, it continues to be used despite the reforms that were introduced after the country moved back to democracy.
The case of Cuba was a different one as the government sought to run the system thus providing free, universal coverage, which saw significant improvements in the healthcare quality delivery. However, the system lacks efficiency and productivity and required management improvements.
In Colombia, the health reforms that were introduced in 1993 offers a different third model altogether. It broke down the social security and much universal public sector health system that was almost everywhere in the region ( Atun et al., 2015) . In replacement, the government brought a model based on neoliberal principles, whereby the public and private providers compete for clients. This strategy has the insurance premiums paid by the employer solely, with the government covering up for the needy who cannot afford to be employed. However, the existence of high co-payments has made the poor unable to access the system. This has given rise to unimpressive results whereby the total healthcare expenditure has skyrocketed without apparent benefits to equity. Also, there is a significant deterioration in the quality and efficiency of the services. On the side of delivery, while some of the hospitals are filing for bankruptcy, the insurance companies are recording high profits and high administrative expenditure.
The Costa Rican Alternative
There is a fourth model which is more promising than the entire region, and that is the Costa Rican alternative of 1974. This approach seeks to integrate the social security program (Caja Costarricense de Séguro Social (CCSS or Caja)) with the public health care services offered by the Ministry of Health. In other words, it is a single-player mode that is financed by the government, employers, and the employees, where the government offers a subsidy to the poor and the needy. The Caja manages the whole system. In this case, the model has recorded impressive results. About 86 percent of the population has access to quality, comprehensive healthcare services. The equity is also high as both the wealthy and the poor can obtain the care ( Atun et al., 2015) . Some medical services, with transplants included, are free the same way prescribed pharmaceuticals are.
The remaining 14 percent that is not included in the model are wealthy and self-employed individuals who prefer to pay as they access the services. This country has now the longest life expectancy in the whole of Latin America, with 75 years for men and 80 for women. However, the journey to this point for Costa Rica was not easy and had to go through some trial and error and some bits of challenges. The major problem is corruption in the top level of management, with some physicians finding leverage to reduce the amount of work they do or using public resources for their personal gain ( Fried et al., 2010) .
The case of Costa Rica shows that despite the region carrying the weight of some constitutive problems that prevent its societies from developing, some progress can be made. To figure out the ailment that the healthcare system in Latin America, it is possible to categorize the areas that need to be addressed. The problems can be approached in three primary areas: the matter of inequality and its effect on health systems, the issue of universal coverage, and the debate on access and quality of the services. With the inclusion of the matters relating to the indigenous people, gender equality, and how the excluded people in rural areas and great urban suburbs are vulnerable.
The question of gender and the access to reproductive and sexual health in the region has been a hectic one to handle. In a place that is frequented with violence, historical inequality, and sexism that are inbred in the context of culture, there should be a particular attention to how that would affect the kind of care that the people who are supposed to access reproductive health get them ( Cotlear et al., 2015) . In the above dimension, some problems are associated with the outbreaks of epidemics (like the case of Zika virus) and highly communicable diseases have caused effects in continental measures.
Inequality
Although there are some improvements in the healthcare goals, Latin America remains the most unequal part of the world. As of 2014, about 71 percent of the region’s wealth belonged to the wealthiest population which represents only 10 percent of the entire area. This type of inequality does not just exist between the countries but even within their borders themselves. There have been several regional analyses aimed at cracking the cause and effects of the profound inequality in Latin America ( Cotlear et al., 2015) . The Economic Commission for Latin America and the Caribbean (ECLAC) suggests that:
“ Inequality in healthcare is due not only to the lack of socio-cultural and geographical accessibility but also to income inequalities which generate living conditions that are inadequate for anticipating and meeting the healthcare needs of the population.” (ECLAC, 2005)
In such a condition, the poor are more likely to develop health problems than the rich and are also less able to use the essential required health services that can help them mitigate or reduce their risks to the diseases, and help them detect early the onset of the illness. The primary access is a crucial intervention in the treatment and control of epidemics and communicable conditions, but the poor have no place and the capability for the access of such in Latin America. In a recent World Bank report, in the nine countries that the study was carried out, the current rate of poverty is lower and continues to decline as there is an increase in public spending on health protection systems. However, there are two to four million individuals who move below the poverty line when their healthcare expenditure is discounted ( Lustig, 2010) .
Similarly, the changing epidemiological and demographic profile of the region, especially among the aging population, causes a shift of load of morbidity towards chronic diseases, which has been increased in the entire population groups ( Cotlear, 2011) . In other words, there is a more significant and more widespread demand for the healthcare in the region, and this will impact on the budget as it would see a rapid increase in the overall spending.
Aging population as a demographic dependency factor is a crucial element which should be considered when studying the dynamics of the protection system and the welfare of the regimes ( Cotlear, 2011) . When considering the most impoverished families, the care for the aged people is something that cannot be met by the market, and the women always fall in the task of taking care of the family’s health environment. This involvement has impacts on the gender effects of the individual development and integration of women in the labor market. When such access happens, the women are left behind and therefore lacking the necessary developmental requirements in the society.
Most of the places in Latin America and the Caribbean have restricted the access to quality healthcare to the wealthy and high-income earners. Also, the fact that the services are seen as a commodity that only the affluent can access makes it even expensive and makes the services be driven out of the poverty-stricken and vulnerable areas ( Lustig, 2010) . Therefore, there exists a vicious cycle that revolves and affects the life quality and the process which guarantees human, social and political rights for the millions of people who are edged out of the model.
The effect of inequality is seen in both the social determinants that influence health and access to quality healthcare. As a result, when there is health inequality, there arises more poverty, and hence makes the community diverted from the way that leads to the progressive realization of a fundamental right. In short, the inequitable access to public resources leads to poverty which also points to the inability to access healthcare, and in turn, leads to more debt ( Lustig, 2010) .
Inefficient provision
Health care provision in the Latin America has been widely criticized as ineffective. However, it is difficult to find accurate measures of resources that are wasted or costs that are excessive. In context, some people argue that the health challenges in Latin America are caused by the delivery of wrong interventions when there exist more cost-effective alternatives. It is this failure to recognize the existence of the other options that cause the entire region to be in a position where its health services are considered inferior. In some instances where there has been a revision and clear focus on the solutions, such as the case of Costa Rica, it is clear that the services are exemplary and give higher health gains per dollar.
Despite the lack of a study that shows the exact amount of cost that could be reduced in a nation by always adopting the most cost-effective alternative, many choices are shown to be able to save costs. However, it is worth mentioning that while the issue of cost-effectiveness is an important one and a useful criterion for choosing among the alternatives to a given health situation, it is also questionable when selecting it for specific diseases or illness. This is so because different populations are affected. The issue of what to buy with public resources is a critical one as there can arise a conflict between the products. In the case of Latin America, the inputs are provided in wrong proportions which make it even harder to allocate some of them to the solution of critical health problems.
This makes outputs to be influenced by the scarcest input while others remain idle or not utilized at all. As a result, the disproportional allocation of contributions manifests itself in the sense that there exists a shortage of the drugs and other vital supplies. The hospital capital is also deteriorated and makes the human resources relatively superfluous and less efficient than how they are supposed to be. In some instances, the drugs can be overprescribed with disregard to how the pharmaceuticals can interact. The runaway corruption and theft of supplies is one cause of such problems in the health sector. It is imperative to note that the imbalance can also occur without the existence of crime when the budgets aimed at the healthcare services are prepared inefficiently.
The unequal allocation of resources encourages misguided investment decisions on the public sector and results in reduced distribution of responsibilities and resources in the different levels of the healthcare system. In turn, this leads to the facilities, especially hospitals, to operate with diseconomies of scale. In Latin America, just like any other middle or low-income country, the inefficiencies that arise from uninformed investment decisions cause a sinkhole in the entire health budget, with estimates around 10 percent.
In conclusion, the health care in Latin America is marred by a myriad of challenges that makes it inefficient, inequitable, and of low quality. The disorganized quality of healthcare manifests itself in many ways. For instance, limited access to the services, inadequate service provision, medical complaints, high costs, the lower credibility of the healthcare institutions, and dissatisfaction on the part of both the professionals and users of the healthcare services. In the end, the whole effect means that there is a threat to human life as it lost. It is important to note that the issue is not only a finance problem but has many other matters that need to be addressed as a region of Latin America.
For instance, the management capacity of the systems in place is crucial as in some countries in the area, the governance and control of these systems are not in the hands of the state. What the management should address is the progress that should be made in the health sector that is centered on the people and offering services even to the vulnerable population and based on their needs. Latin America is considered one of the most unequal regions in the world, and the issue is more complicated than it looks. Progressive democratic aspirations are impossible to meet without addressing the causes of the inefficient healthcare. The electoral democracy is not an effective model when it does not guarantee the citizens of services linked to human rights which include access to health services.
References
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