The aging population and the reduction in overall mortality have led to a predominance of chronic diseases. However, the evident advancements in technology and scientific knowledge have not corresponded with an adequate administration of health systems. Curiously, the most challenging dilemmas today are related to how to manage and prioritize the way organized communities define and design systems to implement their priorities.
As long as these dilemmas remain unaddressed, advancements will not be widely available to those who demand them. This lack of development in prioritization mechanisms generates forced interactions within health systems, the clearest manifestation of which is the high rate of judicialization. As in many other areas of public life, what cannot be resolved through coexistence agreements between parties ultimately ends up in the courts.
Many decisions made by health authorities are not implemented because they clash with judicial decisions that protect interests that have been channeled through this route. Thus, the health systems’ scenario ends up being a crossroads of conflicts and interests mediated to some extent by health policies but also by judicial rulings. One of the most critical aspects is that access to justice is not equal for everyone; in many cases, those who need it most cannot access it.
At the heart of these issues lies a significant equity problem. There is a paradox of coexistence between cutting-edge advancements that allow us to map and identify previously unknown diseases, even offering treatment for many of them, and the “coexistence” advances needed to generate agreements for the adequate and equitable implementation of these advancements. As scientific progress continues, the pressure on the system will only increase.
In one way or another, these forces are shaping the health systems landscape in Latin America, with unique characteristics in each country. The way these conflicts will be resolved depends largely on high-level political decision-making issues. Meanwhile, with judicialization as a symptom, an agenda related to prevention and strengthening Primary Care is being sidelined, which is essential for addressing chronic diseases.
Some “clinical trials” are underway as a form of treatment to improve coexistence. Undoubtedly, the emergence of health technology assessment agencies aims to improve interaction among actors and resources, although it is necessary to generate consensus among stakeholders for these agencies or other instruments to contribute to coexistence. As part of these agreements, it is crucial to include the voices of system users—patients.
“Putting the patient at the center” seems to have consensus among all actors, although it is not clear what that means. For now, and at a minimum, it should mean “listening to them.” This presents an opportunity for patient associations to express their voices. It is vital that they can raise their voices because, as in many other aspects of public life, there are significant micro-macro asymmetries; the reality in a public hospital often differs greatly from what was designed by an expert in public health. What occurs in the middle, known as the patient journey, can provide an accurate diagnosis of the daily difficulties faced by patients and families.
This patient journey helps understand aspects related to prevention, how and in response to what signals or symptoms patients and families interacted with the system, what follow-up occurred, and which barriers were overcome. Without a doubt, there are lessons to be learned there and actions to redesign in search of improvements.
This exercise can contribute to a better understanding of the current situation and thus “listen” to proposals from system users—the patients.
Conclusion
There is an urgent need to address the challenges in access to healthcare in Latin America, emphasizing the importance of equity and the active participation of patients in decision-making. Despite advancements in technologies and treatments, deficiencies in the management of healthcare systems and the judicialization of conflicts reveal the lack of effective mechanisms to prioritize community needs. To achieve real progress, it is essential to foster collaboration among all stakeholders in the healthcare system, ensuring that the voices of patients are heard and their needs are addressed equitably.
Ignacio Zervino
Consultant
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