4

Health care service provision rose during 2021, but in many cases, it has not yet returned to pre-pandemic levels. The service disruptions affected some conditions almost immediately; for example, more people with advanced chronic illnesses and cancers died in the last two years than would have if these individuals had received proper care.

In other cases, the effects of health care service disruptions may not be apparent for many years. For example, cervical cancer screening fell by 70% in Mexico, 28% in Paraguay, and 60% in El Salvador (Bancalari et al., 2021; Doubova et al., 2021; Tullo et al., 2020). Consequently, many cancers will remain undetected or will be detected at advanced stages, increasing treatment complexity, treatment costs, and mortality (Ward et al., 2021).  

The pandemic has also affected mental health. The prevalence of depression and anxiety increased worldwide by 7.6% and 25.6%, respectively (Santomauro et al., 2021), particularly among women, health care workers, and individuals with chronic conditions or psychiatric illnesses (González Ramírez et al., 2020; Pappa et al., 2020; Xiong et al., 2020). Additionally, the pandemic left the region with a new category of disease, Long COVID, defined as having symptoms that persist for more than 4 weeks. For these cases of COVID-19, the most common symptoms that have been documented include fatigue, headaches, and attention disorders (Technical Note: Going Beyond Normal, 2022). Thus, the region must cope with the COVID-19 pandemic while rebuilding the normal health care system and simultaneously addressing new challenges.

Respiratory illnesses are the one category that may have substantially improved during the pandemic. Most countries had fewer deaths due to respiratory disease. Deaths from diseases of the respiratory system fell dramatically in El Salvador, by 54%; Brazil, by 28%; and Chile, by 26% (Technical Note: Going Beyond Normal, 2022). This good news is most likely a side effect of the preventive measures taken against COVID-19, such as masking, handwashing, and social distancing.

The pandemic will have lasting effects on health care spending. Overall, government spending on the pandemic increased the region’s fiscal deficits. Debt levels rose from an average of 58% of GDP in 2019 to 72% in 2020 (Cavallo & Powell, 2021). The rapid increase in deficits and debt is expected to affect resources available for public health in 2022 and beyond. Indeed, recent projections by the International Monetary Fund show a mixed picture regarding countries’ ability to increase their per capita government spending —including health spending— above pre-pandemic levels in the next couple of years (Kurowski et al., 2021).

Countries will continue to face pressures to increase health spending in the near future. Even before the pandemic, health spending was expected to grow in response to population growth, aging, rising prevalence of chronic diseases, medical inflation, and the use of new and more expensive health technologies. Over the next 30 years, health spending per capita is projected to grow between 2% and 3% annually in Latin America and over 4% annually in the Caribbean (Rao et al., 2022).

Continued expenditures on COVID-19, combined with the need for more consistent spending on public health functions such as epidemiological surveillance and emergency preparedness, are likely to push these estimates even higher. In this challenging scenario, countries will have to find ways to expand revenue (e.g., health taxes on harmful products) and increase health-spending efficiency.