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Scoping review of the literature on the historical and economic evolution of the health systems of Chile, Uruguay, and Costa Rica

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  • Matus-López, Mauricio

Abstract

This article presents a scoping review of the scholarly literature on the historical, institutional, and economic evolution of the health systems of Chile, Uruguay, and Costa Rica. These three countries were selected due to their differing institutional trajectories—market-oriented (Chile), universal public (Costa Rica), and hybrid-transitioning (Uruguay)—as well as their shared current status of near-universal coverage and high human development. The review aimed to systematically map peer-reviewed publications to identify key institutions, landmark reforms, long-term quantitative indicators, and critical assessments of system performance. A structured search was conducted in Web of Science, Scopus, and SciELO using terms related to health systems, institutional development, financing, and the three countries. After removing duplicates and applying thematic and geographic filters, 42 articles were selected for full-text analysis. Findings show a disproportionate focus on Chile, reflecting its globally unique model of function separation and private insurance. Costa Rica's system is consistently framed around the centrality of the CCSS and its primary care reforms, though discussion of the private sector remains limited. In Uruguay, the 2007 reform establishing the Integrated National Health System (SNIS) receives positive coverage, while earlier periods remain underexplored. Across cases, available quantitative data is fragmented and short-term, limiting comparative and longitudinal analysis. Despite coverage gaps, the review confirms key trends identified in broader literature and underscores the need to incorporate non-indexed sources—such as national reports and historical monographs—to fully grasp the institutional evolution of Latin American health systems

Suggested Citation

  • Matus-López, Mauricio, 2025. "Scoping review of the literature on the historical and economic evolution of the health systems of Chile, Uruguay, and Costa Rica," MPRA Paper 124790, University Library of Munich, Germany.
    • Handle: RePEc:pra:mprapa:124790
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    References listed on IDEAS

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    1. Viveros-Long, Anamaria, 1986. "Changes in health financing: The Chilean experience," Social Science & Medicine, Elsevier, vol. 22(3), pages 379-385, January.
    2. Rotarou, Elena S. & Sakellariou, Dikaios, 2017. "Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile," Health Policy, Elsevier, vol. 121(5), pages 495-503.
    3. Macq, Jean & Martiny, Patrick & Villalobos, Luis Bernardo & Solis, Alejandro & Miranda, Jose & Mendez, Hilda Cecilia & Collins, Charles, 2008. "Public purchasers contracting external primary care providers in Central America for better responsiveness, efficiency of health care and public governance: Issues and challenges," Health Policy, Elsevier, vol. 87(3), pages 377-388, September.
    4. Araya, R. & Rojas, G. & Fritsch, R. & Frank, R. & Lewis, G., 2006. "Inequities in mental health care after health care system reform in Chile," American Journal of Public Health, American Public Health Association, vol. 96(1), pages 109-113.
    5. Angel González Block, Miguel Angle & Sandiford, Peter & Arturo Ruiz, José & Rovira, Joan, 2001. "Beyond health gain: : the range of health system benefits expressed by social groups in Mexico and Central America," Social Science & Medicine, Elsevier, vol. 52(10), pages 1537-1550, May.
    6. Susana Mondschein & Maria Quinteros & Natalia Yankovic, 2020. "Gender bias in the Chilean public health system: Do we all wait the same?," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-16, September.
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    More about this item

    Keywords

    health care; health systems; history; institutions; Chile; Uruguay; Costa Rica; Latin America;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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