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

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