Strengthening primary healthcare is one of the most effective interventions for improving healthcare systems efficiency and population health. A high-performing primary care system that provides accessible and high-quality services can reduce acute deterioration in people living with four long-term conditions that are widely prevalent in LAC; asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and diabetes, and reduce unnecessary admissions to hospital. For this reason, measuring the number of hospitalisations due to these diagnoses is an indicator of the capacities of the healthcare system to appropriately manage conditions at the primary care level. However, LAC countries generally have lower hospital capacity and use than OECD countries, with fewer hospital beds (23 versus 42 per 10 000 population on average; see Chapter 5) and lower hospital discharge rates (fewer than 500 versus almost 1 400 per 10 000 population on average; see Chapter 5). As a result, low avoidable admission rates may reflect constraints in access to hospital care, rather than stronger primary care performance alone.
Figure 7.7 shows hospital admission rates per 100 000 population for asthma and COPD in eight LAC countries (LAC8) and the OECD average. On average, LAC8 countries report substantially lower admission rates than the OECD – around one‑third of the OECD average for asthma (9.3 versus 25.3 per 100 000) and about one‑quarter for COPD (20.8 versus 76.3). Patterns for the two conditions are broadly similar: countries with low asthma admission rates also tend to have low COPD admission rates. Peru and Ecuador record the lowest rates for both conditions (around 3‑6 admissions per 100 000), followed by Paraguay and Mexico, while Argentina, Chile and Colombia display comparatively higher rates within the LAC group but still well below the OECD average. Part of the gap with the OECD may reflect more limited hospital capacity and lower overall discharge rates in many LAC health systems.
Figure 7.8 presents admission rates per 100 000 population for diabetes and CHF. For diabetes, LAC8 countries again show lower admission rates on average than the OECD (54 versus 93 per 100 000). However, Mexico stands out with a rate well above the OECD average (149), while Chile’s rate (90) is close to the OECD level. Argentina, Costa Rica and Colombia have intermediate rates (around 45‑57), and Ecuador, Paraguay and Peru report very low admission rates (5‑26 per 100 000). For CHF, admission rates in all reporting LAC8 countries are below the OECD average of 89 per 100 000. The LAC8 average stands at 33 admissions, with Chile showing the highest rate in the region (61) and all other countries reporting markedly lower rates: around 34‑42 in Argentina, Colombia, Ecuador and Mexico, and fewer than 25 admissions per 100 000 in Costa Rica, Paraguay and especially Peru (5).
The low admission rates for diabetes, respiratory conditions and CHF must be interpreted against the backdrop of fewer hospital beds and lower hospital discharge rates in LAC than in other OECD countries. While they may partly reflect strong primary care and good management of chronic cardiovascular disease, they may also capture unmet need for hospital care, under-diagnosis, delays in seeking care or barriers to admission where hospital capacity is constrained.
Health systems must find an adequate balance to ensure the least wasteful level of hospital utilisation while ensuring adequate access across the entire population. LAC countries must continue to invest in building primary care capacity in order to minimise waste and prepare for a heavier burden caused by the increased prevalence of chronic conditions brought on by population ageing (see Chapter 9).
