As reported in the previous section, high levels of out-of-pocket (OOP) spending in the region present a challenge not only for governments seeking to improve access, but also for individuals, households and communities. High OOP spending means that households directly finance a substantial part of care when they need it, which can push them into poverty or financial hardship. Globally, the incidence of catastrophic health spending – defined as OOP payments equal to 10% or more of household income or consumption – has increased over time, reaching 11.7% in 2010, equivalent to 808 million people (Flores et al., 2018[1]).
Figure 6.9 shows OOP health payments as a share of household final consumption expenditure. On average, OOP accounted for 3.4% of household final consumption in LAC in 2024, or the latest available year, similar to the OECD average of 3.2%. However, there is substantial variation across countries. OOP represented less than 2% of household final consumption in Venezuela, Guyana, Colombia, Haiti, Antigua and Barbuda, the Dominican Republic, Belize and Saint Vincent and the Grenadines, but exceeded 4.5% in Honduras, Suriname, Paraguay, Saint Kitts and Nevis, Chile and Panama. Between 2015 and 2024, the burden of OOP relative to household consumption rose in several countries, including Panama, Chile, Brazil, Guatemala and Suriname, while it fell in others such as Antigua and Barbuda, the Dominican Republic, Saint Lucia, Ecuador and Haiti. These averages, however, are calculated at the national level and provide no information on how the burden is distributed within countries; a relatively moderate national share can mask substantial inequalities, with low-income households facing much higher OOP shares and greater risk of financial hardship than better-off households.
Figure 6.10 shows voluntary healthcare payment schemes as a share of household final consumption expenditure. On average in LAC, these schemes absorbed about 1.0% of household final consumption in 2024, or the latest available year, very close to the OECD average. The share was close to zero in Cuba and below 0.3% in Guyana, Dominica and Saint Vincent and the Grenadines, but exceeded 2% in Argentina and the Bahamas, reaching 4.6% in Brazil. Between 2015 and 2024, the burden of voluntary payments fell sharply in Haiti and Suriname, and also declined in Uruguay and Guyana, but increased notably in Argentina, the Bahamas, Jamaica, Panama and Brazil. As with OOP spending, these figures are national averages and do not show how the burden is distributed across income groups, which is important given that voluntary schemes are often concentrated among better-off households and may contribute to system segmentation.
Taken together, OOP payments and voluntary healthcare schemes absorbed around 5.7% of household final consumption expenditure in LAC in 2024, or the latest available year, above the OECD average of about 4.2%. The combined burden varies widely, from around 2% or less in Guyana and Venezuela to more than 8% in Brazil, Chile and Panama. In some countries, relatively moderate OOP shares coexist with high voluntary payments, as in Brazil, the Bahamas and Argentina, suggesting more prepayment but also greater segmentation. In others, high OOP with more limited voluntary cover, such as Panama, Chile, Guatemala and Honduras, signals heavier reliance on direct payments at the point of use. As with each indicator on its own, these figures are national averages and do not capture how the burden is distributed across income groups. To ensure adequate access and coverage for all groups, governments need to strengthen financial protection so that OOP payments and voluntary healthcare schemes do not absorb an excessive share of household resources (WHO, 2018[2]). High reliance on these payments schemes, together with fragmented funding arrangements, limits pooling and solidarity and often reinforces segmentation between population groups.
