Health spending outside government and compulsory schemes comprises out-of-pocket expenditure (OOP), voluntary payment schemes and external resources. OOP expenditure refers to direct payments by households for healthcare, while voluntary payment schemes include private insurance premiums and other voluntary prepayment arrangements. External resources refer to funds for health received from donors or similar sources.
On average in 2024, or the latest available year, 32% of current health spending in LAC was paid out-of-pocket, still well above the OECD average of 20% (Figure 6.6). The highest OOP shares were observed in Guatemala, Honduras and Haiti, where more than half of current health spending came directly from households. Barbados, Grenada and Trinidad and Tobago also reported shares above 45%. At the other end of the spectrum, Colombia, Cuba and Uruguay remained below 20%, while Jamaica and Suriname stood at around 20%. Between 2015 and 2024, the share of OOP payments in total health spending in LAC fell only slightly, from 33% to 32%, similar to the modest reduction observed across OECD countries. Some countries recorded substantial reductions, notably Saint Kitts and Nevis, Saint Lucia, Jamaica, Guyana and Grenada. However, OOP shares increased markedly in Haiti, and also rose in Panama, Cuba, Barbados, Chile, Belize and Trinidad and Tobago. Despite some progress, OOP expenditure still exceeds 20% of current health expenditure in most LAC countries, indicating continued vulnerability to catastrophic health spending in the event of illness or emergency.
Figure 6.7 shows that voluntary payment schemes represented 10.3% of current health expenditure in LAC in 2024, or the latest available year, almost twice the OECD average of 5.4%. The highest shares were reported in Venezuela, the Bahamas, Brazil and Haiti, where voluntary schemes accounted for close to 30% or more of current health spending. Antigua and Barbuda also reported a relatively high share, at 20%. By contrast, voluntary schemes accounted for less than 5% of current health spending in Cuba, Dominica, Guyana, Nicaragua, Saint Kitts and Nevis, St. Vincent and the Grenadines and Bolivia. Between 2015 and 2024, the regional average changed very little, rising from 10.1% to 10.3%, but country trends diverged. The largest increases were observed in Argentina, Mexico, Costa Rica, the Bahamas and Antigua and Barbuda, while Haiti, Suriname, Guyana, Uruguay and Chile recorded sizeable declines. Private health insurance remains an important source of secondary coverage in many countries, either supplementing benefits not included in the basic package, complementing public coverage by covering user charges, or duplicating coverage for those seeking faster access to private care.
In 2024, or the latest available year, external resources represented a negligible share of health spending in most LAC countries, but remained substantial in Haiti, at 31.6% of current health expenditure, and in Honduras, at 10.1% (Figure 6.8). External resources also accounted for around 5% of current health spending in Suriname and Saint Lucia. On average across LAC26, the share of external resources fell from 3.8% in 2015 to 3.0% in 2024, but remained well above the OECD26 average of 0.1%.
