Territorial Inequality in Health Service Delivery: Lessons from Latin America’s Federations

Abstract

ABSTRACTAccess to quality healthcare varies across the national territory inside Latin American countries, with some subnational units enjoying higher-quality care than others. Such territorial inequality is consequential, as residents of particular regions face shorter life spans and an increased risk of preventable disease. This article analyzes trajectories of territorial healthcare inequality across time in Argentina, Brazil, and Mexico. The data reveal a large decline in Brazil, a moderate decline in Mexico, and low levels of change followed by a moderate decline in Argentina. The article argues that two factors account for these distinct trajectories: the nature of the coalition that pushed health decentralization forward and the existence of mechanisms for central government oversight and management.