Public-private configuration in health systems and inequalities in Latin America: a scoping review

This study identifies and explores literature evidence on the effects of public-private partnerships in health systems on health inequities in Latin America. For this purpose, a scoping review was conducted following the Joanna Briggs Institute and PRISMA-ScR guidelines, employing the methodological steps of: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) data charting; and (5) collating, summarizing and reporting the results. Study analysis focused on the health systems of Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, Mexico, Peru, and Uruguay, emphasizing financing, coverage, supply, and access. Initial bibliographic search identified 2,596 studies published on the topic between 2002 and 2024, of which 102 were included in this review. All analyzed studies reveal that the nature of public-private relations within Latin American health systems reinforces structural inequalities expressed in various dimensions which require context-appropriate policies, including sufficient financing, strengthening private sector regulation, and redistribution of resources and services that follow the geographical logic of social and health needs. In this context, overcoming the segmentation of coverage and access in favor of universalizing services and consolidating the right to health is essential.