Abstract

To achieve Universal Health Coverage (UHC) is one of the targets defined in the Sustainable Development Goals (SDGs) and Latin American countries have introduced a number of reforms in this regard. However, although ongoing health care systems have increased the population coverage, most of them are still marked by the segmentation and marketization of health care services. This situation has promoted the middle-class self-exile of the public provision of health care services, which implies that public systems lack demanding and powerful users requesting a better quality and, in turn, operates as a feedback for the segmentation of the systems according to the households´ purchasing capacity. This article addresses to elucidate the health care systems’ strengths and weaknesses for including middle-class households in the same schemes than lower social strata in Chile and Uruguay, which due to their high levels of coverage have been taken as models for the other Latin American countries. To do that, it examines the different paths followed by the reforms carried out in these countries and the resulting health care policy architectures, which considers five main components: entry criteria, funding, benefits, provision and outside options. Drawing on this analysis, the article highlights that despite these countries exhibit similar levels of health population coverage, they differ in terms of their potential to achieve a non-segmented and good-quality health care coverage for the entire population, which in turns is related to the rationale behind the social production of welfare and their institutional expression in the policy architectures.