Across Latin America's largest economies, 2025 produced measurable consequences from fiscal contraction, blocked reforms heading into pivotal elections, and large-scale implementation efforts whose results remain uncertain. Now, with Argentina confronting the aftermath of deep budget cuts, presidential transitions in Colombia and Chile set to reshape the direction of health policy, and Mexico and Brazil testing whether new programs and investments translate into improved coverage, 2026 will be decisive. Here is an analytical overview of where each country stands and what to watch in the year ahead.
Argentina: Austerity, Course Correction, and What the Numbers Show
Since taking office in December 2023, Milei's administration cut the Ministry of Health budget by about 48% in real terms and eliminated over 2,000 Ministry of Health positions, representing nearly one-quarter of the ministry's workforce. It could not have come at a worse time: in the first three quarters of 2025, reported incidence of communicable diseases rose sharply versus the 2020–2024 average—e.g., measles (+1,650%), hepatitis A (+296%), and tuberculosis (+31%). While it is worth noting that vaccination coverage had already been declining since 2019, a weaker MoH only affects the country's capacity to respond appropriately. Medicine prices increased sharply, with estimates ranging from 200% to over 300%, while pharmaceutical sales volumes contracted. The Garrahan Pediatric Hospital, one of the country's most important public institutions, lost an estimated 200-300 professionals.
Milei coupled the cuts with structural deregulation, opening obras sociales to competition with private insurers by allowing workers to redirect payroll contributions. It was the most market-oriented health reform in the region, although preliminary data suggest that the transition has been disruptive, particularly for the estimated 200,000 people who lost private coverage due to unaffordable premiums and were pushed into the public system.
Despite winning the October 2025 midterm elections decisively (40.7% of the vote), earlier political pressure, including a 13-point loss for government allies in the September Buenos Aires provincial election and declining approval ratings, contributed to a shift in fiscal policy. The 2026 budget, the first passed under Milei's presidency (he had previously governed via executive decree without congressional approval), was approved by the Senate 46-25 in December, raising health spending 17% above inflation. However, real spending remains 24.6% below 2023 levels.
Key takeaways for 2026
The health emergency decree was extended through December 2026, but providers remain uncertain about what follows. Congress rejected provisions that would have repealed disability emergency and university financing protections, signaling legislative resistance to further cuts. Mental health funding faces a projected 91.5% reduction, even as demand for mental health services has risen 12-20% in the past year.
Colombia: A Blocked Reform, an Open Election
President Petro made health system reform the centerpiece of his agenda, proposing to replace Colombia's private insurer model, the EPS system that has managed health care for three decades, with publicly oriented managers and to route funding directly through the national health fund (ADRES). The reform passed the House of Representatives in March 2025 with 95 votes in favor. Then it stalled.
The Senate's Seventh Committee archived the bill on December 16 by an 8-5 vote, after what the government described as approximately nine months of deliberate delay. This was the second time the Senate blocked a Petro health reform, following a similar outcome in 2024. The government attempted to implement provisions by decree, but Colombia's Council of State suspended it, ruling that the Constitution assigns Congress the power to define the health service model. Opposition came from an unusual coalition: patient groups, medical associations, think tanks, academic researchers, and the private industry, united by multiple repairs to the proposed bill with claims that include a more fragmented system, risk of an even worse financial outcome, and an absence of a credible transition plan and by a structural deficit in the existing system, estimated at COP 29 trillion (approximately USD 7.3 billion).
Key indicators suggest continued system strain. Health-related tutelas (judicial claims for rights violations) reached 265,173 in 2024, a 34.1% increase over 2023, and are projected to have reached 320,000 in 2025. Nueva EPS, with 11 million affiliates and currently under government intervention, faces hospitals and providers restricting services due to accumulated unpaid debts. The interventions of other seven EPS place roughly half the insured population under government management.
Key takeaways for 2026
Health care ranks among the top three voter concerns ahead of the May 2026 presidential election. With Petro's reform archived (though a formal appeal remains pending), the incoming president must address a system under significant financial and operational pressure. The central question is which policy framework will replace the failed reform, as major changes would be required regardless of the election outcome.
Chile: A New President, an Unfinished Agenda
Chile's 2025 was defined by two developments: the implementation of the Ley Corta de ISAPREs (a law addressing private insurer pricing practices) and a presidential election that reoriented the political landscape. The Ley Corta, enacted in 2024 in response to a landmark 2022 Supreme Court ruling, adjusted all plans to the legal 7% contribution rate, eliminated age- and sex-based surcharges through a unified factor table, and ordered insurers to refund overcharges over differentiated timelines: up to 13 years for members under 65, 5 years for ages 65-80, and 2 years for those over 80. Estimates of the total refund obligation ranged roughly from US$1.2–1.5 billion.
Separately, the Boric government expanded guaranteed health coverage (GES) to 90 priority conditions via the Decreto GES 2025-2028, backed by over 100 billion pesos in annual investment, the largest GES expansion since the system's creation. However, the broader FONASA (Chile's public insurance fund) modernization, originally envisioned as an ambitious Universal Health Fund, was scaled back to a package of smaller legislative projects, most of which remained pending at the end of Boric's term.
Then came the election. In November's first round, the field fractured: Evelyn Matthei finished with just 12% amid a split right-wing vote (Kast 24%, Parisi 20%, Kaiser 14%, Matthei 12%). In the December runoff, Jose Antonio Kast won decisively with 58%, defeating left-wing candidate Jeannette Jara. Kast takes office on March 11, 2026.
Key takeaways for 2026
Kast's government inherits Ley Corta's long-term ISAPRE repayment framework but brings a different policy orientation, with a platform centered on public security, economic recovery, and immigration rather than health. He takes office without an absolute congressional majority. Whether the progress on pricing equity and coverage expansion under Boric, including the elimination of copayments for FONASA beneficiaries, continues or is redirected under a socially conservative administration with free-market economic leanings is one of the most consequential health policy questions in the region this year.
Mexico: The Execution Test
Mexico's Sheinbaum government pressed ahead in 2025 with the IMSS-Bienestar consolidation, the third institutional restructuring in under a decade, following the replacement of Seguro Popular by INSABI, which was in turn dissolved in favor of IMSS-Bienestar. The government announced ambitious infrastructure and staffing targets for IMSS-Bienestar and linked programs, including the Salud Casa por Casa preventive home-visit initiative (deploying 20,000 professionals to serve 14 million beneficiaries) and the Farmacias del Bienestar free-pharmacy program.
But the gap between stated targets and operational delivery remains wide. IMSS-Bienestar is projected to handle roughly 50 million general consultations in 2025, compared to the 90 million that Seguro Popular managed in 2016, despite Mexico's population being larger now. The system currently operates in 19 of 32 states. Public health spending dropped 14.3% in the first quarter of 2025, the lowest since 2010, against a total 2025 health budget of MXN 918.4 billion (an 11% cut from 2024). Mexico allocates 2.5% of GDP to public health, well below the PAHO benchmark of 6%, endorsed by member states.
Key takeaways for 2026
Major milestones include the rollout of a national health credential and shared medical records system beginning between mid-February and March, and the nationwide expansion of Farmacias del Bienestar across all 32 states. The health budget rises to MXN 965 billion, with IMSS receiving an 11.7% increase, though other agencies face cuts (ISSSTE -3.6%, PEMEX health services -3.4%). Mexico signed a 2026-2031 health cooperation plan with the Pan American Health Organization focused on primary care and system strengthening. The key challenge remains whether execution can match the government's stated targets.
Brazil: Incremental Expansion Within Fiscal Constraints
While its neighbors pursued large-scale restructuring or fiscal contraction, Brazil opted for incremental expansion of existing programs in 2025. The SUS (Sistema Unico de Saude, Brazil's universal health system) budget reached R$246 billion, up 6.2% year-over-year, supplemented by a R$20 billion BNDES-operated (National Development Bank) credit fund for health and education infrastructure, of which R$18.4 billion in health projects was approved before year's end. A separate R$9.8 billion climate adaptation plan for SUS began preparing the health system for extreme weather through 2035, a program elevated at COP30 in Belem with an additional USD 300 million in philanthropic commitments.
Tax reform added a public health dimension: the Imposto Seletivo (selective tax) on sugary beverages and tobacco, zero-rated healthy food baskets, and a new law guaranteeing free mammograms through SUS for women over 40. On the private side, regulators proposed a regulatory sandbox for simplified, affordable insurance plans to expand access beyond the 26% of Brazilians who currently hold private coverage, though the proposal is currently suspended pending a Superior Court of Justice ruling. The Mais Medicos workforce program reached a record scale, with nearly 24,900 doctors deployed across 4,200 municipalities.
Key takeaways for 2026
Brazil's approach relies on expanding fiscal commitment within existing institutional structures rather than wholesale reform. The BNDES credit line addresses infrastructure gaps, but analysts note it is heavily hospital-oriented, raising questions about the balance between hospital and primary care investment. Health policy prominence may increase as the October 2026 general election approaches, with Lula seeking re-election. The central debate remains whether incremental investment can keep pace with the needs of a system that many analysts consider structurally underfunded.
Different paths, same challenge
These five countries illustrate three distinct phases of the health reform cycle, and each carries its own risks in 2026. Across all five, the underlying lesson is the same: delivering universal health coverage demands not only political will at the moment of reform but also sustained commitment through transitions, fiscal pressures, and the slow work of institutional implementation.
