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On the American continent, one of the countries that invests the most in health is Uruguay, ranking 4th as an investor in public health, second only to Cuba, the United States and Canada, according to data from the World Health Organization.
To reach this level, the Uruguayan government usually directs 8% to 10% of the Gross Domestic Product annually (GNP) for the health sector — percentages that include systems public and private. In practice, as shown in the 2024 Statistical Yearbook, around 100 billion Uruguayan pesos are earmarked for public health. As an example, it is worth considering that Brazil directed 179 billion reais to health in 2023 and 215 billion in 2024, according to data from Agência Gov — however, Uruguay is a country of 3 million inhabitants and just over 176 thousand kilometers long, while Brazil has 212 million inhabitants and more than 8 million kilometers in length.
Thus, it is possible to say that access to health care in Uruguay occurs through a mixed and universal system. In addition, it is considered one of the best in the world, thanks to its focus on structure and primary care, an approach that made it possible to obtain better health indicators than its neighbors. For example:
- They have one of the highest life expectancy rates in Latin America, with an average of 78.73 years, a number higher than the regional average — for example, the IBGE pointed out in 2023 that the Brazilian average was 76.4 years.
- Uruguay has one of the highest proportions of doctors per inhabitant in Latin America. According to the Index Mundi, data from 2017 show that the country had 4.94 doctors for every thousand inhabitants — an index that stands out in the regional comparison.
- In 2006, it was the first in Latin America to ban smoking in closed public environments. In the following years, it advanced on sensitive issues: in 2012, it legalized the voluntary interruption of pregnancy under certain conditions, and in 2013, it approved the legalization of cannabis for recreational use, with regulation of production and sale starting in 2014.
However, let's get down to business.
After all, how does access to healthcare work in Uruguay?
Main features
Uruguay's National Integrated Health System (SNIS), established by Law 18,211 in 2007, is based on the principles of health as a universal human right and public good, with state responsibility.
To achieve this objective, the system integrates public and private providers, a model that allows universal coverage to be offered through 42 comprehensive health providers, based on the set of services established in Comprehensive Health Care Plan (SINKS).
- Financing — Carried out through the National Health Fund (FONASA), a public and mandatory fund with contributions from workers, companies and the State.
- Care model — Organized by levels of care, with an emphasis on Primary Health Care (PHC) as a gateway to the system.
- Management and regulation — The management of the SNIS is centralized in the Ministry of Public Health (MSP), responsible for formulating policies, regulating providers, and supervising the provision of services.
Compared to other Latin American countries, it can be seen that, in 2021, Uruguay registered the highest per capita expenditure on health in the region, totaling US$1,620.33. As pointed out by World Bank data, this amount exceeds investments from countries such as:
- Chile — US$ 1,518.04;
- Argentina — US$ 1,044.77;
- and Brazil — US$761.27.
Regarding direct health expenses - the famous “out-of-pocket” expenses - Uruguay reported an amount of US$256.81 per capita in 2019, according to data from Index Mundi. Although significant, this amount is lower than Chile (US$ 451.26) and Argentina (US$ 261.65), but higher than that of Brazil (US$ 212.32), which suggests a moderate financial burden on Uruguayans compared to their neighbors.
History of the Health System
Uruguay's health system began to take shape in the 19th century, based on so-called “mutual relief societies”. These associations, created by European immigrants and aimed primarily at workers, small merchants, and self-employed professionals, functioned as a community health care network.
Second article published in the magazine Society and State, the model was consolidated as one of the pillars of the provision of health services to the urban population in the first decades of the 20th century, thanks to the growing membership of the middle class.
Still in that period, the country began to implement a series of social protection policies. In 1904, the Civil Retirement Foundation. Three years later, it was the turn of National Labor Office and other labor laws would come in the following decades, expanding the scope of social security in the country.
The consolidation of health as a public policy took place in 1934, with the creation of the Ministry of Public Health (MSP), based on the Organic Law on Public Health. The creation of a new folder helped to incorporate existing structures, such as National Council for Hygiene and National Public Assistance.
From 1973 to 1985, the politics of the time promoted successive budget cuts, which ended up compromising the supply and quality of services. However, with the re-democratization, the country began a process of restructuring the sector.
Years later, already in 2008, it was the turn to implement the National Integrated Health System (SNIS), regulated by Law 18,211. This model helped to reorganize existing public and private services, in addition to creating the National Health Fund (Fonasa), supplied with resources from the contributions of workers, companies, and the State.
Then, this new structure also adopted Primary Health Care (APS) as a pillar, an approach that aims to guarantee universal coverage through disease prevention, health promotion, and early access to diagnosis and treatment, as shown by a survey on the website of the Institute for Advanced Studies of USP on Ibero-American systems.
Health Challenges in Uruguay
Although the Uruguayan health system has well-defined objectives, focusing on equity and quality, studies such as the one published in the journal Science & Collective Health They point out that one of the obstacles to achieving this goal in all regions is difficulty integrating levels of care, which may compromise the continuity and clinical outcome of care.
In this regard, a point of attention that has recently emerged is the type of services with additional payment. Called “VIP plans”, this is a resource used by private health plans to charge an extra fee to perform services that, in theory, are already provided for in a contract. According to a Report published by the newspaper La Diaria, published in October 2024, these actions have grown even among institutions that are part of the SNIS - which contributes to inequalities in access.
Embedded in this issue is the debate about quality of care that, according to experts interviewed by The Daily, It is hampered by absence of a national accreditation and quality control system. Consequently, public health leaders began to analyze proposals for the creation of an independent body to establish technical parameters and monitor compliance by providers.
Another growing demand is related to mental health, especially among the elderly population. According to a Report from El País, published in April 2025, highlighted the increase in suicide cases among people over 65. This phenomenon is associated with social disconnection after retirement and with the perception of being more caregivers than care. For health authorities, this is the result of gaps in public policies for prevention and integration of care systems.
Finally, another worrying issue is infant mortality. Recently, the Uruguayan Ministry of Public Health warned that this rate went from 6.2 per thousand live births in 2022 to 7.3 in 2023. The number contrasts with the downward trend observed in previous years and is associated with the country's inequalities, according to La Diaria.
