The National Health Funds Network of the Americas (REFSA) announced a study on contracting specialized private health services

Washington, September 2026 (PAHO) - A regional study on the contracting of private providers for specialized health services was announced during a special session of the National Health Funds Network of the Americas (REFSA), held as part of the first joint meeting of RedFESP, REFSA, and Impulsa-RISS in Brasília, Brazil, from 2 to 4 September. The initiative is being promoted by REFSA member countries (Brazil, Chile, Colombia, Mexico, Peru, and Uruguay) with technical support from the Pan American Health Organization (PAHO) and the World Bank.

During the opening of the session, Laura Di Giorgio, Senior Economist at the World Bank, noted that many countries in Latin America and the Caribbean currently rely on private providers to complement the public supply of specialized services or are considering doing so to address persistent challenges related to waiting lists, growing demand, fiscal constraints, and insufficient specialized capacity. In this context, she emphasized that "the key question is no longer whether services should be contracted from the private sector, but how to do so effectively, how to align incentives, how to ensure quality, how to strengthen accountability, and ultimately how to provide care that is effective, equitable, and sustainable."

Ernesto Báscolo, Chief of PAHO's Primary Health Care and Integrated Service Delivery Unit, highlighted that this is a strategic agenda identified by REFSA member countries themselves. Referring to the evolution of health systems across the Region, he stated that "it is now undeniable that the private sector plays a crucial role in specialized care" and stressed the need for evidence to better align private sector purchasing with a comprehensive agenda aimed at advancing toward universal health.

Daniel Titelman, World Bank consultant, and David Debrott, PAHO consultant and members of the study's technical team, highlighted that the growing participation of the private sector is being driven by increasing demand for more complex services throughout the Region. According to their presentation, understanding what is purchased, how it is purchased, and how much is purchased is a critical step toward developing more efficient and equitable resource allocation mechanisms. They also noted that the diversity of institutional arrangements across countries represents an opportunity to generate comparative evidence, identify good practices, and strengthen regional learning on the strategic purchasing of specialized services.

The session also featured the participation of representatives from Brazil, Chile, Mexico, and Uruguay, all REFSA member countries, who shared national experiences regarding the different mechanisms used to complement the public provision of specialized services.

From Uruguay's Ministry of Public Health, Chantal Boulay emphasized the importance of complementary provider agreements as a tool to ensure effective coverage throughout the country. Meanwhile, Carolina Salazar Hernández, Deputy Director of Chile's National Health Fund (FONASA), noted that the purchasing of specialized services should be guided by specific health needs and focused on closing health gaps.

Representing Mexico's Ministry of Health, Jorge Sánchez highlighted the need to progressively strengthen capacities for more strategic and effective purchasing. Meanwhile, Darcio Guedes Junior, Director of Brazil's National Health Fund and President of REFSA, underscored the importance of gaining a better understanding of how financing and payment mechanisms can contribute to improving access, efficiency, and the sustainability of specialized services.

Participants agreed that the systematic documentation and exchange of experiences among countries constitute a key asset for better understanding the different models that exist across the Region and for advancing toward more informed decisions on financing, regulation, and service organization. In this context, the study will be conducted through a collaborative process involving participating countries, incorporating evidence with the aim of generating practical tools that strengthen the strategic purchasing of specialized services and contribute to improving access, quality, and the sustainability of health systems in the Americas.

What is REFSA?

The National Health Funds Network of the Americas (REFSA) is a PAHO-supported initiative that brings together public institutions responsible for managing national health funds. It serves as a technical and strategic platform for exchanging experiences, fostering innovation, and strengthening financial management capacities while addressing regional challenges such as resource decentralization, transparency, and sustainability.