Healthcare service disruption in 14 Latin American and Caribbean countries during the COVID-19 pandemic: Analysis of household phone surveys, 2020-2021

BACKGROUND: The coronavirus 2019 (COVID-19 pandemic) and associated responses have significantly disrupted healthcare. We aimed to estimate the magnitude of and reasons for households reporting healthcare disruption in 14 Latin America and the Caribbean (LAC) region countries from mid-2020 to mid-2021, and its relationship with country contextual factors. METHODS: We used COVID-19 high-frequency phone surveys (HFPS) conducted in 14 LAC countries in three rounds in 2020 and one in 2021. We classified the reasons reported for healthcare disruption into four groups: concerns about contracting COVID-19, healthcare supply constraints, financial reasons, and public health measures (PHMs). We used bivariate and multivariate regressions to examine correlates of reported healthcare disruption with the above groups and country context as control variables. RESULTS: On average, 20% of households reported a disruption in May-June 2020 (45% to 10% at country level), dropping to 9% in June-July 2020 (31% to 3%) and July-August 2020 (26% to 3%), and declining to 3% in May-July 2021 (11% to 1%). The most common reason reported for disruption was healthcare supply constraints, followed by concerns about contracting COVID-19, PHM, and financial reasons. In multivariable regression analyses, we found that a higher incidence of new COVID-19 cases (regression coefficient (β) = 0.018, P < 0.01), stricter PHM (β = 0.002, P < 0.01), fewer hospital beds per population (β = -0.011, P < 0.01), and lower out-of-pocket health spending (β = -0.0008, P < 0.01) were associated with higher levels of disrupted care. A higher care disruption was associated with a lower gross domestic product (GDP) per person (β = -0.00001, P < 0.01) and lower population density (β = -0.056, P < 0.01). CONCLUSIONS: Healthcare services for households in LAC were substantially disrupted during the COVID-19 pandemic. Findings about supply and financial constraints can inform the recovery of postponed healthcare services, while public health and contextual factors findings can inform future health system resilience efforts in LAC and elsewhere.