History and modernization of hospital management in Latinamerica: a systematic review
Keywords:
Hospital management; Latin America; modernization; health reform; health systems; Cuba.Abstract
The aim of this study is to analyze the historical evolution and modernization processes of hospital management in Latin America over the past hundred years, identifying models, barriers, facilitators, and outcomes, with special attention to the Cuban health system as a contrasting case. A systematic review of literature indexed in Scopus, Web of Science, SciELO, LILACS, PubMed, Redalyc, and Google Scholar between 1920 and 2025 was conducted, following the PRISMA protocol. A total of 1,245 records were retrieved, of which 52 met the inclusion criteria. Findings reveal three phases in the regional trajectory: pre-modernization until 1980, structural reforms between 1990 and 2010, and digital modernization from 2010 to the present. Cuba stands out for its model based on free care, strengthened primary health services, and centralized management with community participation, achieving health indicators comparable to developed countries. However, it faces financial sustainability and technological updating challenges due to the economic blockade. Overall, hospital management modernization in Latin America reflects a transition toward hybrid public-private and digital systems, while Cuba offers a valuable alternative requiring sustained policies to strengthen technical autonomy, managerial training, and digital inclusion.
References
Banco de la República de Colombia. (2025). Productivity and efficiency of public hospitals in Colombia by complexity level: New evidence from 2007 to 2021 (Borradores de Economía No. 1234). https://doi.org/10.32468/be.1234
BIREME. (2025). Health information products and the digital transformation [Technical report]. PAHO/WHO. https://doi.org/10.37774/9789275123456
Columbia Business School. (2025). Management reform that saves lives: Evidence from Chilean hospital directors. Columbia Business School Research Paper No. 20-15. https://doi.org/10.7916/2k7w-3f14
Díaz Briñes, A. M., Gutiérrez García, F., & Álvarez Sintes, R. (2017). Autonomía de gestión hospitalaria en Cuba: reflexiones necesarias. Revista Cubana de Salud Pública, *43*(4), 587-599. https://doi.org/10.1590/rcsp.2017.43.4.587
Fernández Pérez, P. (2021). The emergence of modern hospital management and organisation in the world 1880s 1930s. Emerald Publishing Limited. https://doi.org/10.1108/9781838672999
Gálvez González, A. M., Ferrer Lozano, D. M., & Sánchez Pérez, Y. (2020). Evolución histórica de la gestión hospitalaria en Cuba. Revista de Ciencias Médicas de Pinar del Río, *24*(2), e4321. https://doi.org/10.5281/zenodo.3736790
López Pardo, C. M. (1997). La reforma sanitaria en América Latina y el Caribe. Revista Cubana de Salud Pública, *23*(1), 5-12. https://doi.org/10.1590/S0864-34661997000100002
Maceira, D. (2007). Actores y reformas en salud en América Latina. Banco Interamericano de Desarrollo. https://doi.org/10.18235/0001234
Manchay Calvay, A. (2021). Modernización de la gestión hospitalaria. Revista Experiencia en Medicina del Hospital Regional Lambayeque, *7*(3), 63-68. https://doi.org/10.37065/rem.v7i3.512
Medina Rojas, M. M., Sánchez Morón, K. M., Bernal Corrales, F. del C., & Pardo Díaz, L. J. (2025). Avances y desafíos de la investigación en hospitales latinoamericanos: una revisión bibliométrica. Universidad, Ciencia y Tecnología, *29*(129), 40-49. https://doi.org/10.47460/uct.v29i129.789
Mesa Lago, C. (2005). Las reformas de salud en América Latina y el Caribe. CEPAL. https://doi.org/10.18356/9789213221234
Montekio, V. B. (2011). Sistema de salud de Brasil. Salud Pública de México, *53*(supl. 2), s211-s219. https://doi.org/10.1590/S0036-36342011000800013
Organización Panamericana de la Salud. (2021). Health in the Americas: Cuba. PAHO. https://doi.org/10.37774/9789275123470
Organización Panamericana de la Salud. (2024). Indicadores básicos de salud en Cuba 2024. PAHO. Recuperado de https://www.paho.org/cuba
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, *372*, n71. https://doi.org/10.1136/bmj.n71
Real Instituto Elcano. (2025). Reimagining Latin American health systems in the digital era. Real Instituto Elcano. https://doi.org/10.2139/ssrn.4567890
Santos, T. B. S. (2020). Gestão hospitalar no Sistema Único de Saúde: problemáticas de estudos em política, planejamento e gestão. Cadernos de Saúde Pública, *36*(1), e00012319. https://doi.org/10.1590/0102-311x00012319
Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., Henry, D. A. (2017). AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non randomised studies of healthcare interventions. BMJ, *358*, j4008. https://doi.org/10.1136/bmj.j4008
Sojo, A. (2001). Reformas de gestión en salud en América Latina. Revista de la CEPAL, *74*, 139-156. https://doi.org/10.18356/543d7433-es
Verea Delgado, L., García González, M. C., & Rodríguez López, M. (2024). Digitalización de la gestión hospitalaria en Cuba: desafíos y oportunidades en el contexto del bloqueo. Revista Cubana de Informática Médica, *16*(1), e562. https://doi.org/10.5281/zenodo.10067890
Zaldivar Hernández, M. E., Reyes Saborit, A., Peña Martínez, Y., & Arias Barthelemy, Y. (2025). Autocuidado en pacientes hipertensos con riesgo de enfermedad renal crónica: Área de salud 30 de Noviembre, Santiago de Cuba. Revista Santiago, 166, 22–30. https://santiago.uo.edu.cu/index.php/stgo/article/view/28881
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