Preventive health and longevity: legal perspectives shaping the future of healthcare

Jonás Bergstein
Managing Partner, Bergstein Abogados, Montevideo
jbergstein@bergsteinlaw.com

Ignacio Torres Negreira
Senior Associate, Bergstein Abogados, Montevideo
itorresnegreira@bergsteinlaw.com

The preventive health and longevity agenda is prompting healthcare systems to revisit legal concepts that for decades appeared settled. The traditional notion of the ‘patient’ – centred on a person seeking care for an already manifest disease – is becoming insufficient in the face of models aimed at identifying risks before they develop into pathology. The same is true of consent. It is no longer limited to authorising a specific medical act, but increasingly extends to broader frameworks involving data processing, remote monitoring and clinical decision-making supported by digital technologies. The concept of healthcare provision is also changing it is no longer confined to therapeutic response, but increasingly encompasses prevention, continuity of care and, more recently, care support. In this context, longevity is no longer merely a demographic aspiration; it has become a distinct legal challenge. Living longer requires rules that safeguard personal autonomy, human dignity, access to care and the sustainability of the system.

Uruguay’s constitutional framework expressly recognises the state’s duty to legislate on public health and hygiene and to promote the physical, moral and social wellbeing of the population. On that basis, Law No 18,211 of 5 December 2007 created the National Integrated Health System (Sistema Nacional Integrado de Salud (SNIS)) and placed health promotion and prevention at the center of the system, alongside the provision of comprehensive, continuous and humane care. This was followed by Law No 18,335 of 15 August 2008, which consolidated the rights of patients and users, including rights relating to healthcare, information, consent and access to medical records, among others. In other words, Uruguay has a regulatory framework that goes beyond financing healthcare services and instead understands health as a right, a public policy objective and a field in which multiple legal relationships converge.

This is one of the reasons why Uruguay offers an interesting case study. The country combines near-universal coverage under the SNIS with a well-established legal framework governing patients’ rights, personal data protection, interoperable electronic health records and telemedicine. In addition, public debate in Uruguay increasingly acknowledges that the health system is entering a new stage, shaped by demographic ageing, the rise of chronic diseases and growing pressure to maintain quality and efficiency.

From a legal perspective, preventive health can no longer be seen in Uruguay as a marginal dimension of the system. The SNIS itself places it at the centre of its guiding principles, which makes it all the more important to strengthen prevention campaigns, targets and incentives, particularly in relation to chronic diseases and early detection. This matters because it reflects a change in regulatory logic: the system is no longer organised exclusively around acute episodes of illness, but is increasingly structured around risk, clinical surveillance and early intervention. That shift has practical consequences. It requires a reassessment of how health priorities are defined, how resources are allocated and what obligations rest on providers and public authorities.

In this respect, Uruguay’s progress in personal data protection, electronic health records and telemedicine is particularly valuable. Law No 18,331 of 11 August 2008 treats health data as sensitive data and requires that such data be adequate, relevant and not excessive. At the same time, the architecture of the National Electronic Health Record (Historia Clínica Electrónica Nacional (HCEN)), supported by Decrees Nos 242/017 and 122/019, seeks to enable the secure and controlled exchange of clinical information for healthcare purposes, with traceability of access and interoperability among providers.

From a regulatory standpoint, this is significant because contemporary prevention depends increasingly on data governance. The issue is not merely confidentiality, but also the conditions under which clinical information may be used to stratify risks, monitor chronic conditions, trigger alerts or shape population-based policies. The challenge is not to choose between innovation and privacy, but to avoid both an overly defensive approach to data, which could prevent legitimate preventive uses, and an overly instrumental one, which could weaken the enhanced protection that health data deserves. The right balance requires clear rules on purpose limitation, access, security, traceability and accountability.

A similar point applies to telemedicine. Law No 19,869 of 2 April 2020, together with its implementing regulation in Decree No 127/024, establishes a framework that no longer treats remote care as a temporary exception, but rather as a regular mode of healthcare delivery. The law highlights its usefulness in disease prevention, health education, improving access and optimising resources, while the 2024 regulation aligns the rights of telemedicine users with those already recognised under Law No 18,335 and requires consent in order to access the service. From a preventive health perspective, telemedicine can play a decisive role in the follow-up of chronic conditions, treatment adherence, monitoring of frailty and continuity of care, particularly in remote areas and for people with reduced mobility. It may also help older people maintain regular contact with healthcare providers without unnecessarily disrupting their daily lives.

Nevertheless, telemedicine still needs further consolidation and clearer standards of healthcare, since not every preventive intervention is equally suited to a remote setting, and digital expansion should not result in lower-intensity medicine for those who are older, frailer or less connected.

As regards longevity, Uruguay offers a useful example of how ageing can be approached not only as a demographic trend, but also as a public health, human rights and care-related issue. The Ministry of Public Health has developed a programme on older people’s health aimed at promoting healthy, active and autonomous ageing, with full access to health services. Importantly, the programme treats population ageing from a preventive and person-centred perspective, with a particular focus on primary care and care provided at home and in the community. In addition, Law No 19,430 of 8 September 2016, approved the Inter-American Convention on Protecting the Human Rights of Older Persons, and Law No 19,353 of 27 November 2015 created the National Integrated Care System (Sistema Nacional Integrado de Cuidados”), declaring the universalisation of care for persons in situations of dependency to be a matter of general interest. Taken together, this framework suggests that longevity cannot be assessed solely in terms of the number of years lived, but also in terms of autonomy, dignity and the support available to navigate that stage of life.

In the longevity debate, autonomy occupies a central place. It cannot be understood in merely formal terms. Informed consent remains a fundamental safeguard, but in contexts of frailty, cognitive decline, loneliness or dependency, the legal response should not be exhausted by a signature. Rather, the Inter-American Convention points to a notion of supported autonomy, free from age-based discrimination and compatible with assistance, shared decision-making and accessible forms of communication. This becomes particularly important when prevention and longevity increasingly rely on digital tools, because a health policy may be technologically sophisticated and yet still be exclusionary if it presupposes levels of connectivity, digital literacy or self-management that not everyone possesses.

Ultimately, Uruguay has a solid foundation for moving towards a health model that is more prevention-oriented and better prepared for a longer-lived society. But that path requires deeper reflection and further adjustment of certain tools. It will be necessary to better integrate preventive health with care policies, strengthen the rules governing the use and protection of health data, consolidate telemedicine with standards suited to older persons and chronic patients, and revisit the concept of autonomy so that it is not reduced to purely formal consent. Above all, the overriding challenge will be equity: ensuring that innovation, rather than expanding rights, does not end up deepening gaps in access, information or support.

For that reason, the issue is not simply one of recognising new rights, but of adapting the operation of the system to a new health and demographic reality. The way in which Uruguay manages to articulate prevention, technology, autonomy and care will be decisive in ensuring that longevity becomes not merely a statistical aspiration, but an experience compatible with dignity and quality of life.