This paper raises the point that only few health reforms implemented in Latin American countries modified the existing health systems in order to fix the problems brought by the institutional fragmentation typical of this sector. A great part of these reforms did not implemented the necessary measures to improve coordination among health systems in the prevailing pluralistic model and besides, they faced strong opposition from relevant actors who obstructed the completion of these reforms. In addition, this work points out that in countries which have implemented comprehensive structural reforms,, health indicators such as child mortality, malnourishment, maternal mortality and specialized care during childbirth have improved faster than in those which conducted only partial reforms or have no reforms at all. This paper analyses some of the processes and constrains of a selected group of countries in implementing health reforms in the Region.