OBJECTIVES:: To describe the most common health related quality of life (HRQOL) states in the general population of Argentina, Brazil, Chile and Uruguay using the EuroQol EQ-5D descriptive system, either with the 3L (243 possible states) or the 5L (3,125 states). METHODS:: We included data from the national health risk survey in Argentina (3L; n=41,392) and from the valuation studies of Brazil (3L; n=3,362), Chile (3L; n=2000) and Uruguay (5L; n=792). We report which are the most frequent health states (those which represent at least 90% of the population) and perform a Pareto analysis. RESULTS:: The healthiest state (11111, or having no limitations in the 5 domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) was by far the most frequent: 60.9%, 44.3%, 49.8%, and 44.6% in Argentina, Brazil, Chile and Uruguay respectively. Out of the 243 possible EQ-5D-3L health states only eight accounted for at least 90% of the population in Argentina, nine in Brazil, and 19 in Chile. In Uruguay, only 33 out of the possible 3125 EQ-5D-5L health states were reported by at least 90% of the participants. Most prevalent states were the ones with mild limitations in pain/discomfort, anxiety/depression and mobility. Considering the three countries that used EQ-5D-3L, 90% of their population reported a total of 19 health states. Only six of these most common states were shared among these countries. CONCLUSIONS:: Our study shows a strong ceiling effect of the EQ-5D in the general population, as nearly half is in the best health state. The bulk of the rest is distributed in less than 10% of the total health "space". These results, together with similar ones from other regions, direct to an important agenda regarding both the reevaluation of the descriptive classification as well as in the design of future valuation studies.