You might remember Chile because of its beautiful landscapes, such as the Atacama Desert and Patagonia. However, the country is more than that: it is a state with a stable economy and high levels of human development. Even so, providing equal and quality access to health care is a challenge for Chileans - just like in Colombia and Argentina.
Currently, the main problems of the Chilean health system are associated with regional inequalities, private system crisis, underfunding in the health sector, and poor working conditions.
The health of Chileans
In general, we can say that the Chilean health system is complex and marked by advances, but also by several challenges. Despite positive indicators - such as high life expectancy, which was 79.3 years in 2020 - and exemplary vaccination coverage for the main childhood diseases, the country still faces structural problems.
One of the main challenges is inequality in access to health. For example, in 2020, 76% of the population was dependent on the public system (FONASA). In this segment, government underfunding ends up generating long waiting lines, poor infrastructure in some regions, and a lack of professionals in specific specialties.
Meanwhile, 24% of Chileans had private health plans under ISAPREs. This means that services are offered faster and access to specialists is easier. On the other hand, monthly costs can be high.
The current moment of ISAPREs is one of a financial crisis that seems to continue to grow, as a result of the increase in judicialization and default.
In the public sector, funding is limited not only for infrastructure, but for equipment and professionals as well. As a result, health professionals are overwhelmed and it is common to lack basic supplies.
Despite this, the Chilean population still has one of the lowest infant mortality rates in Latin America. The most recent data indicate that infant mortality in Chile is around 4.1 per thousand live births. Meanwhile, in Brazil, for example, the rate is 6.1 per thousand live births. In contrast, the South American countries with the lowest rates are Cuba and Uruguay. See more in the graphic below:
One of the reasons why health indices in Chile are not as poor as in other countries may be linked to the creation of programs such as GES (Explicit Health Guarantees), whose focus is on providing expanded assistance to combat 80 priority diseases.
In this list, cardiovascular, oncological, respiratory, digestive, metabolic, mental, and muscular conditions stand out. Among oncological diseases, there is a focus on combating lung, breast, prostate, gastric, colorectal cancers, Hodgkin lymphoma and acute myeloid leukemia, and others.
With regard to cardiovascular conditions, acute myocardial infarction, ischemic stroke, and severe high blood pressure are among the first on the list. Among the others, GES also prioritizes treatments against:
- severe asthma;
- Crohn's disease;
- type 1 and 2 diabetes mellitus;
- congenital hydrocephalus;
- multiple sclerosis;
- epilepsy;
- autism;
- schizophrenia;
- and rheumatoid arthritis.
But how is all this done in practice?
How does Chile's healthcare system work
As in Brazil, the Chilean health system is a Coed of public and private services. The population can choose between the system public, managed by the National Health Fund (FONASA), which offers extensive and free - or low-cost - coverage, and the system privates, managed by Social Security Institutions (ISAPREs), which offers personalized and faster health plans, but at a higher cost.
FONASA, the Chile's public system
The National Health Services System (SNSS) is the system of public health from Chile. Controlled by the National Health Fund (FONASA), they are responsible for serving almost 80% of the population. Its financing is carried out through the collection of taxes and mandatory contributions of 7% of the workers' salary.
Although public, FONASA also allows access to affiliated private clinics, thanks to the co-payments included in each coverage. Within this, the system is based on coverage based on four classifications: groups A, B, C and D. This division corresponds to the level of social vulnerability and income of each beneficiary and works as follows:
- Group A - People with less financial resources and who use government social programs.
- Group B - It includes people whose monthly taxable income is equal to or less than $276,000 pesos and people receiving basic solidarity pensions, for whom they are treated free of charge in hospitals and public offices.
- Group C - It covers people with a monthly taxable income greater than $276,000 pesos, and less than or equal to $402,960 pesos are included in this group. This indicates that they pay a 10% fee at public hospitals. However, if you have three or more dependent family members, you will be assigned to group B.
- Group D - Finally, this group considers those with a monthly taxable income of more than $402,961 pesos. This public pays 20% of the fee at public hospitals. However, with three or more dependent family members, the user is oriented to group C.
Still with regard to FONASA, there are two types of care: the Free Choice Modality (MLE) and the Institutional Assistance Modality (MAI).
At the MLE, it is possible to be treated at private facilities or with a health insurance professional. In the MAI, on the other hand, what happens is the authorization of medical benefits to beneficiaries in other public establishments that make up the health network, such as:
- CESFAM (Family Health Centers)
- SAPU (Primary Emergency Care Service)
- CRS (Health Reference Centers)
- CDT (Therapeutic Diagnostic Centers)
- Public hospitals
In the MAI, those who use these services are people from groups B, C and D, through the purchase of service vouchers.
Already MLE is usually associated with users of health plans. This is because the modality offers subsidies for beneficiaries and affiliates to be served at one of the ISAPRes.
ISAPREs, Chile's private system
Meanwhile, ISAPREs (Social Security Health Institutions) are private organizations of health care, which serve about 20% of the population, generally composed of workers with greater purchasing power.
In these institutions, health plans vary in coverage and cost, based on a mandatory contribution of 7% of their salaries. Services can be extended with additional payments.
As we know in Brazil, ISAPREs beneficiaries have access to a network of private providers, including clinics and hospitals. It is common that in these places the waiting time is shorter and that the facilities are more modern, compared to the public sector.
With regard to the type of care, users of ISAPREs can receive reimbursements if they are treated only by the family doctor, appointed by the health plan provider.
On the other hand, the system controlled by the Superintendency of Health is criticized for the coverage exclusions associated with pre-existing diseases and for its lack of standardization in health plans.
Challenges and discussions of the moment
When it comes to health, Chileans' main concerns are associated with the financing and sustainability of the system. With increasing life expectancy, as well as an increase in the incidence of cancer in the world and other issues, health care costs continue to grow.
Currently, there are proposals for reforms of FONASA, with the intention of making it more efficient and equitable. Among the solutions presented, the possibility of increasing the mandatory contribution and/or reformulating the coverage levels is discussed.
There is also great interest in technology and digitalization, since with them it is possible to improve the efficiency and access of services. Telemedicine, for example, is an increasingly sought after resource.
In addition, the current president Gabriel Boric also announced that he must expand primary care and strengthen the provision of mental health services. Among the measures for the first two years of government, he proposes that primary health care be universalized - which is why APSUniversal was created, which already serves 21 municipalities in the country. It is estimated that so far more than 49,000 people have benefited from the expansion of the service.
To expand access to health, in 2022 the government implemented the program”Copay Zero”, whose purpose is to allow level C and D users of FONASA to enjoy all public health services without having to pay any additional fee for this purpose. As published in Government portal this year, it is estimated that the program has benefited more than 1 million people, generating savings of 138 billion dollars for citizens.
Possible solutions?
Thinking about the future, in December 2023, Chile signed, in partnership with the World Bank, the Universal and Resilient Primary Health Coverage Program, which seeks to improve the population's access to quality health services.
Through a loan of US$ 200 million, Chile must implement the project gradually, to reach at least 187 of the country's 346 municipalities by the end of 2027. This money is intended to expand telemedicine services and build new offices in areas where health infrastructure is lacking.
In addition, the country is already working on the development of contingency plans to deal with natural disasters and other public health emergencies that may occur. Within this framework, health professionals and the population are expected to undergo simulations to deal with natural disasters and other crisis situations. The resources are also intended to adapt the infrastructure of health units, so that they are more resistant to extreme natural phenomena.
Technology is also in the spotlight. The program foresees that the country will deploy digital health platforms for primary health management, which includes the use of artificial intelligence to optimize patient flows and allocate resources. Such tools should also allow public resources to be managed with greater transparency, in addition to allowing the evaluation of the effectiveness of the program's actions.
And you, do you have more ideas for Chilean health?
.png)
.png)
