Notwithstanding good average health indicators, Chile has a poor ranking in terms of economic equality. In the last decades the epidemiological profile has changed substantially posing new challenges to the health-care system. As a result of reforms introduced during the military regime, the Chilean healthcare system is structurally segmented with low-income, high-risk populations being served mainly by the public sector and high-income, low-risk populations generally being treated in the private sector. A drastic intervention of public health policies was required. With the return to democracy, initial interventions were directed to capital investments in the health sector, improvement of primary care and tighter regulation of the private sector. Beginning in 2000, a new set of reforms was proposed focussing on patients' rights and guarantees and increased equity in the financing system. The main result of the new legislation was the introduction of the AUGE Plan, a regime of explicit guarantees (access to treatment, opportunity, quality and financial protection) applied to a list of prioritized conditions progressively increased from 25 to 66. The identification of pathologies to be included was done through an ad hoc defined algorithm including criteria such as magnitude of the problem, effectiveness of available medical treatment, capacity of the healthcare system, costs and social consensus. The AUGE plan benefited both the subscribers of the public as well as the private systems. To cover the cost of the reform additional resources were identified, mainly in the form of a temporary increase in the consumer tax. The reform had to face numerous challenges during the parliamentary debate and was finally approved with some significant compromises. Several unresolved issues have been identified by scholars and social actors, and represent future challenges from ethical, methodological, organizational, quality-related, financial, as well as social and political perspectives. Solutions, however, may now lead away from the solidarity perspective at a moment in which Chile is facing a significant political transition led by a centre-right coalition.

Towards Universal Health Coverage: the Chilean experience. World Health Report (2010) Background Paper, 4

MISSONI, EDUARDO;
2010

Abstract

Notwithstanding good average health indicators, Chile has a poor ranking in terms of economic equality. In the last decades the epidemiological profile has changed substantially posing new challenges to the health-care system. As a result of reforms introduced during the military regime, the Chilean healthcare system is structurally segmented with low-income, high-risk populations being served mainly by the public sector and high-income, low-risk populations generally being treated in the private sector. A drastic intervention of public health policies was required. With the return to democracy, initial interventions were directed to capital investments in the health sector, improvement of primary care and tighter regulation of the private sector. Beginning in 2000, a new set of reforms was proposed focussing on patients' rights and guarantees and increased equity in the financing system. The main result of the new legislation was the introduction of the AUGE Plan, a regime of explicit guarantees (access to treatment, opportunity, quality and financial protection) applied to a list of prioritized conditions progressively increased from 25 to 66. The identification of pathologies to be included was done through an ad hoc defined algorithm including criteria such as magnitude of the problem, effectiveness of available medical treatment, capacity of the healthcare system, costs and social consensus. The AUGE plan benefited both the subscribers of the public as well as the private systems. To cover the cost of the reform additional resources were identified, mainly in the form of a temporary increase in the consumer tax. The reform had to face numerous challenges during the parliamentary debate and was finally approved with some significant compromises. Several unresolved issues have been identified by scholars and social actors, and represent future challenges from ethical, methodological, organizational, quality-related, financial, as well as social and political perspectives. Solutions, however, may now lead away from the solidarity perspective at a moment in which Chile is facing a significant political transition led by a centre-right coalition.
2010
Missoni, Eduardo; G., Solimano
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11565/3804296
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