Chilean Health Reform: Law, Equity, and Access
Law Reform and Health Authority
Total population: 16,454,143 inhabitants.
FONASA: 12.817 million inhabitants (77.9%).
- Inequities in health in Chile: 42% of the population has an average mortality risk. Infant mortality during ’98 in Puerto Saavedra was 42.2 per 1,000 live births and 2.62 per 1,000 in Vitacura.
- Annual expenditure per capita (1999): public U$ 210, private U$ 500.
- 1999: 66.5% of medical care was provided by the public health service, serving 1/3 of the population.
- Perception of users:
- Poor quality care.
- Discrimination: socio-economic, indigenous, etc.
- Prolonged waiting times.
- Perceived by staff:
- Lack of resources (human, material, and financial).
- Excessive centralization of decisions.
- Lack of coordination and poor management and administration.
- Reform:
- Health goals:
- Achievements in improving health objectives.
- Addressing the challenges of aging.
- Reducing inequalities.
- Satisfying the needs and expectations of the population.
- Model:
- Emphasis on promotion and prevention.
- Integration of the service network.
- Strengthening primary health care.
Situation 2005
- Weak integration of the social network, both public and private.
- Inadequate protection due to low coverage of private health insurance, asymmetry, and high transmission costs.
- Mixed health functions and delivery of services across the structure.
- Excessive rules and lack of them in nursing care, environment, and occupational health.
- Insufficient targeting of private health.
- Failure of the legal structure that prevents integration.
Structural aspects necessary for reform:
- Strengthening national and regional health authority.
- Integration of the service network.
- Separation of health authority functions from health service benefits.
- Hospitals: flexibility to manage their resources and their management to realize.
- Incentives based on health goals, program management, and retirement incentives.
Law No 19,937 amending D. L n° 2763 “to establish a new conception of the health authority, different management arrangements, and strengthen citizen participation.”
Purpose of the reform:
- Strengthen the governing and regulatory role of the Health Authority in the public and private sectors.
- Define clear rules, obligations, and regulations for all.
- Supervise, monitor, and assess compliance with health targets at the local and regional levels.
- Develop new skills to ensure protection and health promotion.
- Ensure access to services.
Draft of new reform:
- Finance Law: ensuring resources for reform, including a 1% increase in VAT (approved).
- Health Authority Act: separates the functions of health service provision and regulation of the sector, strengthens the health authority, and creates a system of accreditation of public and private providers (approved).
- AUGE Act: creates an explicit guarantee scheme for access, opportunity, quality, and financial protection for a set of priority diseases (approved).
- ISAPRES Act: ensures system stability, improves transparency, and enhances the role of the Superintendency (approved).
- Law and duties of patients: protects patients and regulates issues such as informed consent (in parliamentary debate).
The thrust of the reform
- Health goals.
- Care model.
- Health Authority.
- Modernization of assistance networks.
- Solidarity financing.
- Social participation.
- GES.
Health Objectives 2000 – 2010
- Maintain and improve the health gains achieved.
- Facing new challenges of population aging.
- Reducing inequalities in health situations and access to health care.
- Provide services according to the needs and expectations of the population.
Functions of the Health Authority:
- Population health diagnosis.
- Regulation and control of the health sector by the health authority.
- Health Planning and Management.
- Health Authority responsible for the national vaccine program, supplementary feeding program of the mother, child, and elderly.
- Epidemiology.
- Environmental monitoring.
- Health Promotion.
- Civic Engagement.
- Public health research.
Care network modernization
- Implementation of direct health actions to the user by the service network of hospitals, clinics, doctors, private laboratories, and dialysis centers.
Security Act explicitly in health: Universal Access Explicit Guarantees (AUGE)
Law No. 19,966 establishes a health guarantee scheme:
- Enacted 25.Aug.2004.
- FONASA and ISAPRE are responsible for fulfilling the guarantees.
- The healthcare network is responsible for realizing the GES system.
Repeated assurances to the first point.
GES Decree 2006/56 guaranteed health problems
Base for reform:
- It must ensure access to health without arbitrary exclusion or discrimination of any kind.
- It must ensure better standards of health, health outcomes, and quality of life for the population.
- Reform should introduce equity and solidarity to the funding issue, where all contribute according to their abilities and benefit from their needs.
- It should complement the public and private provision systems, integrated care networks, and decisive action.
- You must change the model of care focused on promoting health and preventing chronic diseases and others linked to development and lifestyles.
- The reform must consider the rights, duties, and guarantees of health care for people (required).
- You must humanize health care by generating quality standards, access, and opportunity for benefits.
- It should ensure maximum protection of public health for private and public sectors.
- Eliminate or reduce the national and local health gaps related to health care.
North of reform: “to improve health care for all Chileans… avoiding the inequities of today.”
Health reform: a revolutionary change:
- New concept of health rights: the rise and guarantees required of the Public Health Plan.
- The focus of the action, not the fulfillment of institutional goals.
- National and regional health authorities to strengthen public health: promotion and prevention, control, intelligence generation, health, and intersectoral action.
- Strengthening assistance networks: more resources, investment, and technology.
AUGE: GES
To equal access for all, regardless of sex, age, place of residence, or health system.
Opportunity sets a deadline for guaranteed actions.
Quality of care and ISAPRE Fons providers offer similar standards of quality.
Financial protection for free or co-payment cap, according to income.
Strengthening the regional health authority
- Separation of the functions of network management and monitoring of public health services.
Direct Health Service Manager – care networks
Regional Secretary of the Ministry of Health Regional Health Authority