| Resumen: |
Chile relies on social health insurance (SHI) to provide nearly universal health coverage to its 17 million people. Its SHI system has long been criticized for having two separate subsystems: a large public insurer (the National Health Fund, Fonasa) covering three-fourths of the population, including the indigent and low-and middle-income citizens, and providing health services mostly through public providers; and several for-profit private insurers (Isapres) that cover about one-sixth of the better-off population and providing services almost exclusively in the private sector. Further, until 2005 the SHI system lacked an explicit benefits package that allowed for large differences in the content and quality of services between Fonasa and the Isapres. It has also made it possible for Isapres to engage in risk selection.
A reform implemented in 2005, known as Universal Access with Explicit Guarantees (Acceso Universal con Garantías Explícitas, AUGE), defined a basic package for SHI consisting of guaranteed and explicit treatments for 56 priority health problems. In 2010, these were expanded to 69 priority problems and a current government initiative will further broaden the package to cover 80 health problems. The AUGE benefits package not only guarantees treatments, but also sets upper limits on waiting time and out-of-pocket payment for treatment. Coverage for the services left out of the AUGE benefits package is not guaranteed by Fonasa, although the public insurer devotes more than one-half of its budget to finance non-AUGE services. Isapres provide coverage beyond AUGE, but this additional coverage varies from beneficiary to beneficiary depending on their premium contribution and the health plan purchased. |
