Chile’s two-tiered health system: Past and present policy challenges
International Hospital Federation - IHF
| 2 years ago
Author: Ricardo Bitrán, Bitrán y Asociados
ABSTRACT: Chile relies on social health insurance (SHI) to provide universal health coverage (UHC) to its 17 million people. Its two-tiered SHI system was designed under General Pinochet in 1981. Since the return of democracy in 1989, it has been criticized by many for having two segregated subsystems: a large public insurer (Fonasa), covering mostly public health services for the low- and middle-income population (80 percent of the country), and several for-profit private insurers (Isapres) covering private care for the better-off (20 percent).
This paper reviews health reform initiatives implemented over the past 12 years in Chile. Chile’s case is relevant to developing countries with SHI and which are debating the merits of alternative policies to achieve UHC. There are two competing views : SHI with a single insurer, which also acts as a single purchaser of health services; and SHI with a choice of multiple insurers for consumers, each purchasing health services for its insured population. Chileâ€™s two-tiered health system: Past and present policy challenges (pdf 455.54kB)