Healthcare Reform in Chile

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• Healthcare Reform in Chile

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CONTENTS
I
Global Overview
Health Statistics
II
III
The Context of Health Reform in Chile
Aspects not considered in the reform
IV
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Isapres associationINSTITUTIONAL OBJECTIVES

• The ISAPRE Association is a non-profit trade
  association for private health insurers.
• The member entities of the Association together
  give health coverage to 2.8 million people,
  approximately 19 of the country's population.
• The primary objective of the Association is to
  promote the development and enhancement of
  private health care systems and medical insurance
  plans. Also the Association promotes links with
  public and academic organizations, universities
  and institutes involved in health care
  activities.
• The Association represents the private health
  care sector, carry out studies, and organize
  conferences and seminars to further develop the
  health care system and disseminate information
  about private health care activities in Chile.

BANMEDICA-VIDA TRES COLMENA FUNDACIÓN CONSALU
D RIO BLANCO ING
CRUZ DEL NORTE MASVIDA
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General Background of Chile

• 16 MILLION INHABITANTS
• MALNUTRITION PRACTICALLY NON EXISTENT
• VACCINATION ON CHILDREN 95
• PUBLIC HOSPITAL BEDS 30.080
• PRIVATE HOSPITAL BEDS 11.706
• PHYSICIAN 22.000
• MEDICAL SCHOOL 15
• HOSPITAL BEDS PER 1,000 PERS. 2.7
• INFANT MORTALITY PER/1000 7.8
• Health Care system provide coverge to the entire
  population

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HEALTH CARE SYSTEM IN CHILE 2007 FINANCE SYSTEM
MANDATORY DEDUCTION OF SALARIES 7
SUBSIDIES PUBLIC FUND GENERAL REVENUES
máx. 140/month


19 POPULATION
77 POPULATION
50
50
ISAPRES HMO
NATIONAL HEALTH FUND
INSURERS
FONASA
PUBLIC CLINICS HOSPITALS
PRIVATE CLINICS HOSPITALS
PROVIDERS
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DISTRIBUTION OF THE POPULATION IN CHILE ACCORDING
TO HEALTH SYSTEM
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BENEFICIARIES OF THE ISAPREs IN CHILE
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MARKET SHARE ISAPREs SYSTEMNumber of Affiliates
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FINANCIAL STATUS OF ISAPREs SYSTEM In million
US of Dec. 2005
()
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Medical procedures per beneficiaryIsapre system
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Ad. Sales CostsIncome Percentage
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Health Statistics for Latin America Health
expenditure as of GDP
OMS 2000
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Basic Content of The Proposals for Health Reform
The recent health system reform in Chile was
finished in 2005
Citizens right to health services
Improve governing function of the ministry of
health
Administrative decentralization
Community Participation
Quality control and accreditation
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Elements of Health Reform Processes

• Government is trying to resolve the problem of
  access to health care, through
• Basic service packages.
• Definition of Priorities.
• Special programs in management and quality.

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Elements of Health Reform Processes

• 10 MILLIONS USERS OF PUBLIC HEALTH CARE
  SYSTEM SERIOUSLY FLAWED PUBLIC HEALTH CARE
  SYSTEM LONG WAITING LIST 100.000
  EMPLOYEES POOR HOSTELLING CATERING SYSTEM

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Elements of Health Reform Processes
The most import aspect are 1.- Creating benefits
associated to certain diagnoses (illnesses),
(AUGE-GES) for which there would be a guarantee
of care for beneficiaries of public and private
sector. This means that for this diagnoses the
coverage is a right. 2.- Reorganizing the public
health care sector (NHSS) Creating a
Superintendence of Health Creating two Sub
secretaries a) Public Health b) Public Hospitals
Net 3.- Giving more administrative tools to
public hospitals 4.- Strengthening the regulatory
role of the state due to the sophistication of
the systems.
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Elements of Health Reform Processes 1.- EXPLICIT
HEALTH GUARANTEES (GES)
Four guarantees access, quality, opportunity and
financial protection. Access the obligation of
FONASA and Isapres to give to their beneficiaries
the coverage of GES. Quality care must be given
only in a network of accredited providers. The
license for this will be given by the Health
Superintendence. Opportunity maximum waiting
period for the beneficiary to access care allowed
for Fonasa and Isapre. Financial Protection the
co-payment for the care considered in GES is
equivalent to a 20 of the amount fixed by the
Ministry of Health for each illness. Also, there
is a maximum allowed of annual co-payment
(deductible), once reached the coverage is of
100.
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Elements of Health Reform Processes 1.- EXPLICIT
HEALTH GUARANTEES (GES)
Started in July 2005, without any discrimination,
for all the beneficiaries of Fonasa and
Isapre. Mandatory for all beneficiaries of
Fonasa and Isapre, and the Isapres can charge an
additional price for it. From July 2007, GES
will be giving coverage to 56 illnesses that
include cancer, malformations, heart diseases,
chronic diseases (diabetes, hypertension), lung
diseases, eye problems, Scoliosis Hip Prótesis,
schizophrenia, depression.
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Elements of Health Reform Processes 1.- EXPLICIT
HEALTH GUARANTEES (GES)
All doctors must to inform his patient when the
diagnose correspond to GES Patients can decide
whether to continue his care with the
doctor/Hospital of the Plan or change to the
network. The extra costs of this benefits was
financed in the public sector with new taxes and
in the private sector with and increase in their
monthly payments. For the illnesses considered
in the GES, there are clinical guides who
indicate the items covered and guaranteed.
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Elements of Health Reform Processes 2.-
Reorganizing the public health care sector (NHSS)
The most important was Creating the
Superintendence of Health Inheritor of
Superintendence of Isapres Supervise Insurers
Fonasa Isapres Supervise Providers Public
Hospitals Private Hospitals Starting
providers accreditation
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Elements of Health Reform Processes 3.- Giving
better administrative tools to public hospitals
The most important was Giving more flexibility
to the administration of Public Hospitals
Max. 10 of total income could be free managed
(outsourcing services)
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Whats Still Pending in The Health Service Reform
Process?
Freedom of choice for the individual to choose
the health system of their preference.
To increase equity
To increase efficiency and to improve the
allocation of resources
Subsidy policies directed towards the consumer
rather than state institution (FONASA)
To improve the efficiency and quality of services
. Concessions
Autonomy and modernization of public hospital
management.
To increase competition in the provision of
insurance and health care services
Development of private health care
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Whats Still Pending in The Health Service Reform
Process?

• Weakness of the project
• DOES NOT ELIMINATE THE MAIN PROBLEM AS PERCEIVE
  BY POPULATION IN PUBLIC SYSTEM
• DIFFICULT ACCESS TO ALL LEVELS OF HEALTH CARE
  (PRIMARY, SPECIALIST, HOSPITAL CARE)
• BUREAUCRACY
• BAD QUALITY
• OLD FASHION ADMINISTRATIVE WAY

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Whats Still Pending in The Health Service Reform
Process?

• Opportunities of the reform
• Providers
• Possibility of offering services to public system
• Managed Care becomes a useful tool to comply
  with legal minimum coverage Catastrophic
  illness
• Public Private Hospital accreditation will
  recognize the differences in quality of each
  competitor

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Whats Still Pending in The Health Service Reform
Process?

• Opportunities of the reform
• Economic performance for Chile is expected to be
  positive
• The reform will increase the cost of private
  sector, but will also create new markets
• Improvement quality of some services

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