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Minsalud Chile

Everything you should know about the health system in Chile

Foto Constanza esquivel
Constanza Paz Esquivel Barraza
Pharmaceutical Chemist from the Pontificia Universidad Católica de Chile

The Health System in Chile is governed by a structure called the mixed care system, which includes financing, insurance and care providers, divided mainly into two large sectors: public and private.

 

Grafica chile

 

The public pension system is financed by the State, either through general taxes, by contributions from the municipalities or by co-payments made by members. Contemplating two subsystems known as: National Health Fund (FONASA), which covers approximately 80% of the population, and the Armed Forces and Law Enforcement (DIPRECA and CAPREDENA).

 

The private pension system is financed by the contributors themselves through mandatory and voluntary fees and copayments, in addition to out-of-pocket payments that users of private services make at the time of receiving care. This system is made up of the Social Security Institutions (ISAPRES); six of them correspond to open ISAPRES, that is, the affiliation and health plans are publicly offered, and six correspond to closed ISAPRES that are based on benefits to workers of a certain company or institution, contemplating approximately 18.2% of the population .

 

During the last years in Chile, health spending reached approximately 8.5% of GDP, a range that is slightly below the average for OECD countries, this means that the spending generated by the State in Chile in relation to health is lower than the average for OECD countries. Along with this, it is observed that out-of-pocket spending constitutes one of the largest within the countries of this group. At the local level, this expenditure reaches approximately 35% of the total financing contributions of the Health System, and includes financing of copayments for health benefits, outpatient medications, dental benefits, among others.

 

Based on this, it has been seen as a need to promote measures that guarantee access, opportunity, financial protection and quality of care, to mitigate patients' out-of-pocket expenses and increase access to treatments. It is in this line that the Explicit Health Guarantees (GES) are born, which seek to cover the points mentioned above, these are associated with 85 health problems with high prevalence in the country and both ISAPRES and FONASA must ensure their granting. .

 

Along with this, in 2015 the Chilean Ministry of Health created a financial protection system for high-cost diagnoses and treatments, known as the Ricarte Soto Law. This law provides financial protection for specific health conditions, such as oncological and immunological diseases and rare or infrequent diseases. It grants financial protection to all users of the health pension systems: FONASA, CAPREDENA, DIPRECA and ISAPRES, regardless of their socioeconomic situation, known as a universal access measure.

 

Given the social interest in increasing access, it is essential to have a coverage system that includes medicines in insurance - public or private - and with adequate regulation. Therefore, public administrations have begun to establish a stable framework of relations with the pharmaceutical sector that guarantees security and trust to sustainably promote competitive industrial development, a socially relevant scientific policy, greater productivity in investment and management. efficient innovation processes.

 

This leads to greater cooperation of pharmaceutical companies with governments and regulatory authorities to improve the quality of evaluation and consequently guarantee higher standards of safety, efficacy and quality in medicines, with the aim of meeting the health needs of the population. country. In addition to the above requirements, some countries also consider efficiency, that is, the relationship between the costs incurred and the benefits that will be received before the introduction of a new drug.

 

In Chile we find ourselves in an ideal setting to reach agreements in order to guarantee health as a right, based on the construction of a model that allows the desired universal access. Therefore, generating the key inputs of the parameters that are analyzed during the evaluation of technologies, be it analysis at a scientific and economic level, analysis of healthcare networks and innovative value proposals, are the kick-off to carry out these negotiations and increase the access of a product in the market.

 

In this sense, the information must be accurate, concise, reliable and aligned with the client's needs, seeking the best opportunities to obtain the best results and be a relevant and important input when making decisions. Likewise, the data and insight they must be plausible and must generate a relevant basis to present during negotiations in both the public and private systems, and for closed and universal access measures.

 

Outsourcing these analyzes allows the different stakeholders they can trust the document as it is not made by the same company that owns the product; This also allows third parties to interpret and detect the pros and cons of each technology and find a way to enhance and mitigate them, respectively.

 

With this, the first step is covered and there are foundations to promote access and coverage of technology at the national level, with innovative value proposals that encompass all the characteristics of the product and identify a specific approach for each product, that is, , an individualized value proposition and thought about the product. The objective is for it to be an attractive proposal for funders, whether from the public or private health system, in order to contribute to achieving greater coverage of patients, to provide adequate treatment, in accordance with the development and technologies of this century.

 


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References

1. Superintendency of Health, Government of Chile, Dissemination material Health System in Chile. http://www.supersalud.gob.cl/difusion

2. Víctor Becerril-Montekio, Lic in Ec, M in SocI; Juan de Dios Reyes, MC, MSPII; Annick Manuel, MC, MSPIII, Chilean Health System

3. Clinicas de Chile, Executive summary, dimensioning and figures Health System in Chile, 2018.

4. Library of the National Congress of Chile (BCN) Department of studies, extension and publications. Health System in Chile and pathologies with a gender perspective. Area - Economy, 2018.

5. Claudio Sapelli, Pontifical Catholic University of Chile. Mandatory Health Insurance in Chile: Issues of Design in Theory and in Practice

6. Superintendency of Health, Government of Chile. Directory of Isapres. Available in: http://www.supersalud.gob.cl/664/w3-article-2528.html

7. Alejandro Goic G. The Chilean Health System: a pending task Rev. medic. Chile vol.143 no.6 Santiago jun. 2015 http://dx.doi.org/10.4067/S0034-98872015000600011

8. In this Antonio, Luis Angel. The pharmaceutical industry and the sustainability of health systems in developed countries and Latin America. 2011, vol.16, n.6, pp.2713-2724. ISSN 14138123. http://dx.doi.org/10.1590/S1413-81232011000600010.

9. National Center for Pharmacoeconomics. Guidelines for inclusion of drug costs in pharmacoeconomic evaluations, 2010 May 31 Available from: http://www.ncpe.ie/u_docs/ doc_190.pdf

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