The University of Chile, in 1842, began Chile’s strong devotion to medical education. Later, in the ’40s and ’50s, grants from the Rockafeller and Kellogg Foundations aided in academic programs for those learning about public health. Indeed, these investments led to the expansion of the School of Public Health at the University in 1958 to support incoming health care workers. In 1970, under President Allende, several medical reforms were enacted in Chile.

Reforms included a focus on rural and ambulatory services and increased community involvement in health care by the government. Furthermore, importance was placed on opening nationwide health centers, moving resources that the hospital sectors once controlled into the community and expanding the milk distribution program. This six-year health plan was a response to some of the previous health plan’s shortcomings, most notably the lack of comprehensive and complete health care coverage and lack of focus on primary care.

With the military coup in 1973, Allende’s “The National Health Service” was replaced by the “National System of Health Services” under the new leadership. Medical care could no longer be provided for free and competition within medical practice became the norm. The Secretary-General said at the time, “We want to incorporate into the health system certain aspects of the market economy…competition will allow the physician who provides the best care to gain a larger clientele.”

Problems With the Current System

Chile’s health care system is currently financed by two main entities: the Fondo Nacional de Salud (FONASA) and the Instituciones de Salud Previsional (ISAPRE). Approximately 80% of the population is covered by FONASA. The remaining 20% relies on ISAPRE, which includes additional charges based on risk assessments. This structure often leaves many elderly and chronically ill individuals unable to afford the necessary services.

Due to insufficient resources, many of those under the FONASA cannot take advantage of hospital services. Indeed this has led many to not be enrolled with a public health care facility, which has caused an increase in emergency care department visits. The current system faces several additional challenges, including:

1. Outdated per capita calculation methodology
2. Limited capacity to adjust capitations based on the epidemiological realities in different regions of the country
3. Lack of accountability mechanisms

Program for Universal Primary Health Care

In December of 2023, the World Bank approved a loan of $200 million to aid Chile’s current efforts to reform its health care system. By 2027, it hopes to reach approximately 187 out of 346 municipalities with an emphasis on primary care. The program will have three main areas of focus:

1. Free primary care services, regardless of insurance status.
2. Prevention and preparation for the impacts of climate change and public health emergencies.
3. Improvement of health care resources, including developing a virtual health system and enhancing the efficiency of existing systems.

All three focus areas aim to target the population not covered by FONASA. Those with coverage who are not currently in a Public Health Care (PHC) system. The goal is to reduce the number of patients seeking care directly in emergency services. Other medical reforms in Chile seek to further these objectives by expanding effective coverage in PHC. Additional reforms seek to establish a more resilient system, improving the model for both social and health care and optimizing resources for monitoring and evaluating the health care system.

Final Note

With these new implementations, the health care system in Chile aims to grow stronger. Furthermore, care could become more accessible and reliable for its citizens. Chile aims to build on the foundations established by the health care systems of the past and learn from past mistakes and shortcomings.

– Isabella Chavez

Isabella is based in Swampscott, MA, USA and focuses on Technology and Global Health for The Borgen Project.

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