Universalization of Primary Health Care in Chile: regrettably regressive policy

Abstract

The Universalization of Primary Health Care (PHC-U) in Chile has been presented as the “heart” of a future reform. However, it contains strategic, tactical and operational problems that generate regressive effects, mainly affecting the most vulnerable sectors of society. Objective: To evaluate PHC-U, considering financing, administration, access, human talent and community participation. Methods: Documentary analysis based on official reports and data on the development of PHC-U in pilot communities. Results: The financing of PHC-U establishes a cross-subsidy towards private insurers, returning to a situation that had been attempted to be overcome decades ago in our country. Furthermore, in the midst of tax regressivity, the poorest sectors end up subsidizing those who have better health and private insurance. In relation to administration, the vices of municipalization continue, generating territorial disparities and misuse of resources. Finally, in a scenario of low coverage and following the law of care in reverse, the implementation of this policy deepens inequality in care. Conclusion: Rather than generating equity, the APS-U perpetuates exclusion in health, disguising under a progressive discourse mechanisms that reinforce aporophobia, structural injustice and the lack of understanding of the private sector. Urgent structural changes are required in this policy.