Unavoidable challenges facing the Chilean health system in a new political cycle

Abstract

The next political cycle in Chile will have to address urgent healthcare issues in a context marked by significant pressure on the healthcare system, long-standing unmet demands from the population, weakened governance in general and within the health sector, scarce resources, clear signs of deficits in access, timeliness, quality, and equity, and undeniable questions about certain aspects of management as an outstanding task. Public debate has remained focused on financing and the crisis of the private insurance system, relegating to the background the transformations that determine the effectiveness and overall sustainability of the healthcare system. This article, based on the aforementioned diagnosis of the sector, outlines the main areas and more specific pending issues that should be included on the agenda of the next government. Among the key issues are: the consolidation of Primary Health Care (PHC) as the backbone of the system, the modernization of hospital management, and the creation of a robust institutional framework for health technology assessment. In the area of ​​specific issues, two stand out: reform of the medical leave system and the structural reduction of waiting lists. Regarding the Health System as a whole, it is argued that overcoming the current fragmentation requires health governance that unites the public and private sectors under common objectives of equity, quality, and efficiency. The proposed reforms do not demand radical institutional ruptures, but rather broad political agreements that restore legitimacy to the system and direct resources toward measurable health outcomes. Progress in these areas is essential for a people-centered, financially sustainable health system capable of responding to the epidemiological and demographic needs of contemporary Chile.