Trends in public health expenditure allocated to private providers in Chile (2019-2025)

Abstract

The increase in public health expenditure in Chile has been presented as a strategy to strengthen the health system; however, a significant share is channeled into the purchase of private services. Objective: To analyze trends in public health expenditure in Chile (2019–2025), focusing on the share of budget increases allocated to private providers. Methods: Descriptive observational study using executed budget series from the National Health Fund (FONASA), expressed in constant pesos (2026 base), and their relationship to gross domestic product (GDP). Spending on private providers was estimated as Free Choice Modality plus direct purchasing. Results: FONASA’s budget increased by 49% in real terms and spending on private providers by 72%. In years of expansion, the share of the budget increase allocated to private purchases reached 63.5% in 2024. Transfers to private providers amounted to 0.5–0.6% of GDP. Conclusion: The expansion of public spending did not proportionally strengthen public provision and contributed to sustaining private supply, reinforcing subordination to the market in a segmented system with high out-of-pocket spending. Further work should include systematic comparisons of costs and output, and spending growth should be reoriented toward structural public investment to reduce subordination to the market, expand public capacity, and advance the effective guarantee of the right to health.