Impact of payment mechanisms on health services production in Chile. ¿Are the mechanisms in tune with the health policy objectives?

Abstract

The current mechanisms of financial transfer in the Chilean Health Care System imply incentives that are not up to the challenges of the Health Reform initiated in 2002. According to the authors, important modifications are required. We present empirical evidence of the undesired effects of those mechanisms on the overall generation of health services in the last few years. Starting in 2005, the Health Reform introduced Explicit Guarantees (GES) for the provision of certain services, and these are linked to the mechanisms of payment to the providers. There has been a general decrease in the activities of the National Health Services System, an increase of emergency care and in the purchase of external services via the Explicit Guarantees and also via the Free Choice option included in the public system. The reduction of the general activity of the public system is not matched by a fall in productivity: what we observe is a change in the case mix, which is induced mainly by the Explicit Guarantees scheme and its associated commitments. A reduction of access to non GES care may be under way. We describe the general outline of a proposed change in the financial transfer mechanisms, which is being discussed in the health sector.