Vision and proposal of changes to the Chilean Healthcare System

Abstract

This document aims to study the Chilean health system, diagnosing structural problems, and proposing improvements that would optimize its operation. The document has been written as part of the Institute of Political and Social Economy’s work. Public investment in health is recognized and analyzed, in addition to the high out-of-pocket expenditure, various levels of health outcome in[1]equality according to the populations education level and insurance type (public / private), health services purchase and salary differences within the health system workforce. Methodologically, a bibliographic review of various sources and primary studies has been carried out to analyze the characteristics of the Chilean health system, including direct State sources, court rulings, book chapters and press articles. The conclusions point to the need of aligning the incentives in the public sector with health outcomes, increasing the proportion of payments associated to health outcomes and reducing other forms of funding; the adoption of a unique insurance system to improve the system’s pooling and a unique payment scheme that strengthens the purchasing power of the public sector while reducing out-of-pocket expenditure. The need for restructuring the way labor disabilities resources are administered and collected and reforms to the drug market are also discussed. Likewise, the document proposes the creation of corporate governments in the main ministerial instances, health services and municipal health organisms, in order to avoid detected agency problems and the lack of continuity of public management.