Equity in health care financing and financial protection in Chile: a general description

Abstract

The distribution of health care financing, between the public and the private sectors, is not equitable. Out of the total national expenditure, 38 % goes to 21% of the population (private insurance beneficiaries), and 62% goes to the remaining 79% of the insured population (National Health Fund). Due to the income differential between the affiliates of the two systems, 59% of the insurance contributions goes to the private sector and only 41 % to the public sector. This is partially compensated by a central government assignment, which amounts to slightly more than half of the receipts of the public sector. The total per caput expenditure of private insurance is approximately twice that of the National Health Fund. This difference has grown over time; only in the last few years, starting in 2001, the rate of growth of the gap has become stable. The benefits in terms of per caput expenses in health services and in labour disability subsidies are clearly unequal. Out-of-pocket expeses, consisting of co-paymentes, direct payments and purchase of medicines, rank second in the global financing of health care in Chile: 33%. The relative importance of out-of-pocket financing is clearly greater in the private insurance sector (Isapres). As to the uninsured, they must pay for almost the entire cost of the services received.In order to reduce these inequities, it is required to: incentivate solidarity mechanisms between the systems, and the financial protection within each one.