Having a necessary conversation on a health reform for Chile
Nota asociada a categoría: Opinion
Press Expo Hospital 2019
The Minister of Health has announced that at the end of April he will send to Parliament an Isapres (Chilean Social Security Institutions) reform bill in order to create a guaranteed plan, eliminate pre-existing conditions, ensure members mobility and modify the price system by eliminating and/or reducing differences by age and sex through the partial solidarity of contributions.
These are complex issues that require deep and extensive technical and political discussions, since changes affect many people and because the way in which the changes are posed will solve Isapre’s problems and the changes will be viable. This is why in EISACH 2019, whose ninth version will be held at Expo Hospital, we have proposed as one of the main points a complete section of the Congress to analyze the reforms that will be discussed this year in the Parliament and that will be approved in a good scenario during 2020.
It should be noted that it will be technically and politically impossible to achieve the approval and adequate technical implementation of a reform to the Isapre, if FONASA (National Health Fund) does not reform itself in parallel so that it becomes an efficient public health insurance with technical capacity and political independence that will allows its members to offer better coverage and guarantee that their rights as members of the public system will be better respected in coverage and opportunity to access health services covered by their plan. Fonasa must have strong corporate governance independent of the current government and must have technical and legal powers to buy services based on who offers better solutions at the best prices and based on results. It must also offer real coverage regarding market prices so that the middle class affiliated to Fonasa, through their free choice, have access to the private care chosen by them.
The issues related to coverage, mobility and high costs of the population affiliated to Isapre will be solved if the changes are made properly and if a good transitional design to implement the reforms is proposed. In effect, the guaranteed plan, if defined as a service basket with a list of valued benefits, will only partially contribute to transparency, but it will not solve the problem of high system costs since it must incorporate incentives to stimulate the development of modern care systems, chronic management and management of risk groups, using purchasing models in the population in charge and/or buying solutions to health problems where payment is made based on results and the providers are involved in the risk. The Isapres must drastically reduce the free choice of specialists and the payment by medical act since both are inflationary, for this reason the guaranteed plan is key in producing these changes. Likewise, changes in the pricing models should contemplate a flat premium for members of this guaranteed plan, with a compensatory fund for risk to avoid opportunistic behavior and an intelligent transition should be designed to avoid distortions between the public and private systems.
Finally ensuring the free mobility of members will depend on how these changes and the transition are designed.
Héctor Sánchez – Director
Universidad Andrés Bello School of Public Health
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