The main changes included in the proposed new constitution regarding the right to health relate to the way it is covered, proposing the creation of a comprehensive health system.
ConstitucheckFrom International Energy Agency Handbook, consult with experts to find out the main implications for the private sector and whether or not clinics and isapres will remain in this new system. All concluded that it would depend on the law whether they continued to be a party or not, but, on the other hand, if the constitutional draft were approved without amendments, they expect the disappearance of private insurance companies as they have been for the past forty years.
What does the constitutional proposal say?
in that Chapter Two Concerning “Fundamental Rights and Guarantees”The new constitutional regulator is considering an article and 11 subsections that refer to health and its protection, and reforms to the distribution of contributions and sectors that might integrate the system, among other changes. It also deals with the integration of policies and programs related to mental health protection.
However, the two main topics of discussion are the numbers 7 and 9 respectively.
The first of them states that “the national health system may consist of service providers from the public and private sectors,” and includes requirements and procedures established by law regarding clinic participation.
The number 9 specifies that this system will beIt is financed by the general income of the nation “and that the law may establish mandatory contributions for employers, male and female workers for the sole purpose of contributing jointly to the financing of this scheme.”
The statement notes that the system has recorded losses of $170 billion in the past 15 months and that Isapres no longer has an operating margin, “today they are operating only with capital contributions from their owners and the shutdown may happen in just a matter of months.”
What will happen to private service providers and isapres?
To measure the impact that change can have, in the end Public calculation conducted by the Health Supervisory Authority in 2021The beneficiaries’ numbers have been handed over to the system. Of the 19,678,000 users, there are 15,233,000 affiliates of Fonasa. The rest belong to private insurance companies.
Francis Medina, Lawyer from the University of Concepcion and collaborator at the Constitutional Observatory of the University of Los Andes (Police men), asserts that “the text does not mention what conditions or how private health providers can participate. Therefore, from this latter perspective, the possibility of participation is questionable, as no greater guarantees are given.”
Dependent workers are currently required by law to contribute 7% of their income to health. This contribution allows them to choose Fonasa general insurance or isapres insurance, depending on the amount you represent. There are plans that cost just under 7% and there are better plans where the member must pay an extra percentage of their salary.
“The proposed system eliminates the possibility of those more than 3 million people continuing to allocate 7% to the said system, and a large part of them will have to move to the public system, since today there is no indication that they will do so. Being able to choose where to attend ” . As they say from the trade guild Chile Clinicswhich brings together the main private health service providers in the country.
The Committee on Fundamental Rights sent this article to the plenary, where it also states that private providers “shall not pursue profit.”
In addition, they emphasize that the model proposed in the draft does not guarantee the participation of private service providers, since their integration depends on the conditions and requirements established by law. This can create scenarios in which these providers do not meet these requirements, which are unknown today.
Besides, they ensure that the public infrastructure is not sufficient to receive and serve the entire population in conditions of quality and opportunity. They emphasized that “private providers serve approximately 10 million people annually; therefore, insurance and coverage requirements must be in place in order to continue to do so, because our contribution as private providers is very important to the national care network.”
Starting with Article 44 of the new constitutional proposal, Medina makes it clear that it is possible to think about itThe powers and faculties of the private sector in this field will be remaining or marginal, “drastically changing the logic of the current system.”
Doctor of Public Health and Associate Professor of the Faculty of Public Health of the University of Chile, Mark Vergara, a different look than that suggested by private service providers. In his view, “Disengaging the well-off middle class and ending the isapres was a sacrifice for which we were ready on the altar of justice and equity. This reads from the constitutional proposal because it speaks of that the contributions, which give oxygen and life to the isapres, are no longer reserved for this kind of solution , but they will all go to form part of the pooled fund or from the resources that Fonasa has to provide for the general solution.
By raising the premium price, he adds, esaber has become “the most blatant expression of inequality in Chile, a different health system for the wealthy than for the less wealthy, and that is no longer enough for more,” he says.
According to VIrgara, this new health proposal could be “good luck,” because it leaves something structured that can be “rubbed for later” when the debate comes up in Congress. However, he also states that it will take a long time, which will lead to uncertainty because it is not known what the underlying ideas will be, especially what will happen to global coverage like GES or Ricarte Soto’s law.
Specialists point out that restrictions on the voluntary interruption of pregnancy will depend on how the law interprets the mandate to regulate this right.
What will be your main challenges?
One of the biggest complications in the new ‘Unique and Integrated Health System’ is figuring out how to shorten waiting lists for specialist consultations, or resorting to a process and offering optimal, high-quality care at the same time.
“The great public malaise is the waiting list. One is access to specialist inter-consultation, which is not trivial, because what people are waiting for in practice is information about their disease, because they do not know what is there. The other issue is not -GES surgeries. It may be important Long wait for the operation, as is the case, for example, in the case of brain tumors,” Vergara emphasized.
Publication of the Institute of Public Health Policy at the University of San Sebastian (IPSUSS) study Which gives figures regarding waiting for surgical intervention in Chile in 2022. In the first quarter of this year, the rate of non-AUGE surgery is 574 days. According to the analysis conducted within the public system, a person can, for example, wait more than two years for knee surgery.
According to the document, today there are 2,023,000 people waiting to see a specialist who can determine their diagnosis and times compared to 2020 have increased by 38%, raising the waiting period from 329 to 455 days.
About the Advocate of the Pontifical Catholic University of Chile and Executive Director of the Foundation for Social Pact, Alexander FernandezPublic policies should be used in accordance with reality and taking into account the type of country in place and the budgets involved. “I feel, in general, that the constitutional proposal tends to put too much confidence in the state and give it too many powers over things that it is already doing poorly today,” he asserted.
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