Rebecca Pedlow-Collins works and lives in Santiago and took a closer look at the state of healthcare in Chile, one of the recurring complaints in the recent protests. She sent Chile Today her observations.
If you are an expat or traveler it can be hard to see why as the top-level of health care in Chile is very good. However, when you dig into the statistics, the source of the frustration around healthcare quickly becomes clear.
Under the current system Chilean employees must pay 7% of their salary into a FONASA, the government health system, or ISAPREs (Instituciones de Salud Previsionals), which are privately run health insurance providers.
The FONASA system technically covers the whole population but is further stratified into 4 levels (FONASA A, B, C, D) depending on how much people earn. The level of gap payment that is covered by FONASA depends on the level of FONASA as shown here.
Those earning up to CLP$350,000 (~US$454.37 per month) often end up in a hard place where they cannot find ISAPRE coverage for their family without paying significantly more than 7% of their income.
The final outcome is that approximately 75% of the population is covered by FONASA, around 18% by ISAPRE, and the remainder (who don’t earn any income) are covered externally or are not covered for health care.
Limited Resources, Complicated to Navigate
Effectively this leaves most of the population covered by a system with very limited resources, which are largely managed on a municipality by municipality basis. This means that service levels vary by regions and demographics and are highly dependent on the management of local Family Health Center (CESFAM) clinics to source the right mix of services.
In some areas the service works very well, but in others it can be a frustrating and highly inefficient system. Additionally, the segmentation makes it hard to recognize the best practice and improve the system as a whole.
In addition, the multiple levels of health service and different providers can be hard to navigate for people who don’t have consistent housing and/or employment options, as spots on the waiting list can open up quickly and need to be taken up when available.
Healthcare in Chile: The Outcomes
Overall, Chile spends a similar per capita income on health as countries with a strong public health system such as Australia, New Zealand, and the United Kingdom as shown in OECD data at around $US5,000 per capita on a purchasing power parity (PPP) basis. But the results don’t stack up. Infant mortality still sits at 7 per 1000, vs. 3.3 for Australia, 3.9 for the United Kingdom and 4.3 in New Zealand.
There are a similar number of doctors in the system for Chile compared to the United Kingdom, Australia, and New Zealand, but only one fifth the number of nurses, pointing to a top heavy system. The system is also administratively complex and relies on users to advocate for themselves, which can be especially difficult for lower income earners, who often have lower levels of education and less time and resources to advocate for themselves.
The system is heavily skewed towards those who can pay more for the top-level of care, and most importantly, to pay for preventative care that can prevent costly procedures down the road. For people in the middle class and lower class, glimpses of the opportunities of the highest level of care are visible yet not obtainable leading to feelings of frustration.
As a result, one hope for the new constitution is that it can provide a better framework for a more available and efficient healthcare system.
Rebecca Pedlow-Collins is an Australian finance manager currently living in Santiago Chile. In between working for a management consultancy firm, raising 2 kids and studying at the Universidad de Chile she loves exploring Chile.