In the 1980s, Chile followed a neo-liberal policy of encouraging the private healthcare sector. This led to growing inequalities between poor and wealthy people: as the rich opted for private health insurance, healthcare in the public sector deteriorated. Has the situation improved since the democratic government took over in the 1990s?

Research from the UK University of Hertfordshire looks at the lasting effects of the 80s’ health sector reforms and discusses the challenges facing the current government. Increased investment in public health has had positive effects, but fully equitable healthcare is not yet a reality.

Health policy in Chile in recent times has mirrored changes in economic strategy. In the 1980s, policy focused on extending private sector involvement in healthcare. Private health insurance funds became operational in 1981 and an increasing number of high earners decided to join them.

The return to democracy in 1990 produced a reappraisal of health policy. The emphasis is now on strengthening and improving public healthcare and reducing inequalities in access and quality. This study examines these policy changes, the resulting systems of health insurance and provision, and the unresolved problems and challenges for healthcare in Chile. It found that:

• The private health insurance sector grew strongly during the 1980s, encouraged by government policies that provided incentives to private insurers.
• Nearly a quarter of all Chileans have private health insurance: these are mostly people with high earnings and low health risks.
• As the well-off migrated to private healthcare, public health provision deteriorated. Thus the expansion of the private sector led to growing inequalities in healthcare provision and a two-tier system of health insurance.

During the 1990s, the public healthcare system was modernised and given more resources. Inequalities have decreased, but the democratic government in Chile still faces several challenges. These include:

• integrating public and private healthcare provision so that they are complementary, rather than in competition with each other
• allowing private providers to use public healthcare facilities at full cost
• combining private and public health insurance schemes so that those in the private sector contribute to fund healthcare for the uninsured
• assisting consumers in choosing the best scheme for their needs by establishing standards to make plans easily comparable
• investigating ways to contain healthcare expenditures, particularly in the private sector.

Source(s):
‘Getting better after neo-liberalism: shifts and challenges of health policy in Chile’ by A. Barrientos, in 'Health care policy and poverty in Latin America' ILAS-Brookings, London (2000)

Funded by: unknown

id21 Research Highlight: 15 May 2001

Further Information:
Armando Barrientos
Institute for Development Policy and Management
University of Manchester
Crawford House
Precinct Centre
Oxford Road
Manchester M13 9GH
UK

Tel: +44 (0)161 275 2800
Fax: +44 (0)161 273 8829

University of Manchester

Other related links:
Refer to the Centre for Health Economics website for health economics research and links.

Health Reform Online is hosted by the World Bank and has links to many related resources.

Check the Health Economics site for links to health economics resources on the internet.

Refer to the Health Services Delivery site for information on this WHO programme.

The International Clearinghouse of Health System Reform Initiatives has information on research, events and other resources.