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Health care reforms begin with primary service
Ms. Bachelet received a National Health Care Service System that has experienced significant reforms dating back to 1980, when the wave of privatization was covering the country. The fundamental reforms to the system were the decentralization of the public system, the transfer of responsibility of primary health care services to the local governments, the creation of FONASA (National Health Fund) to manage public sector health resources and the implementation of ground rules for the development of private health insurance plans, better known as ISAPRE. With these reforms, insured Chileans who contribute to FONASA may choose a private health care supplier under the public preferred provider system or they have the option of changing from the state system to an ISAPRE.
The National Health Care Service System provides coverage to about 67 percent of the population in 28 centers throughout the regions. It watches over FONASA, the superintendency of ISAPREs, the National Center of Supplies and the Public Health Center, which deals with quality control.
According to Ms. Bachelet, who is the first woman to hold this position, “health care, in addition to being a central subject for our government, is closely linked with protection, which is something that people long for. Security, health and development are important for our society. Our challenge lies in providing this. Years ago, reforms were mostly focused on financial instruments and models. What we want to do is define the type of health Chileans want for the year 2010. For this we need the participation of the internal actors of the system: doctors, associations, universities and the community.”
Given Lagos’ demands that waiting lines be eliminated in the primary health care centers, the ministry is executing a plan to improve the primary health care services. He gave a two-month deadline, which many have deemed unattainable, but Ms. Bachelet focuses on the underlying message: “the urgency with which the president emphasized the topic demonstrates the high priority given to primary health services and all the areas that it affects.”
The plan to improve primary health care services consists of five measures.
On the other side, the ISAPRE system, composed of 29 companies, serves nearly 27 percent of the population. “ISAPREs face two types of challenges. The first has to do with the system’s permanency and development and for that we need political goodwill. We have the impression that the new authorities have a more rational position -- different from predecessors -- and they recognize the importance of the ISAPREs. The second is oriented toward our internal development: identifying problems and correcting them. For example, we incorporated a solution to the coverage of catastrophic illnesses so that no Chilean goes bankrupt for an illness,” explained Rene Merino, president of the Association of ISAPREs as well as president of the ISAPRE Colmena Golden Cross.
According to Rafael Caviedes, executive director of the association, the country faces an important challenge, which is “the challenge to improve accessibility of health services, primarily gearing it toward the poor.” He believes that the only expectation of growth for the ISAPREs is to correlate to the country’s economic growth. Both private and public sectors are looking forward to what the future has to offer, focusing on providing quality health care services for all Chileans.
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Table of Contents New president focuses on future while reconciling the past |
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Within the government program of President Ricardo Lagos Escobar, one of the central poles is health care and its convergence with security and progress. Since the very beginning of his presidency, he has given demanding tasks to his government’s minister of health, Michelle Bachelet. The focus for this six-year tenure is to improve the existing system on the basis of equal opportunities, guarantee of quality service, citizen’s rights and more participation.