Download - CISAS | Centro de Información y Servicios de Asesoría ...

Observatorio Latinoamericano de Salud.developed country. It is on account of this that, despitethe unequal distribution of income, Chile has beenclassified in the PNUD Report as having a high HDI,the 43rd position, with a coefficient of 0.831.In the health system, the assistance and sanitarycoverage is currently as follows: the ministerial programsof public health reach 100% of the population;public services offer medical and hospital care to67.5%, and the Health Provision Institutions (ISAPRES)cover 18.5% with their 16,000 health plans. The restis taken care of in the Armed Forces, Police or privateinstitutions [Ministerio de Salud, Fondo Nacional deSalud, 2004]. On the subject of available hospital beds,81.6% belongs to the SNSS and 18.4% to the ISAPRES.These numbers illustrate that, regardless of authoritarianismand its getting out of hand; the role of the Statein health continues to be important.In the SNSS, two aspects of equity deserve specialattention: the stratification of access and the financing.Concerning access, and based on the premisethat every person is equal in the eyes of the market,the legal distinction between workers and employeeswas eliminated; but, all at once, the free electionco-payments were extended to the institutional caresystem. In this modality, the co-payments depend onmonthly income and, for this, users are classified in thismanner: Group A: indigents – exempted; Group B: incomeclose to 200 dollars – exempted; Group C: incomebetween 200 and 300 dollars – they pay 10% ofthe tariff; Group D: income superior to 300 dollars –they pay 20% of the tariff. The admittance to groups Aand B is done by means of an indigence certificate. Theclassification in groups C or D varies in proportion toincome and the number of dependents. In the last fewyears, free consultation in Primary Care included userswho were older than 65 and those with catastrophicillnesses. The private individuals that require assistancehave to pay 100% of the total cost of the contribution,in accordance with the tariff annually establishedby the Department of Treasury and the NationalHealth Fund (FONASA).With reference to the distribution of users,70,5% is concentrated in groups A and B, where the indigentsare located. This is critical, as it was shown,18% of the population is poor, and just 4% of it is indigent.That is to say, irrespective of the efforts of FO-NASA to eradicate the "false indigents", the majorityof the people prefer to assume a stigmatizing conditionthan to pay for attention.Regarding free election, the co-payments coverthe difference between the improvement allotted byFONASA and the cost of contributions, which vary inline with their complexity. To this purpose, levels of attention1, 2 and 3 were created; with Level 3 being theone which best disburses to lenders, but the most expensivefor users. It is no surprise, then, that the laterconcentrates 98% of the doctors and 75% of all theprofessionals [Ministerio de Salud, Fondo Nacional deSalud, 2004].In relation to the financing, the idea of neoliberalswas that the contribution of the State to healthwould become marginal as families progressively assumedits cost. In fact, from 1974 to 1989, the fiscal resourcesdecreased 49% while the quotations increased180% and the co-payments 50%, being that these represented,in 1989, 15% of the budget. Nevertheless,this tendency has reverted. In 2002, the compositionof health expenditure was the following: fiscal contributions– 51%; quotations – 34.4%; co-payments –8.4%; other earnings – 6.2%. These numbers also demonstratethat the co-payments did not have the expectedimpact, as their participation consisted of only6.5% on average, between 1990 and 2002 [Ministeriode Salud, Fondo Nacional de Salud, 2004].It is essential to reiterate that the current formof financing is characterized by two negative characteristics:on one hand, solidarity is very limited and circumscribedto the affiliates of FONASA, who are the27