SANTIAGO, Chile- “If you have money you buy health and if not, you die waiting,” says Alejandra Pérez, a breast cancer patient who fought to guarantee the right to health in Chile in the Magna Carta proposal that will be submitted to plebiscite on Sunday.
In a country where more than 80% of the almost 20 million inhabitants are treated in the public health system, diminished by lack of resources, “getting sick in Chile is economic ruin; in many cases it is death,” he points out to the AFP Pérez, member of the convention that drafted the new Constitution.
She says that she “buys life” in the private system to treat her cancer and avoid the endless waiting lists and overwhelmed emergencies in public health centers. “If you have money, you have health,” he says.
The health care model in Chile was conceived with the current Constitution of 1980, inherited from the dictatorship of Augusto Pinochet (1973-1990), which does not guarantee the right to health.
The proposed Constitution, drawn up over a year by 154 constituents, popularly elected on a parity basis, recognizes that “every person has the right to health and comprehensive well-being, including their physical and mental dimensions.”
More than 15 million people are called to speak on Sunday about the new Magna Carta. The “rejection” option leads all the polls, with up to 56% support.
How does the health system in Chile work now?
The current health system in Chile, which divides between public and private care, is financed through the mandatory contribution of 7% of the worker’s salary.
This decides whether to pour it into the public system (National Health Fund, Fonasa), which also welcomes those who do not contribute resources, or the private system (Institutions of Health Insurance, Isapres).
Only about 16% of the population attends the private system, although they receive more income through contributions than the public system.
The proposed Magna Carta establishes a “universal, public and integrated” health model, by which a unified system is contributed and it is possible to opt for complementary private insurance.
The objective is to prevent “that finally (only) those who have money in their pockets can pay for care,” Dr. Francisca Crispi, president of the Santiago Medical College (Colmed), told AFP.
How are the resources distributed?
The possibility of choosing the destination of the health contribution currently translates into a lack of resources to finance the public system, which covers most of its budget with State funds. Only 21% comes from workers.
“More people are served in the public sector, but less money enters. More money enters the private sector and fewer people are served, therefore there is better care,” says Pérez.
In public hospitals, emergency rooms are overcrowded daily with waiting times of more than six hours, and waiting lists for some treatments or operations exceed 500 days.
“We have a lot to improve and strengthen in the management of the public system in order to optimize capacity,” said Crispi, who pointed out that public operating rooms are often closed at one in the afternoon.
What doubts do the proposed changes generate?
In the Association of Isapres, which brings together the six existing private insurance companies in Chile, the changes proposed in the new Constitution are worrying. They do not consider that the integrated model “is going to be an advance” because “it is going to overload the public system,” Gonzalo Simón, president of the Isapres Association, told AFP.
“If this new Constitution comes into operation and this new system is put into practice, the possibility of choosing is lost and all people have to necessarily move to the public option,” he said.
But in the Colmed de Santiago they do not agree. “This freedom of choice is partial and it is for very few. It is for the percentage that can pay for private insurance,” says Crispi.
Pérez is confident that with the new text, patients in Chile will be able to have health care without having to lose their house or go into debt for 20 years.
“Strengthening public health is the first thing, that there are enough resources to be able to strengthen it and that tomorrow we can choose whether we want to serve ourselves in the public or private sector,” he maintains.
