When Universal Health Coverage Is Not Enough: What Can We Learn from Chile?

• In Event: Qualitative Methods & Sexuality and Politics & Health Politics and Health Policy Virtual Poster Session
  In Virtual Poster Session: Health Policy and Politics Virtual Poster Session

Abstract

Chile has been seeing as an example of political, social, and economic stability since democratic governments started to run the country after seventeen years of military dictatorship leaded by Augusto Pinochet. With these credentials, the global community was shocked once news cables widespread an unexpected political and social crisis in Chile. On October 17th of 2019 students started to dodging turnstiles in Chile´s capital Santiago subway system as a protest for approximately US$4 fare increase in tickets. Violent protest against public and private property were escalating until the first reports on human rights violations started to be notorious. Reports from Amnesty International, Human Rights Watch, The Inter-American Commission for Human Rights, and United Nations Human Rights Office evidenced an excessive use of force by the police during protests. People continued gathered in massive peaceful rallies demanding major changes in key social policies such pensions, health, and a new Political Constitution. In 2010, the World Health Report highlighted Chile as a successful case in moving toward Universal Health Coverage (UHC). Under the presidency of Ricardo Lagos, the best known as Plan AUGE (Plan de Acceso Universal con Garantías Explícitas en Salud) established a mandatory guarantee in access to healthcare, timely access to healthcare, financial protection, and quality in healthcare for a list of health conditions whether public or private healthcare must provide. The list started with 25 health conditions that were incrementally expanded to the current 85. It is important to address that 16 health condition were included in the first presidency of Michelle Bachelet (2006-2010), 11 in the first presidency of Sebastián Piñera (2010-2014) and 5 announced by President Sebastián Piñera before the crisis. Why a country with a strong commitment towards UHC demands better access to healthcare? What can we learn about democracy stability and the effect of a progressive policy such a UHC? To address this question I analyzed the politics of UHC using the Framework for Evaluation and Action developed by Fox and Reich. The Framework is based in the four stages of policy cycle –agenda setting, design, adaptation, and implementation- and four variables that can affect that kind of reforms -interest, institutions, ideas, and ideology- in Low-And Middle-Income Countries. Despite since 2014 the World Bank consider Chile as a High-Income-Country, the Framework for Evaluation and Action fits well regarding the path to UHC started at the beginning of year 2002. The politics of UHC in Chile have been affected by institutions and interest rather a policy process outcome. The main health institutions have not changed since Augusto Pinochet dictatorship, and UHC has been posed as a threat for the current health systems segmentation, mainly for private insurers. An opportunity to change comes from patient’s perceptions and public health advocates. The current political crisis has strengthening patients and health professionals and workers union for demanding more and better UHC along a change in health institutions and a new Constitutional right to health.

Author

• Claudio A. Méndez, Universidad Austral de Chile