The provision of health services in Chile: historical aspects, dilemmas and prospects

The evolution of the health system in Chile, since its beginning and during the National Health Service period is discribed. The transformations that this system underwent from 1980 on, during the military regime, and the changes introduced by the democratic governments from 1990 on, with the purpose of correcting distortions introduced in the previuos period are commented on. The production of the health services is compared as between the public and private sub-sectors. The indicators used are outpatient attendance per thousand insured inhabitants, use of, lab texts on the same populational basis, hospitalization rates, discharges per thousand insured and surgery rates per thou sand. Differences between the two sub-systems are commented on as also are those related to user satisfaction in the two sub-systems. The chief challenges to the public system are considered as well as their. possible responses to them on the basis of current policies and the solutions implemented. The present situation in the Public/Private mix in health care in Chile gives rise to the positive expectation that the Public subsystem may succed iii maintaining its historical leadership in the orientation and health services offered in this country. This positive view is supported by the rigor-oils geographic and demographic logic of the public subsystem, the stable availability of financial resources (result of the 7% contribution for health applied on all salaries, complemented by tax funds), a not completely modem but reliable network of public health facilities and the considerable motivation shown by its statt. Some features of the Chilean health system's development are mentioned as potentially useful to the development of health systems in other countries, especially in Latin America, such as organization and management of regional health services, innovative methodologies in health service payment (diagnosed related payment, management agreements and per capita financing for primary care); the health surveilance system (especially for food and drugs) and the state regulation of private health care financers.