Seven Per Cent, Two Doors: How Chile Splits Its Health Money — Epoche B1
In Chile, seven per cent of every formal salary goes to health, and the worker decides where it lands: FONASA, the public fund, or a private insurer known as an ISAPRE. Same money, two doors, and the choice is made on paper by people who are usually healthy at the time. FONASA ISAPRE Members roughly four out of five Chileans a minority, generally younger and better paid What the 7% buys a place in the public system, with charges by income group an individual contract, whose price depends on the plan Extra payment possible, to use private doctors under a free-choice arrangement common, when the plan costs more than the 7% Guarantees the GES guarantees — access, quality, waiting time and cost protection for a defined list of illnesses — apply to both The trouble grew out of the pricing. ISAPRE plans were priced with tables of risk factors, so an older member, or a woman of childbearing age, paid several times what a young man paid for the same cover. In 2010 the Constitutional Court held that such tables were incompatible with the constitution, and the courts have been reshaping the system ever since. The industry says the corrections threaten its finances; its critics answer that an insurance market which charges most to those who need most is doing exactly what insurance markets do. Behind the arithmetic sits an old question, and Chile's long constitutional debates kept returning to it without closing it: is a health contribution a premium, which buys a product, or a tax, which funds a common obligation? Chile has answered "both", and lives with the consequences — a public system carrying the older and the sick, a private one carrying the young, and a courtroom deciding where the line falls. References Decreto con Fuerza de Ley N° 1 (2005), Ministerio de Salud, Chile — consolidated text on health benefits and the compulsory health contribution. Ley N° 19.966 (2004), Régimen General de Garantías en Salud (GES/AUGE). Republic of Chile. Tribunal Constitucional de Chile (2010). Sentencia Rol N° 1710-10 — risk factor tables in ISAPRE contracts. Bossert, T. J. & Leisewitz, T. (2016). Innovation and Change in the Chilean Health System. New England Journal of Medicine, 374(1), 1–5.