Healthcare in Chile is provided by the government (via Fonasa) and by private insurers (via Isapre).
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All workers and pensioners are mandated to pay 7% of their income for health care insurance (the poorest pensioners are exempt from this payment). Workers who choose not to join an Isapre, are automatically covered by Fonasa. Fonasa also covers unemployed people receiving unemployment benefits, uninsured pregnant women, insured worker's dependant family, people with mental or physical disabilities and people who are considered poor or indigent.
Fonasa beneficiaries may seek attention at public or private health facilities. When choosing public health facilities, the cost is free for people older than 60, people without income or with disabilities and for workers earning less that one minimum wage (MW), or less that 1.46 MW if they have three or more dependants to take care of. Workers earning between one and 1.46 MW and having less than two dependants, or earning more than 1.46 MW and having three or more dependants, pay 10% of costs. Workers earning more than 1.46 MW pay 20% of costs if they have two or less dependants to look after.[1]
Workers covered by Fonasa may seek attention in the private sector if the private health facility or health professional is associated with Fonasa in one of three pricing levels. The higher the level the more expensive the cost for the worker.
The level of protection offered by the Isapre system depends on the worker's income and their medical risk, estimated by their age, sex, family medical history, etc. (In August 2010 Chile's Constitutional Court declared risk determination based on sex and age to be unconstitutional.[2]) This may force an affiliate to seek treatment under Fonasa when a particular service or health condition is not covered by their Isapre.[3] Isapre participants pay on average 9.2% of their income toward health insurance. The additional paid over the required 7% is voluntary and is paid to increase the benefits available. Almost 60% of payers are in the top two quintiles of income, while only 7% are in the bottom quintile. Isapres often use networks of providers to offer discounted benefits. They also offer shorter time waiting for services. Fonasa, on the other hand, uses lower cost public hospitals, and can include a broader benefit package for the same cost. The trade off is accessibility as the waiting time for services can be substantial.[4]
Over 50% of the public sector health budget is raised through taxation — this goes to the public social security system and the Fonasa plans to help cover expenses. Isapres cover all expenses using only the contributions of members.
There are a number of high-mortality pathological conditions (currently 69) that have special guarantees for both Isapre and Fonasa affiliates. The AUGE or GES plan includes four guarantees in relation to these illnesses:[4]
Beneficiaries by December 2009.[5][6]
| System | Affiliates | % |
|---|---|---|
| Fonasa | 12,504,226 | 73.49 |
| Isapre | 2,705,917 | 15.90 |
| Total pop. | 17,014,491 | 100.00 |
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