Health system: a return to the past

The Constitutional Convention (CC) proposes to the country, in matters of health, to reopen a discussion that has been taking place in the world for several decades between a system based on the “Beveridge” doctrine which promotes a centralized single state system, with funding by taxes similar to the English system, replacing the current system, which is based on the “Bismarck” model, supported by financing by insurances in which both the State and the workers participate, among which exhibitors we find France, Germany, Belgium, Japan, among others.

On the other hand, WHO encourages countries to move towards universal health coverage, where people can access timely and quality health care according to their needs and contribute according to their ability, either by through general taxes, individual contributions or a mixed model, like the one we currently have in Chile. Focusing on objectives highlights that what must be sought is to provide a response to people, to meet their health needs, beyond the imposition of a model or another, especially since none of them has been shown to establish better health indicators, beyond the other, when comparing the different countries of the world.

What the CC proposes, to move Chile dramatically to a single state model, not only emphasizes instruments and not objectives, but also jeopardizes the health tradition by which Chile has advanced since the 20th century. past, allowing us to be among the countries with the best health indicators. At the same time, looking at the past, it seeks to reinstall an outdated discussion, which will force the creation of a new institutionality which supports the system, and which replaces Fonasa as a public insurance entity, which throughout its history has taken care to safeguard people’s interests and guarantee compliance with care guarantees, as in the case of the GES.

The health challenges we have to face in the 21st century are determined by the evolution of the demographic profile, with an accelerated aging of the population; change in the epidemiological profile, with the increase in the prevalence of chronic diseases and with the increase in health costs far greater than the increase in the product. The ways to deal with it have been oriented at the global level by strengthening health programs in the field of prevention, moving from curative medicine to preventive and personalized medicine, establishing new financing models, according to principles of solidarity, efficient use of resources with risk sharing between providers and insurers, public-private collaboration according to irreproachable rules of transparency and responsibility, and the integration of digital health as a new way of providing and democratizing health.

All of the above is possible by perfecting current institutions, without the need to expose Chileans to a social and health experience such as that proposed by the CC, which will only delay the dream of universal health coverage. and delve into issues that particularly affect the most vulnerable.

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