The Chilean healthcare system is primarily structured by mandatory medical coverage. The law provides for a minimum set of medical benefits and the additional features depend on the health institution and health plan (either public or private) chosen by each citizen. As the population of individuals over the age of 65 continues to increase in Chile, healthcare delivery is becoming more essential, with nearly 60 percent of citizens relying on at least one medicine daily.

The Ministry of Health is the main health authority in Chile, while the Public Health Institute (ISP) is the regulatory authority responsible for enforcing the regulatory framework for pharmaceutical products. Currently, the prices of drugs and devices are not regulated in Chile.

Chile’s Payer Stakeholders  

In Chile, there are three types of payers that are financed with workers’ contributions (7 percent of taxable salary):

    • Fondo Nacional de Salud (FONASA): Part of the Ministry of Health, FONASA is a public health insurance which is responsible for funding and insurance for their beneficiaries. The system is stratified into four levels depending on how much an individual earns. FONASA provides coverage to approximately 81 percent of the population in Chile.
    • Instituciones de Salud Previsional (ISAPRE): Privately run health insurance providers that tend to attract those who are wealthier, younger, and healthier. ISAPREs charge risk-rated premiums and may reject applicants with pre-existing medical conditions. ISAPREs provide health coverage to an estimated 16 percent of the population.
    • Health insurance plans provided by the armed forces: This system provides medical coverage to 2.4 percent of the population in Chile and accounts for active and retired personnel of the armed forces (army, navy and air force), uniformed police and gendarmerie (prison service). These plans are financed through direct contributions from the State and contributions from civil servants in a pay-as-you-go system in which the state is responsible for costs not covered by contributions.

In addition to the coverage provided by FONASA and the ISAPREs, there are duly registered insurance companies that can provide supplemental healthcare coverage. These are voluntary and can cover medical expenses, oncology, rare disease treatment, dental, hospitalization, etc. Of note, there are usually enrollment restrictions based on age and pre-existing medical conditions.

Important Points to Keep in Mind

Chile has developed two coverage systems for high-cost medicines and serious, catastrophic illnesses:

    • AUGE, or the Explicit Guarantees System (GES): A universal health plan which grants beneficiaries access to different health interventions, financial coverage, and quality of care for 80 health problems which have been established by law. All Chilean citizens, whether they seek care through FONASA or ISAPRE, are guaranteed coverage for any of these health conditions. Examples include chronic kidney disease, pediatric cancer, Parkinson’s disease, Hepatitis C, HIV/AIDS, Schizophrenia, and traumatic brain injury. 
    • Ricarte Soto Law: According to the Ministry of Health (2015), this bill seeks to “ensure the financing of diagnoses and treatments based on medicines, medical devices and high-cost foods with proven effectiveness, which often have unattainable costs for people and their families.” To qualify for these benefits, an individual’s pathology must be covered by the law and the individual must be a contributor to either FONASA, ISAPREs, or the Armed Forces.

Implications for Industry

Although Chile has expanded drug and treatment coverage to all citizens, the system favors those who can pay for higher quality care and, more importantly, to pay for preventative care that can prevent expensive procedures in the future. The State’s current efforts have focused both on controlling the market and enacting new laws that promote better cost management.

    • Cenabast Law: In January 2020, Chile’s President enacted this law to slash the price of pharmaceutical drugs by up to 80 percent. The National Health System’s Supply Central (Cenabast) acts as an intermediary in purchasing medicine to supply the country’s pharmacies. The Cenabast has the power to set price caps and establish an advisory council to recommend the maximum price of a drug, with the aim of making medicines more affordable and reducing out-of-pocket costs.
    • Drugs II Bill: The Chilean Senate is currently discussing this bill, which includes initiatives that aim to lower drug prices, increase access to medicines, update regulations on bioequivalent medications, and promote competition in the industry.
      • Doctors would be required to write prescriptions under the “International Common Denomination (ICD)” of the compound.
      • Pharmacies would be required to notify customers about the generic versions of the medicines prescribed to them by their physicians.
      • The customer would only be obligated to purchase the amount of medicine he/she needs, not the pre-determined amount in the bottle or container.
      • Patients would be allowed to directly import medicines for their personal use.
      • An international database where patients can compare drug prices.
      • Opening online pharmacies.

Chile is often seen as a beacon within Latin America for communications and the market has seen heavy investments into healthcare by multinational pharmaceutical companies. The GLOBALHealthPR team has years of experience in Chile and can offer valuable insights and regional expertise to your marketing, public affairs and market access teams.

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