Public-private relations in Chile's health system: regulation, funding and service delivery

This article analyzes the configuration of public-private relations in Chile's health system between 2000 and 2018, focusing on organization and regulation, funding and service delivery. The following data collection methods were employed: literature review, content analysis of official documents and secondary data, and semi-structured interviews. With regard to organization and regulation, the findings show a lack of institutional mechanisms to mitigate risk selection and that access to private services is intimately linked to ability to pay. The funding model is incapable of sustaining the public health system. With respect to service delivery, despite the implementation of strategies that suggest advances, the segmentation of the system is sustained by the fragmentation of care and purchase of private services. Our findings show that the nature of public-private relations in Chile's health system reinforces the segmentation of population groups produced by the market-oriented approach. Although the reforms implemented during the study period mitigate the effects of segmentation, they were unable to produce structural changes in the configuration of the health system.

Automated summary

The article analyzes the configuration of public-private relations in Chile's health system between 2000 and 2018, highlighting issues with organization and regulation, funding, and service delivery. Despite implementation of strategies, the segmentation of the system persists along with problems related to access to private services and sustainability of the funding model. The nature of public-private relations reinforces population segmentation and structural changes in the health system remain elusive despite reforms implemented during the study period.