Achieving effective universal health coverage with equity

Evidence from Chile

Bibliographic Data

ID11491377
AuthorsPatricia Frenz (0000-0001-8327-9614, McGill University, corresponding author), Iris Delgado (0000-0002-7021-3357, Universidad del Desarrollo), Jay S Kaufman (0000-0003-1606-401X, Universidad del Desarrollo), Sam Harper (0000-0002-1590-2387, Universidad del Desarrollo)
Year2014
Volume29
Issue6
Pages717-731
Publication date2014-09-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czt054
PMID23921988
OpenAlexW2121877183
LanguageEN
Citations received21
References cited28

Chile's 'health guarantees' approach to providing universal and equitable coverage for quality healthcare in a dual public-private health system has generated global interest. The programme, called AUGE, defines legally enforceable rights to explicit healthcare benefits for priority health conditions, which incrementally covered 56 problems representing 75% of the disease burden between 2005 and 2009. It was accompanied by other health reform measures to increase public financing and public sector planning to secure the guarantees nationwide, as well as the state's stewardship role. We analysed data from household surveys conducted before and after the AUGE reform to estimate changes in levels of unmet health need, defined as the lack of a healthcare visit for a health problem occurring in the last 30 days, by age, sex, income, education, health insurance, residence and ethnicity; fitting logistic regression models and using predictive margins. The overall prevalence of unmet health need was much lower in 2009 (17.6%, 95% CI: 16.5%, 18.6%) than in 2000 (30.0%, 95% CI: 28.3%, 31.7%). Differences by income and education extremes and rural-urban residence disappeared. In 2009, people who had been in treatment for a condition covered by AUGE in the past year had a lower adjusted prevalence of unmet need for their recent problem (11.7%, 95% CI: 10.5%, 13.2%) than who had not (21.0%, 95% CI: 19.6%, 22.4%). Despite limitations including cross-sectional and self-reported data, our findings suggest that the Chilean health system has become more equitable and responsive to need. While these changes cannot be directly attributed to AUGE, they were coincident with the AUGE reforms. However, healthcare equity concerns are still present, relating to quality of care, health system barriers and differential access for health conditions that are not covered by AUGE.

Business · Demographic economics · Economic growth · Economics · Environmental health · Equity (law) · Health care · Health equity · Political science · Public health · Residence · Global Maternal and Child Health · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Nursing · Health Policy