A scoping review and analysis of a series of country experiences to
inform the Chilean health financing reform
Abstract
The Chilean government is committed to reforming the health financing
scheme set up in the eighties, characterized by risk and income
segmentation. There is a need to move towards a universal,
comprehensive, and sustainable health system, the financing component of
which is fundamental. To contribute elements of comparative analysis to
inform Chile’s reform efforts, we reviewed international health reform
experiences carried out in similar settings. We used a scoping review
methodology. Six countries were included in the analysis: Canada,
Denmark, Slovenia, Spain, Estonia, and France. A profile was prepared
for each country describing the financing system, the structures in
charge of managing the public health insurance system, and the
institution responsible for financing and its attributions regarding
health care providers. One-hundred and eighty-eight records were
identified to create the country profiles. In this article, we
narratively analyze the findings, focusing on a) financing (revenue
collection and pooling), b) purchaser-provider relationship and payment
mechanisms, c) governance of institutional capacities and policies for
reform, and d) voluntary private health insurance. For each of these
dimensions, we make focused recommendations that could aid the Chilean
ongoing effort for health care reform to move towards universal public
insurance with a mixed payment mechanism for public and private
providers. We also discuss the type of institutional governance required
and the transition from mandatory to complementary private insurance.