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Social protection systems in Latin America and the Caribbean: Chile - P4H Network

Social protection systems in Latin America and the Caribbean: Chile

The document presents a review of the different social protection systems in Chile, and Chapter VI analyzes the health system, indicating that the 2004 Law establishes the Explicit Health Guarantees (GES) as guarantees of the state health system.

In 2005, an initial list of 40 diseases and healthy conditions was established, which later increased to 56 high-cost diseases, for which the necessary services are universally guaranteed.

The GES are at the core of the Universal Access Plan of Explicit Guarantees and include four sub-guarantees:
Explicit guarantee of access in which both the National Health Fund (FONASA) and the Social Security Health Institutions (ISAPRES) are obliged to guarantee the provision of health benefits that are part of the GES.
2. Explicit quality assurance through which providers must be duly accredited by the Superintendence of Health and provide services according to predefined care protocols.
Explicit guarantee of timeliness that defines the maximum term for the delivery of the benefit by a provider accredited or registered by FONASA or an ISAPRE.
Explicit guarantee of financial protection through which it is defined that the maximum charge to the affiliate should not exceed 20% of the total benefit.