Pertinencia y factibilidad de reforma para crear un sistema universal de salud en Chile

The health system in Chile is well developed, with broad national coverage. However, organizational limitations necessitate urgent structural reform due to a lack of resources and poor performance, with segmentation and inequity. The government's program for 2022–2026 proposes substantial reforms aimed at creating a universal health system. Other reform proposals formulated by various government programs and commissions, as well as think tanks, provide useful inputs to contextualize the government proposal. Different types of models coexist in the health system: public insurance is based on a social security model, the public system provides free care to the insured population, and private insurance and private care providers work on a market basis. The proposed system would function on the national health system model, combining a predominant national health service (Beveridge model) with a complementary social security system (Bismarck model), depending on the need for funding. With a focus on social project evaluation, the relevance (internal coherence and external alignment) and political and economic feasibility of the contents of the government program were reviewed. The proposal has internal coherence, but limited external alignment with the prevailing political and economic system, and little State capacity to increase the financing of public enterprises and their coverage. The contents of the proposal do not show sufficient facilitating conditions to reasonably suggest political and economic feasibility in terms of legal approval and effective implementation of the proposed reform.