CHILEAN CASE STUDY EFFICIENCY OF UNIVERSAL ACCESS TO EXPLICIT GUARANTEED ENTITLEMENTS

Transcription

1 1. Acceso Universal con Garantías Explícitas CHILEAN CASE STUDY EFFICIENCY OF UNIVERSAL ACCESS TO EXPLICIT GUARANTEED ENTITLEMENTS 1 (AUGE) REFORM Ismael Aguilera Carlos Urriola

2 Background: Chilean Health System Mixture System of health insurances (Source: FONASA 2012) Type Insurance Beneficiaries Percentage Insurance Public FONASA (National Fund of Health) 13,377, % Private ISAPRES (Security Health Companies ) 3,064, % Others Military Services and other 1,038, % Total 17,479,723 Every worker must pay a compulsory contribution of 7% of your monthly salary. There are different health insurances that vary by price. Depending on the insurance plan, each worker must pay a copayment to the health care. This is equal to the difference between the cost of the health center and its coverage. Every worker and their families can go to health centers public or private. Most Chileans can not go to private health centers, because they do not have sufficient economic resources).

3 Concerns in the Chilean Health System The guarantee of health care were not satisfied (In private and public system). Long waiting lists. Inequity in access to health services. There was no clear priority how the Chilean Health System used its resources. There was not standardization about medical procedures. to establish maximum times for delivering health treatment. There did not exist the equipment necessary in the Public Sector to deliver treatments early diagnosis.

4 Universal Access to Explicit Guaranteed Entitlements Reform (AUGE) (1) AUGE Main Goal The prioritization in the use of resources, generating right to universal access and attention warranties for the most relevant health issues, in the public and private sector. Access Opportunity Financial Protection Quality Entitlements guaranteed by AUGE Is the right ensures the receive the health care provision by FONASA or ISAPRES. Is the right to receive guaranteed attentions within maximum deadlines Is the right that determines the value to be paid for the attentions the affiliate received, according to the GES or AUGE tariff. Is the right to obtain the guaranteed health attention by a registered provider or accredited. Source: (seen in January, 4th 2014)

5 Universal Access to Explicit Guaranteed Entitlements Reform (AUGE) (2) Actions necessary to implement the AUGE Generation of Legal Framework. Financing by 1% VAT. Investment in infrastructure and equipment. Prioritization of diseases and treatments. Creation of clinical guidelines. Establishment of Law N 19,966 and the decree N 121, which establishes guarantees and penalties for noncompliance. Number of pathologies and universal premium amount per AUGE incorporation period Number of explicit guarantees (disease - treatment) Universal premium (UF) Source: Compiled by Authors 0 Julio 2005 Julio 2006 Julio 2007 Julio 2010 Julio UF = 40 $USD

6 Consequences Effects on efficiency problems: use of priority services quality and opportunity of services waiting lists Equity effects on Chilean people s health care State budget.

7 Consequences of AUGE (1) Use of priority services Number of cases in millions of people per group associated to each Supreme Decree. Health 2005 * ** Issues 25 GES 1,370 1, ,015 1, , (SD N 170) 15 GES (SD N 228) 16 GES (SD N 44) 13 GES (SD N 1) Total 1,370 1,428 1,788 2,336 2,286 2,099 2,810 1,461 Note: *July-December period; ** January-June period Source: Superintendence of Health and National Public Health Fund (FONASA)

8 Consequences of AUGE (2) Quality and opportunity services National Socio-Economic Characterization Survey (CASEN) AUGE Attention Compliance (%) Public insurance Private insurance Year Very good and good Bad and very bad ,2% 8,6% ,2% 8,5% ,6% 7,8% ,4% 3,4% Compliance timeouts involved in AUGE s treatment (%) Public insurance Private insurance Year Very good and good Bad and very bad ,5% 16,5% ,4% 9,4% ,7% 11,4% ,2% 3,2%

9 Consequences of AUGE (3) Waiting lists Health Service director said that The AUGE procedures contributed to make visible the waiting lists for the population -> A public issue AUGE Counsel notes that "if the waiting list is within the AUGE specialty, it tends to decline But the pathologies that are out of AUGE program have tended to rise" -> pressure to the Health System

10 Consequences of AUGE (4) Impact on equity access Table 3.2-k: AUGE Coverage of by self- national quintile,2011 (%). CASEN 2011 I II III IV V Average Average income 130, , , ,622 1,106,709 ($2011) Yes % No % Does not know / % does not remember Source: Own elaboration based on CASEN 2011, Question: s35: Was this medical treatment covered by the AUGE-GES system? (%)

11 Consequences of AUGE (5) Impact on Life Expectancy Table 3.1-a: Regression of Life Expectancy Model (1) (2) (3) (4) (5) (6) (7) (8) Per capita 0.006*** 0.006** health expense (7.06) (4.82) Per capita *** Hospital beds (-8.89) (0.72) Per capita 5.102*** doctors (11.66) (2.03) Per capita ** alcohol (-0.70) (-4.79) consumption +15 (litres) per capita GDP 1.361*** (8.88) AUGE 2.672*** (4.97) (2.49) 0.003** (2.54) 5.825*** (5.79) ** (-2.78) 0.433* (2.21) Remarks Adjusted R Note: t-statistic between parentheses. Significance of 1% ***, 5% **, y 10% *. Source: Compiled by Authors, based on OECD, CEPAL, Banco Central de Chile, INE-Chile.

12 Consequences of AUGE (6) Impact on Years of Potential Life Lost indicator (YPLL) Table 3.2-m: Panel Data Regression for reverse YPLL, Model Fixed effects AUGE coverage (ratio) 0.004* (1.85) Good attention timing 0.004** (2.05) In (Income) 0.004** (2.18) Schooling 0.012*** (7.85) Ubanization (ratio) (-0.70) Drinking Water 0.013*** (ratio) (3.63) Organization per capita 0.078** (2.36) Doctors offices/area (0.02) Infant Mortality/ *** (-5.60) Constant (-5.60) Temporal Effects Yes Test F 9.94*** Chi2`s Hausman test *** Observations Note: t-statistics in parentheses. Significance at 1% ***, 5% ** and 10% *. Source: Own calculations based on Casen 2006, 2009, 2011, SINIM , DEIS- MINSAL

13 Consequences of AUGE (7) Impact on state budget Hospital spending is 30% of total spending on health along Estimated benefit expense GES and no GES. Millions of Chilean pesos at June 2009 Source: Ministry of Health (2011)

14 Consequences of AUGE (8) Impact on private health insurance Private affiliates main answers to the question: "Why was it not covered by AUGE?" (A) Preferred to choose another doctor or venue, or continue with their regular doctor. (B) Decided not to wait for accessing to the medical attention through AUGE or GES to solve their problems faster. (C) AUGE or GES did not cover the necessities of the illness.

15 Policy implications and lessons learnt Observed policy implications. Contain cost More production Improvement in techs and management Possible lessons learnt from this reform implementation experience. Increase the capacity of public hospitals while the health coverage increases, because the costs for the state has led having to use private hospitals costing 3 times higher for attention.