Explicit Health Guarantees for Chileans : The AUGE Benefits Package
This paper focuses on recent and significant health reform implemented in 2005, known as Universal Access with explicit guarantees (Acceso Universal con Garantias Explicitas - AUGE or GES), which mandated SHI insurers to adopt a broad benefits package defined via explicit legal guarantees for all beneficiaries. This innovative reform is a policy reaction to that which previously existed in Chile and which is widespread in many developing countries, whereby the health rights of citizens remain largely undefined or implicit. Limited public resources imply in those countries that access to health care is rationed through queues, patient deflection, legal or under-the-table user fees, and low-quality care. This paper describes the AUGE reform, its implementation, and the functioning of AUGE for the poor and for non-poor citizens. This paper is organized as: section two provides a brief historic overview of health coverage in Chile's SHI system. Section three describes the SHI system in existence today. Section four describes the services offered and mechanisms in place to cover the poor under SHI, while section five spells out the benefits of SHI. Section six introduces the AUGE health reform of 2005, which sought to broaden and make explicit the rights of all SHI beneficiaries. Section seven offers information about the flows and magnitudes of health financing in SHI. Section eight focuses on the system used by Fonasa to target the poor. Section nine explains how Fonasa manages AUGE. Section ten comments on the information environment of AUGE. Section eleven addresses the equity and fiscal implications of expanding the AUGE benefits. Finally, section twelve proposes a pending policy agenda related to the coverage of the poor under SHI and the definition and management of benefits.
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access to health care access to health services access to services adolescents Adult mortality Adult mortality rate aged allocative efficiency ambulatory care aneurysm appropriate treatment ARI arthritis arthrosis asthma Bladder cancer brain breast cancer burden of disease burns Cancer of the uterus cancers capitation capitation payment Cataract Cataract surgery cataracts Central nervous system certification child health childbirth chronic diseases Cleft palate clinics Communicable diseases contraception costs of health care curative health care Cystic fibrosis Deafness delivery system Dental care depression diabetes Diabetes Mellitus diagnosis Disability disease management drugs emergency care employment epilepsy equity in access families fee-for-service financial incentives financial protection financial resources financial risks general practitioners Health Affairs health care health care centers Health Care Coverage health care delivery health care facilities health care organizations health care providers health care quality health care services health centers Health Coverage Health Expenditure Health Expenditure Per Capita health facilities Health Financing Health Insurance health insurance market health insurance markets health insurers Health Organization health outcomes Health Plan health plans Health Policy health posts health promotion health providers Health Reform health sector health service health service utilization Health Services health spending Health System health system efficiency health systems health workers healthcare healthcare services heart disease Hemophilia Hepatitis Hepatitis B Hepatitis C HIV/AIDS hospital beds hospital care hospital services hospitalization hospitals human resources Hygiene hypertension illness immunization income income countries Income Distribution indexes Infant mortality Infant mortality rate informal sector informal sector workers information system insurance plan integration laboratory technicians legal obligation leukemia life expectancy life expectancy at birth Lymphoma managed care market failures maternal and child health Medical doctors medical referrals medical services medical specialists medicines morbidity mortality Multiple Sclerosis Myocardial Infarction National Health national health service National Health Services national health spending nurses oral health pacemakers palliative care patient patients physician physicians pneumonia pocket payment postnatal care Pregnancy pregnant women prenatal care prevalence preventive care primary care primary health care primary health care services private care private insurance private insurers private sector private sectors Prostate Prostate cancer providers of health services provision of care provision of health services public health public health care public hospital public hospitals public insurer public providers public sector public spending referrals renal failure right to health care Schizophrenia sex smoking Social Health Insurance Social Security social welfare social workers Strabismus surgery syndrome TB trauma treatment treatments Tuberculosis tumors Visits workers access to health care access to health services access to services adolescents Adult mortality Adult mortality rate aged allocative efficiency ambulatory care aneurysm appropriate treatment ARI arthritis arthrosis asthma Bladder cancer brain breast cancer burden of disease burns Cancer of the uterus cancers capitation capitation payment Cataract Cataract surgery cataracts Central nervous system certification child health childbirth chronic diseases Cleft palate clinics Communicable diseases contraception costs of health care curative health care Cystic fibrosis Deafness delivery system Dental care depression diabetes Diabetes Mellitus diagnosis Disability disease management drugs emergency care employment epilepsy equity in access families fee-for-service financial incentives financial protection financial resources financial risks general practitioners Health Affairs health care health care centers Health Care Coverage health care delivery health care facilities health care organizations health care providers health care quality health care services health centers Health Coverage Health Expenditure Health Expenditure Per Capita health facilities Health Financing Health Insurance health insurance market health insurance markets health insurers Health Organization health outcomes Health Plan health plans Health Policy health posts health promotion health providers Health Reform health sector health service health service utilization Health Services health spending Health System health system efficiency health systems health workers healthcare healthcare services heart disease Hemophilia Hepatitis Hepatitis B Hepatitis C HIV/AIDS hospital beds hospital care hospital services hospitalization hospitals human resources Hygiene hypertension illness immunization income income countries Income Distribution indexes Infant mortality Infant mortality rate informal sector informal sector workers information system insurance plan integration laboratory technicians legal obligation leukemia life expectancy life expectancy at birth Lymphoma managed care market failures maternal and child health Medical doctors medical referrals medical services medical specialists medicines morbidity mortality Multiple Sclerosis Myocardial Infarction National Health national health service National Health Services national health spending nurses oral health pacemakers palliative care patient patients physician physicians pneumonia pocket payment postnatal care Pregnancy pregnant women prenatal care prevalence preventive care primary care primary health care primary health care services private care private insurance private insurers private sector private sectors Prostate Prostate cancer providers of health services provision of care provision of health services public health public health care public hospital public hospitals public insurer public providers public sector public spending referrals renal failure right to health care Schizophrenia sex smoking Social Health Insurance Social Security social welfare social workers Strabismus surgery syndrome TB trauma treatment treatments Tuberculosis tumors Visits workers |
| spellingShingle |
access to health care access to health services access to services adolescents Adult mortality Adult mortality rate aged allocative efficiency ambulatory care aneurysm appropriate treatment ARI arthritis arthrosis asthma Bladder cancer brain breast cancer burden of disease burns Cancer of the uterus cancers capitation capitation payment Cataract Cataract surgery cataracts Central nervous system certification child health childbirth chronic diseases Cleft palate clinics Communicable diseases contraception costs of health care curative health care Cystic fibrosis Deafness delivery system Dental care depression diabetes Diabetes Mellitus diagnosis Disability disease management drugs emergency care employment epilepsy equity in access families fee-for-service financial incentives financial protection financial resources financial risks general practitioners Health Affairs health care health care centers Health Care Coverage health care delivery health care facilities health care organizations health care providers health care quality health care services health centers Health Coverage Health Expenditure Health Expenditure Per Capita health facilities Health Financing Health Insurance health insurance market health insurance markets health insurers Health Organization health outcomes Health Plan health plans Health Policy health posts health promotion health providers Health Reform health sector health service health service utilization Health Services health spending Health System health system efficiency health systems health workers healthcare healthcare services heart disease Hemophilia Hepatitis Hepatitis B Hepatitis C HIV/AIDS hospital beds hospital care hospital services hospitalization hospitals human resources Hygiene hypertension illness immunization income income countries Income Distribution indexes Infant mortality Infant mortality rate informal sector informal sector workers information system insurance plan integration laboratory technicians legal obligation leukemia life expectancy life expectancy at birth Lymphoma managed care market failures maternal and child health Medical doctors medical referrals medical services medical specialists medicines morbidity mortality Multiple Sclerosis Myocardial Infarction National Health national health service National Health Services national health spending nurses oral health pacemakers palliative care patient patients physician physicians pneumonia pocket payment postnatal care Pregnancy pregnant women prenatal care prevalence preventive care primary care primary health care primary health care services private care private insurance private insurers private sector private sectors Prostate Prostate cancer providers of health services provision of care provision of health services public health public health care public hospital public hospitals public insurer public providers public sector public spending referrals renal failure right to health care Schizophrenia sex smoking Social Health Insurance Social Security social welfare social workers Strabismus surgery syndrome TB trauma treatment treatments Tuberculosis tumors Visits workers access to health care access to health services access to services adolescents Adult mortality Adult mortality rate aged allocative efficiency ambulatory care aneurysm appropriate treatment ARI arthritis arthrosis asthma Bladder cancer brain breast cancer burden of disease burns Cancer of the uterus cancers capitation capitation payment Cataract Cataract surgery cataracts Central nervous system certification child health childbirth chronic diseases Cleft palate clinics Communicable diseases contraception costs of health care curative health care Cystic fibrosis Deafness delivery system Dental care depression diabetes Diabetes Mellitus diagnosis Disability disease management drugs emergency care employment epilepsy equity in access families fee-for-service financial incentives financial protection financial resources financial risks general practitioners Health Affairs health care health care centers Health Care Coverage health care delivery health care facilities health care organizations health care providers health care quality health care services health centers Health Coverage Health Expenditure Health Expenditure Per Capita health facilities Health Financing Health Insurance health insurance market health insurance markets health insurers Health Organization health outcomes Health Plan health plans Health Policy health posts health promotion health providers Health Reform health sector health service health service utilization Health Services health spending Health System health system efficiency health systems health workers healthcare healthcare services heart disease Hemophilia Hepatitis Hepatitis B Hepatitis C HIV/AIDS hospital beds hospital care hospital services hospitalization hospitals human resources Hygiene hypertension illness immunization income income countries Income Distribution indexes Infant mortality Infant mortality rate informal sector informal sector workers information system insurance plan integration laboratory technicians legal obligation leukemia life expectancy life expectancy at birth Lymphoma managed care market failures maternal and child health Medical doctors medical referrals medical services medical specialists medicines morbidity mortality Multiple Sclerosis Myocardial Infarction National Health national health service National Health Services national health spending nurses oral health pacemakers palliative care patient patients physician physicians pneumonia pocket payment postnatal care Pregnancy pregnant women prenatal care prevalence preventive care primary care primary health care primary health care services private care private insurance private insurers private sector private sectors Prostate Prostate cancer providers of health services provision of care provision of health services public health public health care public hospital public hospitals public insurer public providers public sector public spending referrals renal failure right to health care Schizophrenia sex smoking Social Health Insurance Social Security social welfare social workers Strabismus surgery syndrome TB trauma treatment treatments Tuberculosis tumors Visits workers Bitran, Ricardo Explicit Health Guarantees for Chileans : The AUGE Benefits Package |
| description |
This paper focuses on recent and significant health reform implemented in 2005, known as Universal Access with explicit guarantees (Acceso Universal con Garantias Explicitas - AUGE or GES), which mandated SHI insurers to adopt a broad benefits package defined via explicit legal guarantees for all beneficiaries. This innovative reform is a policy reaction to that which previously existed in Chile and which is widespread in many developing countries, whereby the health rights of citizens remain largely undefined or implicit. Limited public resources imply in those countries that access to health care is rationed through queues, patient deflection, legal or under-the-table user fees, and low-quality care. This paper describes the AUGE reform, its implementation, and the functioning of AUGE for the poor and for non-poor citizens. This paper is organized as: section two provides a brief historic overview of health coverage in Chile's SHI system. Section three describes the SHI system in existence today. Section four describes the services offered and mechanisms in place to cover the poor under SHI, while section five spells out the benefits of SHI. Section six introduces the AUGE health reform of 2005, which sought to broaden and make explicit the rights of all SHI beneficiaries. Section seven offers information about the flows and magnitudes of health financing in SHI. Section eight focuses on the system used by Fonasa to target the poor. Section nine explains how Fonasa manages AUGE. Section ten comments on the information environment of AUGE. Section eleven addresses the equity and fiscal implications of expanding the AUGE benefits. Finally, section twelve proposes a pending policy agenda related to the coverage of the poor under SHI and the definition and management of benefits. |
| format |
Publications & Research :: Working Paper |
| topic_facet |
access to health care access to health services access to services adolescents Adult mortality Adult mortality rate aged allocative efficiency ambulatory care aneurysm appropriate treatment ARI arthritis arthrosis asthma Bladder cancer brain breast cancer burden of disease burns Cancer of the uterus cancers capitation capitation payment Cataract Cataract surgery cataracts Central nervous system certification child health childbirth chronic diseases Cleft palate clinics Communicable diseases contraception costs of health care curative health care Cystic fibrosis Deafness delivery system Dental care depression diabetes Diabetes Mellitus diagnosis Disability disease management drugs emergency care employment epilepsy equity in access families fee-for-service financial incentives financial protection financial resources financial risks general practitioners Health Affairs health care health care centers Health Care Coverage health care delivery health care facilities health care organizations health care providers health care quality health care services health centers Health Coverage Health Expenditure Health Expenditure Per Capita health facilities Health Financing Health Insurance health insurance market health insurance markets health insurers Health Organization health outcomes Health Plan health plans Health Policy health posts health promotion health providers Health Reform health sector health service health service utilization Health Services health spending Health System health system efficiency health systems health workers healthcare healthcare services heart disease Hemophilia Hepatitis Hepatitis B Hepatitis C HIV/AIDS hospital beds hospital care hospital services hospitalization hospitals human resources Hygiene hypertension illness immunization income income countries Income Distribution indexes Infant mortality Infant mortality rate informal sector informal sector workers information system insurance plan integration laboratory technicians legal obligation leukemia life expectancy life expectancy at birth Lymphoma managed care market failures maternal and child health Medical doctors medical referrals medical services medical specialists medicines morbidity mortality Multiple Sclerosis Myocardial Infarction National Health national health service National Health Services national health spending nurses oral health pacemakers palliative care patient patients physician physicians pneumonia pocket payment postnatal care Pregnancy pregnant women prenatal care prevalence preventive care primary care primary health care primary health care services private care private insurance private insurers private sector private sectors Prostate Prostate cancer providers of health services provision of care provision of health services public health public health care public hospital public hospitals public insurer public providers public sector public spending referrals renal failure right to health care Schizophrenia sex smoking Social Health Insurance Social Security social welfare social workers Strabismus surgery syndrome TB trauma treatment treatments Tuberculosis tumors Visits workers |
| author |
Bitran, Ricardo |
| author_facet |
Bitran, Ricardo |
| author_sort |
Bitran, Ricardo |
| title |
Explicit Health Guarantees for Chileans : The AUGE Benefits Package |
| title_short |
Explicit Health Guarantees for Chileans : The AUGE Benefits Package |
| title_full |
Explicit Health Guarantees for Chileans : The AUGE Benefits Package |
| title_fullStr |
Explicit Health Guarantees for Chileans : The AUGE Benefits Package |
| title_full_unstemmed |
Explicit Health Guarantees for Chileans : The AUGE Benefits Package |
| title_sort |
explicit health guarantees for chileans : the auge benefits package |
| publisher |
World Bank, Washington DC |
| publishDate |
2013-01 |
| url |
http://hdl.handle.net/10986/13288 |
| work_keys_str_mv |
AT bitranricardo explicithealthguaranteesforchileanstheaugebenefitspackage |
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1756572724687273984 |
| spelling |
dig-okr-10986132882021-04-23T14:03:07Z Explicit Health Guarantees for Chileans : The AUGE Benefits Package Bitran, Ricardo access to health care access to health services access to services adolescents Adult mortality Adult mortality rate aged allocative efficiency ambulatory care aneurysm appropriate treatment ARI arthritis arthrosis asthma Bladder cancer brain breast cancer burden of disease burns Cancer of the uterus cancers capitation capitation payment Cataract Cataract surgery cataracts Central nervous system certification child health childbirth chronic diseases Cleft palate clinics Communicable diseases contraception costs of health care curative health care Cystic fibrosis Deafness delivery system Dental care depression diabetes Diabetes Mellitus diagnosis Disability disease management drugs emergency care employment epilepsy equity in access families fee-for-service financial incentives financial protection financial resources financial risks general practitioners Health Affairs health care health care centers Health Care Coverage health care delivery health care facilities health care organizations health care providers health care quality health care services health centers Health Coverage Health Expenditure Health Expenditure Per Capita health facilities Health Financing Health Insurance health insurance market health insurance markets health insurers Health Organization health outcomes Health Plan health plans Health Policy health posts health promotion health providers Health Reform health sector health service health service utilization Health Services health spending Health System health system efficiency health systems health workers healthcare healthcare services heart disease Hemophilia Hepatitis Hepatitis B Hepatitis C HIV/AIDS hospital beds hospital care hospital services hospitalization hospitals human resources Hygiene hypertension illness immunization income income countries Income Distribution indexes Infant mortality Infant mortality rate informal sector informal sector workers information system insurance plan integration laboratory technicians legal obligation leukemia life expectancy life expectancy at birth Lymphoma managed care market failures maternal and child health Medical doctors medical referrals medical services medical specialists medicines morbidity mortality Multiple Sclerosis Myocardial Infarction National Health national health service National Health Services national health spending nurses oral health pacemakers palliative care patient patients physician physicians pneumonia pocket payment postnatal care Pregnancy pregnant women prenatal care prevalence preventive care primary care primary health care primary health care services private care private insurance private insurers private sector private sectors Prostate Prostate cancer providers of health services provision of care provision of health services public health public health care public hospital public hospitals public insurer public providers public sector public spending referrals renal failure right to health care Schizophrenia sex smoking Social Health Insurance Social Security social welfare social workers Strabismus surgery syndrome TB trauma treatment treatments Tuberculosis tumors Visits workers This paper focuses on recent and significant health reform implemented in 2005, known as Universal Access with explicit guarantees (Acceso Universal con Garantias Explicitas - AUGE or GES), which mandated SHI insurers to adopt a broad benefits package defined via explicit legal guarantees for all beneficiaries. This innovative reform is a policy reaction to that which previously existed in Chile and which is widespread in many developing countries, whereby the health rights of citizens remain largely undefined or implicit. Limited public resources imply in those countries that access to health care is rationed through queues, patient deflection, legal or under-the-table user fees, and low-quality care. This paper describes the AUGE reform, its implementation, and the functioning of AUGE for the poor and for non-poor citizens. This paper is organized as: section two provides a brief historic overview of health coverage in Chile's SHI system. Section three describes the SHI system in existence today. Section four describes the services offered and mechanisms in place to cover the poor under SHI, while section five spells out the benefits of SHI. Section six introduces the AUGE health reform of 2005, which sought to broaden and make explicit the rights of all SHI beneficiaries. Section seven offers information about the flows and magnitudes of health financing in SHI. Section eight focuses on the system used by Fonasa to target the poor. Section nine explains how Fonasa manages AUGE. Section ten comments on the information environment of AUGE. Section eleven addresses the equity and fiscal implications of expanding the AUGE benefits. Finally, section twelve proposes a pending policy agenda related to the coverage of the poor under SHI and the definition and management of benefits. 2013-05-02T17:57:26Z 2013-05-02T17:57:26Z 2013-01 http://hdl.handle.net/10986/13288 en_US UNICO Studies Series;No. 21 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo World Bank World Bank, Washington DC Publications & Research :: Working Paper Publications & Research Latin America & Caribbean Chile |