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.

Bibliographic Details

Main Author:	Bitran, Ricardo
Format:	Working Paper biblioteca
Language:	en_US
Published:	World Bank, Washington DC 2013-01
Subjects:	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,
Online Access:	http://hdl.handle.net/10986/13288
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