Explicit Health Guarantees for Chileans : The AUGE Benefits Package

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dc.creatorBitran, Ricardo
dc.date2013-05-02T17:57:26Z
dc.date2013-05-02T17:57:26Z
dc.date2013-01
dc.date.accessioned2026-07-01T00:50:59Z
dc.descriptionThis 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.
dc.descriptionChile, alcanzó una cobertura casi universal por medio del seguro social de salud a mediados del siglo XX ofreció a los pobres cobertura subsidiada con recursos públicos en las primeras etapas de la evolución del seguro social. Chile también fue pionero en la creación de un servicio nacional de salud que constaba de una red pública de hospitales y centros de atención primaria que abarcaba todo el país. Este documento se centra en la reciente y significativa reforma del sistema de salud que se ejecutó en 2005 y se conoce con el nombre de Acceso Universal con Garantías Explícitas, AUGE o GES), la cual dispuso que las aseguradoras del seguro social debían adoptar un plan amplio de beneficios definido por medio de garantías legales explícitas para todos los beneficiarios.
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dc.identifierhttps://hdl.handle.net/10986/13288
dc.identifierhttps://doi.org/10.1596/13281
dc.identifier.urihttp://hdl.handle.net/123456789/411917
dc.languageen_US
dc.publisherWorld Bank, Washington DC
dc.relationUNICO Studies Series;No. 21
dc.rightsCC BY 3.0 IGO
dc.rightshttp://creativecommons.org/licenses/by/3.0/igo
dc.rightsWorld Bank
dc.subjectaccess to health care
dc.subjectaccess to health services
dc.subjectaccess to services
dc.subjectadolescents
dc.subjectAdult mortality
dc.subjectAdult mortality rate
dc.subjectaged
dc.subjectallocative efficiency
dc.subjectambulatory care
dc.subjectaneurysm
dc.subjectappropriate treatment
dc.subjectARI
dc.subjectarthritis
dc.subjectarthrosis
dc.subjectasthma
dc.subjectBladder cancer
dc.subjectbrain
dc.subjectbreast cancer
dc.subjectburden of disease
dc.subjectburns
dc.subjectCancer of the uterus
dc.subjectcancers
dc.subjectcapitation
dc.subjectcapitation payment
dc.subjectCataract
dc.subjectCataract surgery
dc.subjectcataracts
dc.subjectCentral nervous system
dc.subjectcertification
dc.subjectchild health
dc.subjectchildbirth
dc.subjectchronic diseases
dc.subjectCleft palate
dc.subjectclinics
dc.subjectCommunicable diseases
dc.subjectcontraception
dc.subjectcosts of health care
dc.subjectcurative health care
dc.subjectCystic fibrosis
dc.subjectDeafness
dc.subjectdelivery system
dc.subjectDental care
dc.subjectdepression
dc.subjectdiabetes
dc.subjectDiabetes Mellitus
dc.subjectdiagnosis
dc.subjectDisability
dc.subjectdisease management
dc.subjectdrugs
dc.subjectemergency care
dc.subjectemployment
dc.subjectepilepsy
dc.subjectequity in access
dc.subjectfamilies
dc.subjectfee-for-service
dc.subjectfinancial incentives
dc.subjectfinancial protection
dc.subjectfinancial resources
dc.subjectfinancial risks
dc.subjectgeneral practitioners
dc.subjectHealth Affairs
dc.subjecthealth care
dc.subjecthealth care centers
dc.subjectHealth Care Coverage
dc.subjecthealth care delivery
dc.subjecthealth care facilities
dc.subjecthealth care organizations
dc.subjecthealth care providers
dc.subjecthealth care quality
dc.subjecthealth care services
dc.subjecthealth centers
dc.subjectHealth Coverage
dc.subjectHealth Expenditure
dc.subjectHealth Expenditure Per Capita
dc.subjecthealth facilities
dc.subjectHealth Financing
dc.subjectHealth Insurance
dc.subjecthealth insurance market
dc.subjecthealth insurance markets
dc.subjecthealth insurers
dc.subjectHealth Organization
dc.subjecthealth outcomes
dc.subjectHealth Plan
dc.subjecthealth plans
dc.subjectHealth Policy
dc.subjecthealth posts
dc.subjecthealth promotion
dc.subjecthealth providers
dc.subjectHealth Reform
dc.subjecthealth sector
dc.subjecthealth service
dc.subjecthealth service utilization
dc.subjectHealth Services
dc.subjecthealth spending
dc.subjectHealth System
dc.subjecthealth system efficiency
dc.subjecthealth systems
dc.subjecthealth workers
dc.subjecthealthcare
dc.subjecthealthcare services
dc.subjectheart disease
dc.subjectHemophilia
dc.subjectHepatitis
dc.subjectHepatitis B
dc.subjectHepatitis C
dc.subjectHIV/AIDS
dc.subjecthospital beds
dc.subjecthospital care
dc.subjecthospital services
dc.subjecthospitalization
dc.subjecthospitals
dc.subjecthuman resources
dc.subjectHygiene
dc.subjecthypertension
dc.subjectillness
dc.subjectimmunization
dc.subjectincome
dc.subjectincome countries
dc.subjectIncome Distribution
dc.subjectindexes
dc.subjectInfant mortality
dc.subjectInfant mortality rate
dc.subjectinformal sector
dc.subjectinformal sector workers
dc.subjectinformation system
dc.subjectinsurance plan
dc.subjectintegration
dc.subjectlaboratory technicians
dc.subjectlegal obligation
dc.subjectleukemia
dc.subjectlife expectancy
dc.subjectlife expectancy at birth
dc.subjectLymphoma
dc.subjectmanaged care
dc.subjectmarket failures
dc.subjectmaternal and child health
dc.subjectMedical doctors
dc.subjectmedical referrals
dc.subjectmedical services
dc.subjectmedical specialists
dc.subjectmedicines
dc.subjectmorbidity
dc.subjectmortality
dc.subjectMultiple Sclerosis
dc.subjectMyocardial Infarction
dc.subjectNational Health
dc.subjectnational health service
dc.subjectNational Health Services
dc.subjectnational health spending
dc.subjectnurses
dc.subjectoral health
dc.subjectpacemakers
dc.subjectpalliative care
dc.subjectpatient
dc.subjectpatients
dc.subjectphysician
dc.subjectphysicians
dc.subjectpneumonia
dc.subjectpocket payment
dc.subjectpostnatal care
dc.subjectPregnancy
dc.subjectpregnant women
dc.subjectprenatal care
dc.subjectprevalence
dc.subjectpreventive care
dc.subjectprimary care
dc.subjectprimary health care
dc.subjectprimary health care services
dc.subjectprivate care
dc.subjectprivate insurance
dc.subjectprivate insurers
dc.subjectprivate sector
dc.subjectprivate sectors
dc.subjectProstate
dc.subjectProstate cancer
dc.subjectproviders of health services
dc.subjectprovision of care
dc.subjectprovision of health services
dc.subjectpublic health
dc.subjectpublic health care
dc.subjectpublic hospital
dc.subjectpublic hospitals
dc.subjectpublic insurer
dc.subjectpublic providers
dc.subjectpublic sector
dc.subjectpublic spending
dc.subjectreferrals
dc.subjectrenal failure
dc.subjectright to health care
dc.subjectSchizophrenia
dc.subjectsex
dc.subjectsmoking
dc.subjectSocial Health Insurance
dc.subjectSocial Security
dc.subjectsocial welfare
dc.subjectsocial workers
dc.subjectStrabismus
dc.subjectsurgery
dc.subjectsyndrome
dc.subjectTB
dc.subjecttrauma
dc.subjecttreatment
dc.subjecttreatments
dc.subjectTuberculosis
dc.subjecttumors
dc.subjectVisits
dc.subjectworkers
dc.titleExplicit Health Guarantees for Chileans : The AUGE Benefits Package
dc.titleGarantís explícitas de salud para los Chilenos : el plan de beneficios del AUGE - Serie de estudios ÚNICO
dc.titleGarantias explicitas de salud para los Chilenos : el plan de beneficios del AUGE

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