By Veronica Vargas
At this unprecedented COVID moment, health has been revealed as one of our most precious possessions and protecting it has become imperative. The right to health was articulated by the WHO in the Declaration of Alma-Ata of 1978. The upcoming constitutional debate in Chile is an opportunity to re-examine this concept.
The Chilean constitution specifies the right to “free and egalitarian access” to health care. Simultaneously, the constitution guarantees that “each person has the right to choose the health system they wish to join, either public or private.”
These provisions have championed a prospering private health sector, with corporate clinics and a private insurance system that represents almost half of total health spending.
However, this private sector serves less than 20 percent of the population. Nearly 80 percent of the population utilizes public sector insurance. Although the public sector has been expanding its coverage of health services, and health indicators for those with public insurance have been improving, the public sector is chronically underfunded. Public sector health care spending represents only 4% of the GDP.
Public health interventions and pharmaceutical innovations have been essential in extending life expectancy and improving well-being. In particular, access to pharmaceuticals represents a critical part of health care. But access to drugs is far from universal. Nearly a third of out-of-pocket spending in Chile is for drugs. And out-of-pocket expenditures represent 33 percent of Chile’s total health expenditures, which is one of the highest proportions of out-of-pocket expenditures for the OECD countries. Many feel that they must handle the health risks they encounter by themselves, with wages seldom stretching to cover these expenses. As a consequence, social protection is being seriously undermined.
Access to health care and pharmaceuticals were among the key demands during the social protests of last year —which had nearly 1 million demonstrators on October 25th. One of the main targets of discontent was pharmacy chain stores. Tenuous access to necessary drugs is bolstered by high variation in prices at pharmacies. Patients are nudged to purchase goods they don’t need in times of greater vulnerability. This situation is compounded by the state’s unwillingness to intervene and regulate retail pharmacies and drug prices. As a result, citizens are demanding that the right to health be guaranteed in the constitution.
Incorporating the right to health in the constitution has had mixed results in Latin America. In the late 1990s and early 2000s in Brazil, the right to health positively impacted the access to HIV/AIDS treatment and overcame the gaps between what was stipulated in the public policy and what was implemented. Since the mid-2000s, disputes over the coverage that the state must provide have been resolved through litigation. Sometimes, litigation has led to the provision of ineffective care in the public sector — something we should be cautious about in the future.
The upcoming plebiscite presents a historic opportunity to open a debate and incorporate the principles of a right to health and universal health care into the nation’s constitution, which, in turn, should facilitate legislative reforms that protect people, especially at their most vulnerable. All Chileans stand to benefit from such reforms.
Veronica Vargas, Ph.D., is an economist who focuses on health economics, global health, and health policy. She is affiliated with the Alberto Hurtado University, Chile. For the last three years, she has been a visiting scholar at Harvard University. Her current research explores the research and development of novel vaccines and pharmaceuticals for infectious diseases, in both Latin America and South Asia. She is a former visiting scholar at the David Rockefeller Center for Latin American Studies, Harvard University.
Vargas would like to thank Bernardo Aguilera and Sergio Poblete for their comments.