Fragmentation of Health Benefits Plans in Chile: Findings from a comparative policy analysis and implications for...

Health Benefit Packages (HBPs) are essential for advancing universal health coverage (UHC) globally. In Chile, a fragmented and segmented health system includes multiple HBPs. Understanding their characteristics is crucial to inform policy debates on whether to maintain multiple HBPs or move toward a unified national plan.

To characterize Chile's HBPs by examining their foundations, mechanisms for defining and updating covered services, and their interactions with health system functions and outcomes.

We conducted a document review informed by methodological approaches from rapid reviews. Primary sources included laws, decrees, regulations, and technical norms governing HBPs in Chile, complemented by information from institutional websites and selected grey literature. Data were systematized using a conceptual matrix with three domains and twelve dimensions capturing the main elements of any HBP.

Seven HBPs were identified, including the "Explicit Health Guarantees Plan" and the "Ricarte Soto Law", the "High-Cost Oncological Drugs Fund", and the essential HBP for the public, private and the armed forces and security forces system. Significant variability was found across eight of the twelve dimensions, particularly regarding health technology assessment mechanism. Similarities were observed in principles, laws, healthcare provisions, and regulatory dimensions.

Maintaining multiple HBPs may hinder equitable access to health services. We recommend that Chile advance toward harmonizing or unifying the set of services into a universal HBP, supported by a robust HTA mechanism to ensure transparency and fairness. This approach could enhance the effectiveness of the health system and help achieve UHC.