[Chile, the difficult path towards a national health service]

The objective of this paper is to describe and analyse the healthcare reform project in Chile following the 2019 social uprising. It outlines the progress, obstacles, and challenges within its historical context. Chile presents very positive health indicators, but also marked inequities stemming from the existing inequality in the country. The Chilean healthcare system has experienced a pendulum swing throughout its history, going from being one of the first integrated healthcare services in Latin America to becoming one of the best examples of the neoliberal model, before attempting to transition once again toward a social protection system with universal access and coverage. The arrival of President Boric to power in 2022 was accompanied by a program that established a conception of health as a social right, generating an agenda of transformations in the sector, consistent with the principles of universal healthcare. Although significant progress has been made (zero co-payments, universal Primary Health Care), the inability to pass the tax reform that would guarantee the structural financing of these changes, along with the difficulties in creating a Universal Health Fund and advancing the transformation of private health insurers (Isapres) into supplementary insurance providers, has significantly limited the scope of these transformations. The difficulties observed in Chile in moving towards a single insurance model demonstrate that the dismantling of welfare states proceeds much more easily than the strengthening of social protection.