Attitudes toward Health Systems Financing in Chile

González, P.; Gutiérrez, Laura L.; Oyanedel, Juan Carlos; Sánchez-Rodríguez, Héctor L.

doi:10.1177/00469580211020187

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…Experience from other settings shows that determining specific revenue sources to finance the scheme, including the extent to which the scheme is financed through general taxes as opposed to contributions, can involve confrontation and disagreements between stakeholders with conflicting values and interests ( Daniels, 2007 ; Debie et al. , 2022 ), with the tensions between solidarity and freedom of choice often at the forefront ( González et al. , 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Procedural fairness in decision-making for financing a National Health Insurance Scheme: a case study from The Gambia

Njie,

Dale,

Gopinathan

2023

Health Policy and Planning

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Achieving universal health coverage (UHC) involves difficult policy choices, and fair processes are critical for building legitimacy and trust. In 2021, The Gambia passed its National Health Insurance (NHI) Act. We explored decision-making processes shaping the financing of the NHI scheme (NHIS) with respect to procedural fairness criteria. We reviewed policy and strategic documents on The Gambia’s UHC reforms to identify key policy choices and interviewed policymakers, technocrats, lawmakers, hospital chief executive officers, private sector representatives and civil society organizations (CSOs) including key CSOs left out of the NHIS discussions. Ministerial budget discussions and virtual proceedings of the National Assembly’s debate on the NHI Bill were observed. To enhance public scrutiny, Gambians were encouraged to submit views to the National Assembly’s committee; however, the procedures for doing so were unclear, and it was not possible to ascertain how these inputs were used. Despite available funds to undertake countrywide public engagement, the public consultations were mostly limited to government institutions, few trade unions and a handful of urban-based CSOs. While this represented an improved approach to public policy-making, several CSOs representing key constituents and advocating for the expansion of exemption criteria for insurance premiums to include more vulnerable groups felt excluded from the process. Overload of the National Assembly’s legislative schedule and lack of National Assembly committee quorum were cited as reasons for not engaging in countrywide consultations. In conclusion, although there was an intent from the Executive and National Assembly to ensure transparent, participatory and inclusive decision-making, the process fell short in these aspects. These observations should be seen in the context of The Gambia’s ongoing democratic transition where institutions for procedural fairness are expected to progressively improve. Learning from this experience to enhance the procedural fairness of decision-making can promote inclusiveness, ownership and sustainability of the NHIS in The Gambia.

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Section: Introductionmentioning

confidence: 99%

Procedural fairness in decision-making for financing a National Health Insurance Scheme: a case study from The Gambia

Njie,

Dale,

Gopinathan

2023

Health Policy and Planning

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“…Triggered by a 30 peso (about USD 0.20) rise in the cost of public transport, a sustained period of social, economic and political unrest took place during October of 2019 in Chile, known as the “Social Outburst'' or Estallido Social . Mobilization and strikes revolved mainly around deep inequalities concerning pensions, health and education [ 16 ]. However, these demonstrations quickly escalated into public disturbances, violence, repression, and serious human rights violations, bringing tension around security matters and (mis)trust in political authorities.…”

Section: Introductionmentioning

confidence: 99%

The social and health protection of migrants in Chile: qualitative analysis of civil society proposals for constitutional change

et al. 2023

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Background A sustained period of social, economic, and political unrest took place during October of 2019 in Chile. As an institutional solution, the “Agreement for Social Peace and the New Constitution” was signed. In this document, most political parties committed to reestablishing peace and public order in Chile, agreeing on the initiation of a constitutional process. To promote participation of civil society actors, the “Popular Initiative for Norms” was enabled. This was a platform where civilians could submit proposals for constitutional norms to be discussed by the Constitutional Convention. We aimed to analyze proposals related to migrants and migrant health. Methods We conducted a qualitative thematic analysis of the proposals. Sixteen of them were related to migrants, and we analyzed their association to health. We also evaluated their link to the Health Goals 2030 set out by the Chilean Ministry of Health and the Global Action Plan 2019–2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Results Four main thematic categories were identified: 1) Humans rights of migrants, refugees, and asylum seekers; 2) Nationality and regularization of migrants and refugees; 3) Political participation and cultural integration of migrants and refugees; and 4) Specific regulations on slavery and human trafficking. These resonated with broader frameworks established in the Health Goals 2030 (Chile) and the Global Action Plan 2019–2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Conclusions The ‘Popular Initiative for Norms’ was a non-binding participatory mechanism. Although the proposals sent through were not guaranteed to be included in the constitutional draft—and despite the final draft being rejected last September 2022—the platform allowed to gain insights into civilian opinions. Our findings showed that there is an incipient yet weak recognition of the rights and situation of migrants in Chile. There was no direct mention of health nor an explicit contemplation of social determinants of health. Despite there being an urgent need to define strategies for migrants’ health in Chile, this study demonstrated that civil awareness and interest are still insufficient.

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“…In this context, a survey carried out by the Center for Conflict and Social Cohesion Studies (COES), in December 2019, asked people to assign a score from 1 to 10 regarding the importance of the different social demands, with 10 being very important. A total of 89.5% of people assigned 10 points to health [ 26 , 27 , 28 ]. Similarly, a survey carried out by the Center of Public Studies (CEP) during that same period showed that people placed “bad quality public health and education” in the fourth position when asked what they thought to be the main reason for social manifestations in Chile [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Health in Chile’s Recent Constitutional Process: A Qualitative Thematic Analysis of Civil Proposals

Cabieses

Esnouf

Blukacz

et al. 2022

IJERPH

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(1) Background: In response to the recent political crisis in Chile, the “Agreement for Social Peace and the New Constitution’’ was approved. We aimed to analyze the health-related civil proposals uploaded to the official website for popular participation in the new constitution in Chile. (2) Methods: We carried out a qualitative thematic analysis of 126 health-related valid proposals. Moreover, we analyzed their link to the Health Goals 2030, established by the Ministry of Health of Chile and to the Sustainable Development Goals (SDGs). (3) Results: Sixteen main categories were reached. In all, they were organized into four main areas: (i) the right to health and the establishment of a universal health system; (ii) effective access to selected healthcare services; (iii) improving health outcomes for all and for the relevant subgroups; and (iv) the social determinants of health, health in all the policies, and community health. We found that these four areas were strongly linked to the Health Goals 2030 for Chile and to the SDGs. (4) Conclusions: Despite the fact that the new constitutional proposal was rejected in September 2022, the civil health-related proposals and the areas of health and healthcare were of interest to the citizens as the request showed a strong demand from the population for participation in matters of health, healthcare, and public health.

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Attitudes toward Health Systems Financing in Chile

Cited by 4 publications

References 33 publications

Procedural fairness in decision-making for financing a National Health Insurance Scheme: a case study from The Gambia

Procedural fairness in decision-making for financing a National Health Insurance Scheme: a case study from The Gambia

The social and health protection of migrants in Chile: qualitative analysis of civil society proposals for constitutional change

Health in Chile’s Recent Constitutional Process: A Qualitative Thematic Analysis of Civil Proposals

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