COVID-19 pandemic and mental healthcare: Impact on health insurance with guaranteed universal access in Chile

Abstract

BackgroundUniversal health coverage (UHC) is a goal of the member states of the United Nations. The negative impact of the COVID-19 pandemic on mental health, inequalities in access to care, and financing gaps set a problematic scenario for universal mental health coverage. In Latin America, depression and anxiety disorders have increased by more than 30%. Chile implemented a reform for UHC in 2005 generating a mandatory guaranteed plan for health insurance (GES) that covers schizophrenia, depression, bipolar disorders, and Alzheimer's disease. We assume that the pandemic increased cases of mental illness in GES of public and private insurance.ObjectivesThis study aimed to explore the effects of the pandemic on the use of the GES mental health plan of public and private insurance.MethodsA descriptive analysis of secondary data from public and private insurance on the use and expenditure of the GES plan in mental illness between 2005 and 2020 was carried out. An aggregate analysis of the use of psychiatric consultations without a guaranteed plan and sick leave was performed.ResultsBetween 2005 and 2020, 18.5% of GES cases corresponded to four mental health illnesses (1,682,021 cases). Public insurance covered 80% of cases. In the pandemic, cases of mental illness fell by 10.5% in public insurance and 28.7% in private ones, reducing spending by 33 and 6.2%, respectively. Psychiatric consultations without using the GES plan doubled in 2020 in private insurance, and medical discharges due to mental illness also increased. Leave due to mental illness increased by 20% in both types of insurance.ConclusionThe results suggest that the demand for mental healthcare increased during the pandemic, but public and private health insurance reduced admissions to the GES universal plan for schizophrenia, depression, and bipolar disorder. A universal guaranteed plan in an individual contribution system can have essential weaknesses for people when the principles of social security are not complied with, especially concerning the solidarity of the health insurance system.

Gender differences in life expectancy free of depressive symptoms in Chile between 2003 and 2016

“…A study that compared depressive symptoms among older adults, before and during the pandemics, found an increase between both periods (Herrera et al, 2021 ). Furthermore, an analysis of data on the use of mental health services in Chile suggests that the demand for mental health care increased during the pandemics, but the admissions to the Regime of Explicit Health Guarantees program for people with depression and other mental health conditions decreased, resulting in a higher individual expenditure to access mental health care (Toro-Devia and Leyton, 2023 ).…”

To PCR or not? The impact of shifting policy from PCR to rapid antigen tests to diagnose COVID-19 during the omicron epidemic: a nationwide surveillance study

“…Medical insurance has played important roles in the COVID-19 pandemic, but the government and private insurance systems vary in different countries ( 32 – 34 ). During the COVID-19 epidemic, people have typically avoided unnecessary hospital visits to decrease the risk of infection.…”