Política de Salud en Chile

Abstract

Este artículo analiza el proceso político que condujo al establecimiento de la política de acceso universal con garantías explícitas en Salud (AUGE-GES), expone las ideas y creencias que sustentaron los actores protagónicos, describe las etapas por las que transcurrió el proceso y explica por qué la reforma de salud chilena que condujo a la política del AUGE-GES pudo ser posible en la década del 2000 y no antes. El artículo se basa en la teoría del equilibrio discontinuo y en el esquema de la coalición promotora. Constituye un estudio de caso explicativo, que analiza la evolución del sector salud chileno desde 1990 al 2006. El análisis que se presenta se basa en 36 entrevistas en profundidad a personas que desempeñaron destacados roles en el cambio de la política pública, en la revisión de 1.400 recortes de prensa escrita, en documentos elaborados por organismos públicos y en publicaciones de expertos. El trabajo concluye que las políticas públicas pueden ser vistas como el resultado de la confrontación de sistemas de creencias -desde las cuales actores políticos influyentes seleccionan problemas sobre los cuales intervenir e ideas que representan las soluciones- y de la acción decidida de actores que concilian posiciones y articulan acuerdos que permiten materializar una nueva intervención.

Explaining Uneven Social Policy Expansion in Democratic Chile

“…Within the Lagos administration, there was a high level of ideological diversity, as three different visions of healthcare reform prevailed. According to Olavarría Gambi (2011), there was a “statist” view that rejected profiting in the realm of social provision, questioned whether regulation could correct market inequalities, and favored limiting the role of ISAPREs. Additionally, he claims that there was an “integrated health” approach that sought to increase public sector efficiency, wanted to improve management mechanisms, recognized the role of ISAPREs but wanted to reduce discrimination in the private healthcare subsystem, and advocated the creation of a superintendency with monitoring responsibilities in both the private and public systems.…”

“…Additionally, he claims that there was an “integrated health” approach that sought to increase public sector efficiency, wanted to improve management mechanisms, recognized the role of ISAPREs but wanted to reduce discrimination in the private healthcare subsystem, and advocated the creation of a superintendency with monitoring responsibilities in both the private and public systems. A third, “proprivate” view, endorsed by right-wing sectors outside the executive office, favored improving the ISAPRE system, increasing efficiency in the management of public healthcare, boosting the competitiveness of the public and private sectors, introducing new subsidies that beneficiaries could freely use in the private or public subsystems, and avoiding increasing taxes and regulatory pressures on ISAPREs (Olavarría Gambi 2011, 363–64).…”

“…Partly because of the existence of these contrasting views and partly because of tension over the roles of both commissions (Lenz 2007, 12; Olavarría Gambi 2011, 364), healthcare reform was comparatively much more complex than pension reform.…”

Biopolitics and speculative objects in Chilean health projects

“…The sociological literature on these projects is large (e.g. Bascolo et al, 2018;Bastías & Valdivia, 2007) and tends to focus on their historical origins, the types of governments that promote them and the socio-political and cultural conditions that have enabled them to succeed or fail (Ferrer, 2004;Olavarría, 2011Olavarría, , 2012.…”