Describing out-of-pocket health payments in Chile: a look at two health care systems

Background: The importance of the Out-of-Pocket payments (OOP) for health, as well as the share of the household's income devoted to this purpose provide relevant information for the characterization of the health system. Chile has two coexisting alternative insurance systems (a public system called FONASA and a private system generically called ISAPRE or preventive health institutions), becoming an interesting scenario for the analysis of OOP and the comparison of the financial protection provided by different insurance schemes. Aim: To characterize OOP for households enrolled in FONASA and ISAPRE. Material and Methods: Using data from the Chilean Household Budget Survey 2007, we calculated measures of OOP payments for households enrolled in FONASA and ISAPRE, as well as different statistics for the items associated to direct health payments and their importance in household's total health expenditure. Results: The average OOP expenditure for FONASA and ISAPRE enrollees in 2007 was about CLP$ 21.500 and CLP$ 86.000, respectively (3.8% and 6.1% of their income). Drugs were the most important item of this expenditure, ranging from approximately CLP$ 6.500 for FONASA enrollees (31.4%) to CLP$ 25.800 for ISAPRE enrollees (29.9%). The poorest ISAPRE households (comparable to some FONASA households) are those with the higher OOP/income ratio. Conclusions: ISAPRE enrollees have larger OOP payments than FONASA enrollees, not only in absolute terms, but also in terms of the share of their income devoted to direct payments.