Implementation of the Universal Access with Explicit Guarantees (AUGE) reform

Overview

The manner by which public and private health insurance developed in Chile resulted in a health financing system that segmented the population by income and health risk. This resulted in inequitable access and use of health services and outcomes, with the richer population covered by private insurance enjoying much greater benefits than the rest. In 2005, a reform known as Universal Access with Explicit Guarantees (AUGE) was designed and implemented to provide a defined set of benefits to citizens irrespective of their public or private insurance status. The reform was supported with additional public resources mobilized through 1% value added tax increase, and the defined package initially included 56 priority health services representing 65% of the Chilean disease burden, among which were high cost interventions that had posed a catastrophic cost risk for many people. The paper discusses efficiency aspects and effects of the reform on access (e.g. impacts on patient financial barriers and waiting times), equity, service use and financial protection for all socioeconomic groups, and especially for the people in the lowest income quintile.

Synthesis report

The Chile case study is part of a synthesis report that applied a causal framework to synthesize lessons from ten case studies of various health system reforms which aimed to improve the efficiency in health systems.