Page 168 - GHES-2-4

Global Health Economics and
Sustainability
Evaluation of mental health law in Chile

Depending on the local context, some individuals and an MH budget of 6% of the total budget, covering
social groups may be at significantly higher risk for mental promotion, prevention, treatment, and rehabilitation
disorders, and such individuals have excessively high rates actions, aiming to collaborate that individuals, families, and
of disability and mortality (Prince et al., 2007). communities reach the highest possible level of well-being
Mental disorders increase the risk of communicable (National Plan of MH 2017 – 2025). In contrast, the Lancet
and noncommunicable diseases and contribute to Commission on Global MH and Sustainable Development
accidental and intentional injuries. Conversely, many (2018) suggests that MH should be allocated at least 5% of
health conditions increase the risk of mental disorders, the health budget in low- and middle-income countries and
and comorbidity complicates help-seeking, diagnosis, and 10% in high-income countries (the World Bank classifies
Chile as a high-income country).
treatment and influences prognosis (Prince et al., 2007).
Mental disorders often lead individuals and their In this aspect, spending reflects MH’s priority within
families into poverty. Health systems do not adequately each country’s health system. Low spending should be
respond to the burden of mental disorders; thus, the a warning to governments, especially since, in the next
10 years, depression is predicted to be a more significant
divergence between the need for treatment and its provision burden for countries than any other disease.
is significant around the world (PAHO-WHO, 2018).
Nearly 1 billion people live with mental disorders; Health expenditure as a % of the global gross domestic
however, in low- and middle-income countries, more than product (GDP) has increased from 3% in 1948 to 10.35% in
75% of people with mental, neurological, and substance 2021 (Source: World Bank Health Data, 2024). In Chile, it
reached 9.0% in 2022 (7.0% in 2000), while the average for
use disorders receive no treatment. Every year, nearly 3 Latin America and the Caribbean (LAC) was 8.65% (2020)
million people die due to the adverse effects of alcohol use, and 9.3% for the Organisation for Economic Co-operation
while every 40 s, a person dies by suicide (in the United
States, 100,000 people a year die by suicide). Moreover, and Development (OECD) countries (2022).
about 50% of mental disorders begin before the age of 14 The consistent increase in health spending raises the
(Source: Mental Health key facts, WHO, 2024). question of who finances health systems and how they are
financed. The question is crucial because the ability to pay
More than 160 million people are estimated to need should not hinder people from access to health system
humanitarian assistance due to conflicts, natural disasters, services.
and other emergencies. Rates of mental disorders can
double during such crisis periods. An estimated one in five In this sense, the issue of the mechanisms of contribution
people affected by conflict subsequently suffer from mental to the financing of Chile’s health system becomes relevant.
disorders (Charlson et al., 2019). Figures show that private health spending (also known as
out-of-pocket [OOP] spending) in Chile reached 29.8% in
Affordable MH care before the pandemic was further 2022 (Source: OECD Health Statistics, 2024) from 42.8% in
diminished due to COVID-19, as it disrupted health 2000 and 34.5% in 2010. Comparatively, the average OOP
services worldwide. Indeed, a WHO survey revealed that spending in 2021 was 17.05% globally and 27.5% in LAC
the COVID-19 pandemic either disrupted or completely (Source: World Bank Health Data, 2024). In comparison,
halted critical MH services in 93% of countries (in the OECD countries with similar levels of health spending as
Americas region, 100% of MH services were affected by a proportion of GDP had an average of 20.4% (i.e., OOP is
the pandemic) (WHO, 2020). In contrast, demand for 46% higher in Chile). This relatively high OOP spending
MH is steadily increasing; given the chronic nature of in Chile indicates the low financial protection that the
MH problems, this carries a significant economic impact current health system offers to its insured population. OOP
(present and future) worldwide. health expenditure has the most significant impact on the
The pandemic has had a significant and uneven impact on household budget; it could even become a catastrophic
MH worldwide, where cases of mental disorders, particularly event for families, as it is an integral part of the decision
in young people and mainly women, have increased to seek health care and is the most inequitable and least
dramatically (e.g., depression and anxiety disorders increased efficient source of financing.
25% in the first year of the pandemic) (WHO, 2022). For beneficiaries in Chile’s private health-care system,
In this context, it is important to consider that most suffering from a mental disorder is not the same as
countries allocate <2% of their health budgets to MH. In contracting a physical illness; from a financing point of
contrast, the figure reaches 2.06% in Chile (the region’s view, most health plans in the private health-care system
average) (WHO, 2018). Nonetheless, the WHO recommends have coverage constraints for MH services.

Volume 2 Issue 4 (2024) 2 https://doi.org/10.36922/ghes.3408