Page 169 - GHES-2-4

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

In this context, the 21,331 Law on the Recognition and From a regulatory perspective, two relevant milestones
Protection of the Rights of Persons in MH Care was enacted occur for developing this study’s analysis. In effect, the
on May 11, 2021 (Biblioteca del Congreso Nacional, 2021). 21,331 law was enacted in May 2021. To comply with the law
Regarding the financing system, Article 20, in its numeral 6, above, the Superintendence of Health (SoH) issued Circular
establishes that “health care may not give rise to discrimination IF/Nº 396 on November 8, 2021 (Superintendencia de Salud,
concerning other diseases, about coverage of services and rate of 2021a), which provides instructions on coverage and access
acceptance of sick leaves.” The above law aligns with the WHO for MH services in Isapres by 21,331 law. Regarding effective
proposal to reduce the importance of household OOP spending financial coverage, the aforementioned circular states that
as a source of health financing, particularly for mental disorders. “health plans may not stipulate for health services related to

Telemedicine in the private health system is a factor that mental or intellectual disabilities, mental illness, and MH,
is in total development. The MH analyses show a lower OOP bonus ceilings and maximum contract year ceilings per
expenditure concerning face-to-face consultations and beneficiary lower than those established for physical health
lower costs for the system. These decreased expenditures services,” which was effective as of March 2022.
are essential for universal health coverage (UHC), helping Given the above, two periods of 12 months are
to solve the low rate of MH professionals in several regions contrasted for this study. The first period, 2021, comprises
of Chile (excluding the Metropolitan Region), facilitating March 2021 – February 2022, while 2022 comprises from
treatment adherence, and helping reduce the stigma- March 2022 to February 2023. In 2021, it is assumed that
related barriers in the care of mental disorders. there will be no effects of the law above or the circular (in
This current study aims to evaluate whether the entry its scope of financing), while 2022 will be used as a contrast
into force of law 21,331 affected the financing of mental to see the potential expected impacts of the law and the
disorders in Chile’s private health-care system. Specifically, circular above.
this study analyzes the effects of increased financial coverage The data used in the study correspond to administrative
associated with services for mental disorders (i.e., decrease data sent by the insurers to the SoH every month.
in OOP expenses) and the acceptance rate of medical leave
compared to the effects observed in physical health care. 3. Results
2. Data and methods 3.1. Before the enactment of 21,331 law: Financial
coverage and sick leaves in Chile’s private health-
Effective financial coverage corresponds to the value of the care system
care charged by the provider that the insurer covers. In the
present study, referring to the private health-care system Table 1 presents information as of January 2022, showing
in Chile, effective financial coverage corresponds to the that of the total number of individual health plans in
amount covered by the private insurer (called Isapre). force (40,838), 3.2% are being sold (1,297), of which 62%
(801 plans) have coverage constraints associated with
Analyzing the effective financial coverage of MH MH. Of the total number of individual plans in force
requires examining the provisions of Article 190 of that are not being sold (39,541), 51% (20,026) have MH
DFL 1 (2005), which states, “A supplementary plan may coverage constraints. When analyzing the information as
1
not stipulate services for any specific benefit for a value of January 2023 (i.e., after the SoH Circular on the subject
<25% of the coverage that the same plan confers to the is implemented), none of the total number of health plans
corresponding generic benefit. Likewise, the services may sold (1,083) has coverage constraints associated with MH.
not have a bonus lower than the financial coverage that the
National Health Fund assures, in the free choice modality, All individual health plans sold out by Colmena,
to all the services contemplated in the tariff referred to in Cruz Blanca, Vida Tres, and Banmédica have coverage
Article 31 of Law No. 19,966, which establishes the General constraints associated with MH. In contrast, none of the
Health Guarantees Regime. Any clauses that contravene individual plans sold out by Nueva Masvida or Consalud
this rule shall be deemed not to be written.” have MH coverage constraints.
The aforementioned is relevant since MH services The relative importance of MH spending is low in
typically have substantial financial coverage constraints Chile’s private health-care system. In fact, by 2021, 5.8% of
through annual or per-event caps in health plans the total billed at the system level corresponds to services
(Superintendencia de Salud, 2021b). related to MH; however, concerning the total covered by
the insurers, it represents only 3.9% of the total, which is
1 This corresponds to the Health Law that governs the entire correlated with copayments, where the weight of MH rises
system in Chile. to 8.9%.

Volume 2 Issue 4 (2024) 3 https://doi.org/10.36922/ghes.3408