Page 173 - GHES-2-4

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

Table 6. ICD‑10 groups and disease details effective financial coverage of services for mental disorders
concerning physical health services. The instruction issued
ICD‑10 group Description by the SoH through the circular means that the Isapres (in
A00 – B99 Infectious and parasitic their health plans sold from March 2022 onward) must not
C00 – D48 Tumors (neoplasms) differentiate financial coverage between MH and physical
COVID COVID-19 health services.
D50 – D89 Blood and hematopoietic organ diseases In this sense, for the 2022 analysis, two groups of health
E00 – E90 Endocrine, nutritional, and metabolic disorders plans are formed. On the one hand, individual plans sold
F00 – F99 Mental and behavioral disorders from March 2022 onward are analyzed, which theoretically
G00 – G99 Nervous system have no constraints on coverage for MH services. This
group contrasts with the rest of all the individual plans
H00 – H59 Of the eye and its appendages
in force during the period, which may or may not have
H60 – H95 Of the ear and mastoid process constraints on MH services coverage (excluding those
I00 – I99 Circulatory system in the other group mentioned above). This study seeks
J00 – J99 Respiratory system to establish whether the instruction issued by the SoH
K00 – K93 Digestive system increased the effective financial coverage of MH services,
L00 – L99 Skin and subcutaneous tissue on average, to the same level as physical health services.
M00 – M99 Musculoskeletal and connective tissue system When analyzing the GES health problems for 2022, a
N00 – N99 Genitourinary system high level of effective coverage occurs (similar to 2021, it
O00 – O99 Pregnancy, childbirth, and puerperium reached 95.7%), reflecting absolute financial protection for
Other diagnoses Other diagnoses those who use the health problems covered therein.
P00 – P96 Certain conditions originating in the perinatal period 3.2.1. Outpatient and inpatient services
Q00 – Q99 Congenital malformations, deformities, and
chromosomal abnormalities Analyzing the average effective coverage in face-to-
R00 – R99 Symptoms, signs, and abnormal clinical findings face medical consultations for 2022 (Tables 7 and 8)
in plans without restricted coverage, concerning those
S00 – T98 Trauma, poisoning, and other consequences of with restricted coverage, the absence of information for
external causes Colmena on amounts billed for MH medical consultations
V01 – Y98 External causes of morbidity and mortality
without restricted coverage is striking. This study assumes
Z00 – Z99 Factors influencing health status and contact with that there would have been no services for face-to-face
health services
Unclassified MH medical consultations in that period for that group of
plans.
dismissed or reduced by the Isapre. This situation occurs In Vida Tres and Banmédica, in plans without coverage
exclusively in diagnoses for mental disorders since, in all constraints, the low financial coverage in psychiatric
other diagnostic groups, the proportion of authorized sick medical consultations of MH (adult and pediatric) is
leaves far exceeds the proportion of rejected/reduced – the maintained. In both cases, it is even lower than the average
following lowest proportion of authorized after mental 2021 level (i.e., before the issuance of the SoH regulations).
disorders is that of group G (nervous system) with 70.3%. In addition, for these two Isapre, the effective coverage for
individuals in plans without coverage constraints is even
Regarding the number of sick leaves in MH, if one lower than in plans with restricted coverage.
considers the elements above concerning restricted In the case of Isapre Cruz Blanca, Nueva Masvida, and
financial coverage, a plausible hypothesis is that the number Consalud, coverage increased from 2021 to 2022 and in
of sick leaves processed should be even higher than those plans with restricted coverage.
observed without such highly restricted coverage.
Analyzing plans without restricted coverage shows that
3.2. Enforcement of 21,331 Law: Financial coverage all the Isapres increased significantly in the coverage of
and sick leaves in the Chilean private healthcare clinical psychologist consultation.
system
Despite the relative increase in MH medical consultation
As mentioned in the previous section, the 21,331 law, coverage in some Isapres, the coverage is lower compared
together with circular IF/Nº 396 issued by the SoH, provides to medical consultations of other specialties. Although the
clear instructions concerning the nondifferentiation of the differences are narrowing, MH medical consultations still

Volume 2 Issue 4 (2024) 7 https://doi.org/10.36922/ghes.3408