Page 178 - GHES-2-4

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

plans that eliminate coverage constraints, which the SoH has occurred, with the proportion of authorized sick
instructed through circular IF/No. 396. leaves decreasing even more and the gap concerning other
Comparing the results of effective financial coverage diagnostic groups increasing. In this sense, it is essential
between the plans without and with coverage constraints to complement the provisions of the law through other
in terms of medical consultations and bed days shows an specific regulations issued by the Superintendence of
increase in coverage in plans without coverage constraints Social Security and the SoH.
concerning those with restricted coverage (the favorable It is essential to pay attention to the differences by
result of the law). However, differences still show lower gender in the financing of MH, both in terms of lower
effective coverage in MH services concerning physical financial coverage for women than men (except in specific
health services, which in some cases are pretty marked cases, this occurs in most MH services), as well as a higher
(e.g., in face-to-face medical consultations). proportion of rejected and reduced sick leaves for women.
Interestingly, medical consultations by telemedicine, It is a worrying and relevant issue to consider in public
which led to significant increases in coverage in the case policy. Worldwide figures show a deterioration in the MH
of MH, were already observed before the law and further of girls and adolescents with significant increases in suicide
strengthened after it, reaching coverage close to 50% in rates (higher than in men) (Jo et al., 2023), experiences of
psychiatry consultations and 69% in clinical psychologist sadness and hopelessness, which is ratified for Chile, where
th
consultations. From a financing perspective, telemedicine the 10 National Youth Survey (2022) shows that for each
decreases OOP expenses and containment of health MH discomfort consulted, a higher proportion of women
expenditures (due to the lower value of the service). This than men reported having experienced them. Actions
effect is particularly relevant in MH to improve access must be taken to address this latent, silent, and growing
to care for mental disorders and treatment adherence, demand expected to come on an equal footing with men.
especially in regions (excluding the capital city) with low For example, measures could be applied, such as improving
presence of lack of professionals. Telemedicine also has the the administrative institutional framework for sick leaves,
benefit of reducing the barriers associated with stigma in the as well as improving the institutional framework for the
care of mental disorders, especially in specific populations. authorization of sick leaves and the regulation of the
Additional issues arise that require further study, such as appeals process.
whether social determinants influence access to and use of The results show the reality faced by beneficiaries
telemedicine, whether health outcomes equivalent to face- who use MH services: on average, and despite the law,
to-face consultations are achieved, and whether the same they continue to face low relative effective coverage
quality of care is ensured versus face-to-face consultations. (except GES), i.e., high relative levels of OOP expenses
Regarding sick leaves, the 21,331 law stated that health (copayments). However, this has been attenuated with the
care could not give rise to discrimination concerning new health plans without theoretical constraints on MH
other diseases about the acceptance rate of sick leaves. coverage. Coverage is far from equal to physical health
However, the subsequent SoH regulations provide no services, which ultimately discourages health care and
further information (this study found nothing from the adherence to treatment (which we also know in the long
Superintendence of Social Security); thus, this condition term implies higher costs, both for the system and OOP).
was only established in the law but not operationalized The most affected are people who face mental disorders
through other administrative regulations. In this sense, the without adequate financial coverage. Insufficient coverage
practice of rejection and reduction of sick leaves for mental may dissuade such individuals from going to health
disorders is more pronounced, where only 1 of every 5 providers to treat their mental disorders, as such treatment
sick leaves (20%) processed is authorized. In comparison, could generate an economic catastrophe for the household.
49.2% of intermuscular sick leaves are authorized (more Although the 21,331 law goes in the right direction of
than double that of MH), further deepening the gap what the WHO recommends in this matter, in practice,
concerning other diagnostic groups. This disparity may be a significant gap remains between the effective financial
due to the significant increase in the number of licenses coverage of MH services concerning physical health and
processed by HM, which implies a considerable increase in the resolution of sick leaves for mental disorders versus
the number of days granted; thus, it is an expected (though another diagnostic group.
not desirable) response from insurers to contain costs in
the short term. 5. Conclusion
The results show no change concerning sick leaves The implementation of law 21,331 on MH affected
with the 21,331 law; the figures show that the opposite financing in Chile’s private health-care system and shows

Volume 2 Issue 4 (2024) 12 https://doi.org/10.36922/ghes.3408