The new Chilean Constitution has just been approved. It is an important step in the final break with the Pinochet dictatorship, since the previous one is still in force. It was drafted by the Constitutional Convention and will be submitted to a plebiscite in September. It is innovative, among other things, for its defense of the rights of women and indigenous nations. It also has important content on social rights and nature.
Articles 44 and 45 refer to health and social security. They are crucial because they fundamentally change the privatized health system – the Isapres (Previsional Health Institutions) and the pension system with the AFPs (Pension Fund Administrators) – whose privatization model has spread throughout Latin America and other parts of the world. Currently it is preserved mainly in Chile, Mexico, Colombia and Peru, an interesting fact seen in light of the electoral results in each one. Both issues will also be submitted to a plebiscite after those of the Constitution and the tax reform.
Both this last issue and that of health and pensions are intrinsically related, since profound modifications to these two require an increase in funds to be carried out.
Article 44 expands the current constitutional text, article 19 paragraph 9, and reorganizes the entire health system of the country. It has a broad content, including some aspects that in other countries correspond to the regulatory law. It is understood that this happens so as not to leave Parliament, where the current president does not have a clear majority. Its most outstanding content is the role it ascribes to the State.
Thus, it enshrines the right to health and comprehensive well-being, both physical and mental. It obliges the State to provide the necessary conditions to reach the highest level of health, and for this it must take into account its social determinants. Likewise, it raises to constitutional rank the right of indigenous nations to their medicines, which will be integrated into the health system.
It makes explicit that the leadership of the system corresponds exclusively to the State and encompasses both public and private institutions. This is transcendental in a structure with a very important and powerful private component that also consumes more financial and technological resources. Thus, the regulation, supervision and control of the sector are in the hands of the State. It stipulates that the National Health System is universal, public and integrated and is governed by the principles of equity, solidarity, interculturality, territorial relevance, deconcentration, efficiency, quality, opportunity, gender approach, progressiveness and non-discrimination. However, it gives rise to private providers, although it indicates that the law will specify the conditions under which they can be incorporated.
The care model of the National Health System incorporates all actions from promotion to rehabilitation and inclusion in social life. He points out that primary care forms its basis. In this context, it determines that the participation of the communities in the policies of the sector will be promoted and that the necessary conditions will be created for its effective exercise, which reveals that it is not about the traditional committees, but about a real participation in the decisions on local and national policies.
The issue of financing the National Health System is explicit in the constitutional text, by decreeing that it is carried out through the nation’s general income, that is, taxes. However, it leaves open the establishment of mandatory contributions for employers and workers. In other words, it is expected that quotas for financing can be imposed, but it would not be like before, when the payment of services was the most important source of inequality in access to necessary services. This was not resolved with the AUGE program, established under the government of President Bachelet. It mandates that the regulatory law will determine which public body will be in charge of administering all the funds of this system.
The proposal reveals that the constituents propose to the Chilean nation to recover the National Health System established by Salvador Allende, as well as to advance even more.
Together with the reform of the pension system, efforts are being made to recover health and social security from the hands of financial capital and restore them as social rights.
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