Making health policy gender sensitive in Chile

Santiago: As a woman of childbearing age, “I pay more than double what a man my age pays for the same health plan,” said 27-year-old Carolina Leyton.

Women waiting for treatment at a health centre/ Photo credit: IPS

Leyton is a subscriber of one of Chile’s private healthcare providers, known as ISAPREs (Instituciones de Salud Previsional), which set different premiums depending on the “risk” associated with the beneficiary.

Since socialist President Michelle Bachelet came into office in 2006, her administration has worked to advance health policies with a gender perspective.

“But we’re still weighed down by a huge debt to women,” said Health Ministry gender adviser María Isabel Matamala.

Seventeen percent of Chile’s nearly 17 million people are currently insured through one of the ISAPREs, which were created in 1981 as a result of a partial privatisation of the country’s healthcare system carried out by then dictator Augusto Pinochet (1973-1990) as part of his neoliberal recipe.

The rest of the population receives health coverage through the public National Health Fund (FONASA) system.

“In the ISAPREs everyone pays an identical basic rate, but they must also pay an additional risk factor,” said Alberto Muñoz, head of Funds and Insurance at the Office of the Health Superintendent (a ministerial-level body established as part of a series of health reforms implemented by Bachelet’s predecessor Ricardo Lagos).

The risks associated with women are the greater services they require and the benefits they receive for maternity leave.

The ISAPRE Act, passed in 2005 as the culmination of Lagos’ wider health system reform, reduced the huge inequalities that women and the elderly suffered under these health insurers. Consequently, the law boosted the percentage of private subscribers.

But the law did not completely eliminate the perverse risk-based logic.

Patricia Encina is 30 years old and pays around 93 dollars a month for a plan that costs her husband – also 30 – only 35 dollars. “The ISAPREs charge women three times more because we’re mothers, even though it takes two to have a baby,” she complained.

Before the reform, the cost of health plans available for women aged 25 to 45 could be as high as six times the cost of plans for men in the same age range, and while that difference was lowered substantially it’s still around three times more.

The law also did away with the so-called “no uterus” plans that provided no maternity coverage and were created to lower the cost of insuring women, but which left them without coverage in the event of an unplanned pregnancy.