The new reforms have strengthened the public system, and enrollment in ISAPREs has declined to 16 percent of the population.
The latter law, also known as the Plan de Acceso Universal con Garantias Explicitas (AUGE) established a list of 56 priority health conditions determined through a cost-analytic approach that both FONASA and ISAPREs were mandated to cover.
Patients with public insurance coverage exhibited the highest prevalence of mental disorders but the lowest rates of consultation, while patients enrolled in ISAPREs had lowest prevalence of mental disorders but the highest rates of consultation.
Additionally, ISAPREs could refuse coverage to pre-existing conditions, forcing the sick to enroll in the public system.
By 1995, enrollment in the ISAPREs had peaked at 26 percent.
Using the Chilean ISAPREs as an example, we can identify particular forms of discrimination against women in these risk-based coverage systems.
The Chilean health coverage system is divided into two sub-sectors: the ISAPREs, which are private health insurers that cover most higher-salaried workers in the formal labor market; and FONASA (Fondo Nacional de Salud, the National Health Fund), which is a public health insurance system covering most lower-salaried workers and the indigent.
Given that ISAPREs enter into individual contracts with each policyholder and that the insurer itself sets the value of the plans it offers, economic discrimination is an inherent part of the system--the insurer may refuse to provide coverage to any client it considers economically unviable.
8% of the population covered by ISAPREs, only 35% are women.
Surveys also indicate that much public dissatisfaction with ISAPREs is related to their discrimination against women, as well as their discrimination against senior citizens.