Health Care and Insurance in Chile
From Chile Wiki
Health care in Chile is very advanced and state-of-the-art on the high end. The national health care system (FONASA) provides basic medical service and coverage to all levels of society. Quality is better at private clinics and hospitals around Chile, though even the most expensive private clinics are relatively affordable (at least by U.S. standards).
Doctors are well-trained and professional. Hospitals are generally run as professional businesses, with national regulation of standards that meet or exceed international standards of care. Chile tends to rank well on international benchmarks comparing metrics such as life expectancy at birth or infant mortality.
Chile does not have a system of Primary Care, or having a local GP as the norm, as other countries may have.
General Practitioners can be relatively rare, as most Doctors specialise if they are able to. The type of Family Doctor who might be the first point of contact for medical concerns is not a concept well-known in Chile as it is in some other countries, but they do exist.
You do not need a referral to see a specialist, so many Chileans will go directly to the type of Doctor who they need to see.
Orden de llegada
In Antofagasta, most Doctors, and for example Physiotherapists (kinesiologo), will see people by orden de llegada or order of arrival. This means that when you make an appointment for 9am, ALL other people that the Doctor is to see that day will have been given the time 9am, and the Doctor will attend patients by the order of their arrival in the consulta. Always check if you have a real Hora (time), or if it's 'orden de llegada', and be prepared to wait a long time either way.
To see a Doctor, you will need to buy a bono in advance. If you have Insurance (FONASA or ISAPRE), then you will pay the co-pay (copago) amount. In some consultas you can do this on the spot, electronically, but in others you will need to have bought your bono in advance. For example, if you have Colmena as your Isapre, you will go to Colmena before your appointment and buy a bono. You can pay cash and then get reimbursed (reembolso) afterwards.
Make sure that you have your Boleta (receipt). Usually you will pay less if you buy in advance.
If you do not have insurance, you will pay as a 'Particular'. The cost varies depending on the Doctor. A General Practitioner in Antofagasta costs $15,000 particular.
Blood Tests / X Rays etc
If the Doctor orders blood tests or Xrays, then you'll be given a script. Again, you will need to buy a bono. Your ISAPRE will need the doctors script in order to sell you a bono. ISAPREs have different agreements with different testing centres. A blood test in one place may cost you nothing (costo zero), and down the road the same test is $15.000.
For blood tests, they might all end up at the same lab, but depending on where the blood is drawn, the cost is different. Again, with your script, you will be able to pay privately if you have no health insurance. You will pick up your results and then will need to go and see your doctor again if you need them interpreted. There is no communication back to your doctor about your results.
If you are employed in Chile and you are sick for even one day, you will need to present a Medical Certificate or 'Licencia Medica'. Universities, schools and even some daycare centers also require them for absence. A licencia for 3 days or less is not paid for those days. For more than 3 days, the first three are not paid, but the remaining days are. A licencia for 11 days or more is paid for ALL days. Sick days covered by licencia are paid by your isapre.
Hospitals and Clinics
It is important to understand the terms "Hospital" and "Clinic" used in Chile.
A 'hospital' is public.
A 'clinica' is private; it can have a diversity and quality of services as good as or better than a hospital.
Generally speaking, the environment and treatment will be much better in a clinica. Both clinicas and hospitals might have emergency departments. The ER attends by the urgency of the problem. If you have a cold, you might wait hours. Pregnant women are seen by Matronas, often faster than seeing a Doctor. Some ERs do attend by order of arrival. At an ER in a Clinica, you'll be asked to pay for the visit.
If you are admitted to Hospital via the ER, you will be asked to sign a 'Pagare'; a guarantee that you will pay the bill when in comes, plus you'll be asked your Health Insurance details.
When researching private health insurance in June 2012, the author of this section was told that there are five "base" hospitals in Santiago which each have all the medical services available in Chile. They are
- Hospital Clínico de la Pontificia Universidad Católica de Chile; 400m east of the Santa Lucia metro station website
- Hospital Clínico de la Universidad de Chile; 500m northwest of the Cerro Blanco metro station website
- Hospital Militar, La Reina; 3km east of Plaza Egana metro station, on Ave. Larrain map website
- Clínica Alemana map website
- Clínica Las Condes map website
Clínica Alemana in Santiago is recognized as one of the best and most advanced hospitals in the country. Other Clínica Alemanas can be found around most major cities in Chile, and also are excellent.
Clínica Reñaca is reputed in Viña del Mar.
ISAPREs and FONASA
Medical insurance is offered through two systems:
- FONASA is government health insurance, with services usually delivered by hospitals and
- ISAPRE, which are privately operated health funds. Each ISAPRE has several health plans, depending upon which where one lives and the clinics and/or hospitals a member prefers to use. A plan usually favours using one or more clinics, but allows use of the plan at other clinics or hospitals.
In both cases, a deduction of 7% is made from a person's wage toward their health insurance. This amount can be supplemented to obtain increased coverage.
Here is a full list of ISAPRE funds and their contact details.
Each company has several policies depending on your needs. Prices vary depending upon which hospitals or clinics one wishes to use, the level of deductible/excess one wishes to pay and where you are located. The policies cost more in Santiago than elsewhere.
One of several ISAPREs that offers plans that foreigners can purchase as a 12-month contract without credit is Banmedica. They offer many low-cost to full-service plans.
To sign up you'll need a RUT or RUN and a valid credit card, though some companies may issue a letter of credit or accept cash upfront if they won't accept a debit card and that is all you have. You might also be accepted with a passport and no RUT.
For example for 1 UF a month with consauld you can get insurance for all your medicines from salcobrand, will give you birth control free and that type of things, $120,000 year membership at pacific fitness whereas at cruz blanca they will cover your insumos, colemana golden cross cover old people each has a phamacy they are affiliated with each has hospitals they are affiliated with, for example colemena gold cross will give you a better policy at clinica alemana...
At Clinica Tabancura in Las Condes (Santiago) there are sales rep for every ISAPRE, so you can work your way around the different sales reps. At Clinica Alemana some of the offices only give bonos and do not have sales reps.
ISAPRE health insurance policies are priced in [UF], therefore the CLP price increases over time.
Joining age limit
ISAPREs have maximum age limits for which they accept new members, ranging from approximately 55 years old to approximately 65 years old.
The following age limits were stated over the phone:
- Masvida, 55 years 11 months, 29 days, stated in June 2012.
- Cruz Blanca, 59 years, 11 months, stated in July 2013, but might consider if older.
- Banmedica, 64 years, 11 months, 30 days, stated in July 2013.
An ISAPRE member can change plans within the same ISAPRE despite exceeding the maximum joining age.
Other health insurance
Supplemental insurance can be purchased from some clinics to "top up" an ISAPRE's coverage so that deductible/excess is reduced or eliminated under certain conditions.
Drug prices in Chile may be considered low by some expatriates, and to others who have come from highly subsidized systems, very high! It's relative.
There are many pharmacies, some are open 24 hours a day. Most pharmacies belong to one of three networks:
They offer cheap or free home deliveries in the biggest cities.
Drugs that are commonly sold over-the-counter in the USA (such as cold medicines) are often kept behind the counter at pharmacies in Chile. Many drugs that require a prescription in the USA, such as insulin, do not require a prescription in Chile. If you can convey what you need to the pharmacist, then they will get it for you.
Extended hours pharmacies
They are called "farmacia de turno".
The following sites provide online information on drugs etc, (Not online shopping)
A six-month checkup and teeth cleaning at a dentist in Las Condes cost CLP40.800 in May 2012 without ISAPRE membership.
Dentists usually give a quote for the work they suggest doing in one visit, then commence work in a later visit. Sometimes they will offer to start work immediately.
The cost of dental work can vary significantly between dentists:
- In May 2012 one Los Condes dentist charges CLP45.900 or CLP60.350 to fix a cavity, depending upon its difficulty, less 10% for membership in a specific ISAPRE.
- In May 2012 one La Reina dentist charges CLP27.800, CLP31.275 or CLP39.875 to fix a cavity, depending upon its difficulty, with membershipo in a specific ISAPRE.
Unlike Australia (and perhaps other countries), where an optometrist measures eyes, oversees eye care and supplies glasses/contacts, in Chile the person who measures the eyes and oversees eye care is separate from those who supply glasses/contacts. A list of eyesight measurements supplied by an optometrist is adequate to obtain eyeglasses in Chile.
- An overview of the healthcare system by the Superintendence of Health http://www.supersalud.gob.cl/568/w3-propertyvalue-3332.html