The Fallout of Reform

The fallout of the political reforms is still difficult to measure. Certainly, the AUGE plan is expanding care. However, it is generating criticism that public health projects in certain provinces have been cut back in order to pay for the ambitious program. The national health budget increased by 8.4 percent from 2004 to 2005, and 28 percent of the budget increase can be attributed to advances in AUGE.

Others have criticized that the plan is arbitrary. Why should someone with heart disease be covered, while someone with cystic fibrosis must still wait years for any adequate care? The government believes that it is doing the best it can. According to the Ministry of Health, “The resources that the country has to take care of the health of the population are limited and scarce. It is necessary, therefore, to distribute these resources to ensure that the sicknesses that cause the most suffering, pain, and preventable death are treated adequately.”

The government is trying to address what it has seen as glaring inequalities in the system, where diseases that cause the greatest burden on the population are neglected because the greatest amount of money can be earned by treating diseases that affect the more affluent segments of society.

It is too early to empirically measure the success of the reforms. A recent report of the Socio-Economic Characterization Poll found that the Lagos Administration has enjoyed some successes in economic indicators. Poverty dropped from 20.6 percent to 18 percent over the past several years, while measures of economic inequality have also shown improvement. However, equal distribution of health continues to lag. This is largely because many of the reforms have not yet been fully implemented, and it may take years to measure the results of these complex changes.

Among the Chilean people, the verdict appears to be positive. Many appreciate Lagos’s efforts on their behalf, and they also believe that Lagos was largely successful in passing and implementing his reform package. Lagos currently enjoys tremendous popularity. Still, support among health professionals is less strong. In reality, those with the most experience in health policy understand that it will take time to see the full effect of Lagos’s reforms. Among health practitioners and policy elites, the jury is still out.

Focusing on the Future

Until 2004, it appeared that Joaquin Lavin of the Chilean right was set to win the presidential election in December 2005. That would mark the first time that the right had won the presidency since popular elections began in 1990. This might have spelled the end of many of Lagos’s efforts, as Lavin would have worked to deregulate and reprivatize much of the health care system.

However, with a damaging sex scandal on the right and Lagos’s impressively rising popularity, the prospects for December 2005 have changed. A recent poll by Fundación Chile put former Health Minister Michelle Bachelet well in the lead over Lavin by a margin of 26 points. While other opinion polls show the race somewhat closer, it appears that members of the current governing coalition have gained an edge. In fact, two of the leading candidates, including Bachelet, are former ministers in Lagos’s government. The candidate that wins on December 14, 2005 may well carry the torch of health reform that Lagos has pioneered.