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CHILE
Money talks
IPS
4/10/2003
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Health and education elude the poor.

Graduates of public high schools were the most rejected university applicants in Chile this year — one of the clearest indications of the inequalities generated by the partial privatization of the country’s education system.

Similar inequities are found in healthcare, where the participation of the private sector ushered in by the dictatorship of Gen. Augusto Pinochet (1973-90) has also drawn criticism that quality of healthcare depends on the wealth and "risk" level of patients.

"In high school I got good grades, but my score on the PAA (academic aptitude test) showed me that in Chile there is one educational system for the poor and another for the rich," said 17-year-old Sandra Zúñiga. She attended high school in Lo Espejo, a low-income neighborhood on Santiago’s south side. The PAA score is crucial to acceptance to one of Chile’s 25 public or partially publicly financed universities.

Juan Luis Moya, a graduate of the National Institute, the most prestigious public high school in Chile, obtained the top score on the PAA in December 2002, with 830 points, while Sandra was 12 points below the minimum score of 450 required at the 25 universities.

Like Zúñiga, 62 percent of the 52,477 graduates of public high schools who took the PAA failed to obtain the minimum score required for entrance to the country’s public universities. Many of them will also be unable to attend a private college, due to the high cost of tuition.

"My only chance now is to enroll in a two-year course in a vocational-technical institute to become a dental technician," said Zúñiga. "That is the closest I could get to becoming a dentist, which is what I wanted to study, but I don’t know how easy it will be to find work afterwards."

In contrast to the poor performance of students in the public high schools, 83.5 percent of the 19,114 graduates of tuition-charging private schools who took the PAA obtained scores above the minimum 450 points.

When the selection process for the 25 public universities was completed on Jan. 20, authorities reported that only 25.6 percent of the 54,068 successful applicants came from public schools, 30 percent from subsidized private schools, and 42.4 percent from tuition-charging private schools.

As in education, inequality is the dark side of the 1981 privatization of healthcare which created "Instituciones de Salud Previsional" (ISAPREs), private insurers which receive social security contributions and compete with the state National Health Fund (FONASA).

The ISAPREs provide health insurance and coverage that is financed by contributions amounting to at least 7 percent of workers’ wages. The private system offers healthcare plans that vary in cost according to the characteristics of each client.

The best packages are offered to those who are classified as "low risk" due to their age or medical and family history. For instance, a childless young man with a high income has access to a better plan than a father of four earning a mid-range salary.

But the worst discrimination is seen in the case of women of child-bearing age, who pay up to four times more than what men in similar age and income categories are charged, due to the "risk" represented by maternity.

The ISAPREs draw in people from low-income sectors by offering lower prices and fees than those charged by FONASA for basic doctor visits and simple treatments. But in the case of chronic, complex or catastrophic health problems, the costs are higher and coverage is thinner. A law defining illnesses to be covered by public and private healthcare services, guaranteeing access, quality of service and financial cover for all, has been awaiting Congress approval since last year (LP, July 29, 2002).

"I abandoned FONASA in 1994 to sign up with an ISAPRE,’’ said taxi driver Hernán Pozo. "I was very satisfied until my wife was diagnosed with cancer two years later, and the coverage for chemotherapy was minimal. I had to return to FONASA, where I was able to afford the costs until she died two years ago."

But Adolfo Rodríguez, a 50-year-old engineer with a monthly income of around US$2,000, said he was pleased with the private healthcare system. Thanks to the ISAPRE cover, he was only charged the equivalent of $80 when he underwent prostate surgery six months ago in a private clinic.

According to the United Nations, user satisfaction with a healthcare system is measured by the quality of treatment and access to services. At the same time, these factors are linked to the user-registration level, all of which, combined, define what the World Health Organization (WHO) calls "equity of delivery and access."

Although the WHO ranks Chile 45th in the world with respect to overall quality of healthcare, survey results placed the country 103rd in terms of equity of delivery and access.

 

 


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