The Primary Health Care (APS) In Chile it has been historically recognized as the strategic level of the health system, with a high degree of population coverage, especially through the public system.
However, talking today about “universalization” of APS demands to go beyond theoretical coverage or administrative ascription: It implies rethinking Its governance, its financing, its territorial articulation and its capacity for coordination with the different actors of the health system.
From 2023, the Ministry of Health has promoted a pilot plan for universalization of APS in several communes of the country (Cunco, Renca, San Clemente, Calle Largo, Chiguayante, Huechurababa, among others) where The beneficiaries of Fonasa They can access primary care without restrictions by registration.
The pilot, who seeks to move towards a more flexible and efficient network, has opened an interesting space to evaluate new models of territorial and functional integration. However, there is still a central dimension in the discussion: The role of the private sector in a universal APS model.
Universal Health Primary Care and Private Health Role
Chile has a mixed health system, with a significant presence of the private sector in the provision of services and less in insurance (ISPRES). However, APS has historically operated as a public space, almost exclusive, with little articulation with private providers. In a real universalization scenario, this It constitutes a structural limitation.
Public-private integration in APS does not mean privatizing the model or weakening its public base, but incorporating private providers in a regulated, transparent and oriented framework by population and territorial criteria.
In countries with mixed systems such as Chile, move towards a universal APS It requires taking advantage of all installed capabilities of the system, public and private, without replicating fragmentation or duplicating efforts.
There are multiple possible forms of cooperation: provision agreements between municipalities and private medical centers to resolve waiting lists; Strategic purchase of services for rural areas where there is no sufficient public coverage; Shared use of diagnostic or infrastructure platforms; and development of mixed networks under common standards of quality, interoperability and evaluation.
Strategic vision
This requires establishing clear regulatory frameworks, efficient payment mechanisms (risk -adjusted capitation, performance payments), and a robust control and evaluation system. Moreover, the debate on public-private integration in APS should consider the role of digital health, shared information systems and patient traceability.
Without these tools, any attempt to collaborate is limited. Interoperability between providers is a basic condition for an integrated network, focused on people and not on institutionality.
The question is under what rules and in what conditions that participation of the private sector Provides value to the system. In this sense, universalization must be understood not as an expansion of the state apparatus, but as a health policy aimed at maximizing coverage, efficiency and health results, taking advantage of all system capabilities.
Chile today has a unique opportunity to reformulate its APS, expanding access, and also reconfiguring its management and coordination model. Public-private integration, if designed with strategic vision, It can be a lever to achieve really universal, resolutive and sustainable primary care in time.
Co -author
Karla Rubilar, Head of Public Health Unit
Faculty of Health Sciences
Autonomous University of Chile
