On September 4, the process by which Chilean men and women, by voting, will decide whether to approve or reject the proposals made by the Constitutional Convention ends. In the health sector, the Magna Carta design stipulates a universal National Health System, in which the private sector can be involved to form an integrated system.

In this context, the UK’s National Health Service (NHS) has been praised several times by the current Chilean authorities and seen as a benchmark when planning local system reforms. in fact, Kamilo Ciddirector of Fonasa, said last week that “It is a system that has wide reach and access. The entire UK population, across all social strata, is covered by the NHS and has an excellent standard of service. It is regulated through the first level of primary care, the prevention systems strategy. This has very good results in terms of population health.”

Likewise when the Minister of Health, begona yarza, consulted by the models he looked at, replied that “Chile was thinking of an integrated universal system, raising funds, when the only country that proposed it was the UK. And Chile raised it in 1952 because in addition to postwar reflections, it also experienced earthquakes.

Moreover, he adds that the two models serve the same purpose: “We have historical benchmarks in Chile and that’s why we have a very close historical dream relationship with the British system. And also because of quality problems. For the UK, quality issues run throughout the healthcare system and we share that intention too”.

However, in recent years the UK healthcare model has faced difficulties.

According to British organization The King’s Fund, the NHS is in deep financial trouble. Two in three UK healthcare providers were operating at a deficit in 2016, which forced the British government to launch a 5 year plan to improve the financial situation of the system.

In fact, in March this year, according to NHS England, 6.7 million people are on the waiting list for treatment with specialists. And 355 thousand of them have been in it for more than a year.

In this scenario, Héctor Sánchez, director of the U. Andrés Bello Institute of Public Health, criticized and emphasized that “right now the British system has an important role to play in private insurance, because people don’t want to wait. Today there are six million waiting lists in the UK, so about 15% of the population has purchased complementary insurance”.

In addition, according to OECD data, 4.5% of the UK’s population stated that they had problems with access to health care due to financial, geographic or waiting list issues. This figure is much higher than the average of the countries that make up the organization (2.6%) and that shown by countries with multi-insurance systems such as the Netherlands and Germany.

In fact, Andrea Srur, Chilean doctor with extensive experience in Great Britain, reported last week that the UK is dissatisfied with healthcare: “In studies that have been carried out over time, it has been concluded that currently only 36% of the population are satisfied with the NHS. The main reasons are the waiting lists and the unequal access we have to various services.”

Now, faced with a new constitutional proposal, former Minister of Health and professor in the U. Chile Department of Primary Care and Family Health, Soledad Barría, pointed out that “There’s a lot of the UK system proposed in the new Constitution project and I think that’s a huge step forward. it is a universal system financed by a common tax. Of course, there are elements that I don’t think are completely adequate and the primary care there is very medically based. Instead, we are basing primary care on a more multidisciplinary healthcare team.”

Now, faced with waiting lists, academics warn that this is a consequence of a universal model: “Any health system that does not charge fees and does not limit access to care for money, it is not limited by time limit. The important thing is that this waiting time does not endanger the health of the population or is inappropriate. For example, today in Chile it is inadequate, because there are no resources in the public system to remove waiting lists quickly.”

Pablo Eguiguren, director of Public Policy at the Libertad y Desarrollo Foundation, confirms that “The English model works well and it’s not a bad system, so it’s not strange to see. However, the NHS currently has several issues that we would like to address in the Chilean model. For example, waiting lists and in-care segregation.

For this reason, Eguiguren argues that there are other models that are more functional and will better suit Chilean realities.: “The health insurance system needs to be reformed. We have to move in a politically feasible direction that addresses issues and aspects that are valued by the Chilean people. In this sense, multi-insurance systems such as those in the Netherlands or Germany are a better path than the British model. This allows us to build on what we already have, avoid problems such as waiting lists and high costs, which are now the subject of discussion in the UK, and maintain freedom of choice”.