Allard Soto Raúl
Departamento de Ciencias Jurídicas, Universidad de La Frontera, Temuco, Chile.
Rev Med Chil. 2019;147(1):103-106. doi: 10.4067/S0034-98872019000100103.
Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.
医疗保健在民主社会中引发了一些结构性问题,比如中央政府在健康风险管理中的角色,以及社会保险实施所产生的再分配后果。这些问题常常引发激烈的政治争议。本文考察了美国的医疗改革,即广为人知的“奥巴马医改”。其三个主要要素,即个人强制参保、创建新的医疗保险交易所,以及扩大医疗补助计划,在经过近一个世纪旨在保障最低限度全民覆盖的立法努力受挫之后,在美国保险市场上引发了健康风险的重新分配。文章提出,美国如此大规模的变革将在即将到来的智利议会关于医疗改革的讨论中产生影响,智利仍维持着高度自由化的私人医疗体系。