Health Reform in Chile 2000-2005: Path dependence, critical junctures and feedback mechanisms

The most recent health reform in Chile was aimed at modernizing and restructuring the Chilean health system. Using the path dependence and policy feedback conceptual framework, two of the main laws of the 2000-2005 Chilean health reform were analyzed: the General Guarantees in Health (GGH) and the Financing Law. For the GGH, law one critical juncture was identified (prioritization of health and maternal health in the 1950s) and two types of policy feedback: interpretive effects (priorization rather than rationing) and to a lesser degree, policy learning (health programs rationale consistent with guarantees in health for a limited set of conditions). For the Funding Law, two critical junctures were identified (separation of private and public health insurance pools and creation of ISAPREs) which unleashed two types of policy feedback effects: lock-in (large commitments by private insurers and providers) and interpretive effects (“individual ownership of individuals of health insurance contributions”). Policymakers embarking in reformist efforts should have available an historical institutionalist analysis of their proposals in order to anticipate the obstacles and barriers they will encounter and should also be aware of the fact that the policy they would be implementing could constitute a critical juncture that unleashes mechanisms of policy feedback impossible to modify in the future.