Box 1.

Procedure for defining guarantees (GES Regulation, Decree No. 121, 2005).

AUGE law 19.966 defines the procedure for the prioritization of problems to be incorporated into the regime of explicit guarantees. The complete cycle considers the following steps:

(1) Definition of the budgetary framework by the Ministry of Finance.

(2) Technical health and economic studies to prepare a list of health problems with associated effective interventions (diagnosis, treatment, or rehabilitation). These include burden of disease, social preferences, efficacy of interventions, and cost-effectiveness of intervention studies.

(3) Prioritization of health problem, using the following criteria: magnitude of the problem, importance of the problem (qualitative), effectiveness of Interventions, and feasibility of Implementation of Interventions. The final criterion considers cost and supply capacity in the health system. Also mentioned is the financial burden on households.

(4) Determination of the average expected cost, which requires the measurement of both the cost to deliver each intervention, and potential demand. The maximum co-payments for users of public and private insurance are also defined in this phase (financial protection).

(5) External verification of the cost by an external study, to ensure that the proposal does not exceed the budgetary framework defined in step 1.

(6) Consultation by an advisory council, comprised of independent professionals representing the faculties of medicine, economics, chemistry and pharmacy, the Chilean Academy of Medicine, and representatives of the president. This checks the consistency of the proposal.

(7) Final drafting of the decree and its enactment.