LETTER FROM CHILE - REESTABLISHING HEALTH-CARE IN CHILE

Chile's long term social policy has produced very impressive outcomes in general health indicators, with a national health service establish ed as early as 1952. During the years of the Pinochet dictatorship (19 73-89) public health institutions were greatly affected, with sharp di minution in financing which affected investment and salaries. The demo cratic government initiated in 1990 faced a difficult situation, with underpaid staff and decrepit hospitals. The ministry took immediate ac tion to improve salaries and start an ambitious health sector reform i ncluding investment in infrastructure, technology, and modern manageme nt. Decentralisation and autonomy, changes in payment for service mech anisms, and a public-private mix are the main objectives of this refor m, keeping the public role as predominant in the proposed structure. T his process has been affected by union unrest and public opinion dissa tisfaction, which tend to present obstacles to progress in this compli cated issue.