Health is among the main concerns of Chilean citizens, according to various surveys. This is not surprising: Chile’s health system has suffered for years from a structural crisis that has left the state in debt to citizens. As we pointed out in the chapter on the health of the Annual Human Rights Report 2025this crisis has multiple causes. Its origin lies in a segmented and discriminatory model according to gender, age and socio-economic level, in the lack of financial sustainability, in the inequality between the public and private sectors, in the low importance given to primary care as a gateway to the system, and in the opacity and weak supervision of the insurance sector. These factors generate inequalities in access and quality and perpetuate a market logic that favors the ability to pay rather than the right to health.
In this context, the presidential election takes on a decisive character. Although both candidates acknowledge the health crisis, their diagnoses and responses differ significantly. While Jeannette Jara interprets it as a structural phenomenon that requires strengthening the public network, José Antonio Kast focuses the problem on waiting lists and proposes greater dependence on the private sector, without addressing systemic reforms or explaining its financial viability.
Kast’s plan proposes a massive shift toward the private sector, financed by a one-time investment of $770 million (equivalent to 3 percent of the Department of Health’s budget), achieved through reallocations, tax adjustments, greater control of medical licensing, and the elimination of poorly evaluated programs. It also proposes workplace changes to eliminate “union privileges” and strengthen technical leadership in hospitals, without detailing their implementation.
This approach may relieve pressure in the short term, but it does not constitute structural reform. As indicated in the Annual Human Rights Reportthe system requires long-term transformations. Without sustained investment in infrastructure, specialties, management and human resources, the buy-out of services reproduces the state’s dependence on private providers. Furthermore, it omits essential pillars: strengthening primary care, taking into account social determinants and investing in public capacity. Instead of strengthening the state, it deepens outsourcing without resolving the causes of the crisis.
Unlike proposals focused on the outsourcing of functions from the public system to the private system, Jeannette Jara’s program adopts a more global approach aimed at strengthening the public system, through the investment master plan, which would make it possible to prioritize investments in oncology, primary health and mental health centers, with territorial strengthening. At the same time, it recognizes the complementary coverage modality as an intermediate state to progress towards universal health insurance, one of the main conclusions of the health chapter of the Annual Human Rights Report.
Concerning treatment times, it proposes maximum limits of six months for examinations, one year for surgical interventions and consultations with specialists, and 90 days for high-risk pathologies. To achieve these goals, it plans to increase surgical capacity by an additional 150,000 surgeries per year through the use of pavilions during extended hours and on weekends, as well as the expansion of telemedicine services. Concerning primary care, the program proposes to extend the opening hours of CESFAMs between 8:00 a.m. and 8:00 p.m., including weekends, and to equip them with greater diagnostic technology, integrating x-rays, ultrasounds, endoscopies and mammograms.
Among the health priorities, we distinguish cancer – with emphasis on early detection in primary health care and prevention and rapid diagnosis, particularly of gynecological and breast cancers – and mental health, through an increase in funding for psychiatric beds, the expansion of COSAM and the strengthening of home hospitalization, in addition to suicide prevention strategies and support for adolescents and caregivers. It also prioritizes oral health, through alliances with universities and private clinics to reduce waiting lists and the establishment of mobile clinics to expand access. Finally, it incorporates reproductive health measures within the framework of the “Chile is born with you” initiative, aimed at expanding access to assisted fertilization and promoting the humanization of childbirth, and continuing the discussion on the abortion project until the 14th week.
In short, this election confronts two competing visions on the future of public health in Chile: one focused on strengthening and expanding the capacity of the state system to guarantee the right to health with criteria of universality and prevention, and another that favors the outsourcing of services to the private sector as an immediate response to the crisis, without even establishing an explanation of the financial viability of such a proposal.
The challenge for the next government will not simply be to reduce waiting lists, but to tackle the structural roots of a system that today reproduces inequalities and limits the state’s capacity to guarantee dignified and timely access. Citizens not only need rapid solutions, but also a public health project that goes beyond the short term and that makes health a right and not a market good.
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