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| Ley Ricarte Soto | |
|---|---|
| Name | Ley Ricarte Soto |
| Long title | Ley N° 20.850 "Ricarte Soto" |
| Enacted | 2015 |
| Jurisdiction | Chile |
| Status | in force |
Ley Ricarte Soto is a Chilean health policy enacted as Ley N° 20.850 in 2015 that created a national explicit guarantee for financing high-cost and low-prevalence health interventions. The statute established a benefits package and an administrative mechanism to provide access to prostheses, oncology therapies, and other technologies for people with catastrophic health needs, administered through a dedicated fund within the Ministry of Health (Chile). It represents a convergence of legislative action involving actors such as the Chilean Congress, patient organizations, and professional societies including the Sociedad Chilena de Pediatría and the Colegio Médico de Chile.
The law arose from longstanding public debates in the aftermath of reforms like the AUGE/GES guarantees and precedents set by litigation such as recurso de protección cases before the Corte Suprema de Chile. Advocacy by patient groups influenced lawmakers in the Chamber of Deputies of Chile and the Senate of Chile, producing bipartisan support that culminated in presidential signature during the administration of Michelle Bachelet. Stakeholders included nongovernmental organizations such as Fundación Integra and clinical associations including the Sociedad Chilena de Cirugía and the Sociedad Chilena de Neurología. International comparative models referenced by policymakers included programs in Brasil, Argentina, Reino Unido, and Estados Unidos specialized funds and orphan drug policies debated within the World Health Organization forums.
The primary objective is to ensure financial protection for individuals facing catastrophic health expenditures by covering high-cost interventions not routinely included in standard plans like those provided by FONASA and private Isapres. The law aims to reduce out-of-pocket payments cited in reports from the Banco Mundial and the Organización para la Cooperación y el Desarrollo Económicos. It seeks equity goals similar to initiatives advocated by Amnistía Internacional and patient rights movements such as Acción Sol. Scope decisions are informed by clinical guidelines from institutions including the Instituto de Salud Pública de Chile, health technology assessment from the Agencia de Calidad y Evaluación Sanitaria and inputs from international evidence syntheses like Cochrane Collaboration reviews.
The law covers a rolling list of conditions and technologies determined by clinical need and cost-effectiveness assessments. Early inclusions encompassed rare oncological agents referenced by Instituto Oncológico Fundación Arturo López Pérez, cochlear implants associated with programs at the Hospital Clínico Universidad de Chile, and prosthetic devices used by veterans and civilians similar to items procured by Fuerzas Armadas de Chile medical services. Subsequent incorporations have referenced treatments for conditions catalogued by the Organización Mundial de la Salud and technologies evaluated by the Instituto Nacional del Cáncer (Chile). The formulary and device list are periodically updated following recommendations from expert panels including members from Universidad de Chile, Pontificia Universidad Católica de Chile, and specialty societies like the Sociedad Chilena de Cardiología.
Eligibility criteria combine clinical diagnosis, severity thresholds, and financial eligibility assessed by administrative units within the Ministerio de Salud (Chile). Enrollment pathways include referrals from public hospitals such as Hospital del Salvador, private clinics like Clinica Las Condes, and primary care networks tied to Municipalidades and CESFAM centers. The process interfaces with social services like the Servicio Nacional de Menores (SENAME) for pediatric cases and disability certification from the Servicio de Registro Civil e Identificación and Servicio de Impuestos Internos for socioeconomic verification when applicable. Appeals may be adjudicated through administrative review and, in contested cases, through litigation before tribunals including the Corte de Apelaciones.
Funding streams include allocations from the national budget approved by the Ministerio de Hacienda (Chile and line items managed within the Fondo Nacional de Salud (FONASA) framework, supplemented by negotiated procurement mechanisms with suppliers and occasional donations from foundations like the Fundación Mustakis. Administration is centralized under a coordinating unit in the Ministerio de Salud (Chile), which contracts insurers and providers across the public red de salud and private sectors. Procurement strategies draw on frameworks used by the Central Nacional de Abastecimiento (CENABAST) and pricing negotiations take cues from international mechanisms such as pooled purchasing initiatives in the Mercado Común del Sur region.
Evaluations report reduced catastrophic spending for beneficiary households in studies conducted by research centers at Universidad Adolfo Ibáñez and public health units at Universidad de Santiago de Chile, with clinical outcome improvements documented in specialty registries at institutions such as Hospital Clínico UC Christus. Impact assessments cite changes in utilization patterns monitored by the Superintendencia de Salud and public reporting in the Diario Oficial de la República de Chile. Comparative analyses reference metrics used by the Banco Interamericano de Desarrollo and OCDE health indicators to measure equity, access, and financial protection results.
Critiques have come from policy analysts at think tanks like Libertad y Desarrollo and patient advocates pointing to delays, exclusion of certain orphan drugs listed by the European Medicines Agency, and administrative bottlenecks observed by the Defensoría de la Niñez. Proposals for reform include enhanced health technology assessment capacity modeled on the National Institute for Health and Care Excellence and legislative amendments debated in the Congreso Nacional de Chile to streamline procurement and expand the benefit list. Ongoing debates involve the Contraloría General de la República audits, civil society coalitions such as Red Chilena de Pacientes and international donors evaluating sustainability under fiscal constraints canvassed with the Fondo Monetario Internacional.
Category:Health law of Chile