Andrew Cooke: C[omp]ute

Chilean Health Insurance (AUGE, GES, ISAPREs, etc)

From: andrew cooke <andrew@...>

Date: Sat, 17 Nov 2012 09:08:17 -0300

This is a note about Chilean helath insurance and long-term illnesses (like
MS).

If you are reasonably well-off in Chile then you probably have private health
insurance with an ISAPRE (eg Banmedica).  The cover provided is described in
your contract, and varies with company and plan (price), but is typically
intended for "unpredictable" expenses - sudden illnesses, emergencies and,
usually, pregnancy.  This may include hospitalisation, investigation (exams)
and treatment in the hospital.

But an ISAPRE plan is much less likely to cover medication taken outside of a
hospital.  This means that long-term support for illnesses like cancer,
multiple sclerosis, etc, is typically not covered by an ISAPRE.

However, there is a separate, state-enforced plan, called GES (previously
AUGE) that covers many of these cases.  You can read a good, simple
explanation of GES at http://www.bcn.cl/leyfacil/recurso?item_id=4263&leng=es
(in Spanish).

The GES provides several "canastos" (baskets), each of which has a fixed
price, and each of which can be bought monthly - effectively placing a monthly
price ceiling on the contents.

So, for example, there is a canasto for long-term medication that costs approx
$200.000 CLP a month.  Assuming you gain access to GES (which means being
diagnosed by a doctor associated with the plan) then you can access any of the
medications in that canasto (assuming you have a prescription) for a month,
for that price.

In Chilean terms this is not cheap - it's about the same as the minimum wage -
but it is significantly cheaper than paying for the medication directly (in my
case Beta Interferon costs about $800.000 CLP a month).

Other canastos cover things like emergency treatment related to the diesase.
But if you have an existing health plan then these may also be covered by that
plan.  In such cases you need to carefully consider the alternatives.  In my
case, for example, it may make more sense to use my existing health plan for
hopsitalisation since it pays for a significantly nicer (more expensive)
hospital.


Disclaimer: I am no expert on this; the above is simply what I have learnt
over the last few days.  If you do not have insurance with an ISAPRE you may
have soething similar with Fonasa, which is the state-run equivalent.  They
may have different prices, I do not know.

Andrew

Price Correction, More Details

From: andrew cooke <andrew@...>

Date: Thu, 22 Nov 2012 21:00:09 -0300

[This is an updated version of an earlier reply, which contained further
errors - I am learning as I go along...]

I had the prices wrong above - Betaferon is about $1.000.000 CLP a month, and
the GES charge is only $120.000 CLP.  So it's a better deal than I said.

More details on exactly how you get the drug follow.  This is for insurance
with the Banmedica ISAPRE - details are going to differ for others (for
example, I suspect the Cruz Verde pharmacy is part of the same group as
Banmedica and that is why I need to go there).

Anyway, I got a prescription from an approved doctor (at the same time as she
confirmed my diagnosis) and gave that to the ISAPRE (Banmedica).  Within 48
hours they arranged the GES and I was able to buy the Betaferon from the Cruz
Verde chain of chemists (only) where I paid the GES amount.

Not any Cruz Verde worked - it had to be a "special" one (of several).  I
don't know what they are called, or how you know which they are without
asking, but it also had a nurse in attendance (the one I used outside the
Piramide del Sol, in Providencia, opposite the Tobalaba metro entrance).

Since the drug shouldn't be above 25C you need to get it home quickly and into
the fridge in a Santiago summer (cooler and ice packs work fine, and the
chemist privded me with ice packs for free).

Also, Cruz Verde don't really have a clue how the drug is used (nor does the
nurse, although she was smart, friendly and competent enough to say so,
thankfully).  What you need to do is call Bayer (56-2-5208200 from
http://www.bayer.cl) and arrange for a nurse to visit.  I didn't do this til
the afternoon and had to wait til next day, so you might want to plan ahead.
Anyway, the nurse comes and shows you how to do everything.

The box of drugs comes with a booklet that also explains what to do and is
very clear (except that the area on the arm is at the back, which I did not
find ckear from the diagram), so you could also follow that.  BUT the nurse
brought a spring-loaded automatic injector thing that makes life easier - that
and having confirmation that you are doing everything right makes the nurse
worthwhile (especially as it is a free service!).

And the injections are easy to do and don't hurt much (didn't feel one on my
leg at all; did feel a prick and burn on my stomach).  I had flu symptoms with
the first - we'll see how I react to the second in the next few hours...

Andrew

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Chilean Health Insurance (AUGE, GES, ISAPREs, etc)

Price Correction, More Details