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Chile expands Depression Coverage to Include Children Under 15 Through GES Plan
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chile is considerably expanding access to mental healthcare, with the government announcing that, as of December, the country’s Explicit Health Guarantees (GES) plan will cover treatment for depression in children under the age of 15. This builds upon an existing program that has provided coverage for individuals 15 and older for two decades,marking a major step forward in addressing mental health needs across all age groups.
The Universal Access plan for Explicit Guarantees (AGE), which encompasses the GES, aims to ensure timely access to a range of health problems for both public (Fonasa) and private (Isapre) healthcare users. Currently, the GES includes coverage for 87 pathologies, and depression, in its various stages, is a key component of this plan.
Accessing Depression Treatment Through GES
Individuals aged 15 or older with a confirmed diagnosis of mild, moderate, or severe depression can now access GES coverage by presenting a medical certificate to thier respective healthcare provider – Isapre or Fonasa – and completing the necessary paperwork. The location for diagnosis varies depending on the health system:
- Fonasa: Diagnosis is available at CESFAM/CECOSF/Consultorio, Cosam, Cesam, therapeutic diagnostic centers (CDT)/Health Reference Centers (CRS), or hospitals.
- Isapre: Diagnosis can be obtained at private medical centers or clinics.
Once activated, the GES provides a tiered system of treatment “baskets” tailored to the severity of the depression. These baskets encompass access to care with doctors and psychologists, necessary examinations, and prescribed medications. In the moast acute cases, hospitalization is also included.
Treatment Baskets Cater to Severity
The GES outlines specific treatment approaches for different levels of depression:
- Mild depression treatment
- Moderate depression treatment
- Severe depression treatment
- Depression treatment with psychosis, high suicidal risk, or refractory cases (acute phase)
- Depression treatment with psychosis, high suicidal risk, or refractory cases (maintenance phase)
Treatment begins immediately upon diagnosis confirmation, with a specialist consultation guaranteed within 30 days of referral. Importantly, the treatment plan can be adjusted as the patient progresses, based on their evolving needs and the physician’s assessment.
Cost Considerations: Copayments and Affiliation
The financial burden of treatment varies depending on the healthcare system. Affiliates of Fonasa A, B, C, and D will have a 0% copayment for GES-covered depression treatment. However, Isapre members will be responsible for a 20% copayment.
For example,a benefit with a $13,200 tariff would require an Isapre affiliate to pay $2,640,while a Fonasa A,B,C,or D affiliate would pay nothing.
It is crucial to remember that activating the GES means healthcare providers will typically refer patients to their closed network of providers. However, individuals have the option to utilize their complementary health plans for coverage if they prefer to seek care outside of the designated network.
This expansion of the GES plan represents a important investment in the mental wellbeing of Chile’s population, notably its youngest citizens, and underscores a growing national commitment to accessible and comprehensive mental healthcare.
