Chile public health system sees sharp productivity drop despite staff surge

Chile’s public insurer FONASA now covers nine out of ten residents, with its portfolio expanding 15.4% between 2019 and 2025 while private insurers (Isapres) fell 26.6%. The system’s fiscal reliance grew, as government contributions rose from 58.1% of FONASA’s revenue in 2011 to 74.6% in 2025.

From 2013 to 2025 the number of staff in FONASA‑run hospitals nearly doubled (a 95.5% increase) and weekly work hours rose proportionally. However, productivity per employee, measured without diagnostic exams, fell 40.75% over the same period. The private sector continues to deliver almost five times more services per beneficiary, and cost differentials between public and private providers range from 15% to 33% in favor of private care.

Waiting‑list cases have risen to over 600,000 by December 2025, and medical‑leave expenditures jumped 50.3% from 2019 to 2025. Analysts propose adopting performance indicators, similar to Catalonia’s health‑result model, to set enforceable productivity targets for Chilean hospitals.