About the Superintendence of Health

The Superintendence of Health is a public organization which legally succeeded the Superintendence of Isapres on January 1, 2005, in accordance with the Law on Health Authority [Ley de Autoridad Sanitaria] (Law No. 19,937). Such legal body provides the basis for a new institutional framework in the Chilean Health System, as it ntroduces the most important changes to this area in the last 50 years. This legislation bestows rights and warranties on the people, ensuring their access, on an effective and egalitarian basis, to healthcare services which satisfy their health-related needs.

The history of the Superintendence of Health, formerly the Superintendence of Isapres, is linked to the structural changes the Chilean economy underwent at the end of the seventies. It was then that Chile chose to adopt an open economy model in which private initiative is welcome.

With that economic reform, the State no longer was the exclusive administrator of the payments for healthcare services and pensions made by the Chilean workers, who decide whether to derive their payment for healthcare to the hands of the private sector or to stay as beneficiaries of the State. Thus, people increased their freedom of choice, and the market of healthcare providers became more competitive.

On March 19, 1981, when the Decree with Force of Law No. 3 [Decreto con Fuerza de Ley No. 3] was passed, the Healthcare Institutions, known as Instituciones de Salud Previsional or ISAPRES, were created, enabling workers and people, in general, to deposit their obligatory payments for healthcare in those Isapres, if they chose to.

The Isapres are organizations that relieve the State of functions that can be taken over by the private sector. Isapres are entities which, practically, receive no subsidies from the Treasury and operate in a free competition system. On the basis of an insurance scheme, the Isapres provide healthcare services for their clients who access to financing for their expenditures in case of illness, in exchange for the people’s making periodical payments or prepayments to their Isapre. With such funding, people can choose a hospital or clinic where to get medical attention.

The National Health Trust, or Fondo Nacional de Salud (FONASA), was the very first State’s institution responsible for overseeing the system of Isapres, as established by the DFL No.3 of 1981. Such decree ruled that the Isapres had to request registration at Fonasa, which accepted or rejected the application, based on the requisites imposed by the corresponding laws.

Also, Fonasa had to ensure that the Isapres actually had and kept at least 2,000 UFs in capital, which had to be demonstrated at the time of applying for registration. Furthermore, the Isapres had to have a warranty which amounted to a whole month of payments made for healthcare, which had to be no less than 600 UFs. If any of these conditions were not met, the Isapre’s registration could be revoked.

In March of 1990, Law No. 18,933 was passed, creating the Superintendence of Isapres, whose main duties were to enforce the obligations referred to in that law, oversee the healthcare contracts imposed by the Isapres on their clients, promote solutions to the market’s imperfections and guarantee the long-term stability of the system of Isapres.

On January 1, 2005, the Superintendence of Health was created, successing the Superintendence of Isapres. in accordance with the Law on Health Authority [Ley de Autoridad Sanitaria](Law No. 19,937) whose Article 6 states that it is an organization that: «is functionally decentralized, possessing its own assets and legal personality, which will be ruled by this law and its regulations, and will be linked to the President of the Republic through the Ministry of Health».

The organic structure of this institution considers the existence of 2 Intendances:

• Intendance of Funds and Insurance for Healthcare [Intendencia de Fondos y Seguros Previsionales de Salud], responsible for overseeing the Isapres, Fonasa and the System of Guarantees in Health.
• Intendance of Providers [Intendencia de Prestadores], in charge of overseeing all healthcare providers, public and private, in the services they give to the beneficiaries of Laws No. 18,469 and No. 18,933.

When becoming the Superintendence of Health, the institution had 136 staff in its Santiago headquarters and regional agencies. Currently, there are more than 200 people in its staff and new agences have opened in Chile’s main cities.

Since the organization was created, on January 1, 2005, the post of Superintendent of Health was held by Dr. Manuel Inostroza Palma. He was later confirmed in his post as from September 1, 2006, after having been nominated by the Top Public Management System [Sistema de Alta Dirección Pública]. Dr. Inostroza left the post on March 31, 2010.

Nowadays, the Superintendent of Health is Mr Luis Romero Strooy, Civil-Industrial Engineer from Pontificia Universidad Católica de Chile, with an MBA from the University of San Francisco, in California. He has ample experience in the Chilean system of health. Mr Romero was appointed by the Top Public Management System and assumed his post on July 8, 2010, succeeding Dr Vito Sciaraffia, who had been deputy Superintendent since April 1, 2010.

1. Unit of Strategic Planning and Management Control

It is a consultant to the Superintendent and all across the Institution; coordinates the establishment and revision of the organization’s strategic definitions. Additionally, it supervises the making of action plans and their consistency with the annual budget, and implements those plans by using the right management control tools to run a system of quality management.

2. Legal Department

The Legal Department has to study, analyze and resolve all matters related to law and justice which are under the domain of or affect the Superintendence of Health and its units; it prepares the norms, instructions and memoranda which are issued to the people or bodies under inspection, and advises all of the units at the Superintendence’s on legal subjects. For those effects, the interpretation of the norms made by the Legal Department will be binding for the Intendances mentioned above, without prejudice to those units’ capacity to resolve the conflicts sent for their consideration.

3. Internal Audit

Periodically, this unit has to verify the working of the internal control systems as well as the adaptation and effectiveness of both processes and procedures. To achieve it, the Internal Audit department has to be in close contact with the other units at the Superintendence. Also, this department is responsible for the official coordination between the Superintendence of Health and the Controller General of the Republic, without prejudice to the capacity of the Controller’s to summon the Superintendent directly.

4. Communications unit

This section has to advise the Superintendence of Health’s units on the design and implementation of communication strategies which make it possible to: disseminate information about the institution’s work; to design and create communication strategies that comply with the Superintendence’s mission; and organize, coordinate and implement both internal and external communication activities.

5. Intendance of Healthcare Providers

This unit must oversee all the public and private healthcare providers regarding their accreditation and registration, and ensure they comply with the standards set in the accreditation.

This Intendance works with the following Subdepartments:

• Subdepartment of Regulation: This unit has to make proposals for regulations and to systematize the norms that rule the healthcare providers’ assessment, as well as carrying out the summary proceedings which are started when there is a breach to the regulations.

• Subdepartment of Assessment: This unit has to manage the accreditation and registration systems for the healthcare providers. Additionally, the Intendance of Healthcare Providers relies on a Medical Committee which advises on the design of health-related standards and requisites for the assessment of healthcare providers.

• Medical Committee: This committee has to advise the Intendance on the design of standards and requisites for the evaluation of healthcare providers.

6. Intendance of Healthcare Funds and Insurances

This unit has to: oversee and control the Instituciones de Salud Previsional, henceforth ISAPRES, following the terms established in DFL No. 1, from 2005, in matters related to health and any applicable provisions; enforce the obligations imposed by law on the Isapres as to the Explicit Guarantees in Health, the health contracts, as well as the laws and regulations ruling the Isapres. Additionally, this Intendance exerts control and supervises the National Health Trust, henceforth FONASA, in all those matters related to the rights of the Trust’s beneficiaries in the modalities of Institutional Provider, free choice, and what the law defines as Explicit Guarantees in Health.

The Intendance is comprised of the following Subdepartments and units:

• Subdepartment of Regulation: It has to create, systematize, update and disseminate the regulations that rule both the Isapres and FONASA.

• Subdepartment of Arbitrational Claim: This subdepartment has to settle the disputes that arise between the Isapres or FONASA and their affiliates or beneficiaries, whose knowledge and resolution are incumbent on the Intendance of Healthcare Funds and Insurances. Here, the Intendant plays the role of an arbitrator.

• Subdepartment of Administrative Claims: This subdepartment has to administratively settle and resolve those claims filed against the replies given by FONASA and the Isapres when their affiliates or beneficiaries have found themselves in conflict with those institutions.

• Medical Subdepartment: This subdepartment has to incorporate and strengthen the healthcare mission in all the Intendance’s functions and procedures, as well as providing the technical foundations for solving conflicts in the medical field and act as mediator here. Also, it is to provide a technical interpretation for applying healthcare standards, particularly those connected with the Explicit Guarantees in Health.

• Subdepartment for Management and Analysis of Claims: This subdepartment has to analyze and process al the complaints presented at the Intendance, deciding which is the most efficient resolution and encouraging alternative solutions by making direct contact between the beneficiaries and their insurers (Isapres and FONASA).

• Unit of Comprehensive Management Control: It is in charge of the Management Control at the Intendance of Funds, supplying information for decision making, managing the assigned strategic projects as well as administering and maintaining the IT systems under its domain.

7. Department of Client Management

It has to satisfy the requirements of the users who contact the Superintendence of Health, empower the users of the healthcare system, educate them and let them know about their rights and obligations, and coordinate the work of the other units which are located across Chile.

This Department is comprised of the following Subdepartments and Units:

• Subdepartment of Customer Service: It has to develop and implement a high-quality customer service that sees to the users’ needs and provides solutions to their problems.

• Subdepartment of Regional Management: It is responsible for planning, organizing, directing and controlling the work of the nationwide agencies, ensuring that their work is done following the laws and competences assigned.

• Unit of Dissemination of Information and Education: It is responsible for the design, development, control and evaluation of a plan for education and dissemination of information aimed at the beneficiaries of both FONASA and the Isapres.

• Unit of Analysis and Marketing: It is responsible for the generation, analysis, complementation and distribution of the information about the clients, integrating the info gathered through market research, opinion polls and the analysis of databases.

8. Department of Studies and Development

This department has to generate knowledge about the Chilean Healthcare System, through research and development of studies and proposals aiming at perfecting the system, as well as managing the operation of the Shared Compensation Fund [Fondo de Compensación Solidario] in the Isapres.

9. Department of Management of Human Resources, Finances and Technology

This department has to administer the finances, staff, technology, purchases, infrastructure, logistics and welfare benefits, thus it must ensure a correct budget proposal and execution, enforce the policies on human resources, supervise the work of the IT unit, maintain and upgrade the hardware and software needed at the institution, abide by the policies on internal and external acquisitions, supply and maintain a suitable infrastructure and logistics for the general services, and, also, seek the most benefits for the personnel who are under the organization’s welfare scheme.

Is comprised of the following Subdepartments and units:

• Subdepartment of Finances and Accounting: This subdepartment has to formulate and execute the budget, and is responsible for its correct accounting. Also, it has to report on the internal and external finances. Additionally, it has to manage the treasury and the acquisitions made by the Superintendence.

• Subdepartment of Human Resources: This subdepartment has to create and enforce the policy on human resources, which includes: procedures for hiring personel; granting promotions; managing careers; detecting breaches in competences; providing training; recording information about employees, vacations and holdays, qualifications and dismissals; and ensuring the correct working of the welfare scheme.

• Subdepartment of Information Technology and Communications: This subdepartment has to plan the action strategies in IT in accordance with the guidelines set by the Superintendent. Additionally, it has to help the institution gather information requirements in order to implement automated systems, capture and process that information, guarantee that the databases used at the organization are working correctly, supply the appropriate software and hardware, ensure the data transfer and keep a steady service to solve any issues presented by the computing equipment.

• Unit of Logistics: This unit is responsible for the maintenance of the infrastructure; hiring and deploying the services provided by third parties; managing the office of records, both the internal and external logistics and the institution’s fleet of vehicles.

• Communications Unit: This Unit has to advise the Superintendence of Health’s sections on the design and implementation of communication strategies which make it possible to: disseminate information about the institution’s work; to design and create communication strategies that comply with the Superintendence’s mission; organize, coordinate and implement both internal and external communication activities.

• Unit of Strategic Planning and Management Control: It is a consultant to the Superintendent and all across the Institution, coordinates the establishment and revision of the organization’s strategic definitions. Additionally, it supervises the making of action plans and their consistency with the annual budget, and implements those plans by using the right management control tools to run a system of quality management.

10. Department of Control and Supervision

This department has to control and supervise the correct granting of rights, benefits and healthcare services established by law to the people who have joined either FONASA or an Isapre. Also, it has to oversee public and private healthcare providers as to their accreditation, certification and registration.

Mission of its Subdepartments

• Subdepartment of Control for Guarantees in Healthcare: This subdepartment has to ensure the correct granting of the Explicit Guarantees in Health to which both FONASA’s and the Isapres’ beneficiaries are entitled, and certify the complying with the coverage goals in the Examination of Preventive Medicine set for these institutions.

• Subdepartment of Control for Complementary Regulations: In charge of ensuring that the rights, benefits and healthcare services are actually bestowed on the beneficiaries of FONASA and the Isapres, in the modalities of healthcare provided by hospitals or clinics and free choice, and in the complementary health plan, respectively.

• Subdepartment of Financial Control: In charge of controlling information about the finances, assets and accounting of the Isapres so that they comply with the minimal legal requirements. Additionally, this subdepartment has to enforce the compliance of Isapres with the regulations involving matters of healthcare payments.

• Unit of Risk Assessment: It is in charge of supporting the Department in the identification and analysis of risk areas, by making systematic use of the information and by improving internal performance.

• Unit of Legal Supervision: This unit is in charge of collaborating with the Department in the analysis of claims filed against the regulated institutions and reporting their irregularities, duties which are defined in its overseeing processes. Also, it has to control the work done by sales agents and all the matters involving legal aspects.

• Supervise and control the Isapres, ensuring they comply with the obligations imposed on them by the law, such as the Regime of Guarantees in Health, healthcare contracts, and any laws or regulations which rule the Isapres.
• Supervise and control the National Health Trust (FONASA) in all those matters strictly dealing with the rights of the beneficiaries of Law No. 18,469 in the modalities of healthcare provided by hospitals or clinics, free choice, and what law considers as Regime of Guarantees in Health.
• Oversee all private and public healthcare providers, no matter whether they are natural persons or legal entities, as to their accreditation and registration, and ensure that those providers comply with the standards established in the accreditation.

The mission of the Superintendence is to guarantee a strict regulation and supervision, which upgrade the Chilean healthcare system, by ensuring that the rights of the people are respected.

View

In 2010, we want to be perceived by the users like this:

• We are valued by the people and respected by the health insurance and healthcare providers. We are international leaders in regulation and supervision.
• We have staff of excellence who take part in an organizational culture which is flexible, modern, friendly and efficient, features that make us a great place to work.
• We achieved the goal of comprehensiveness in our System of Social Protection in health, guaranteeing that the people’s rights are respected.
• Through information and education we empower the people, who, with the help of our regulators, receive services with high standards in quality, making us one of the best public agencies in Chile.

Values

The values on which our ethics and behavior are based at the Superintendence of Health:

• Transparency and probity
• Equity
• Excellence
• Respect
• Commitment

Guidelines

• In order to comply with our role as regulators and overseers: we seek to perfect the regulation and overseeing model in order to ensure the people are respected in their rights and guarantees.
• To comply with our role as guarantors: we empower the people by providing them with information, education and participation so that they know about and are respected in their rights, duties and guarantees related to healthcare.
• To comply with our role as a service: we promote an organizational culture centered on commitment, talent and good quality of the services we supply.