Evaluation of mental health law 21,331 in Chile
This study evaluates whether the implementation of law 21,331 on mental health (MH) affected financing in Chile’s private health-care system. The effects of effective financial coverage and the acceptance rate of sick leaves are analyzed. The results show increased coverage in plans without coverage constraints in MH concerning those with restricted coverage; however, differences imply a lower effective coverage in MH services concerning physical health services. Regarding sick leaves, the practice of refusing and reducing sick leaves for mental disorders increased, further deepening the gap concerning other diagnostic groups. Notably, medical consultations by telemedicine have allowed significant increases in coverage, including for MH. Analyzing the differences by gender shows that there is less financial coverage for women than for men regarding MH services. Furthermore, women experience a higher proportion of rejected and reduced sick leaves than men. Law 21,331 works toward the World Health Organization recommendations in this area; however, a significant gap remains between the effective financial coverage of MH services compared to physical health services and the resolution of sick leaves for mental disorders versus other diagnostic groups.
Biblioteca del Congreso Nacional. (2021). Ley 21.331 Sobre “Reconocimiento y Protección de los Derechos de las Personas en la Atención de Salud Mental”. Available from: https://www.bcn.cl/leychile/navegar?idNorma=1159383 [Last accessed on 2024 Oct 16].
Charlson, F., Van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194):240-248. https://doi.org/10.1016/S0140-6736(19)30934-1
INJUV. 10th National Youth Survey, 2022.
Jo, E., Seo, K., Nam, B., Shin, D., Kim, S., Jeong, Y., et al. (2023). Deterioration of mental health in children and adolescents during the COVID-19 pandemic. Soa Chongsonyon Chongsin Uihak, 34(1):21-29. https://doi.org/10.5765/jkacap.220041
Li, S., Xu, Y., Zheng, L., Pang, H., Zhang, Q., Lou, L., et al. (2022). Sex difference in global burden of major depressive disorder: Findings from the global burden of disease study 2019. Front Psychiatry, 13:789305. https://doi.org/10.3389/fpsyt.2022.789305
Ministry of Health, National Plan of MH 2017-2025. Available from: https://www.repositoriodigital.minsal.cl/ handle/2015/889 [Last accessed on 2024 Oct 16].
O’Connor, K., Wrigley, M., Jennings, R., Hill, M., & Niazi, A. (2021). Mental health impacts of COVID-19 in Ireland and the need for a secondary care mental health service response. Irish Journal of Psychological Medicine, 38(2):99-107. https://doi.org/10.1017/ipm.2020.64
OECD Health Statistics. (2023). Available from: https://www. oecd.org/en/data/datasets/oecd-health-statistics.html [Last accessed on 2024 Oct 16].
PAHO-WHO. La Carga de los Trastornos Mentales en la Región de las Américas 2018. Available from: https://iris.paho.org/ bitstream/handle/10665.2/49578/9789275320280_spa.pdf [Last accessed on 2024 Oct 16].
Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M., et al. (2007). No health without mental health. The Lancet, 370(9590):859-877. https://doi.org/10.1016/S0140-6736(07)61238-0
Superintendencia de Salud. (2021a). Circular IF/Nº 396. Available from: https://www.superdesalud.gob.cl/normativa/circular-if-n396 [Last accessed on 2024 Oct 16].
Superintendencia de Salud. (2021b). Estudio de las Coberturas Financieras de Salud Mental en Isapres Abiertas año 2020. Documento de Trabajo. Available from: https://www. superdesalud.gob.cl/app/uploads/2021/11/articles-20494_recurso_1.pdf [Last accessed on 2024 Oct 16].
The Lancet Commission On Global Mental Health and Sustainable Development. (2018).
The Lancet. (2022). Global Burden of Disease 2019.
WHO. (1946). World Health Organization Constitution of the World Health Organization. Available from: https://apps. who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1 [Last accessed on 2024 Oct 16].
WHO. (2011). Impact of Economic Crises on Mental Health. World Health Organization, Regional Office for Europe. Available from: https://iris.who.int/bitstream/ handle/10665/370872/who-euro-2011-4645-44408-62759- eng.pdf?sequence=1 [Last accessed on 2024 Oct 16].
WHO. (2018). Mental Health Atlas 2017. Geneva: World Health Organization.
WHO. (2020). The impact of COVID-19 on Mental, Neurological and Substance Use Services: Results of a Rapid Assessment. Geneva: World Health Organization.
WHO. (2022). Mental Health and COVID-19: Early Evidence of the Pandemic’s Impact. Scientific Brief. Available from: https://www.who.int/publications/i/item/who-2019-ncov-sci_brief-mental_health-2022.1 [Last accessed on 2024 Oct 16].
World Bank Health Data (2024). Available from: https://data. worldbank.org/indicator/SH.XPD.CHEX.GD.ZS [Last accessed on 2024 Oct 16].