Key points
- Chile runs a mixed system: a public fund (Fonasa) alongside private insurers (ISAPREs), both funded by a mandatory 7% contribution.
- Coverage is close to universal: every worker and pensioner contributes 7% of income, and those who do not join an ISAPRE are in Fonasa.
- Care is delivered by the public network — municipal primary care first — and by private providers.
- Since September 2022, Fonasa members pay nothing for care in the public system (Copago Cero); households still pay more than a third of all health spending out of pocket (OECD Health at a Glance 2025).
- Life expectancy at birth was 81.6 years in 2024, and health spending was 10.5% of GDP in 2024 (OECD Health at a Glance 2025).
Direct answer: Chile runs a mixed system: a public fund (Fonasa) alongside private insurers (ISAPREs), both funded by a mandatory 7% contribution from workers and pensioners. Coverage is close to universal: anyone who does not join an ISAPRE is in Fonasa, which covers most of the population, including people on low incomes, retirees and the uninsured. Care is delivered by the public network — municipal primary care first — and by private providers. Since September 2022, Fonasa members pay nothing for care in the public system (Copago Cero); households still pay more than a third of all health spending out of pocket (OECD Health at a Glance 2025). Life expectancy at birth was 81.6 years in 2024, and health spending was 10.5% of GDP in 2024 (OECD Health at a Glance 2025).
At a glance
| Item | Detail |
|---|---|
| Model | Mixed — social insurance, public + private |
| Who pays | Mandatory 7% contribution from workers and pensioners, directed to Fonasa or an ISAPRE, plus state subsidies for Fonasa |
| Who delivers | Public network (municipal primary care first) and private providers; Fonasa members use public facilities, ISAPRE members private ones |
| What is free at the point of use | Fonasa members pay nothing for care in the public system since September 2022 (Copago Cero); ISAPRE members pay top-up premiums and co-payments |
| Life expectancy at birth | 81.6 years (2024, OECD Health at a Glance 2025) |
| Health spending | 10.5% of GDP (2024, OECD Health at a Glance 2025) |
| Source for the model and coverage | Commonwealth Fund — Chile country profile |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
Chile’s system has two financing arms, created in the late 1970s and early 1980s: the National Health Fund (Fonasa), the public insurer, and the private health insurance institutions (Instituciones de Salud Previsional, ISAPREs), established in 1981. Every worker and pensioner must contribute 7% of income towards health coverage, and directs that contribution either to Fonasa or to an ISAPRE of their choice; those who do not join an ISAPRE are automatically in Fonasa. Fonasa also covers people receiving unemployment benefits, uninsured pregnant women, dependants of insured workers, people with disabilities, and people classified as poor or indigent (Commonwealth Fund).
The first point of contact is primary care, delivered through a network of municipal health centres. Public hospitals provide specialist and inpatient care for Fonasa members, and private hospitals and clinics serve ISAPRE members. A distinctive feature is the GES guarantees (Garantías Explícitas en Salud, formerly AUGE): a named list of health conditions for which the law guarantees access, a maximum waiting time, financial protection and quality standards, whichever arm the patient belongs to.
Who pays, and what people pay
The 7% contribution is the base: Fonasa members pay it (with the state subsidising the fund for people on low incomes — subsidies make up about two-thirds of Fonasa’s budget), and ISAPRE members pay it plus a voluntary top-up premium for broader private cover. Since September 2022, Copago Cero (zero co-payment) has made all services in the public system free for Fonasa members, regardless of income bracket (Government of Chile). What people still pay is substantial: households bore more than a third of all health spending directly (OECD Health at a Glance 2025), mostly through ISAPRE top-ups and co-payments, private consultations and medicines. The two arms are unequal: ISAPREs cover a small, mostly higher-income share of the population while receiving a disproportionate share of the contributions.
What is free, and what is not
For Fonasa members, care in the public system is free since September 2022, and the GES guarantees cap what anyone pays for the listed conditions. What is not free is the margin: ISAPRE premiums above the 7% contribution, co-payments for private care, medicines bought outside the public system, and care outside the GES list, where waiting times for non-guaranteed elective specialist care and surgery can be long. The boundary is set by which arm the patient belongs to and whether the condition is on the GES list.
How it compares
Chile spends 10.5% of GDP on health — above the OECD average of 9.3% — and $3,749 per person, below the OECD average of $5,967 (USD PPP, 2024). Its life expectancy of 81.6 years (2024) is 0.5 years above the OECD average of 81.1 years (2023, OECD Health at a Glance 2025). Its distinguishing feature is the dual system itself: one mandatory contribution feeding two separate arms — a public fund covering most of the population and private insurers covering a smaller, higher-income share — held together by the GES guarantees and, since 2022, by free public care for Fonasa members. Diabetes prevalence is among the highest in the OECD, at 14.0% of adults in 2022 (OECD Health at a Glance 2025). Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
What is Fonasa?
The National Health Fund: the public insurer, funded by the mandatory 7% contribution plus state subsidies for people on low incomes. Anyone who does not join a private ISAPRE is in Fonasa, which covers most of the population.
What is an ISAPRE?
A private health insurer (Institución de Salud Previsional): members direct their 7% contribution to it and usually pay a top-up premium, in exchange for private-sector care and shorter waits.
Is care free for Fonasa members?
In the public system, yes since September 2022: Copago Cero ended co-payments for Fonasa members at public facilities, whatever their income bracket (Government of Chile).