which allows the user health to choose between public or private suppliers, on the basis of previously established tariffs. This system is financed by the compulsory contribution (7% of the salary), plus the user’s copayment for care (variable amounts) and resources from the state.

The insurance has a solidarity nature

so that the population without economic health resources can receive medical care, but only in the institutional mode (Public Service). Private insurance or Isapre (welfare health institutions) is managed by for-profit insurance companies responsible for providing medical care directly or indirectly. This modality is financed with the contribution of the worker, which can not be less than 7% of his remuneration, but whose monthly cost varies according to the insurance health program that the user contracts, being also an individual insurance that does not contribute to the health Solidarity

Fund (Gumucio, 2009).1in 2005, the health law was enacted that created the Universal Access with explicit guarantees in health (auge/ges) program whose objective is to guarantee access, quality, opportunity and financial protection to users of public and private insurance, with a ceiling of 20% of the payment on a health reference tariff, which is considered a series of Health pathologies with high impact on the budget and high incidence in the population (Bastias and Valdivia, 2007; Erazo, 2011). While the boom was to reduce inequalities in health between 2000-2009 (Ortiz and Pérez, 2014), their achievements have involved the derivation of many medical benefits to private companies by the mode of procurement of health

  • services, which has involved the transfer of public resources into the private sector and weakened and other needs existing at the level of the public services (Bossert and Leisewitz, 2016).Health System in Costa Ricathe Costa Rican health system is organized through sickness and maternity insurance, which covers comprehensive care benefits, providing coverage to the insured and his family group. The insurance operates as a Solidarity Fund, health financed by
  • tripartite contributions provided by the employer (9.25%), the worker (5.50%) and the state (0.25%), of the total salary. Persons without health insurance, such as under 18, uninsured pregnant women, non-contributory pensioners and the homeless, are covered by the state. The health provision of health care is provided mainly by the public system through the hospitals of the Costa Rican Social

Security Fund (CCSS), the basic teams

of Comprehensive Health Care health (ebais) and Cooperatives and private universities in agreement with the ccss. The offer of private health services shows a recent development, offering outpatient care and medical specialties for profit, financed mainly by direct payments from users or through a system of premiums through private insurance. The National Insurance Institute (ins) is responsible for the coverage of Occupational and traffic risks, providing hospital care and trauma rehabilitation services for workers in the public and private sectors (Saenz et al., 2011).Currently, the ccss is working on the inclusion of the population that does not have health coverage, consisting mainly of micro-entrepreneurs, self-employed workers and immigrants, although all persons without exclusion have the right to receive emergency care, maternity and pediatrics. In recent health

decades there have been threats of commercialization of health services, resulting from the low quality of some public services and the long waiting lists for specialized health services, difficulties that generate a process of flight to the private sector by the population of middle-high and high incomes (Bitrán, 2014; Clark, 2014).Brief comparison of Chile and Costa Ricain order to provide a brief overview of the main characteristics of the health systems of Chile and Costa Rica, we have selected some indicators that provide information on coverage, financial investment and health

  • private spending on health.Table 1 summarizes the selected indicators, highlighting the similarity between the two countries, with virtually universal coverage for the population with health insurance. The financial indicators show the public effort each system makes in this area. Related to public spending on health as a percentage of GDP,
  • Costa Rica spent more than Chile, with a difference in favor of the former of 2.4 in 1995 and 2.9 in 2014, increasing both countries ‘ public spending during that period. Public health spending as a percentage of total health spending is also higher in health Costa Rica than in Chile. The first spends about 75% and the second about 50%. But it is also observed that in the span

of 19 years Chile increased health

this expenditure by 1.3% , while Costa Rica decreased it by 3.8%. The per capita expenditure indicator in current U.S. dollars shows an increase in expenditure in both countries for the period 1995-2013, increasing slightly more in Chile than in Costa Rica. Considering the higher public spending in percentage of health expenditure and the highest expenditure on health in percentage of gdp in Costa Rica, it is possible to estimate that the expenditure in Chile is health associated to a greater degree of inefficiency of the public sector, an unwarranted use of medical procedures and

most administrative expenses (Ortiz and Perez, 2014) and a higher private expenditure in respect of Costa Rica.two months of the 70th World Health Assembly of the World Health Organization to be held in may next, here we review the precise health agenda that Margaret Chan, who Director General, established in 2016, anticipating 10 serious and pressing health problems facing the world: 1. Air pollution ” a transboundary hazard that affects the global atmosphere and contributes to climate change.”Today, environmental pollution causes 1.7 million child deaths per yearsouth Korea bans antibiotic treatments for Childhood flu2. Resistant pathogens increasing the number of drug-resistant” supermicrobs”. To this is added that they move internationally through people, animals and