Health system and hospital utilization in Chile, 1952–2020: trends, reforms, and inflection points

Objective. To collect and analyze longitudinal data on hospital discharges in Chile between 1952 and 2020, both at the national level and within the public subsystem. Patterns of change were identified in relation to the following key institutional milestones: the Curative Medicine Act of 1968, the creation of the National Health Services System in 1979, and the implementation of the Universal and Guaranteed Access Reform in 2005. Methods. A first-of-its-kind time series was constructed using official sources from the Ministry of Health and institutional documents. Indicators were calculated for the total number of discharges, discharge rates per thousand population, and comparisons with the United States. The analysis included exploratory graphics and construction of segmented regression models. Results. Hospital discharges rose steadily, with two periods mirroring robust expansion of the private sector: between 1982 and 1987 and between 2006 and 2019. Public provision of hospital services slowed or decreased with the 1979 reform and with the 2005 reform, although not with the 1968 reform. Conclusion. This study provides empirical evidence on the long-term trajectory of Chilean hospital services and confirms a structural contrast between the country's major health system models and the differences in their reforms. It also underscores the need for long-term information to analyze the impact of health reforms.