Observation (CEACR) - adopted 2009, published 99th ILC session (2010)

Article 4, paragraph 3, of the Convention. Medical benefits. In reply to the Committee’s previous comments, the Government states that section 139 of Ministry of Health “Decree with Force of Law” No. 1 of 2005 (DFL) to “revise, coordinate and systematize” Legislative Decree No. 2.763 of 1979 and Acts Nos 18.933 and 18.469, requires the State to ensure that care is free from the onset of pregnancy until the sixth month following the birth of the child, and for newborn children until the sixth year of their lives. The Committee notes that what section 139 actually provides is that all pregnant women, during pregnancy and until the sixth month following the birth of the child, are entitled to care including medical checks during pregnancy and following confinement (subsection 1); and that newborn children likewise have this entitlement until the sixth year of their lives (subsection 2). Subsection 3 provides that care during confinement is included in the medical assistance laid down in section 138(b) of DFL No. 1, which specifies that curative medical assistance includes consultations, diagnostical and surgical examinations and procedures, hospitalization, obstetric care and treatment including the medicines specified in the national form and the other health care and measures. With regard to the costs of these benefits, the Committee notes that section 145 of DFL No. 1 provides that the care established in subsections 1 and 2 of section 139 is free, whereas the care during confinement laid down in subsection 3 of section 139 (including hospitalization) is charged for. It also notes that under sections 158, 159, 160 and 161, the State’s participation in medical costs during confinement has been maintained in respect of beneficiaries whose income exceeds a certain amount (categories C and D). Consequently, some women workers remain under the obligation to share in the cost of medical care received during confinement as laid down in subsection 3 of section 139. The Committee would remind the Government in this connection that, as it has been pointing out for several years, the Convention guarantees ipso jure, for all women within its scope fulfilling the requirements, free medical benefits (prenatal care, care during confinement, postnatal care and hospitalization where necessary). It notes with regret that the Government has failed to take the opportunity to adopt regulations to this effect in order to bring its legislation into conformity with this provision of the Convention. It draws the Government’s attention to the need to fulfil the international obligations assumed by Chile by providing in the national legislation for free medical benefits for maternity. The Committee requests the Government to provide information on progress made in this connection in its next report. Please also indicate whether Ministry of Health Resolution No. 1717 of 1985, referred to by the Government in its 2004 report, is still in force and, if so, provide a copy of it.

The Committee notes that the Government’s report does not contain the information that the Committee requested previously regarding freedom of choice of doctor and hospital. The Committee requests the Government to specify in its next report whether, in the context of DFL No. 1, insured persons have freedom of choice of doctor and between a public or a private hospital, in accordance with this provision of the Convention, and to specify the relevant legislative and regulatory provisions.

Article 4, paragraph 5. Assistance benefits. The Committee notes with regret that the Government’s report does not answer its previous comment that no benefits out of social assistance funds are payable, subject to the means test, to women who do not fulfil the affiliation requirements set in section 4 of Decree with Force of Law No. 4 of 1978 and so are not eligible for cash benefits. The Committee accordingly hopes that in its next report, the Government will indicate the measures taken or envisaged to give full effect to this provision of the Convention.