What are the pathologies covered by the GES? What guarantees does it give? Where can I claim in case of non-compliance by health providers? These are some of the usual questions that exist around the Explicit Health Guarantee System (GES) that this 2023, will be 18 years old since its entry into force.
A law that came into force in 2005 and that has gradually increased its coverage, going from 25 to 87 pathologies, being among the last incorporated, rehabilitation for Covid-19 and comprehensive care in case of sexual assault.
It ensures the diagnosis, treatment and monitoring of multiple diseases, including different types of cancer, acute myocardial infarction, outpatient dental emergencies; refractive vices; arterial hypertension, diabetes mellitus, among others.
“This set of benefits delivered through the AUGE-GES grants greater coverage to problems with high prevalence in the most economically vulnerable population, considerably improving equity in access. For this reason, we highlight its evolution in our region during these 18 years, in which more than 1,200,000 admissions have been completed”, highlighted the deputy director of Assistance Management of the Ñuble Health Service, Dr. Max Besser Valenzuela.
Likewise, the specialist stressed that “Ñuble registers a wide coverage, which compares us with other regions that are larger, which means that our users consult and are more informed. However, we still detect that there is a population that often reports late and loses the opportunity to enter, therefore, the call is to stay informed, through different channels, either in the OIRS of their health establishments or through the Salud Responde telephone lines, 600 360 7777, or FONASA, 600 360 3000 ”.
GES guarantees
The Explicit Health Guarantee System (GES) is a set of benefits, guaranteed by law, that ensures all Fonasa and Isapres affiliates have access to care in the event of suffering any of the health problems included in the plan.
Andrea Hernández Sánchez, head of the Section of Processes and Management of Explicit Guarantees in Health of the SSÑ, explained that “the GES guarantees required by law are four: guarantee of access, which has to do with those who have the right to access these benefits, which are people affiliated with Fonasa and Isapres; the guarantee of opportunity, which speaks of the deadlines that must be met in each of the stages of the health process; the financial protection guarantee, which means how much the user will have to copay when he is treated at a specialty level for a health problem, but for the purposes of Fonasa users, that guarantee no longer exists, due to the implementation of Zero Copayment; and the last one has to do with quality, which talks about the providers that have to be accredited under the Health Superintendency and also all the officials who work in GES care have to be registered with the Health Superintendency”.
“To enter the GES, Fonasa users do so through their primary care establishment, either their Cesfam, or the Community Hospital where they are registered, because the majority enter this way, except for pathologies that are urgent, but 80% enter and are treated in the APS. For Isapre affiliates, they access through them, which has to provide the information that the provider is registered to access care for the pathology that is afflicting them”, added the professional.
