[The pending health reform in Chile: reflections on a proposal to transform the systemA inacabada reforma da saúde no Chile: reflexões sobre proposta de transformação do sistema].

Chile maintains a health system segmented by risks and income. A Presidential Commission convened in 2014 presented two scenarios for its health system in accordance with a timeline of expected results. For the long term, it proposed a vision for the direction of the Chilean health system that would converge in a single public insurance. For the short term, it proposed a transition that consisted of regulating pension health institutions to function under social security rules and principles. The central approaches were based on international evidence of systems that have achieved success in offering universal health access and coverage to the population, through appropriate transformations and regulations. The analysis carried out by the Commission signaled the beginning of a new paradigm for health policies in Chile. This points out that the strategy used previously-to promote greater competition and freedom of choice in health insurance markets-has not yielded results, and that in order to advance towards equitable access to health it is necessary to focus on the right to health and the principles of solidarity and equity, as well as assessing progress in the world, recognizing that the Chilean scheme moves away from the best practices in terms of the design of health systems. The proposal has not been implemented yet, and it will be necessary to propose an accelerated implementation plan for its long-term vision. Chile's experience is relevant for other countries in the Region of the Americas that discuss the problems of health segmentation.