Lessons from European Health Reforms for Chile: The Governance Gap in Building Integrated Health Systems

Abstract

European experience demonstrates that the integration of health services does not primarily depend on emerging technologies or structural reforms, but rather on governance capacity to coordinate stakeholders, align incentives, and sustain long-term transformation processes. While interoperability, telemedicine, and shared information systems serve as critical facilitators, their impact remains constrained in the absence of robust mechanisms for stewardship, strategic planning, and accountability. In Chile, the challenges in consolidating integrated health services networks (RISS) precisely reflect these systemic gaps in institutional and territorial governance. Consequently, healthcare integration must be conceptualized as a fundamentally political and organizational challenge rather than a technological one.