Quote of the moment

"I have to tell it again and again: I have no doctrine. I only point out something. I point out reality, I point out something in reality which has not or too little been seen. I take him who listens to me at his hand and lead him to the window. I push open the window and point outside. I have no doctrine, I carry on a dialogue." Martin Buber

Friday, March 23, 2012

Health care in Chile: Resources and research

When moving to a new country health care is a critical concern for many. Questions asked include, "Where do I go for health care that is good and that I can afford."  Chile's health program has also entered the USA political arean in this presidential and political season. Candidates have been comparing Chile's health programs to that in the USA.

 I have had personal experience with the private side of health care. In fact friends tease me as coming to Chile to sample the various health care options. I have also seen a friend of mine with an intellectual disability receive minimal care only after great advocacy of his friends. See my post: Health Care- A Tale of Two Patients, A Tale of Two Crazy Pigs

After seeing what was available for my friend with an intellectual disability and the efforts of another friend to make changes in the Chilean AUGE health system so that dystonia would be covered, I realized I needed to learn more about the issues. This post is a collection of the references and information with abstracts that I have discovered along the way. I have ordered the information by publication date. If you know of other references to add to this list please include it in a comment or contact me directly. 

Health Care in Chile

This site was created for GE's healthymagination by the Economist Intelligence Unit. It presents the results of a wide-ranging investigation into the critical healthcare issues facing countries around the world. The analysis, data and commentary can be viewed in multiple formats. Information for Chile includes 

Health Care and Insurance: All Chile.Net
Chile Wiki For Expats, Gringos, Foreigners, and the curious covering information and resources for working living, relocating, and visiting, ALL of CHILE, South America. This page covers information regarding health care.

Chile's government is debating reforms to the country's healthcare system, but is unlikely to dismantle the private funds. (November 23, 2011) Economist Intelligence Unit. 
Chile's Parliament looks set to debate a package of healthcare reforms that are among the priorities of the right-wing government of president Sebastián Piñera. The goal, according to officials, will be to improve the quality of health services provided to poorer Chileans....The most common complaint among Chileans, however, is that the country's healthcare system is highly unequal – a complaint many link to its mixed public-private system. Chile is one of only three OECD countries where private healthcare spending outweighs public - the others being Mexico and the US. Public spending as a percentage of GDP is low, with only Mexico ranking lower, and the same goes for health spending on a per capita basis. Families can opt between health services provided by the public system run by the Fondo Nacional de Salud (Fonasa) or those offered by private firms known as Instituciones de Salud Previsionales (Isapres). Even though the two systems charge workers 7% of their monthly income for their services, it is widely agreed that the Isapres provide much better and more comprehensive healthcare service. 

In 2005 the government of Chile passed comprehensive health reform. The law mandated coverage by public and private health insurers for selected medical interventions related to fifty-six priority diseases and conditions. This paper presents previously unpublished evidence on various consequences of the reform. It also presents a first, partial evaluation of the reform’s impact on access to care, treatment outcomes, hospitalization rates, and medical leave rates for six chronic diseases. For some of those diseases, such as hypertension, types 1 and 2 diabetes, and depression, we find that the reform was linked to growing access to services and increased coverage. For those diseases and for childhood epilepsy and HIV/AIDS, the hospital case-fatality rate dropped.

This paper examines the introduction of a prioritized list of fifty-six health conditions in Chile, for which access to treatment is guaranteed. This is an important health reform issue, and the discussion of Chile’s rich and complex approach may benefit other countries. Conditions on the list were selected using multiple criteria: burden of disease, inequality, high costs, social preferences, rule of rescue, and cost-effectiveness. The dominant criteria were high burden of disease and social preferences. Cost-effectiveness was introduced after the fact to identify effective treatments at a cost that the country could afford.

The current health system in Chile began to take shape in 1952, with the creation of the National Health Service (SNS), which united different public health service providers and centralized nearly 90% of public health resources under one entity. See also:  National Health Fund (FONASA)

Rex A. Hudson, ed. Chile: A Country Study. Washington: GPO for the Library of Congress, 1994.
An on-line version of a book previously published in hard copy by the Federal Research Division of the Library of Congress as part of the Country Studies/Area Handbook Series sponsored by the U.S. Department of the Army between 1986 and 1998. Each study offers a comprehensive description and analysis of the country or region's historical setting, geography, society, economy, political system, and foreign policy.

Health Compared - Chile and USA

John Boehner is sure the U.S. has “the best health-care system in the world.” But to lots of other people, the question of where we rank is a real head-scratcher. Countries vary enormously in demographic, economic and cultural terms (and treatment can be judged in multiple ways) complicating what might seem a straightforward issue.  Researchers have only very recently come up with a neat way to pierce the fog....So, how’s the United States doing? Not so well. The US placed 24th (just behind Chile and just ahead of Portugal) among the 31 countries that are members of the OECD. 

Total health spending accounted for 8.4% of GDP in the Chile in 2009, one percentage point below the average of 9.5% in OECD countries.  The United States is, by far, the country that spends the most on health as a share of its economy (with 17.4% of its GDP allocated to health in 2009). Health spending tends to rise with income, and generally OECD countries with higher GDP per capita tend to spend more on health. It is not surprising, therefore, that Chile also ranks well below the OECD average in terms of total health spending per capita, with spending of 1,186 USD in 2009 (adjusted for purchasing power parity), almost three times lower than the OECD average of 3,223 USD.  

The Chilean authorities plan to raise budgetary allocations over the medium term for a variety of social programmes, including education, health care and housing. This incremental spending will need to be carried out in a cost-efficient manner to make sure that it yields commensurate improvements in social outcomes. Chile’s health indicators show that it fares relatively well in relation to comparator countries in the OECD area and in Latin America. But this is less so in the case of education, where secondary and tertiary educational attainment remain low, despite a significant increase over the years, and performance is poor on the basis of standardised test scores, such as PISA. Even though comparison with countries in the OECD area is difficult, a sizeable housing deficit has yet to be closed in Chile. To meet these various challenges, efforts will need to be stepped up to: i) narrow the disparities in performance that currently exist among schools with students from varying backgrounds through use of the “differentiated” voucher scheme and additional measures to improve the quality of teaching and management;  ii) improve risk sharing among private and public health insurers, while increasing the coverage of health insurance to a broader variety of pathologies under AUGE; and iii) continue to tackle the shortage of housing, while enhancing the quality of subsidised housing units and their surrounding neighbourhoods for the poorest segments of society. This paper relates to the  2007 Economic Survey of Chile (www.oecd.org/eco/surveys/chile). 

Comparisons of Chile to United States 
An interactive map created for GE's healthymagination by the Economist Intelligence Unit. on Health care inputs, outcomes and risks

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