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Borgeat M, Espinoza I, Navarro K, Carvajal C, Carvajal P. Inequalities by sex on remaining teeth in adults: A decomposition analysis. Community Dent Oral Epidemiol 2023. [PMID: 37235482 DOI: 10.1111/cdoe.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To identify which social determinants of health explain the gap in the remaining teeth between men and women. METHODS A secondary analysis of data from the Chilean National Health Survey (CNHS) 2016-2017 was performed on the number of remaining teeth in adults. The explanatory variables were organized into structural and intermediate social determinants of health according to the WHO framework. The contribution of both groups and the contribution of each individual explanatory variable to the remaining teeth gap was estimated using the Blinder-Oaxaca decomposition analysis. RESULTS The predicted average number of remaining teeth for men was 23.4 and 21.0 for women, thus a mean difference of 2.4 teeth. 49.8% of the inequality between men and women was due to the different distribution (endowments) of the predictors in the model. Among them, structural determinants of health, namely education level (15.8%) and employment status (17.8%), contributed the most. Intermediate determinants had no relevant contribution to explain the gap. CONCLUSIONS Results revealed that the difference in the mean number of remaining teeth between men and women was mainly explained by two structural determinants: education level and employment status. The lack of explanatory power of intermediate determinants and the large explanatory power of structural determinants means that tackling oral health inequity in Chile requires strong political commitment. The role of intersectoral and intersectional public policies to address gender inequalities in oral health in Chile is discussed.
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Affiliation(s)
- Marjorie Borgeat
- Interdisciplinary Center for Health Studies, Faculty of Dentistry, University of Valparaíso, Valparaíso, Chile
- Interuniversity Center for Healthy Aging, Chile
| | - Iris Espinoza
- Interuniversity Center for Healthy Aging, Chile
- Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile, Santiago, Chile
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Santiago, Chile
| | - Karina Navarro
- Department of Sociology, Faculty of Social Sciences, University of Chile, Santiago, Chile
| | - Claudia Carvajal
- Department of Oral Health, Division of Prevention and Control of Diseases, Ministry of Health, Santiago, Chile
| | - Paola Carvajal
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Santiago, Chile
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
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2
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Kim S, Kwon S. Has South Korea achieved the goals of national health insurance? Trends in financial protection of households between 2011 and 2018. Soc Sci Med 2023; 326:115929. [PMID: 37137200 DOI: 10.1016/j.socscimed.2023.115929] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
This study aims to investigate the evolution of financial protection of households against OOP in South Korea, where subsequent policies of expanding benefit coverage have been implemented primarily focusing on several severe diseases, by measuring catastrophic healthcare expenditure (CHE) and the characteristics of households vulnerable to CHE. Using the Korea Health Panel 2011-2018, this study analyzed CHE trends by the targeted severe diseases and other health problems and household income and examined the determinants of CHE using binary logistic regression. Our findings showed that CHE decreased in households with the targeted severe diseases but increased in households experiencing hospitalization that were not related to the targeted diseases, which appeared to have a significantly higher likelihood of CHE in 2018 than households with the targeted severe diseases. In addition, CHE was more prevalent and increased or remained stagnant among households whose heads had health problems than others. Inequalities in CHE also increased, showing increased Concentration Index (CI) and increased incidences of CHE in the lower income quartile during the study period. These results suggest that the current policies are insufficient to achieve its financial protection goals against healthcare expenditure in South Korea. In particular, benefit expansions targeting a specific disease may cause inequitable distribution of resources and may not enhance protection against households' financial burden.
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Affiliation(s)
- Sujin Kim
- Korea Institute for Health and Social Affairs, South Korea
| | - Soonman Kwon
- School of Public Health, Seoul National University, South Korea.
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3
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Borgeat Meza M, Espinoza I, Carvajal P, Cuevas R. Changes in oral health inequalities in adults in Chile. Community Dent Oral Epidemiol 2022; 50:506-512. [PMID: 34713473 DOI: 10.1111/cdoe.12701] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 01/27/2023]
Abstract
The adult population in Chile has a high prevalence of dental caries and non-functional dentition. Fifteen years after the Health Reform, aimed to reduce health inequalities, it is necessary to analyse changes in social inequalities in oral health in Chilean adults. METHODS A secondary analysis of data from 2003 and 2016-2017 National Health Surveys (NHS) in Chile was performed on seven oral health outcomes in adults: prevalence of untreated caries, prevalence of severe untreated caries, number of teeth with untreated caries, prevalence of functional dentition, prevalence of edentulism, number of remaining natural teeth and utilization of dental services. Inequalities were measured with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) by education level. RESULTS A decrease of caries inequalities measured with SII was observed from 2003 to 2016-17 NHS but an increase of remaining teeth inequalities was measured. The SII of the remaining teeth increased from 6.6 [95% CI = 5.0, 8.2] in 2003 to 8.8 [95% CI = 7.3, 10.3] in 2016-17. The SII of functional dentition by education increased from 29.0 [95% CI = 22.0, 36.0] in 2003 to 38.8 [95% CI = 32.6, 45.0]) in 2016-17. The utilization of dental services ≤1 year was the only outcome that showed a decrease in absolute and relative inequality, the SII was 33.9 [95% CI = 23.3, 45.6] in 2003 and 26.2 [95% CI = 16.6, 35.8] in 2016-17 and the RII decreased from 2.5 [95% CI = 1.7, 3.3] in 2003 to RII = 1.8 [95% CI = 1.4, 2.3] in 2016-17. CONCLUSION The increase of tooth loss inequalities in contrast to the decrease of inequalities in dental services utilization show the need to re-evaluate the current dental programmes for adults in Chile. This may include establishing a stronger oral health promotion strategy and greater dental treatment coverage focusing on avoiding tooth extractions in vulnerable social groups.
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Affiliation(s)
- Marjorie Borgeat Meza
- Interdisciplinary Center for Health Studies, Faculty of Dentistry, University of Valparaíso, Valparaíso, Chile.,Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Iris Espinoza
- Faculty of Dentistry, Universidad de Chile, Santiago, Chile.,Center for Epidemiology and Surveillance of Oral Diseases (CESOD) and Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Paola Carvajal
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD) and Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile, Santiago, Chile.,Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Rosa Cuevas
- Faculty of Dentistry, University of La Serena, La Serena, Chile
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4
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Epidemiology and trends of ocular trauma hospitalizations in Chile from 2001 to 2020. J Fr Ophtalmol 2022; 45:1055-1062. [DOI: 10.1016/j.jfo.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/27/2022] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
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5
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Piñones-Rivera C, Liberona N, Arancibia R, Jiménez V. Indigenous Border Migrants and (Im)Mobility Policies in Chile in Times of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9728. [PMID: 35955083 PMCID: PMC9367877 DOI: 10.3390/ijerph19159728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
The commodification of healthcare and the structural violence towards the migrant population in the Chilean system materialize in a series of structural barriers to accessing healthcare. In the face of this structural vulnerability, cross-border health mobility is one of the primary resources of indigenous border migrants living in the Tarapacá region (Chile). This involves crossing the border of both people (specialists/patients) and objects (such as ritual supplies or biomedicines), which play a crucial role as, in many cases, it is the only way to satisfy their healthcare needs. The security-orientated geopolitics of border closure (Plan Frontera Segura) has been reinforced by immobility policies linked to the COVID-19 pandemic. While doing so leaves people without the fundamental resource of healthcare mobility or obliges them to cross the border via unauthorized crossings, exposing them to criminalization and abuse by different agents of violence (the military, people smugglers, etc.). In this paper, we will offer a description of these processes of (im)mobility, analyzing their conformation both by the current policies of the Chilean State and by the notorious deficiency in indigenous and migrant rights, denouncing the material impact they have on the health/illness/care process of indigenous migrants.
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Affiliation(s)
| | - Nanette Liberona
- Departamento de Antropología, Universidad de Tarapacá, Arica 1000000, Chile
| | | | - Verónica Jiménez
- Programa de Doctorado en Psicología, Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica 1000000, Chile
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6
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Bravo P, Dois A, Martínez A, González-Agüero M, Soto G, Rioseco A, Campos S, Bustamante C, Vargas I, Stacey D. Advancing towards the implementation of patient-centred care in Chile: An opportunity to effectively practice shared decision-making. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:30-35. [PMID: 35643804 DOI: 10.1016/j.zefq.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
In Chile, local normative and guidelines place patient-centred care (PCC) as a desirable means and outcome for each level of health care. Thus, a definition of PCC is provided, and for the first time shared decision-making (SDM) is included as an intended practice. During the past five years the country has shown progress on the implementation of PCC. A large pilot study was conducted in one of the Metropolitan Health Services, and now the health authority is committed to escalate a PCC strategy nationwide. From the practice domain, most of the work is being placed on the training of health professionals. Patients' preparation for the clinical encounter is scarce, thereby limiting their potential to participate in their care. At the research domain, the country shows a strengthened agenda that has advanced from a diagnostic phase (including the exploration from social sciences) to a purposeful stage which involves the development of training programs, patient decision aids, international collaborations, and other PCC interventions. The country is now positioned to secure new initiatives to empower patients and allow them to take an active role, as a key component of PCC and SDM.
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Affiliation(s)
- Paulina Bravo
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro Núcleo Milenio Autoridad y Asimetrías de Poder / Millennium Nucleus Center Authority and Power Asymmetries, Santiago, Chile; Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile.
| | - Angelina Dois
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Martínez
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Gabriela Soto
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Rioseco
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Solange Campos
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Bustamante
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Irma Vargas
- Departamento de gestión de los cuidados, División de Atención Primaria, Ministerio de Salud, Santiago, Chile
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
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7
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The 2019 crisis in Chile: fundamental change needed, not just technical fixes to the health system. J Public Health Policy 2021; 41:535-543. [PMID: 32747702 PMCID: PMC7396457 DOI: 10.1057/s41271-020-00241-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chile has been viewed as an exemplar of social and economic progress in Latin America, with its health system attracting considerable attention. Eruption of widespread civil disorder marred this image in 2019. We trace the evolution of Chilean health policy and place it in context with developments in other sectors, pensions and education. We argue that much has been achieved, but further progress will necessitate politicians tackling the enduring power of elites that has prevented reform of a two-tier system enshrined in policies of the dictatorship.
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8
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Castillo C, Villalobos Dintrans P, Maddaleno M. The successful COVID-19 vaccine rollout in Chile: Factors and challenges. Vaccine X 2021; 9:100114. [PMID: 34518818 PMCID: PMC8425670 DOI: 10.1016/j.jvacx.2021.100114] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/27/2021] [Accepted: 09/04/2021] [Indexed: 10/25/2022] Open
Abstract
As the COVID-19 pandemic continues causing problems around the world, Chile is facing a new episode of increasing cases and deaths. However, at the same time, the country has succeeded in providing vaccines for an important part of its population over a short period. What are the factors behind this successful process? What are the challenges faced by the country today? This article explores potential explanations for the "Chilean paradigm", regarding the COVID-19 vaccine rollout. Borrowing from implementation science frameworks, the analysis proposed an alternative explanation-based on multiple actors, approaches, and history-as opposed to one in which the outcome is due mainly to the government's performance. The rapid and extensive coverage of vaccination can be explained by the role played by the government and the academia in securing vaccines through a pragmatic approach; the capacity built at local level, as well as the coordination between the health system and local authorities; and favorable vaccine culture, developed through the implementation of the National Immunization Program. Short and long-term elements (such as investment in infrastructure and relationships between stakeholders, and actions carried out during the pandemic), as well as contextual factors (such as the political and socioeconomic context), provide a more complex story to explain the observed outcomes. While other countries could try to follow the Chilean example, the article shows that short-term actions are necessary but might not be sufficient to achieve results. At a global level, the situation calls for rethinking how countries will face these global challenges, including issues such as international cooperation and global health governance.
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Affiliation(s)
- Claudio Castillo
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Av. Libertador Bernardo O'Higgins 3363, Estación Central, Santiago, Chile
| | - Pablo Villalobos Dintrans
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Av. Libertador Bernardo O'Higgins 3363, Estación Central, Santiago, Chile
| | - Matilde Maddaleno
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Av. Libertador Bernardo O'Higgins 3363, Estación Central, Santiago, Chile
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9
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Bossert TJ, Villalobos Dintrans P. Health Reform in the Midst of a Social and Political Crisis in Chile, 2019-2020. Health Syst Reform 2021; 6:e1789031. [PMID: 32706280 DOI: 10.1080/23288604.2020.1789031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The protests in Chile in October 2019 raised the issue of health reform to the public agenda again. This article reviews some of the explanations for why there was a widespread protest, including the expectations of continued progress, the emergence of a "fear-based populism" and the decline in legitimacy of most social and political actors. Using the theories of Kingdon to explain how reforms are placed on the political agenda, we describe how the protests raised health reform as a problem to be addressed, discuss the tendency toward consensus on policy options by technical health reform advocates, and examine the uncertain political processes that would be necessary for a consensus reform to be adopted and implemented. A lesson for reformers is the need to pay attention to growing signs of popular resentment over failures of health reforms to address accumulating problems and to try to address them with urgency to avoid populist crises.
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Affiliation(s)
- Thomas J Bossert
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA
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10
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Medical Cost of Cancer Care for Privately Insured Children in Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136746. [PMID: 34201571 PMCID: PMC8267683 DOI: 10.3390/ijerph18136746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 11/27/2022]
Abstract
Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007–2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients’ characteristics, type of cancer, and by service. Children with cancer had high annual medical costs, USD 32,287 on average for 2018. Costs were higher for the younger children in the sample. The vast majority of the cost was driven by inpatient hospital care for all types of cancer. The average total cost increased 20% in real terms over the period of study, while out-of-pocket expenses increased almost 29%. Private insurance beneficiaries faced a significant economic burden associated with medical treatment of a child with cancer. Interventions that reduce hospitalizations, as well as systemwide reforms that incorporate maximum out-of-pocket payments and prevent catastrophic expenditures, can contribute to alleviating the financial burden of childhood cancer.
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11
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Undurraga J, Bórquez-Infante I, Crossley NA, Prieto ML, Repetto GM. Pharmacogenetics in Psychiatry: Perceived Value and Opinions in a Chilean Sample of Practitioners. Front Pharmacol 2021; 12:657985. [PMID: 33935777 PMCID: PMC8082421 DOI: 10.3389/fphar.2021.657985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022] Open
Abstract
Use of pharmacogenetics (PGx) testing to guide clinical decisions is growing in developed countries. Published guidelines for gene–drug pair analysis are available for prescriptions in psychiatry, but information on their utilization, barriers, and health outcomes in Latin America is limited. As a result, this work aimed at exploring current use, opinions, and perceived obstacles on PGx testing among psychiatrists in Chile, via an online, anonymous survey. Among 123 respondents (5.9% of registered psychiatrists in the country), 16.3% reported ever requesting a PGx test. The vast majority (95%) of tests were ordered by clinicians practicing in the Metropolitan Region of Santiago. Having more than 20 years in practice was positively associated with prior use of PGx (p 0.02, OR 3.74 (1.19–11.80)), while working in the public health system was negatively associated (OR 0.30 (0.10–0.83)). Perceived barriers to local implementation included insufficient evidence of clinical utility, limited clinicians’ knowledge on PGx and on test availability, and health systems’ issues, such as costs and reimbursement. Despite the recognition of these barriers, 80% of respondents asserted that it is likely that they will incorporate PGx tests in their practice in the next five years. Given these results, we propose next steps to facilitate implementation such as further research in health outcomes and clinical utility of known and novel clinically actionable variants, growth in local sequencing capabilities, education of clinicians, incorporation of clinical decision support tools, and economic evaluations, all in local context.
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Affiliation(s)
- Juan Undurraga
- Department of Neurology and Psychiatry, Clínica Alemana Universidad Del Desarrollo, Santiago, Chile.,Early Intervention Program, Instituto Psiquiátrico Dr J. Horwitz Barak, Santiago, Chile
| | | | - Nicolás A Crossley
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile.,Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Miguel L Prieto
- Department of Psychiatry, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile.,Mental Health Service, Clínica Universidad de Los Andes, Santiago, Chile.,Center for Biomedical Research and Innovation, Universidad de Los Andes, Santiago, Chile.,Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Gabriela M Repetto
- Center for Genetics and Genomics, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad Del Desarrollo, Santiago, Chile.,Department of Pediatrics, Clínica Alemana, Santiago, Chile
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12
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Villalobos Dintrans P. Health Systems, Aging, and Inequity: An Example from Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6546. [PMID: 32916795 PMCID: PMC7559430 DOI: 10.3390/ijerph17186546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 12/03/2022]
Abstract
Background: Just like many other countries around the world, Chile is facing the challenges of demographic transition and population aging. Considering this context, the question of how prepared the health system is to deal with these challenges arises; Methods: A framework to assess the health system's preparedness for aging was proposed, considering the health system's goals and features and using an equity approach. Indicators related to the health system's goals were calculated for the year 2015 using three nationally-representative sources: health status (suicide rate), financial protection (out-of-pocket and catastrophic expenditures), and responsiveness (satisfaction). Age ratios were used to compare the system's response to different age groups; Results: Results for Chile revealed the existence of inequities, particularly when assessing the system in terms of its ability to improve health status and financial protection. These gaps increase with age, suggesting that the Chilean health system is not prepared to meet older people's needs; and Conclusions: These results call for a reform in the health system, as well as the need for implementing a long-term care system in the country.
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Affiliation(s)
- Pablo Villalobos Dintrans
- Programa Centro de Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, 8320000 Santiago, Chile
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13
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Villalobos Dintrans P. Why Health Reforms Fail: Lessons from the 2014 Chilean Attempt to Reform. Health Syst Reform 2020; 5:134-144. [PMID: 31194642 DOI: 10.1080/23288604.2019.1589916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In 2014, Chile started a process to reform its private health insurance scheme. A commission was created and released a report with recommendations, but no changes have been introduced yet. This article analyzes that reform process. The analysis included document review and interviews with key stakeholders involved in the process. Results show that although the Commission failed in producing the intended changes, it contributed to opening the debate regarding the Chilean health system, making explicit the different positions on the issue. The analysis shows that the reform did not advance because of the lack of basic consensus on the Commission's role, scope, and main purpose among stakeholders. Previous reforms highlight the relevance of time and information in creating a successful reform process.
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Affiliation(s)
- Pablo Villalobos Dintrans
- a Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA.,b Programa Centro de Salud Pública, Facultad de Ciencias Médicas , Universidad de Santiago , Santiago , Chile
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14
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Aguayo GA, Schritz A, Ruiz-Castell M, Villarroel L, Valdivia G, Fagherazzi G, Witte DR, Lawson A. Identifying hotspots of cardiometabolic outcomes based on a Bayesian approach: The example of Chile. PLoS One 2020; 15:e0235009. [PMID: 32569307 PMCID: PMC7307745 DOI: 10.1371/journal.pone.0235009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a need to identify priority zones for cardiometabolic prevention. Disease mapping in countries with high heterogeneity in the geographic distribution of the population is challenging. Our goal was to map the cardiometabolic health and identify hotspots of disease using data from a national health survey. METHODS Using Chile as a case study, we applied a Bayesian hierarchical modelling. We performed a cross-sectional analysis of the 2009-2010 Chilean Health Survey. Outcomes were diabetes (all types), obesity, hypertension, and high LDL cholesterol. To estimate prevalence, we used individual and aggregated data by province. We identified hotspots defined as prevalence in provinces significantly greater than the national prevalence. Models were adjusted for age, sex, their interaction, and sampling weight. We imputed missing data. We applied a joint outcome modelling approach to capture the association between the four outcomes. RESULTS We analysed data from 4,780 participants (mean age (SD) 46 (19) years; 60% women). The national prevalence (percentage (95% credible intervals) for diabetes, obesity, hypertension and high LDL cholesterol were 10.9 (4.5, 19.2), 30.0 (17.7, 45.3), 36.4 (16.4, 57.6), and 13.7 (3.4, 32.2) respectively. Prevalence of diabetes was lower in the far south. Prevalence of obesity and hypertension increased from north to far south. Prevalence of high LDL cholesterol was higher in the north and south. A hotspot for diabetes was located in the centre. Hotspots for obesity were mainly situated in the south and far south, for hypertension in the centre, south and far south and for high LDL cholesterol in the far south. CONCLUSIONS The distribution of cardiometabolic risk factors in Chile has a characteristic pattern with a general trend to a north-south gradient. Our approach is reproducible and demonstrates that the Bayesian approach enables the accurate identification of hotspots and mapping of disease, allowing the identification of areas for cardiometabolic prevention.
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Affiliation(s)
- Gloria A. Aguayo
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Anna Schritz
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Maria Ruiz-Castell
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Valdivia
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Guy Fagherazzi
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Daniel R. Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Andrew Lawson
- Department of Public Health Sciences, Medical University of South Carolina, South Carolina, Charleston, United States of America
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Becerra M, Jerez A, Aballay B, Garcés HO, Fuentes A. Forecasting emergency admissions due to respiratory diseases in high variability scenarios using time series: A case study in Chile. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 706:134978. [PMID: 31862585 DOI: 10.1016/j.scitotenv.2019.134978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 05/24/2023]
Abstract
Respiratory diseases are ranked in the top ten group of the most frequent illness in the globe. Emergency admissions are proof of this issue, especially in the winter season. For this study, the city of Santiago de Chile was chosen because of the high variability of the time series for admissions, the quality of data collected in the governmental repository DEIS (selected period: 2014-2018), and the poor ventilation conditions of the city, which in winter contributes to increase the pollution level, and therefore, respiratory emergency admissions. Different forecasting models were reviewed using the Akaike Information Criteria (AIC) with other error estimators, such as the Root Mean Square Error (RMSE), for selecting the best approach. At the end, Seasonal Autoregressive Integrated Moving Average (SARIMA) model, with parameters (p,d,q)(P,D,Q)s=(2,1,3)(3,0,2)7, was selected. The Mean Average Percentage Error (MAPE) for this model was 7.81%. After selection, an investigation of its performance was made using a cross-validation through a rolling window analysis, forecasting up to 30 days ahead (testing period of one year). The results showed that error do not exceed a MAPE of 20%. This allows taking better resource managing decisions in real scenarios: reactive staff hiring is avoided given the reduction of uncertainty for the medium term forecast, which translates into lower costs. Finally, a methodology for the selection of forecasting models is proposed, which includes other constraints from resource management, as well as the different impacts for social well-being.
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Affiliation(s)
- Miguel Becerra
- Departamento de Industrias, Universidad Técnica Federico Santa María, Av. España 1680, Casilla 110-V, Valparaíso, Chile
| | - Alejandro Jerez
- Departamento de Industrias, Universidad Técnica Federico Santa María, Av. España 1680, Casilla 110-V, Valparaíso, Chile.
| | - Bastián Aballay
- Departamento de Industrias, Universidad Técnica Federico Santa María, Av. España 1680, Casilla 110-V, Valparaíso, Chile
| | - Hugo O Garcés
- Computer Science Department, Universidad Católica de la Santísima Concepción, Alonso de Ribera 2850, Concepción 4090541, Chile
| | - Andrés Fuentes
- Departamento de Industrias, Universidad Técnica Federico Santa María, Av. España 1680, Casilla 110-V, Valparaíso, Chile
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Vargas V, Leopold C, Castillo-Riquelme M, Darrow JJ. Expanding Coverage of Oncology Drugs in an Aging, Upper-Middle-Income Country: Analyses of Public and Private Expenditures in Chile. J Glob Oncol 2019; 5:1-17. [PMID: 31860377 PMCID: PMC6939746 DOI: 10.1200/jgo.19.00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The population of Chile has aged, and in 2017, cancer became the leading cause of death. Since 2005, a national health program has expanded coverage of drugs for 13 types of cancer and related palliative care. We describe the trends in public and private oncology drug expenditures in Chile and consider how increasing expenditures might be addressed. METHODS We analyzed total quarterly drug expenditures for 131 oncology drugs from quarter (Q)3 2012 until Q1 2017, including public and private insurance payments and patient out-of-pocket spending. The data were analyzed by drug-mix, sources of funding, growth, and intellectual property status. The Laspeyres Price Index was used to analyze expenditure growth. RESULTS We found 131 oncology drugs associated with 87,129 observations. Spending on drugs rose 120% from the first period, spanning from the first 3 quarters (Q3, Q4, Q1 2012-2013) to the last period (Q3, Q4, Q1 2016-2017), corresponding to an annualized rate of 19.2% and totaling US$398 million (in 2017 dollars). The public sector accounted for 84.2% of spending, which included 50 drugs in the official treatment protocols, whereas private insurance accounted for 7.3% in on-protocol drugs. The remaining 8.5% was paid out of pocket. In the public sector, more than 90% of growth resulted from increased use. Seven drugs, including 3 with nonexpired patents, accounted for 50% of total expenditures. CONCLUSION Increased use and access enabled by expanded public expenditures drove most of the growth in oncology drug expenditures. However, the rate of public expenditure growth may be fiscally unsustainable. Policies are urgently needed to promote the use of generic drugs, the appropriate mix of on-protocol versus off-protocol drugs, and the curbing of off-label prescribing.
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Affiliation(s)
- Veronica Vargas
- Department of Economics, Alberto Hurtado University, Santiago, Chile, and David Rockefeller Center for Latin America Studies, Harvard University, Boston, MA
| | - Christine Leopold
- Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Marianela Castillo-Riquelme
- Epidemiology Program, Institute of Population Health, School of Public Health, University of Chile, Santiago, Chile
| | - Jonathan J. Darrow
- Program on Regulation, Therapeutics, and Law, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Villalobos Dintrans P. Informal caregivers in Chile: the equity dimension of an invisible burden. Health Policy Plan 2019; 34:792-799. [DOI: 10.1093/heapol/czz120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Population aging is driving a process of increase in long-term care needs in Chile and many countries around the world. In this context, this article asks about the consequences of this increase in informal caregivers, emphasizing the inequity issues arising from these changes. Using the CASEN 2017 survey, caregivers are identified and matched to people with long-term care needs. Results show that most caregivers are women, and a large fraction of them are also elderly; this is similar to what has been found previously in developed countries. Caregivers have fewer opportunities than non-caregivers, which translates into lower income-generating ability and higher poverty. The nature of these tasks creates a vicious cycle in which people get trapped with increasing needs and fewer resources to meet them. Important differences arise between caregivers and the rest of the population. Even more concerning is that these disparities are avoidable to some extent, adding an equity dimension to the problem. This emphasizes the need for the generation of policies that will support caregivers and meet their needs.
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Affiliation(s)
- Pablo Villalobos Dintrans
- Programa Centro de Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Avenida Libertador Bernardo O'Higgins 3363, Estación Central, Santiago, Chile
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