THE CASE OF CHILE. Equity in access to health Adjustments on time. Antonio Infante IOM workshop Washington DC July 2011

Transcription

1 THE CASE OF CHILE Equity in access to health Adjustments on time Antonio Infante IOM workshop Washington DC July 2011

2 HEALTH PROBLEMS CHILE 2006 a) Serious inequities b) Epidemiological changes e) Need for more efficiency in use of resources f) Citizens dissatisfaction

3 1995 BURDEN OF DESEASE CHILE MINSAL - UC % 15% 2% Grupo I Grupo II Grupo III 20% 4% Grupo I Grupo II Grupo III Mal Def. 73% 76% Grupo I: Enfermedades transmisibles, causas maternas, perinatales y enfermedades o condiciones nutricionales Grupo II: Enfermedades no transmisibles Grupo III: Lesiones intencionales y no intencionales

4 15th SPECIFIC PROBLEMS BURDEN OF DISEASE Both Sexes 2004 Hipertensive cardiopaty Unipolar Depression Gallblader and biliary tract Alcohol dependency Hepatic Cirrosis Accidentes del tránsito Injuries Peptic ulcer Adult audition problems Diabetes II Cardiovascular diseases Isquemic heart disease Anxiety disorders Cataracts Falls Adult Vision problems DALY

5 INEQUITIES Waiting time is the poor s payment Francisco Mardones Restat

6 HIGH CARDIOVASCULAR RISK >=3 of 5 criterion (waist, HDL, Triglycerides, Blood Pressure and glycemia)

7 DIABETES

8 OBESITY

9 Total teeth and educational level Chile 2003 Men Women

10 Average height and educational level Chile 2003 Men Women

11 STRUCTURE AND FINANCE IN CHILEAN HEALTH SYSTEM AFILIACIÓN POR QUINTILES DE INGRESO CASEN ,0 80,0 other 10% Public Insurance Dic ,0 40,0 20, people 73.5% US$ 404 Per capita - I II III IV V TOT More poor Private Insurance Dic people 16.5% US$ 850 Per capita 50.6% compulsory people s contribution (7% monthly income) 30% of people without contribution 49.4% Fiscal contribution 70% compulsory people s contribution (7%) 30% aditional out of pocket contribution Plan s annual premium: US$ per capita

12 REFORM S STRATEGY Prioritysation in activities with greater health impact Health priorities and epidemiological adjustment Accountable rights to people Plan with guarantees defined by law

13 PRIORITY SETTING ALL HEALTH PROBLEMS People s Priorities The most Frecuent The most severe The most Expensive Priorities to the health care system Epidemiologic impact (DALY) Do we have a good treatment? Can we offer it in the whole country? SOCIAL DEBATE AND CONSENSUS EXPLICIT GUARANTEES Aprox 60% of the burden of disease

14 THE PLAN S PRIORITIES Universal Access Explicit Guarantees (56 problems, currently 69) HBP, Diabetes, Cancer Waiting time Protection of Family budget Quality of Care Acreditation of health institutions Certification of Professionals

15 DIFFICULTIES OF THE PROCESS

16 CULTURAL AND POLITICAL PROBLEMS College of Physicians Threatened clinical practice autonomy: Guides Managed Care and autonomy Ideological resistances Universal guarantees vs focused plan (Implicit vs explicit) Risk of privatisation Dificulties in explaining the Plan

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18 GRADUAL IMPLEMENTATION Evidence based Clinical Guides Universities and Clinical Societies Financing and the Plan s premium Universities; experts and Ministry of Finance Health supply capacities and needs of investment Detailed study of health supply capacities

19 PRELIMINARY IMPACTS

20 THE PLAN S EVALUATION Superintendencia de Salud Enero % Total access oportunity quality infrastructure equipment Budget protection 1 a 4 6 7

21 SEDENTARY LIFESTYLE

22 HIGH BLOOD PRESSURE

23 DIABETES

24 IMPACT IN SUBJECTIVITY.as a difference with the1996 study, people don t have fear of dying without attention or having a financial cathastrophe of illness origin MIN HEALTH. Social Priorities Study. Dec 2008.

25 DANGER The lobbying to change health priorities

26 NEXT STEPS

27 PRIORITY Public health preventive interventions

28 FOOD CONSUMPTION

29 ALCOHOL CONSUMPTION

30 SMOKING

31 OVERWEIGHT AND OBESITY

32 OTHER PRIORITIES Waiting lists and guarantees Strengthening primary health care Physicians support

33 THANKS Hace bien