During my time spent in Santiago, I had studied the Chilean System of Health through both text and personal observations. Throughout this time I had observed several Chilean health approaches including... "Hospitales," "Clinícas," Rural Institutions and the Mapuche, an indigenous group's, technique towards medicine. What are the differences between these places? Here is a brief summary...
The United States and Chilean health systems share similar characteristics. Both health systems allow their citizens to choose between two types of health care (aka medical insurance): PUBLIC vs PRIVATE.
Within the US, a majority of the population holds private health insurance. How does private health insurance work? For most citizens, their occupations provide medical insurance. Although there are individuals of private healthcare who pay for their own insurance. However, the majority of health insurance is supplied via citizens' occupations. Public health insurance includes the aid of governmental agencies. Governmental agencies such as Medicare/Medicaid provide coverage for citizens who meet specific guidelines and are unable to receive private healthcare.
In Chile, most citizens hold public health insurance. In contrast to the US where a citizen's occupation may pay for insurance, Chilean citizens have an automatic 7% deduction from their paychecks. This deduction is donated to the Chilean government where it is used to provide ALL citizens with healthcare. Because citizens must donate 7% to the government, the entire Chilean population has access to free primary medical care (Annual check-ups, medications etc.). The alternative to Chilean public health insurance is private health insurance. Citizens who obtain private health insurance pay for their entire medical care including items like medical appointments, hospitals stays (>$1,000/day), and emergency room hospitalizations... needless to say, this plan is pricy and thus explains why most citizens avoid a private plan.
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| Hospital Dr. Sotero del Rio |
In Chile, patients who have PUBLIC healthcare can only attend hospitales. Hospitals receive direct funding through government assistance and the 7% deduction through citizen paychecks. Although because hospitals support the majority of the public, these hospitals are often run down and have too little funding for the amount of people that they support.
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| Hospital Dr. Sotero del Rio |
Due to per capita funding, some public hospitals have too little medical staff and supplies. Often during my observations, nurses would be working with patients at 1:15 ratio during the day, and at night 1:18. In the US, nurses are instructed to work at a ratio no greater than 1:6. Limited supplies were also an issue with only 1 bloodpressure cuff & thermometer per floor of 30 patients. Other outlying details that I found include hygiene. Although conditions varied between hospitals I did witness outstanding concerns. Some hospitals were so poorly funded that the entire institution was working without soap, Purell or alcohol swabs. Can you imagine no soap in bathrooms for patients nor medical staff?
Although the conditions of these hospitals sound much different than the US, I would like to assure you that the medical staff who worked throughout these circumstances were amazing with attentive care and strong work-ethic. They had adapted to their environment and were able to provide phenomenal care despite their limited conditions.
Chilean patients who obtain PRIVATE health insurance have excess to institutions referred to as clinícas. With the help of both government funding (via 7% salary deductions) and the extra pay from citizens of private insurance, these institutions are state of the art facilities. Imagine a US hospital, for instance Massachustes General Hospital (MGH). MGH was recently ranked as #1 on the 2012-13 US News & World Report "America's Best Hospitals" list. A majority of these hospitals are equivalent to appearance and care of MGH, if not better. The technology in these institutions are ahead of their time.
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Hospital Clinico
Universidad Catolica |
Clinics are often known for both their degree of care and their short wait periods. Because the minority
of citizens (about 30% of the Chilean population) have public health insurance, very little patients attend these institutions in comparison to hospitals. As an example, I recently attended the Emergency Room ("Urgencia") of a clinic. While observing this clinic only 5 of 15 exam rooms were in use with a vacant waiting room. This is compared to an Urgencia of a hospital where at least 50 patients are sitting in an overcrowded waiting room.
Ofcourse, like the US, there are exeptions to the Chilean healthcare system. For instance, upon referral a citizen with public health insurance may be able to attend a clinic upon request. Other exceptions also exist, but I would like to assure you that after speaking with several health professionals I have been informed that, "It is likely for a PUBLIC citizen to never see the inside of a PRIVATE institution."
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| Maria Pinto |
Rural Institutions are often attended by citizens with PUBLIC health care although, those who hold private healthcare are also welcome to attend. These instutions are plotted throughout the country side without other medical resources located nearby. Because emergency rooms are essentially non-existent in these rural areas, these institutions serve as both Family Care and the Emergency Room for these citizens.
Maria Pinto, above, is as big as the picture displays. Within this small building there is a "Farmacia"(enclosed solely within the cabinet displayed in the picture to the left), a gynecological room, a room for dentistry, a room specifically assigned for pediatrics, also a room for adults and ofcourse a room for minute surgeries. All the while, this institution also has a van designated for emergency calls. Most importantly the staff who have established this site are extremely dedicated and live next door inorder to be appropriately prepared for the instance of an emergency.
The Mapuche are one of many indigenous groups that live throughout Chile. Their practice of medicine remains true to their beliefs as they utilize the earth's herbs and the presence of energy in order to cure their loved ones. In relation to the pictures displayed, the Mapuche are trying to express their method of practice to the modern world by hosting gatherings on their remaining plots of land. Like my experience, they welcome people to their homes to express their approach of life and spiritual practices in order to keep their heritage alive while displaying their unique methods to medicine.
Rather than draw upon my opinion and conclusion of the Chilean system of health, I would like to complete this post with an on-going finding. According to the article, "Chile's healthcare offers public and private plans" written by Mari Edlin, Chile holds a higher life expectancy compared to the United States of 0.3 years. More interestingly, Chile holds a higher life expectancy while paying less for their healthcare system.
http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/chiles-healthcare-offers-public-and-private-plans
