Does the Minister of Health lie when he says Chile has one of the best health systems on the planet? Technically not. So why does the phrase create discomfort, annoyance or rightly rage? Over the years there have been various rankings to position the health systems of the world and Chile – with some fluctuations depending on the year and the ranking – in general, has had good results. However, there is a particularity here, because the figures in general involve averages and the averages hide realities.
In Chile, two health systems coexist, one public and one private. According to CASEN 2017 figures, the public (Fonasa) receives 78% of the population, the Isapres at 14.4%. When looking at some data from the same survey, we find marked differences between users of these systems. Proof of this is that in the question that it gives an account of the percentage of the population who claim to have had any problems getting health care, 27.8% of FONASA’s beneficiaries reported this situation while for isapres beneficiaries it was 12.6%. We could give multiple examples of the differences found between the beneficiaries of both health systems and what happens is the result of a single concept: INEQUITY, a word that in the last 40 days has become a hashtag.
It has been one of the main demands of recent weeks, and despite the decline of the Gini, it is quite notorious and obvious that in health inequality is profound. You do not have to be an expert to realize that it is tremendously unfair, inequitable and painful that a recipient of Fonasa living in Alhué (rural commune of the Metropolitan Region, 150 km from Santiago), to access a specialist, it is highly likely that you will have to wait weeks and even months and with some luck you would only have to travel to Melipilla, since in many cases your time of care would be in Santiago.
With regard to different pathologies, the examples are varied and I will stop at oral health, which is also due. Health problems with GES coverage are few and set as a requirement some ages or conditions to be able to access care. And what about the middle ages? For example, in adults before they turn 60. Many have to opt for emergency care or admission to a program with limited coverage in each commune.
What about a girl, boy or adolescent who requires orthodontic treatment? Unfortunately little and nothing in some areas of the country. This has even historically led to waiting lists of some dental specialties under-registered because the attention is virtually unworkable, so it would be “better” not to give “false expectations” to users. When there is currently an oversupply of dentists in Chile according to OECD figures, it is very disappointing what epidemiological data show.
Will there be any way forward and out of this problem? Perhaps for some, it is not so important, considering that our “averages” place us as a low risk country of cavities with a COPD index (decayed teeth, shuttered or lost to cavities) from 1.9 to 12 years of age, however when analyzing that figure by socioeconomic level, we find that in the high NSE COPD is 0.66 (less than 1 tooth with cavities, clogged or lost by cavities) and in the lower NSE is 2.22 with statistically significant differences between the two.
The only solution to be able to level up is to invest more in health. Chile spends 8% of GDP on health and the average in OECD countries is 9.5%. And the investment should be in building more hospitals? Definitely not, investment, to have fruits in the medium and long term, must be in promotion, prevention, and new prevention and more promotion. Diseases of the oral cavity share risk factors with other chronic noncommunicable diseases where we exceed the OECD country average; we have distressing records in obesity (25%), smoking (30% of the 30-year-old population smokes), among others. By attacking these factors we could contribute to the decrease in the prevalence of several other diseases besides oral ones.
The population turned to the streets is expecting substantial improvements in social demands and one of the main ones is health, a right enshrined in the current constitution that is fulfilled in a twisted and mañosa manner, with many better results in the population of high socioeconomic level. The solution is in the hands of our institutionality, however, most congressmen and authorities have never been cared for in public hospitals, family health centres and/or rural posts.
How long will people in our society come to the dawn at a health facility to get care? How long will many continue to fund their health through bingos? How long will women be more “expensive” in calculating a health plan in an isapre? How long will we continue to show so much inequality? I hope it’s so far….Chile woke up.
The content poured into this opinion column is the sole responsibility of its author, and does not necessarily reflect the editorial line or position of El Mostrador.
