translated from Spanish: Budgetary challenges in post-pandemic health

The COVID-19 pandemic has shown that its impact is multidimensional, different spheres that cross the public and private, economic, health and social effects that can resonate for years. These effects must also be projected, in order to face the scenarios with greater preparation and avoid critical knots of the public health system whose solution is impossible. And the budgetary issue is fundamental, the signs of the challenges in this area are already visible.
Proof of this is that public hospitals have increased their level of spending by approximately 63%, between April 2020 and April 2021. This is a product of efforts to care for COVID-19 patients, especially by intensive care units. This increase is justified by the increase in variable salaries, hiring to cover substitutions and replacements, hiring of medical personnel under the modality of fees, such as: doctors, nurses, kinesiologists, medical technologists, among others. There is also an increase in the expenditure on pharmaceutical products, surgical materials and tools, chemicals and the purchase of benefits.
This situation must be addressed, given that public hospitals to date have not received additional budgetary transfers to cover the increase in this health expenditure, therefore, it must be understood that their level of indebtedness will increase by the end of this year.
Also, the COVID-19 epidemic has had an impact on the decrease in visits for reasons unrelated to this disease. There is a group of patients who are not accessing adequate care, in pathologies where therapies are available that can improve the patient’s prognosis. This involves a significant impact on public health demand in the coming years. In the same vein, surgeries that are not urgent are being suspended.
Likewise, a study published in the journal Lancet (2020) shows that the main cause of death by pathology group in Chile, between 2009 and 2019, is cancer (28.8%), displacing cardiovascular diseases to second place (26.6%). In third place are diabetes and kidney disease (7.83%), then digestive disease (7.45%), neurological disorders (6.06%) and, in sixth place, respiratory diseases (5.65%). It should be noted that this study shows mental health in fourth place, in the ranking of quality of life adjusted for disability. Situation that in pospandemia will be even more complex. Numerous studies are demonstrating the impact of the COVID-19 pandemic on the mental health of the Chilean population in general.
The increase in the rate of aging of the Chilean population and the change in the epidemiological profile require the implementation of preventive strategies to deal with these changes and, also, the implementation of public policies that increase health coverage for these pathologies.
At the same time, in the opinion of specialists, published in the Journal of Rehabilitation Medicine (2020), 25% of those who underwent intensive care experience a dramatic decrease in their independence after one year of medical discharge, which implies a decrease in patients’ quality of life and an increase in health spending.
It should be noted, in times of health crisis, the effort and support that the citizens of the public health institutions of our country have felt. Professionals and officials who work there have not benefited from remote work, having to take health risks and expose their respective families. Meanwhile, they have levels of tiredness and stress that could be at the limit. Professionals and officials who in this new health context should receive fair compensation, also require new skills to take on the new health challenges.
There is no doubt that in the coming years the public health network will have to make significant efforts to take on these new health challenges, the aftermath of a pandemic that has not yet ended.
In this context, bearing in mind that economic resources are limited, it is essential that in the next budgetary discussions – especially for the next three years – the Chilean State should sacrifice plans and programs that are not relevant in order to increase the health budget, based on actual hospital spending, during the pandemic. These are all clear signals that must be heeded and, thus, face the uncertain scenario that will be generated after the reactivation of the health network to care for patients who were in the background during the waves of COVID-19 and those who were left with sequelae from the disease.

Sandra Alvear Vega is director of a Master’s Degree in Health Systems Management. Faculty of Economics and Business of the University of Talca. Doctor of Science in Education, Conservatoire National des Arts et Métiers

The content of this opinion column is the sole responsibility of its author, and does not necessarily reflect the editorial line or position of El Mostrador.

Original source in Spanish

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