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Chile'shealthcareofferspublicandprivateplans|ManagedHealthcareExecutive

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Chile's healthcare offers public and private

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Chronic care has guarantees

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December01,2009

ByMariEdlin

DIGGINGINTOREFORM
Spending5.4%ofgrossnationalproduct,orabout$689percapita,onhealthcare,Chileisstill
readjustingtoareforminitiativethatbeganin2002.Itistacklingobjectivesinphases.
Initialgoalsaretoaddressinequitiesanddisparitiesinhealthcare,strengthenthefocusonprimarycare,
reducewaitingtimeinthepublicsector,introducemorecompetitionintotheISAPREsmarket,improve
efficienciesandcarefortheevergrowingseniorpopulation.
Amongthenewlawsthatarekeytoreformiswhat'sknownastheAUGEPlan(inEnglish:theplanfor
universalaccesswithexplicitguarantees).AUGEspecifiesfourbasicguaranteesforhealthcare
concernsrelatedto56definedhealthconditions,basedonthehighestburdenofdisease,effectiveness
oftreatmentsandhighestcost.Guaranteesinclude:access,timeliness,qualityandfinancialprotection.
Twentyfourmoreconditionsareslatedforinclusionnextyear.
Inshort,AUGEguaranteesabasic,uniformbenefitplan,whichappliesequallytobeneficiariesofpublic
andprivateinsurers.
"IfyouareasupporterofChile'sreforms,AUGEguaranteesaccessandassuresquality,"saysBruce
Pollack,presidentofAIHSandMHEeditorialadvisor."Detractorsrefertothemethodologyasrationing."
Onedelegate,GabrielHanna,presidentandCEOofDCCharteredHealthPlanbasedinWashington,
D.C.,sayshedoesnotbelievethatthereisanycompetitionbetweenthepublicandtheprivate
healthcaresectorsinChile.
"Thosewhocanaffordtobuyprivatecoveragewillreceivemuchbetteraccessnowaitinglisttoa
somewhatbetterdeliverysystem.Ontheotherhand,competitionamongprivateinsurersseemstoexist
basedonlevelsofcareandpricehowever,withonly13privateinsurerstoservetheentirecountry,it
appearstomethatthereissomecompetition,butitdoesn'tappeartobefierce,"Hannasays.
Chilehasapublicplancoveringthemajorityoflives,butitisnotdrivingtheprivateplansoutof
business,accordingtodelegateMargaretMurray,CEO,AssociationforCommunityAffiliatedPlansalso
inWashington,D.C.

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Chile'shealthcareofferspublicandprivateplans|ManagedHealthcareExecutive
StandardsinChile'spublicsectorneedabitoftweaking,however.Sincemanylowincomepeoplecan
onlyoptforthepublicsystem,thereislittleincentiveforhighperformance,qualityandefficient
managementfromproviders.Morethan1millionmembersarecurrentlyonawaitinglistforAUGE
services,including117,000surgeriesaswellashundredsofthousandsofmedicalappointments.
AIHSdelegateshadanopportunitytovisitapreeminent270bed,forprofithospital,Santiago'spremier
tertiarycarepublichospitalwith340beds,anda403bedprivatehospitalthatalsoservesasignificant
proportionofpublicpatients.Delegatesobservedthecomparativelysuperioraccess,negligiblewaiting
listsandprivateroomsthatcomewiththeprivatehospitals.
Anotherfieldtriptookdelegatestothe216bedClinicaLasCondes,accreditedbytheJointCommission
International,whichbenefitsfroma10yearaffiliationwithJohnsHopkinsMedicineInternationalandthe
institution'sexpertise.
TECHNOLOGYLEAVESAPRINT
Manydelegatesagreethatoneofthemostmemorablediscoverieswastheinnovativefingerprint
technologyusedbyallpublicandprivateproviderstoimmediatelyverifyeligibilityandbenefits.
Thebiometricidentificationsystemcapturestheimpressionofapatient'sfingerprint,whichisthenused
asproofofidentity.Thetechnologycanalsogenerateelectronicvoucherstocoverspecificmedical
exams,procedures,treatmentsandconsults.ItisnotsurprisingthataCaliforniaSiliconValleycompany
isresponsibleforthetechnology.
ClinicaDavilaalsoutilizescolorcodedelectronicboardsinitsoutpatientandinpatientdepartments,
whichindicatethestatusofpatientsintheclinic.Asoneclinicphysicianputit,Chilefallssomewhere
betweenbeinga"developingandadevelopedcountry."
"Chile'shealthcaresystemdoesanadmirablejobofprovidingreasonablygoodcareatremarkablylow
cost,"Pollacksays."Anationalfocushasbeenonpublichealthandaccesswhileguaranteeingnearly
universalcoverage.Thepublic/privateinterfaceworksandworkswell.Thepublicoptionisnotthe
optionoflastresort,butratherthefirstchoiceformostChileans."
MariEdlinisafrequentcontributortoMANAGEDHEALTHCAREEXECUTIVEandhastraveledwith
AIHSonpreviousmissions.

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Mari Edlin
MariEdlinisafrequentcontributortoManagedHealthcareExecutive.Sheis
basedinSonoma,California.

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