1. Dr. JOSÉ LUIS ROJAS B. NATIONAL TRANSPLANTS COORDINATOR MINISTRY OF HEALTH 2011 ORGAN DONATION CONGRESS GES (Explicit Health Care Guarantees) and Transplants: Funding System in Chile

3. ISAPRE FONASA ISAPRES and FONASA Beneficiaries By Age Group Age groups Percentage of the group

4. FUNDING FUNDING PUBLIC PRIVATE FONASA FISCAL CONTRIBUTION 7% Worker Institutional Free Choice ISAPRES 7% Worker Voluntary Contribution Clinics

5. Funding in the Health Sector in Chile Contributions High income workers Low income workers Pensioner Private providers LL Subsidies Free choice LL Subsidies LL Subsidies Note: the arrows represent the money flows and their thickness indicates their amount. Adapted from Cobarrubias, Álvaro. Unpublished FIGURE I. SUMMARY CHART OF THE CHILEAN HEALTH FUNDING SYSTEM, 2000 Indigents Bonuses Transferences Municipalities Own income State contributions Primary medical care Co-payment Payment health care provision

10. Main Health Problems in Chile

12. Source: Economic Studies OECD: Chile, 2003 Graph 28. GDP and expenditure on health per capita GNP Health care expenses

13. Demography Chile CHILE: ESTIMATED POPULATION BY JUNE 30TH Men Women THOUSANDS OF PEOPLE Source: Population Projection INE-CELADE Age (years) Age (years)

14. Disease Burden AVAD Measurement (DALY)

15. Pocket spending per capita as percentage of the total per capita expenditure. Chile and OECD, 2002 Source: elaborated by the author based on Dipres and OECD data % of pocket spending

16. Health Reform in Chile

20. LAW 19.966 GES UNIVERSAL ACCESS PLAN WITH EXPLICIT GUARANTEES Explicit Guarantees Access Quality Opportunity Financial protection Preventive Health Component Collective or population based actions Individual Actions People’s Health Component Priorities with maximum and intermediate guarantees

22. 69 Health Problems Serious Accidents Serious Burning Serious Polytraumatised TBI Severe Ocular Trauma Elderly Hip replacement Ambulatiry pneumonia Refractive defects Orthosis Knee and hip osteoarthritis Hearing loss Parkinson’s disease Chronic Diseases Chronic Renal Failure 1 Diabetes Mellitus 2 Diabetes Mellitus HTA Rheumatoid arthritis hemophilia HIV / AIDS Cystic fibrosis Adult epilepsy Children epilepsy Relapsing-remitting Multiple Sclerosis hepatitis B hepatitis C Juvenile Idiopathic Arthritis Heart and cerebrovascular diseases Operable Congenital Heart Disease AMI pacemaker CVA cerebral hemorrhage ESRD secondary prevention Respiratory Diseases ARI Adult Asthma Child Asthma COPD Eye Disease Strabismus Cataracts Diabetic Retinopathy Non-Traumatic Retianl Detachment Surgeries allbladder Your benign prostate Your benign brain spinal dysraphism cleft lip and palate scoliosis Lumbar hernia Cancer Cervical Breast Gastric Paediatric Prostate Lymphoma Leukaemia Pain relief and palliative cares Labor, premature births and newborn diseases Labor Analgesia Prematurity prevention Hearing loss Retinopathy Bronchopulmonary Displasia ) Newborn Respiratory Distress Hip Dysplasia Mental Health Depression Alcohol and drugs consumption in people under 20 years old Schizophrenia Oral Health Integral in six year-old children Dental Emergency Integral 60 years old Pregnant

23. ACT 19,966 AUGE PROBLEM PRIORITIZATION Priority Problems The most frequent The most serious The most expensive Feasibility Supply capacity of the system Resources available DEBATE AND SOCIAL CONSENSUS EXPLICIT GUARANTEES Effective Interventions Promotion Prevention Healing Rehabilitation

24. Cervical cancer Lung Cancer Childhood Leukemia Myocardial Infarction Promotion Prevention Early Detection Treatment Rehabilitation Palliative costs Health Subclinical Dis. Clinical Dis. Disability DEATH Health-Disease Continuum

25. HEALTH CARE PROCESS ( with ges) Diagnostic Suspicion Diagnostic Confirmation Treatment Follow-up t t t Inclusion criteria ACCESS OPPORTUNITY QUALITY FINANCIAL PROTECTION IN THE CASE OF ONE OF THESE 69 PATHOLOGIES, THE DOCTOR MUST INFORM THE PATIENT THROUGH A FORM CERTIFYING THE PATIENT AS GES.

26. País 95,08% 96,6% 93,2% Second Semester Second Semester Second Semester Second Semester Second Semester Second Semester First Semester First Semester First Semester First Semester First Semester % Carried out within the period % Carried out outside the period

27. Country Delays FONASA GES Delays

28. Natural History Population strategies Individual strategies Promotion Prevention Early diagnosis Treatment Rehabilitation Health Disease Keeping healthy Avoid getting sick Early diagnosis Start early treatment Go back to initial stage Education Risky behaviour Examination Integral Control and Treatment EPM HTA DM1 DM2 Secondary prevention ESRD Dialysis Renal Transplant

31. U$ 54.000 U$ 44.000 U$ 40.000 U$ 14.000 U$ 4.000

33. Thank You.