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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 Unpublished FIGURE I. SUMMARY CHART OF THE CHILEAN HEALTH FUNDING SYSTEM, 2000 Indigents Bonuses Transferences Municipalities Own income State contributions Primary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
Identify priority health problems, set goals and define general strategies.
Explicit Health Guarantees:
Identify specific diseases and their related provisions, in the framework of the health objectives.
More years of healthy life for peso($) invested:
Focus on the most important health problems for Chilean population.
Focus on cost-effective provisions or for those in which there is evidence of efficiency.
Guidelines for public health actions targeted on priority problems.
Health Guarantees System (AUGE Plan) (Law 19.966)
Compulsory coverage (Fonasa and Isapres) of a set of priority diseases
Explicit Health Guarantees System (GES)
Additional Financial Coverage
Isapres forced to grant MLE coverage of Fonasa
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
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
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
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
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.
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
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
CKD is a global public health problem because of its epidemic character, its high morbidity and mortality, and its cost.
CKD is common with a prevalence of 10%, and it can be treated in case of early detection
1. Chronic Renal Failure Vascular access within 90 days from confirmation
Vascular access (3 Kinds Repair included)
Confirmation and treatment Skeletal delayed growth (Growth hormone in children)
Erythropoietin in adults
Donor evaluation (live and dead)
Treatment of rejection (immunosuppressants, plasmapheresis)
Prophylaxis of cytomegalovirus
Patient with Chronic Kidney Disease Service: MEDICAL CONSULTATION Reasonable suspicion? SIGGES SIGGES Older patient with Chronic Kidney Disease Order of attention Provision: Hemodialysis 1901029 1901028 Provision: peritoneal dialysis 1901026 1901126 Erythropoietin Confirmation and skeletal delayed growth treatment Service Monthly Dialysis Consult to Specialist Specialty Code: Order of attention Order of attention PRE-TRANSPLANT STUDY 3005004 Consult to Specialist Service 1 Service 2 Service n Transplant Service Study of the Donor Immunosuppressive Drugs Cytomegalovirus Prophylaxis Kidney Transplant Rejection Autologous Vascular Access, with Prosthesis, high complexity Autologous; repair Diagnosis Process Report Referral Commission
GES ensures coverage, access, funding and quality of the Chronic Kidney Failure –transplant for all the Chileans.
Extrarenal transplants are covered according to public insurance (Fonasa) and private insurance (Isapres) plans ensuring the universal access to this therapy or the Chileans.
75% of the transplants carried out to beneficiaries of the Public Health System in accordance with the distribution of health coverage for Chilean population which reflects the fairness and justice of the access to transplant in our country.