Search

Background: Access to medicines is a serious problem globally and in Chile. Despite the creation of coverage policies, part of the population with chronic conditions of high prevalence, still does not have access to the medicines it requires and disease control continues to be low. The objective of the study was to estimate the medication use and effective coverage for diabetes, dyslipidemia and hypertension in Chile, analyzing them according to sociodemographic variables and social determinants of health. Methods: Cross-sectional analytical study with information from the 2016–2017 National Health Survey (sample = 6,233 people aged 15 years or older, expanded = 14,518,969). Descriptive analyses of medication use and effective coverage for hypertension, diabetes and dyslipidemia were carried out, and multivariate logistic regression models were developed to analyze possible associations with variables of interest. Results: 60% of people with hypertension or diabetes use medications and only 27.7% in dyslipidemia. While 54.2% of those with diabetes have their glycemia controlled, in hypertension and dyslipidemia the effective coverage drops to 33.3% and 6.6%, respectively. There are no differences in use by health system, but there are differences in the control of hypertension and diabetes, favoring beneficiaries of the private subsystem. Effective coverage of dyslipidemia and hypertension also increases in those using medications. The drugs coincide with the established protocols, although beneficiaries of the private sector report greater use of innovative drugs. Conclusion: A significant proportion of Chileans with hypertension, diabetes or dyslipidemia still do not use the required medications and do not control their conditions. [ABSTRACT FROM AUTHOR]

Meningococcal disease has a case-fatality rate of 50% for patients not given treatment and 10%-20% for those given treatment (1,2). The causative agent is Neisseria meningitidis, for which 14 serogroups [...]

INTRODUCTION Population aging is a worldwide phenomenon. It is estimated that by 2050, one of five persons will be aged ≥60 years. In Chile, 15.8% of the population is now aged ≥60 years, and this figure will reach 30.7% by 2050. In 2006, a national program was implemented to provide assistive devices to older adults aged ≥65 years with limited mobility or difficulty performing activities of daily living. To date, there have been no assessments of the program's effectiveness. OBJECTIVE Assess the effectiveness of an assistive devices policy in Chile on improving functional capacity of older adults aged ≥65 years, and benefi ciaries' perceptions of the services received, including changes in their quality of life. METHODS This was a before--after longitudinal study. A cohort of 309 persons was recruited, consisting of patients who received care at a public hospital in Santiago, Chile during 2014--2015. They were assessed before delivery of assistive devices, then followed for seven months, with repeated evaluations made in their homes. The following indicators were measured: functional capacity (Tinetti scale and Barthel Index); changes in perceived quality of life related to use of assistive devices; and other sociodemographic, clinical and protocol-compliance variables. A longitudinal analysis of before--after progress was carried out, as well as a description of service delivery and medical followup. RESULTS Sixty-eight percent of those surveyed were women; median age was 74 years, average schooling was 6 years, and 93% had low income (monthly income

INTRODUCTION Health systems are one determinant of health; their role is to facilitate timely and equitable access to quality services. The way in which a health system is organized can profoundly affect achievement of its objectives. The main feature of the Chilean health system is the coexistence of a public health insurance program (based on a social insurance model) with several market-based private health insurance companies. This hybrid structure provides an interesting framework for analyzing and evaluating the system’s effects on health inequalities. OBJECTIVE Assess Chilean public and private health insurance schemes’ performance and its effects on health inequalities. METHODS Public health insurance was compared with private insurance using indicators from 2013 (or the closest year) in the following domains: inputs, outputs (provider visits, discharges), outcomes (coverage) and impact (on health, quality of life, finances and patient satisfaction) as well as demographic and social determinant indicators. A conceptual framework for measuring health system performance was used. Data were obtained from administrative records and population-based surveys. RESULTS The publicly insured population had greater health care needs, was older (aging index 83.4 vs. 36.5) and poorer (17.2% vs. 1.5% below the poverty line) than the population covered by private insurers. The public insurer received average monthly funding of US$50.94 per beneficiary and spent US$51.43, while private insurers on average collected US$94.79 monthly per beneficiary, and spent US$69.63 on health services (excluding medical leave benefits). Private health insurance beneficiaries were more likely than their publicly insured counterparts to access specialized medical services (18.3% vs. 9.3%) and dentists (11.2% vs. 5.9%), have laboratory tests (18.1% vs. 4.8%), and undergo surgery (7.8% vs. 5.9%). Risk factor and disease prevalence was lower among private insurance beneficiaries for 16 of 18 tracer conditions, although age-adjusted differences were not significant. Finally, incidence of catastrophic spending was slightly lower among private insurance beneficiaries (3.7% vs. 4.2%), and a greater proportion of them were satisfied or very satisfied with the health system (37% vs. 17%). CONCLUSIONS The relative youth and better financial status of beneficiaries of private insurers is compatible with selection for lower risk. While private plans offer greater financial protection and receive higher user satisfaction ratings than the public plan, differences in financing between the two types of insurance affect availability and utilization of services. This constitutes a structural problem for the Chilean health system. There is an urgent need to move toward an integrated health system, in which incentives are aligned with social insurance objectives. [ABSTRACT FROM AUTHOR]

INTRODUCTION Changes in the conceptualization of health and illness have led to development of theory and methods to study healthrelated quality of life. One instrument used frequently to measure this concept is the SF-12 survey, included in the Second National Health Survey carried out in Chile between 2009 and 2010. OBJECTIVE Estimate the association between socioeconomic status stratifiers and health-related quality of life in the adult population residing in Chile. METHODS We conducted a cross-sectional study of a subsample of the National Health Survey, in the population aged ≥25 years. Healthrelated quality of life was operationalized from two SF-12 composite scales: physical health-related quality of life and mental health-related quality of life. Both were categorized as good or poor relative to their median scores. Socioeconomic status stratifiers were education, employment status and monthly per capita household income. Multiple logistic regression models were generated for physical health-related quality of life and mental health-related quality of life, according to socioeconomic status stratifiers adjusted for several covariates. RESULTS The sample comprised 4473 respondents, 51.6% women, median age 47.8 years. The probability of poor quality of life was higher in persons with only primary school education, those not in the workforce and those whose monthly income was below 100,815 Chilean pesos (US$140); the effect was stronger for physical healthrelated quality of life (OR 2.8, 95% CI 1.8–4.2; OR 1.7, 95% CI 1.2–2.3 and OR 2.2, 95% CI 1.3–3.8, respectively) than for mental healthrelated quality of life (OR 1.4, 95% CI 1.1–1.8; OR 1.6, 95% CI 1.2–2.2 and OR 1.9, 95% CI 1.1–3.0, respectively). CONCLUSIONS The probability of poor health-related quality of life is higher in the worst socioeconomic status strata, and the effect is most pronounced in the most vulnerable groups. The direct effect of social stratifiers on living conditions and access to services—both strong influences on subjective health—would explain this finding and highlight the need to adopt equity-oriented strategies aimed at addressing the impact of socioeconomic status on health-related quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences., Objective: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile., Material and Methods: Case series considering 149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihood of dying., Results: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score., Discussion: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.