Health Systems, Aging, and Inequity: An Example from Chile
Abstract
:1. Introduction
2. Materials and Methods
2.1. A Framework to Assess the Health System Preparedness for Aging
2.1.1. Health System Goals
- i.
- Improving health status
- ii.
- Providing financial protection
- iii.
- Meeting people’s expectations
2.1.2. Benchmark Strategy
- i.
- Evolution (time indicators)
- ii.
- Overall performance (cross-section between indicators)
- iii.
- Inequality (cross-section within indicators)
2.1.3. Health System Features
2.2. Data Sources and Indicators
2.2.1. Data Sources
2.2.2. Indicators for the Assessment
3. Results
4. Discussion
5. Conclusions
Funding
Acknowledgments
Conflicts of Interest
References
- United Nations. World Population Prospects. 2019. Available online: https://esa.un.org/unpd/wpp/DataQuery (accessed on 15 June 2020).
- Comisión Económica para América Latina y el Caribe. Estimaciones y Proyecciones de Población Total, Urbana y Rural, y Económicamente Activa. América Latina—Revisión 2017. Available online: https://www.cepal.org/es/temas/proyecciones-demograficas/estimaciones-proyecciones-poblacion-total-urbana-rural-economicamente-activa (accessed on 5 May 2020).
- World Health Organization. World Report on Ageing and Health; World Health Organization: Geneva, Switzerland, 2015. [Google Scholar]
- World Health Organization. Global Strategy and Action Plan on Ageing and Health: A Framework for Coordinated Global Action by the World Health Organization, Member States, and Partners across the Sustainable Development Goals; World Health Organization: Geneva, Switzerland, 2016. [Google Scholar]
- Thumala, D.; Kennedy, B.K.; Calvo, E.; González-Billaut, C.; Zitko, P.; Lillo, P.; Villagra, R.; Ibáñez, A.; Assar, R.; Andrade, M.; et al. Aging and health policies in Chile: New agendas for research. Health Syst. Reform 2017, 3, 253–260. [Google Scholar] [CrossRef]
- Villalobos Dintrans, P. Is aging a problem?: Dependency, long-term care, and public policies in Chile. Rev. Panam. Salud Publica 2018, 42, e168. [Google Scholar] [CrossRef]
- Villalobos Dintrans, P. Long-term care systems as social security: The case of Chile. Health Policy Plan. 2018, 33, 1018–1025. [Google Scholar] [CrossRef] [PubMed]
- Unger, J.P.; De Paepe, P.; Cantuarias, G.S.; Herrera, O.A. Chile’s Neoliberal Health Reform: An Assessment and a Critique. PLoS Med. 2008, 5, e79. [Google Scholar] [CrossRef] [Green Version]
- Aguilera, X.; Castillo-Laborde, C.; Ferrari, M.N.-D.; Delgado, I.; Ibañez, C. Monitoring and Evaluating Progress towards Universal Health Coverage in Chile. PLoS Med. 2014, 11, e1001676. [Google Scholar] [CrossRef] [Green Version]
- Bossert, T.; Leisewitz, T. Innovation and Change in the Chilean Health System. NEJM 2016, 374, 1–5. [Google Scholar] [CrossRef] [PubMed]
- Hsiao, W. What Is a Health System? Why Should We Care? Available online: https://pdfs.semanticscholar.org/47a8/1a8f1fa7b7cd0d3436d819b053e7bfba1b57.pdf?_ga=2.13034743.1344524954.1573561730-1675254905.1573561730 (accessed on 20 June 2020).
- World Health Organization. Everybody Business: Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action; World Health Organization: Geneva, Switzerland, 2007. [Google Scholar]
- World Health Organization. Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies; World Health Organization: Geneva, Switzerland, 2010. [Google Scholar]
- Yip, W.; Hafez, R. Reforms for Improving the Efficiency of Health Systems: Lessons from 10 Country Cases; World Health Organization: Geneva, Switzerland, 2015. [Google Scholar]
- World Health Organization. World Health Report 2000. Health Systems: Improving Performance; World Health Organization: Geneva, Switzerland, 2000. [Google Scholar]
- López, A.D.; Mathers, C.D.; Ezzati, M.; Jamison, D.T.; Murray, C.J.L. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet 2006, 367, 1747–1757. [Google Scholar] [CrossRef]
- Etches, V.; Frank, J.; Di Riggiero, E.; Manuel, D. Measuring Population Health: A Review of Indicators. Annu. Rev. Public Health 2006, 27, 29–55. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Costa-Font, J.; Hernández-Quevedo, C. Measuring inequalities in health: What do we know? What do we need to know? Health Policy 2012, 106, 195–206. [Google Scholar] [CrossRef] [PubMed]
- Wagstaff, A. Measuring Financial Protection in Health; Policy Research Working Paper 4554; World Bank: New York, NY, USA, 2008. [Google Scholar]
- Hsu, J.; Flores, G.; Evans, D.; Mills, A.; Hanson, K. Measuring financial protection against catastrophic health expenditures: Methodological challenges for global monitoring. Int. J. Equity Health 2018, 17, 69. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Darby, C.; Valentine, N.; Murray, C.J.L.; de Silva, A. World Health Organization (WHO): Strategy on Measuring Responsiveness; GPE Discussion Paper Series: No. 23; World Health Organization: Geneva, Switzerland, 2003. [Google Scholar]
- Núñez, A.; Chi, C. Equity in health care utilization in Chile. Int. J. Equity Health 2014, 12, 58. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Frenz, P.; Delgado, I.; Kaufman, J.S.; Harper, S. Achieving effective universal health coverage with equity: Evidence from Chile. Health Policy Plan. 2014, 29, 717–731. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dalhgren, G.; Whitehead, M. Policies and Strategies to Promote Social Equity in Health; Institute of Future Studies: Stockholm, Sweden, 1991. [Google Scholar]
- Whitehead, M. The Concepts and Principles of Equity and Health. Int. J. Health Serv. 1992, 22, 429–445. [Google Scholar] [CrossRef] [PubMed]
- Daniels, N. Just Health: Meeting Health Needs Fairly; Cambridge University Press: New York, NY, USA, 2008. [Google Scholar]
- Ministerio de Salud. Serie Defunciones 2000–2016. Available online: http://www.deis.cl/wp-content/2017/gobCL-sitios-1.0/assets/SerieDefunciones_2000_2015.html (accessed on 5 April 2020).
- Instituto Nacional de Estadísticas. Encuesta de Presupuestos Familiares EPF. Available online: https://www.ine.cl/estadisticas/ingresos-y-gastos/epf (accessed on 12 April 2020).
- Superintendencia de Salud. Estudio de Opinión a Usuarios del Sistema de Salud, Reforma y Posicionamiento de la Superintendencia de Salud. Available online: http://www.supersalud.gob.cl/documentacion/666/articles-12432_recurso_1.pdf (accessed on 8 April 2020).
- Xu, K. Distribution of Health Payments and Catastrophic Expenditures: Methodology; EIP/HSF Discussion Paper No. 2; World Health Organization: Geneva, Switzerland, 2004. [Google Scholar]
- Mirzoev, T.; Kane, S. What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework. BMJ Glob. Health 2017, 2, e000486. [Google Scholar] [CrossRef]
- Koch, K.J.; Cid Pedraza, C.; Schmidt, A. Out-of-pocket expenditure and financial protection in the Chilean health care system—A systematic review. Health Policy 2017, 121, 481–494. [Google Scholar] [CrossRef]
- Villalobos Dintrans, P. Out-of-pocket health expenditure differences in Chile: Insurance performance or selection? Health Policy 2018, 122, 184–191. [Google Scholar] [CrossRef]
- Castillo-Laborde, C.; Villalobos Dintrans, P. Caracterización del gasto de bolsillo en salud en Chile: Una mirada a dos sistemas de protección. Rev. Med. Chile 2013, 141, 1456–1463. [Google Scholar] [CrossRef] [Green Version]
- Murray, C.J.L.; Chen, L.C. Understanding morbidity change. Popul. Dev. Rev. 1992, 18, 481–503. [Google Scholar] [CrossRef]
- Mathers, C.D.; Douglas, R.M. Measuring progress in population health and wellbeing. In Measuring Progress: Is Life Getting Better? Eckersley, R., Ed.; CSIRO Publishing: Collingwood, Australia, 1998; pp. 125–155. [Google Scholar]
- Villalobos Dintrans, P.; Izquierdo, C.; Guzmán, R.; Gálvez, M.J.; Santander, S. Defining “older people” in Chile: Challenges in planning policies for aging populations. Health Policy Plan. 2020. [Google Scholar] [CrossRef]
- Kowal, P.; Dowd, J.E. Definition of an Older Person. Proposed Working Definition of an Older Person in Africa for the MDS Project. WHO Technical Report; World Health Organization: Geneva, Switzerland, 2001. [Google Scholar]
- Organisation for Economic Co-operation and Development. Elderly Population. Available online: https://data.oecd.org/pop/elderly-population.htm (accessed on 20 June 2020).
- Kruk, M.E.; Freedman, L.P. Assessing health system performance in developing countries: A review of the literature. Health Policy 2008, 85, 263–276. [Google Scholar] [CrossRef]
- Amarlberti, R.; Nicklin, W.; Braithwaite, J. Preparing national health systems to cope with the impending tsunami of ageing and its associated complexities: Towards more sustainable healthcare. Int. J. Qual. Health Care 2016, 28, 412–414. [Google Scholar] [CrossRef] [Green Version]
- McPake, B.; Mahal, A. Addressing the Needs of an Aging Population in the Health System: The Australian Case. Health Syst. Reform 2017, 3, 236–247. [Google Scholar] [CrossRef]
- Fulmer, T.; Mate, K.S.; Berman, A. The Age-Friendly System Imperative. JAGS 2017, 66, 22–24. [Google Scholar] [CrossRef]
- Anderson, I.; Irava, W. The Implications of Aging on the Health Systems of the Pacific Islands: Challenges and Opportunities. Health Syst. Reform 2017, 3, 191–202. [Google Scholar] [CrossRef] [Green Version]
- Peltzer, K.; Pashwana-Mafuya, N. Patient experiences and health system responsiveness among older adults in South Africa. Glob. Health Action 2012, 5, 18545. [Google Scholar] [CrossRef]
- Organisation for Economic Co-operation and Development. Health at a Glance 2017: OECD Indicators; OECD Publishing: Paris, France, 2018. [Google Scholar]
- Institute for Health Metrics and Evaluation. GBD Compare|Viz Hub. Available online: https://vizhub.healthdata.org/gbd-compare/ (accessed on 8 May 2020).
Health System Indicator | Health Status | Financial Protection | People’s Expectations | |
---|---|---|---|---|
Indicator | Suicide Mortality Rate (per 1000 People) | OOPE/Expenditure | Catastrophic Expenditure (% Households) | Satisfaction with the Health System (Scale from 1 to 7) |
National level | 0.10 | 4.19% | 2.13% | 4.96 |
Ratio 65+/65− (total) | 1.32 | 1.49 | 2.68 | 1.07 |
Ratio 65+/65− (FONASA) | No data | 1.53 | 2.54 | 1.09 |
Ratio 65+/65− (ISAPRE) | No data | 1.74 | 3.81 | 0.99 |
Health System Indicator | Health Status | Financial Protection | People’s Expectations | |
---|---|---|---|---|
Indicator | Suicide Mortality Rate (per 1000 People) | OOPE/Expenditure | Catastrophic Expenditure (% Households) | Satisfaction with the Health System (Scale from 1 to 7) |
Ratio 60+/60− (total) | 1.31 | 1.44 | 2.48 | 1.01 |
Ratio 65+/65− (total) | 1.32 | 1.49 | 2.68 | 1.07 |
Ratio 80+/80− (total) | 1.44 | 1.69 | 3.90 | 1.15 |
© 2020 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Villalobos Dintrans, P. Health Systems, Aging, and Inequity: An Example from Chile. Int. J. Environ. Res. Public Health 2020, 17, 6546. https://doi.org/10.3390/ijerph17186546
Villalobos Dintrans P. Health Systems, Aging, and Inequity: An Example from Chile. International Journal of Environmental Research and Public Health. 2020; 17(18):6546. https://doi.org/10.3390/ijerph17186546
Chicago/Turabian StyleVillalobos Dintrans, Pablo. 2020. "Health Systems, Aging, and Inequity: An Example from Chile" International Journal of Environmental Research and Public Health 17, no. 18: 6546. https://doi.org/10.3390/ijerph17186546