1. Chile UHC

2. Outline Context Chilean Health System
Measurement and Monitoring of UHC
Discussion

3. Context: Chile at a glance
17,5
Millions total population (2013, INE)
21,590
PPP US$ GNI per capita (2012, WB)
14,4%
Poverty (2011, CASEN)
87%
Urban population (2013, INE) 79
Years Life expectancy at birth (2012, WB) 8
IMR per 1000 live births (2011, WB) 1%
Child malnutrition
96%
Access to improved water source
99%
Literacy of population age 15+ (2009, WB)
0.54
GINI coefficient (2011, CASEN)
9,7%
Elderly population 65 years and over (INE, 2013)
The main challenge is to tackle inequality. While Chile has made substantial progress in reducing poverty (15% in 2009), the average income of the richest 20% was 14.5 times that of the poorest 20% in Although Chile has actively invested in social protection programs, middle- and low-income households remain vulnerable to crises.
Source: WB World Development Indicators 2011; OECD Statistics 2011

4. Chile: Economic, social and demographic evolution

5. Chile: Burden of Diseases Injuries and Risk Factors
Source: IHME 2013

6. Chilean steps towards UHC

7. Chilean Health System

8. Measurement and Monitoring of UHC
Inputs
Outputs
Outcomes
Prevalence of Risk factors
Effective Coverage
Impact
Finantial Risk Protection
Health Status

9. M&M UHC: Inputs

10. M&M UHC: Outputs

11. M&M UHC Outcomes: Coverage of Interventions
Indicator
Coverage %
year
source
DPT immunization 94
2011
WB WDI
Prenatal services 95
1993
Contraceptive prevalence 58
2006
Skilled birth attendance
100
2009
Improved Sanitation 96
2010
TB treatment success 71
HIV-AIDS ART coverage 66
Indicator
Public
Private
year
source
Depression
56.2%
82.1%
MOH – NH Survey
High Blood Pressure
40.0%
30.5%
Diabetes
54.3%
78.6%
Mammography
47.0%
71.0%
2011
CASEN Survey
PAP Smear
55.0%
61.0%

12. M&M UHC Outcomes: Effective Coverage

13. M&M UHC Outcomes: Prevalence of Risk factors
Source: MOH- Chile, National Health Survey

14. M&M UHC Impact: Financial Risk Protection
Sources:
Cid, C. y Prieto, L., Rev Panam Salud Publica 31(4), 2012
Castillo-Laborde, Villalobos, Rev Médica de Chile , accepted for publication
*By income quintiles: over total household expenditure; By system: over total income

15. M&M UHC Impact: Health Status
years of education
total
urban
rural
None -
1-3
11,2
12,5
8,5
4- 6
13,6
13,3
14,0
7-9
10,0
10,1
9,8
10-12
7,4
7,1
10,2
13 +
5,8
5,6
8,4
average
Ratio 1-3/13+
1,93
2,21
1,01

16. Discussion
Over the last 60 years the Chilean health system has moved towards UHC, evidenced by the high coverage on primary health care and relative good performance on health indicators on average.
However there are structural constraints that prevents further advance and determine the existence of important inequalities in terms of access, but more importantly, in terms of health results (e.g. geographic, socioeconomic, public/private system).
For instance, the public expenditure on health (the total expenditure on health), is one of the lowest among OECD countries. Furthermore, an important component of the total health expenditure is financed through out-of-pocket expenditure (i.e. insufficient financial risk protection).
At the household level, about 5% of the total expenditure/income is devoted to pay directly for healthcare services (although the % is greater for the better offs)
There is important limitation in terms of the inputs.
Specially in the public sector (human resources and facilities)
On the other hand, the system is fragmented (at the pooling and providers level)
Not allowing for a unique pooling of funds (but 1 public fund and 13 private funds).
Therefore, there is an unequal availability of funds for the population served in both sectors, as well as unequal access (specially regarding more complex health care services such as surgical procedures and specialist consultation).
Besides, there is risk selection (with the poorer, the older and the sicker going to the public fund).

17. Discussion
The geographic characteristics of the country also impose difficulties in reaching the rural and extremely isolated population.
There are still some gaps in addressing some increasingly important diseases (groups II and III). For instance, the dementias, enzymatic diseases, secondary preventive strategies (e.g. for some cancers).
One of the major limitation in the measurement of indicators related to UHC is the availability of disaggregated data (specially at the health results level).
In order to measure the advances in UHC, one possibility is to consider the specific health needs profile of each country according to the burden of disease study, as well as the relative importance of the three different groups (communicable maternal and child health, non communicable and injuries), and use tracer indicators of effective coverage for each group.