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Health waiting lists in Chile: a matter of life and death

SANTIAGO – According to the latest numbers from the Health Ministry, between January and June last year, over 9,000 patients died waiting for medical care. This represented almost a fifth of all deaths in the first half of 2018. At the same time, a quarter of patients was taken off waiting lists before actually receiving surgery.

According to the Health Ministry’s latest figures, from January to June last year, 9,724 people died while awaiting medical attention, 54% more than in the year-ago period and representing 19.1% of all deaths in the country during the period. In the first half of 2017, 6,320 died while awaiting medical care.

In more detail the figures reveal that in the first half last year 360 patients died waiting for treatment under the Explicit Health Guarantees (GES) plan. The plan provides care to both private and public patients, guaranteeing access to medical care, opportunity, financial protection and quality service. It covers 80 diseases such as breast cancer, diabetes and gastric cancer, and patients need to be referred from doctors to access any benefits.

Still, the vast majority (9,240) passed away waiting for a medical attention that is not covered under the GES.

Uncertain causes

The Health Ministry claimed it is impossible to determine if the long lists and related prolonged waiting times contribute to patients’ death.

Paula Daza, Undersecretary of Public Health, told EmolTV that the 54% increase is due to “a change in the records and that was one of the issues that is probably influencing these numbers that are published”.

Héctor Sánchez, director of the public health institute at Andrés Bello University, however, told daily “El Mercurio” that indeed the longer patients are waiting, the higher the risk they die in the meantime.

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Not just death

But the health system creates another problem. According to Bío-Bío news site, patients wait 385 days on average for surgery. Patients in O’Higgins region wait the longest, around three years.

Crucially, the Health Ministry said that last year 74,405 (26% of the 290,227 patients that were waiting for surgery) dropped off surgery waiting lists without having received a procedureThis number is separate from the deaths, though as dropping off a list can have multiple reasons.

Multiple Factors

Juan Pablo Barria, waiting lists manager at Sótero del Río Hospital, told Chile Today that ‘administrative expenditures’, as this process is called in technocratic jargon, have many causes. Most common are the patients’ health status, communication problems and the pre-surgical process.

  • Patients’ health becomes a factor when they contract another disease and their status deteriorates, so surgery becomes impossible and they are dropped off the list.
  • Communications present problems, when patients do not answer their phones when called, due to loss or number change, for example. But Barria said that in case of no reply, a letter is sent to the patient. If they don’t reply within three months, the patient loses their place on the list.
  • Last, the pre-surgical process refers to procedures previous to surgery the patient has to undergo, like preliminary and preparatory examinations. If during this process the patient presents a problem, surgery is canceled.

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System issue?

Importantly, Barria claims, administrative expenditures do not arise from systemic issues, since patients cannot to be taken off arbitrarily. Eliminating anyone from the list requires some justification based on the causes above.

IIzia Siches, president of the Medical Association, criticized in daily La Tercera the “disorder” with waiting lists in the public health system, stressing that some “cases are resolved and the process of closing them is not done. There is a lot of disorder in the network and also cases pending.

Elisa Llach, Head of the Clinical Processes Department in the Health Ministry, told Bío-Bío that the department wants to achieve by March 31 that no patient has to wait more than two years for surgery.

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