The medical system in Chile

Lots has happened since our last post! We had been postponing for a while using the medical system in Santiago (for general check ups and other non-urgent stuff). This was not out of worry about bad doctors or hospitals but instead, we were aware that we had to learn to use the system and in Chile things are often not as straight-forward as one may think.


So, as a little background for our foreign readers: In Chile there is a national health service. It is called Fonasa (Fondo Nacional de Salud). This system, like in many other countries that have a health service, will take care of anybody, even those that are out of work and therefore cannot pay tax. However, unlike in most countries with a national health system, giving a part of your income (7% is the minimum stipulated by law) to finance Fonasa is not compulsory. One decides whether the percentage of their income associated to health finances Fonasa or alternatively goes to the private health system (to companies called ISAPRES).

Clearly, in most cases this ends up with the following situation: if you get paid enough, your money goes to an ISAPRE and if you do not, your money goes to Fonasa.  In any case, unless your income is very very low or your private health coverage is incredible (which would amount to giving much more than the stipulated 7% to your health system of choice), you always need to pay a percentage of any medical attention you receive.

Issues with this:

1. This must, without a doubt, result in Fonasa being very underfunded.
2. When you or someone of your family gets seriously ill, you don't just have a health problem (potentially an emotional one too), you also have a significant financial burden. It is not that uncommon here, for people to end up with a dead family member and a huge debt at the back of that. In Patricia's work in the last year there have been several money collections among the employees to help colleagues pay their medical bills.
3. You are most likely to need the health system when you are old and have a reduced income. Unless you are willing to pay exorbitant amounts of pension into the health system, you will need to use your savings (if you are lucky or well organised enough to have some) to pay for your health care or use a very underfunded Fonasa.
4. There is also the fact that women need to pay significantly more for their medical care as they are the ones that have children (?! without the help of a male?!) and may have birth related complications. And culturally here, this is accepted as a fundamental law of nature (say like gravity... no-one queries it anymore and no-one has thought that perhaps it would be more fair if the ISAPRES would spread the increased cost between males, females that will never have children and females that will have children). This particular matter is interesting as even if the woman has no womb or does not want to have children, the increased cost of medical coverage still remains (though if one does opt out of birth coverage, one can get a somewhat reduced cost).
5. Culturally (?) there are also some interesting inefficiencies, for example, you go to the doctor, she tells you that you need to have some tests done, you literally go next door to get these tests done with some other specialist, the results from the tests come back in 2 days...  for some bizarre reason, the results do not go back to your doctor, you need to go to the clinic and pick them up and walk them the 50 steps between the "test results room" and the "doctor's secretary room" as no-one has thought that it would be useful if the patient did not have to go back to the clinic merely to walk 50 steps. 

Moving on, we have decided (selfishly and a little reluctantly) to take private coverage and in truth, we have so far received excellent medical attention. You need an appointment, mostly, you can have one tomorrow. The hospital is super clean, seemingly happy doctors everywhere, you want to hand in your lab samples at 2am in the morning? no problem, the lab is open etc... you get the picture... though we have never spent so much money in health coverage EVER and it is unlikely if we were pensioners, we would be able to afford it!

The questions that remain (and given the changes taking place in Europe and in countries like Spain in particular)  are:

1. Do we, as a species, really not see value in looking after the most vulnerable members of society while we are strong so that others can look after us when we are not so strong? 
2. How do we make sure that everyone is pulling their weight in these collective systems? 
3. Is it necessary to avoid allowing people getting into the situation where one of their parents gets ill, dies and in addition, they need to sell their house to pay for the hospital bed?
4. Is it acceptable that someone needs to wait months for an operation/appointment/intervention they need?
5. Should people that (knowingly) do not take care of their health (smoking, drinking heavily, eating high cholesterol foods...) be given the same level of priority as people who try their best not to strain the system? Why?
6. Does a health system need to be profitable? (is the army, fire brigade, police etc... profitable? what are the repercussions of a profitable health system?)
7. Surely there is vested interest in doctors suggesting more treatments than perhaps one would strictly need (then the customers/patients spend more money which means the business/medical care institution has more earnings) Who regulates this? does anyone care

Recently we went to the dentist. On 2 separate days, we had to wait roughly 20-30mins in the waiting room. During this time, there was a TV screen (non-stop) telling everyone there to eat meat: advert, after advert after advert after a how-to-cook-meat-program after advert and so on. Given that the average chileno's meat consumption (without including fish or other forms of sea-life) stands at an obscene 82Kg (this has doubled in the past 20 years) and that in the top 6 of the most common causes of death in Chile are coronary heart disease, stroke, hypertension and diabetes (scroll down in the hyperlink for the top 50 causes), one would hope that Fonasa (which is not a profit making institution) has a similar campaign promoting eating more fruit and vegetables and exercising! 

The meat industry may well create more jobs than our politicians bargained for after all... and it seems that there is money to be made by encouraging us all to die more slowly and ideally with a few visits to hospital in between.

More post on our long weekend will follow soon!