Health Ministry presents the Council for Achieving Universal Primary Healthcare

The Health Minister, María Begoña Yarza, along with Public Health Undersecretary Cristóbal Cuadrado and Healthcare Networks Undersecretary Fernando Araos, led a session at La Moneda Palace on the formation and presentation of the Council for Achieving Universal Primary Healthcare.

This new cross-sector entity will advise the National Committee for Achieving Universal Primary Healthcare, the body which has been tasked with leading the process of making primary healthcare universal. This is a joint effort, whose goal is to establish a new State policy in which primary healthcare will become the main healthcare strategy for the entire population, the first port of call for assistance, and the touchstone for transforming the healthcare network and developing the healthcare system.

Universal primary healthcare is one of the key steps for initiating the transformation of the Chilean healthcare system into a universal healthcare system.

“For our government, universal primary healthcare is at the heart of the healthcare system. We believe that a broad range of stakeholders acknowledge the importance of strengthening primary healthcare,” said Health Minister, María Begoña Yarza.

This effort is being spearheaded by the National Committee for Achieving Universal Primary Healthcare, which is chaired by the Health Minister and the Public Health and Healthcare Networks Undersecretaries, along with a technical team comprising the respective divisions and departments of the Health Ministry (MINSAL), the National Health Service (FONASA) and the Superintendency of Health.

The Council for Achieving Universal Primary Healthcare is made up of a High-Level Health Committee, comprised of former Chilean Health Ministers and a Socio-Political Committee, consisting of representatives of the legislative power (Presidents of the health committees of both chambers of Congress), academia (the School of Public Health and the Chilean Society of Family Medicine), health workers (the Medical College of Chile and CONFUSAM*), and organizations representing users of the public healthcare system (ANCOSALUD).

“What we’re aiming to do with this Council is give the full support of the State to a public policy, namely making primary healthcare universal, so that it can transform the situation in Chile, where over 11 million people suffer from more than one chronic illness or condition and diseases are particularly growing among our children and youth,” said Minister Yarza. She added that universal primary healthcare is intended to “change this trend and transform primary healthcare into the main solution, generating preventative and anticipatory policies. We want these measures to have a lasting impact and for society as a whole to view them as part of a collective effort.”

In today’s meeting, which lasted for over an hour, the current state of the primary healthcare system was revealed, as was the role it should play going forwards, as the main healthcare strategy for the population’s health. The shortfalls in the current system, such as coverage, access, management, funding, personnel and infrastructure, were also identified. Furthermore, the strategy for achieving universal primary healthcare was announced, as well as the work to be undertaken to address the shortfalls identified. The meeting also looked at the strategy for rolling out universal coverage and the overall goals for the universal primary healthcare pilot schemes planned for 2022.

The following people were present at the meeting: the health Minister and both Undersecretaries; Jaime Peña, the Health Minister’s chief advisor; María Soledad Martínez, the Head of the Primary Healthcare Division; Camilo Cid, the Director of FONASA and Víctor Torres, the Health Superintendent. Also in attendance were: former Health Ministers, Osvaldo Artaza, Soledad Barría and Pedro García; Oscar Arteaga, the Director of the School of Public Health at Universidad de Chile; Fernando Leanes, representative of the Pan American Health Organization in Chile (PAHO); Ricardo Fábrega, former Healthcare Networks Undersecretary; Rosa Vergara, the Head of ANCOSALUD; Gabriela Flores, the President of CONFUSAM and Patricio Meza, the President of the Chilean Medical College (COLMED).

Making primary healthcare universal

 During this government’s term, primary healthcare coverage will become universal. This means that it will become responsible for the integral facets of the entire population’s healthcare (promoting healthy living, prevention, treatment, rehabilitation, palliative care and dying with dignity). The application of the new system shall be timely, pertinent and of a high standard, regardless of a person’s insurance, whether they are registered at a family health center (CESFAM), or any other type of obstacle.

– Work will be done to eliminate the barriers to entry. One of these is the type of health insurance that a person has. This means that people covered by health insurance other than the national health service (FONASA) - currently more than three million people - will be able to access the public system. The barrier to accessing primary healthcare centers and the tranche of services offered under the family healthcare plan will be eliminated, irrespective of whether or not a person is registered. This will impact over two million people. Finally, work is planned on the access barriers to ensure that those citizens who are registered can access the services at primary healthcare centers. Currently, only 50% of the population has access to services at this level, and around six million people receive no form of primary healthcare, so their health status is not recorded within the system. The main demographic affected by this is young and adult men whose access to the system is below 40%.

– A Virtual (Telemedicine) System will be implemented nationwide. This will enable people to more easily access the system, improving contact and follow-up, as well as prioritizing care. Meanwhile, an active screening strategy will be put into place in workplaces from primary healthcare to increase access, especially for young and adult men, the segment of the population that currently presents the greatest barriers. 

– Effective clinical integration of primary healthcare with the secondary and tertiary levels, through a digital and management strategy based on the creation of a clinical database, permitting primary healthcare information to work in tandem with other healthcare levels, bettering the flow of patient referrals. A primary healthcare telemedicine strategy will be developed, including specialists from other levels of the same healthcare network.

– A new Family Health Plan, a new model of clinical care will be set up, based on the best national and international standards. This optimized clinical management model is geared towards high-risk groups of people with multiple, non-contagious chronic diseases and prioritizes their medical care, which will reduce avoidable hospitalizations and their consequences. Alongside this, work will be done to incorporate new management indicators and improve health targets, which, with the cooperation of health workers and patients, will be used to evaluate primary healthcare performance.

– Funding Improvement Plan. The aim is to enhance the per-capita performance by improving the method by which funds are transferred, avoiding intermediaries that detract from the mechanism. The base amount will be raised in an attempt to address the shortfall that is forecast by the end of this government’s term. Improved indexes will be used for forecasting and health risk stratification and resource utilization will be implemented.

– Plan for addressing shortfalls in the primary healthcare infrastructure. This plan is expected to address the existing shortfalls of 115 family health community centers (CECOSF), 48 family health centers (CESFAM), 121 rural health clinics and 123 high-resolution emergency primary healthcare services (SAR), according to figures from the National Productivity Commission.

Implementation Strategy

 – An implementation strategy will be prepared and rolled out nationwide. It will begin this year, with universal primary healthcare pilot schemes in 6 different municipalities. They will make it possible to assess the feasibility of implementing the main management measures. Improvements can be made and then the scheme can be implemented in a greater number of municipalities as the shortfalls start to decrease nationwide.

– Meanwhile, proposals for a new Family Health Plan will be drawn up during 2022, incorporating new services and adjusting the health goals and indicators. An analysis of the shortfalls in human resources, equipment and infrastructure in every municipality will be carried out. This will culminate in November with the announcement of a plan to address the shortfalls, including a primary healthcare personnel training and retention plan.