The UK’s National Health Service (NHS) has been lauded on several occasions by the current Chilean authorities and is thus seen as a benchmark when it comes to imagining domestic system reform. Indeed, Camilo Seid, Director of Fonasa, stated last week that it is “a system with wide coverage and access. The NHS covers all English populations, of different social classes, and has excellent service standards. It is organized through the first level of primary care, which is a system strategy Preventive. It has excellent results in terms of population health.”
Dr. Andrea Srour has over 15 years of experience, both in Chile and the United Kingdom. Between 2014 and 2016, she was the Head of the Department of Noncommunicable Diseases at the Ministry of Health (MINSAL). In addition, he has been involved in the implementation of the Value Based Healthcare project for 68 hospitals in the UK, Europe and Latin America. The 40-year-old professional based in London is now the Associate Director of the Global Center for Person-Centered Value-Based Healthcare (PCVBHC).
In this context, the expert on global health systems and policy warns that “we must understand that the NHS is a strong system, but it has many challenges that it shares with Chile.” At the same time, the doctor highlights the national action: “It is important to stress that Chile has not done badly. The health progress of the past 30 years has been important, and this must be emphasized.”
What are the advantages of the English health system?
One of the main advantages is that everyone has free access to the system. The same is free on quotes, because we all pay taxes and an additional insurance scheme that covers part of the NHS. Unlike Chile, the NHS has a very strong primary care, it is the gateway to the health service. For example, I can’t go to the hospital directly: I have to go to my primary care doctor. This means that there are more possibilities to do prevention and treatment of diseases than before. Also, this means that the secondary and tertiary system do not collapse. This portal of entry regulates who goes through and is where most people’s problems are solved, where only those who really need it are referred. In general, the quality of care is quite similar to that of Chile. Although there is a difference for different reasons, the majority of the population has access to basic health and is of relatively good quality.
What are the challenges?
The way the NHS is regulated There is a great deal of inequality in the way people access services. Using Chile as an example, people with diabetes who need insulin pumps who live in Las Condes have access to one type of insulin pump, those who live in Maip get four options while people from Providencia have none. That’s what’s going on here, what we call the zip code lottery, that is, depending on which region you live in, you can access different types of services. Another challenge is that there is a huge increase in waiting lists. Today approximately 10% of the population are waiting to be seen and on average they wait 13 weeks to be seen by a specialist. Low-income areas have an average waiting that can be more than a year.
Why is there an increase?
We have the same problems that occur in all developed countries, where populations are aging, chronic diseases are increasing, human resources and infrastructure are limited. Thus the population increases, the diseases and their complications increase, but the system does not have the capacity to respond. The epidemic also played against it. Many people with cancer or cardiovascular disease have been diagnosed with late or delayed treatment. The NHS is the third organization in the world with the largest number of recruits, but many of them are not necessarily clinical professionals, but are administrative. They have regulated much of what is part of the organization of health professionals, so the number of professionals produced here is not enough to cover the needs of the system. It also has a lot to do with Brexit, as many health workers here decided to migrate, creating an even bigger gap. It is estimated that by 2030 there will be a gap in clinical professionals of approximately 300,000.
Are people in the UK dissatisfied with the healthcare system?
Yes, in studies conducted over time, it has been concluded that at this time only 36% of the population is satisfied with the NHS. The main reason is queues and unequal access to various services. Now, with quality care there is 85% satisfaction.
How is the cooperation between the public and private sectors?
In Chile, people can choose not to pay Fonasa and pay the isapres fee. Here we are all obliged to pay Fonasa, in quotes, and people who want to get private health services, pay some kind of supplementary insurance. Many medical or infrastructure professionals are shared between the public and private sectors. For example, a doctor who works in the mornings on the NHS, in the afternoons can do medical consultations in the same hospital. That is, you can have a private consultation in the same hospital. Waiting lists are the reason many people today get supplemental insurance. Currently, 10% of the population has private health insurance and it is estimated that more or less in the next three years will increase to 25%. What the NHS is doing to reduce waiting lists is to contract services from the private sector, particularly in mental health or for the elderly. As they see queues getting a little out of control, this year a contract was signed with private providers for the next four years to help reduce queues. So there is a common reliance on the private system to cover the requirements of the public system.
Do you think it is a system that Chile can replicate?
It’s a complicated question. I think it’s a mistake to think that health systems from other countries can be copied and pasted without knowing what the structure is, what the system of government is, or what the culture is. Of all the OECD countries, Chile is the country with the fewest health professionals available. It is important to stress that there are no perfect health systems. You have to understand that the NHS is a strong system, but it has many challenges that it shares with Chile.
What should Chile’s new health reform look like?
Health reform must acknowledge Chile’s existing infrastructure. Today the system is not perfect, and it may still have many loopholes, but we must understand that the health system is already in Chile. The NHS was formed when there was none. We must realize what we have and build on it. If isapres were removed, we would have 3.5 million people who would not be able to cover this supplemental insurance. So, there are 3.5 million people who are going to fall into Fonasa and we don’t have the infrastructure or the capacity to take those people. Learning from Europe’s health systems, reform should aim to strengthen primary care. Second, much more prevention efforts need to be done than what is being done. Here the model moves to put more resources into prevention, especially in chronic disease. Third, we should stop looking at health care and focus on what the costs are, but rather what people’s needs are and what their consequences are. It is very difficult in Chile to measure whether what we do is effective and whether it has good results, because we all measure differently. Therefore, the models are moving here to standardize the way information is collected, something with which apples can be compared to apples.
If isapres expires suddenly, will it affect?
Of course it will affect. Approximately 20% of the Chilean population receives care in the private sector. What will happen to those 20%? Probably located in Fonasa. How will the public health system respond without any warning or with too little time to accommodate the rest of the population? My opinion is that this would be counterproductive for people and their health.
Do the English and Chilean systems have very different results?
It is important to stress that Chile’s performance was not bad. Health progress in the past 30 years has been significant, and this must be emphasized. Clearly there are things in the UK that are doing better. But, for example, in Chile, the rate of incidence and mortality from cancer is better than in the United Kingdom.
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