Goic Alejandro, Armas Rodolfo
Rev Med Chil. 2003 Jul;131(7):788-98.
In Chile there has been a close interaction between medical teaching and health care. In 1943, the University of Chile School of Medicine (founded in 1833) created Chairs in several public hospitals. The University of Chile School of Public Health (founded in 1943) played a key role in the creation in 1952 of a centralized National Health Service (NHS). The NHS had outpatient clinics and hospitals all over the country and was responsible for health care and for the promotion of health and disease prevention programs. In 1954, the NHS and the School of Medicine set up Residencies and General Practitioners programs aimed at improving the distribution of specialists and general practitioners throughout the country. In 1979, the NHS was replaced with 27 autonomous Health Services headed by the Ministry of Health, while the administration of primary care outpatient clinics was transferred to the municipal government. However, sanitary programs were still managed at the central level. Higher education also expanded and was decentralized. There are currently 60 universities and 17 medical schools, compared to eight and six, respectively, in 1981. The number of students in higher education has increased by 370% in 20 years. At the present time, the Chilean health case system is a predominantly public system with a strong and sizeable private system. Sixty two percent of the population is covered by public health insurance, while 27% is covered by private insurance. New and well equipped private clinics have multiplied. Private non profit institutions manage the prevention and treatment of work related injuries and diseases. Chile's outstanding health indicators (fertility rate: 17.2 x 1,000; mortality: 5.4 x 1,000; maternal mortality: 2.3 x 10,000; neonatal mortality: 4.5 x 1,000; life expectancy: 76 years) are a direct consequence of the improved social, cultural and economic condition of the general populations as well as of the sanitary programs sustained over the past half century.
在智利，医学教学与医疗保健之间有着紧密的互动。1943年，智利大学医学院（成立于1833年）在几家公立医院设立了教授职位。智利大学公共卫生学院（成立于1943年）在1952年创建中央国家卫生服务体系（NHS）的过程中发挥了关键作用。NHS在全国各地设有门诊诊所和医院，负责医疗保健以及健康促进和疾病预防项目。1954年，NHS和医学院设立了住院医师培训项目和全科医生项目，旨在改善全国专科医生和全科医生的分布情况。1979年，NHS被27个由卫生部领导的自主卫生服务机构取代，同时初级保健门诊诊所的管理工作移交给了市政府。然而，卫生项目仍由中央层面管理。高等教育也得到了扩展并实现了分权。目前有60所大学和17所医学院，而在1981年分别为8所和6所。高等教育学生人数在20年里增加了370%。目前，智利的医疗体系主要是公共体系，同时也有强大且规模可观的私立体系。62%的人口享有公共医疗保险，27%的人口享有私人保险。新的、设备精良的私人诊所大量增加。私立非营利机构负责管理与工作相关的伤病预防和治疗。智利出色的健康指标（生育率：17.2‰；死亡率：5.4‰；孕产妇死亡率：2.3/万；新生儿死亡率：4.5‰；预期寿命：76岁）是普通民众社会、文化和经济状况改善以及过去半个世纪持续实施的卫生项目的直接结果。
