Cuadrado Cristóbal
Programa de Políticas, Sistemas y Gestión en Salud, Escuela Salud Pública, Universidad de Chile, Santiago, Chile. Address: Escuela Salud Pública, Universidad de Chile, Avenida Independencia 939, Independencia, Región Metropolitana, Chile. Email:
Medwave. 2016 Sep 7;16(8):e6532. doi: 10.5867/medwave.2016.08.6532.
Healthcare represents a key area in the public agenda. In the case of Chile, this central part of citizen demands has emerged with an increasing criticism of the health system, its actors and institutions, while a major democratic and legitimacy crisis in Chilean society unfolds. The starting point of this analysis is the link between the critical and widespread societal dissatisfaction with the legitimacy crisis in the health sector. There is an interdependence and parallelism between these two different aspects of the crisis. The analysis is built around the dimensions of trust and legitimacy as a potential driver of the conflict, taking as an analytical framework the socio-political matrix. Conceptual elements around the ideas of trust and legitimacy in public policies are reviewed. This article focuses on recent situations surrounding the dynamics of the Chilean health system such as the rise of the Instituciones de Salud Previsional (ISAPRE) and the market-driven health system, the failed health care reform of the last decade, conflicts of interest in the formulation of public policies, loss of legitimacy of healthcare authorities, and the role of the health professionals in this process. Finally, a discussion arises seeking to regain public trust as a central issue for the future development and sustainability of health policies.
医疗保健是公共议程中的关键领域。就智利而言,随着对卫生系统、其参与者和机构的批评日益增多,公民需求的这一核心部分出现了,与此同时,智利社会也正在经历一场重大的民主和合法性危机。本分析的出发点是对卫生部门合法性危机的广泛社会不满与批评之间的联系。这场危机的这两个不同方面之间存在相互依存和平行关系。分析围绕信任和合法性维度展开,将其作为冲突的潜在驱动因素,并以社会政治矩阵作为分析框架。对公共政策中信任和合法性概念的相关要素进行了审视。本文重点关注智利卫生系统动态方面的近期情况,例如预付费健康保险机构(ISAPRE)的兴起和市场驱动的卫生系统、过去十年医疗改革的失败、公共政策制定中的利益冲突、医疗保健当局合法性的丧失以及卫生专业人员在这一过程中的作用。最后,引发了一场讨论,即寻求重新赢得公众信任,将其作为卫生政策未来发展和可持续性的核心问题。