Azevedo A C
Organización Panamericana de la Salud en Chile, Santiago, Chile.
Rev Saude Publica. 1998 Apr;32(2):192-9.
The evolution of the health system in Chile, since its beginning and during the National Health Service period is described. The transformations that this system underwent from 1980 on, during the military regime, and the changes introduced by the democratic governments from 1990 on, with the purpose of correcting distortions introduced in the previous period, are commented on. The production of the health services is compared as between the public and private sub-sectors. The indicators used are outpatient attendance per thousand insured inhabitants, use of, lab texts on the same populational basis, hospitalization rates, discharges per thousand insured and surgery rates per thousand. Differences between the two sub-systems are commented on as also are those related to user satisfaction in the two sub-systems. The chief challenges to the public system are considered as well as their possible responses to them on the basis of current policies and the solutions implemented. The present situation in the Public/Private mix in health care in Chile gives rise to the positive expectation that the public subsystem may succeed in maintaining its historical leadership in the orientation and health services offered in this country. This positive view is supported by the rigorous geographic and demographic logic of the public subsystem, the stable availability of financial resources (result of the 7% contribution for health applied on all salaries, complemented by tax funds), a not completely modern but reliable network of public health facilities and the considerable motivation shown by its staff. Some features of the Chilean health system's development are mentioned as potentially useful to the development of health systems in other countries, especially in Latin America, such as organization and management of regional health services, innovative methodologies in health service payment (diagnosed related payment, management agreements and per capita financing for primary care); the health surveilance system (especially for food and drugs) and the state regulation of private health care financers.
本文描述了智利卫生系统自创建以来以及在国家卫生服务时期的发展历程。文中评论了该系统在1980年军事政权时期所经历的变革，以及1990年起民主政府为纠正前一时期出现的扭曲现象而引入的变化。文章还比较了公共和私营部门的卫生服务产出情况。所使用的指标包括每千名参保居民的门诊就诊人次、基于相同人口基数的实验室检查使用情况、住院率、每千名参保居民的出院人次以及每千名居民的手术率。文中评论了两个子系统之间的差异以及与两个子系统中用户满意度相关的差异。同时考虑了公共系统面临的主要挑战以及基于当前政策和已实施的解决方案它们可能做出的应对措施。智利医疗保健领域公私混合的现状引发了一种积极的期望，即公共子系统可能成功保持其在该国卫生服务导向方面的历史领先地位。这种积极观点得到了公共子系统严谨的地理和人口逻辑、财政资源的稳定可得性（所有工资的7%用于卫生保健，辅以税收资金）、虽不完全现代化但可靠的公共卫生设施网络以及其工作人员所表现出的相当积极性的支持。文中提到了智利卫生系统发展的一些特点，这些特点可能对其他国家，特别是拉丁美洲国家的卫生系统发展有用，例如区域卫生服务的组织和管理、卫生服务支付的创新方法（诊断相关支付、管理协议和初级保健人均筹资）；卫生监测系统（特别是食品和药品监测）以及国家对私营医疗保健融资机构的监管。
