Wednesday, March 24, 2010

Health Care: Chile vs. United States

¡Hola Lefties! I've been in Chile for almost two months now and it has surprised me (not only with earthquakes!) by how progressive it is. Chile went about fifty years without democratically electing a conservative president (streak ending last year with Sebastián Piñera). The last president, Michelle Bachelet, is an agnostic socialist woman, three adjectives that have yet to describe any American president. But most amazing of all (at least with the current health care frenzy) - Chile has a health care system with a public option! Yes! Chile, a developing country, guarantees health care to all citizens, regardless of their ability to pay.

I'm not creative enough to think of a picture that represents Chilean health care, so here's the beautiful 2010 Santiago study abroad group :)

*Disclaimer, I am not a Chilean health care system expert, but I had to go on a field trip to a Chilean hospital for a presentation about health care with the rest of the ND study abroad students. My understanding of the health care here mainly comes from that.

More than 50% of Chileans use FONASA, Chile's public health care system. From what I understand, Chileans are classified by their annual income, which determines how much money is taken out of their wages or salaries to cover their health care costs. They can choose to pay into FONASA or into the private insurers, which would obviously cost more. People who use FONASA can go to any public hospital or clinic for treatment without paying. However, people who pay into FONASA can also choose to go to whatever private doctor they want, they would just have to make a co-pay. Essentially, the best of both worlds. Pay less premiums, but go to a private clinic for a bit extra.

For those of you who are number oriented, like I am, here are some stats (2006 numbers) from the World Health Organization (Organización Mundial de la Salud):

Gross national income per capita (PPP international $): USA, 44,070; Chile, 11,300
Life expectancy at birth m/f (years): USA, 75/80; Chile, 75/81
Probability of dying under five (per 1 000 live births): USA, 8; Chile, 9
Total expenditure on health per capita (Intl $, 2006): USA, 6,714; Chile, 697
Total expenditure on health as % of GDP (2006): USA, 15.3; Chile, 5.3

(Sources: Chile United States)

We already knew that the United States spends the most on health care per capita with mediocre results, but it's not just developed countries like the United Kingdom and France that have more and pay less. If we accept life expectancy and infant mortality rate (yes, I know that the WHO statistic isn't exactly the infant mortality rate) as the best quantitative measures of the quality of health in a country, then Chile, a poor, developing country, has achieved essentially the same quality of health as the United States, while also guaranteeing health care for every citizen and paying one tenth the amount per capita.

I'm glad that we've finally accomplished something for health care in the United States, but I think it's more of a step towards basic decency than something to actually be proud of. Millions of people still won't be covered and decisions regarding our health will still be made by profit seeking institutions. Maybe I'll just stay here in Chile forever, or at least until the United States makes some real progress.


ShamRockNRoll said...

Good post, Andrea. It really is astonishing how even less developed countries are able to provide better access to basic health services than we are.

David Lemme, DO, MPH said...

I wonder what Chilean doctors have to pay for malpractice insurance?

ShamRockNRoll said...

Republicans love to harp on medical malpractice/tort reform as if that is the sole reason why we spend so much on healthcare. The issue is worth debating, but your silly comment tries to imply that it is far much more significant than it actually is.

Gregory said...

It's interesting to hear that Chile is some sort of progressive paradise. I thought it was thought of as a free enterprise success story:

Also, life expectancy by itself doesn't tell you that much about the health care policies of a country.