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    090128

    Re-establishing health care in Chile.

    Jimenez J

    BMJ. British Medical Journal. 1993 Sep 18; 307(6906):729-30.

    The former Minister of Health responds to an earlier, inaccurate article about the dispute between some emergency ward physicians and the public sector in Chile. Even though the economy appears to be healthy, 38% of the population are poor. Chile has had a longterm social policy addressing socioeconomic problems in health and in education, resulting in impressive health indicators (e.g., in 1990, 97% immunization rate for children under 5 years of age. The Pinochet regime whittled away at the strong national health service, however, including a large reduction in staff in the mid-1970s and a 40% reduction in expenditures (and a response to the economy adjustment crisis). These actions became time bombs which exploded in May 1990, 2 months after the inauguration of the 1st democratically chosen president in years. The health unions and, later, physicians asked for higher wages. In late 1992, the government increased salaries by 35% in real terms and 100% in nominal terms. Between 1990 and 1993, 6000 people, which included 1200 physicians for rural areas, were added to the public sector staff. The government increased investment in equipment (around 10,000 pieces of equipment, including 10 CAT scans) and in infrastructure by 240%. 190 public hospitals are undergoing repair and renovation. 2 small hospitals have opened. 4 large regional hospitals are scheduled for completion in 1993 and 1994. During the 3 years of democracy, the public sector budget increased 50% in real terms. The World Bank has provided assistance for a health sector reform project to meet the challenges that accompany the demographic and epidemiologic transition, transitions from a planned to a market economy and from dictatorship to democracy, a cultural transition, and behavioral changes. Politicians and physicians do not necessarily support reforms, however, sometimes resulting in changes in ministers, such as the author of this article.
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