Chile
Despite increased access to medicines, asthma remains underdiagnosed in primary care.
Chile is a middle-income country, with per capita Gross Domestic Product US$24,089 (2015) and health expenditure of US$1,606. The Public Health System covers more than 70% of the population but in the last 15 years, the health expenditure per person was the second lowest in the Organisation for Economic Cooperation and Development (OECD). Chileans have coverage for only 3.2 medical appointments per year, compared to the OECD average of 6.4.
Government programmes
Since the 1990s, the Chilean government has progressively implemented medical programmes to cover common respiratory diseases, including asthma. In 2006, the government established an Explicit Health Guarantees law, ensuring universal access to ambulatory coverage and free inhaled therapy for asthma patients. Children less than 15 years represent 21% of the population and 6.6% of them receive treatment for moderate or severe asthma. All have free access to salbutamol, inhaled corticosteroids (ICS) and spacers.
Underdiagnosis
In spite of this coverage at primary and specialist care levels, the current challenge is asthma underdiagnosis at the primary care level. This is evident at emergency services or secondary care, where doctors prescribe salbutamol, but not ICS for children with asthma symptomatology.
Adult Respiratory Diseases Units
In 2000, Primary Health Centres established “Adult Respiratory Diseases Units”, consisting of a physiotherapist, a nurse and a part-time doctor. All teams had previous training in Chilean national guideline management of asthma, chronic obstructive pulmonary disease and pneumonia. In 2015, there were 133,269 adults with asthma under regular care with these teams, 2.7% of the adult population in the National Health Service; 58% were mild cases, 7% had severe asthma and 55% had well controlled asthma (using the score of Global Initiative for Asthma (GINA)). Over 10 years a progressive reduction in adult asthma hospital admissions resulted, from 22.3/100,000 to 16.3/100,000. The Chilean experience of providing free access to therapy through an asthma outpatient programme shows a clear impact. Clearly, there is a need to move towards a quality-centred health strategy in Chile.
