Access to knee arthroplasty among National Health Fund beneficiaries in Chile between 2004 and 2021

Abstract

Introduction Knee osteoarthritis affects the quality of life, with knee arthroplasty being a cost-effective treatment for the severe stage of this disease. Access to knee arthroplasty is a health indicator of the Organisation for Economic Co-operation and Development. The objectives of this study are to determine the incidence of knee arthroplasty between 2004 and 2021 in beneficiaries of the National Health Fund in Chile, the proportion of patients who underwent surgery in the private system, and to estimate the patient's out-of-pocket expenditure for surgery. Methods Cross-sectional study. We used the Department of Statistics and Health Information database. Patients discharged from a Chilean health center who underwent knee arthroplasty surgery between 2004 and 2021 were investigated. We analyzed the proportion of patients by their National Health Fund category and whether their surgery was performed in public or private network facilities. Results Of the 31 526 knee arthroplasty procedures, 21 248 (67.38%) were performed on National Health Fund patients and 16 238 in public institutions (51.49%). Patients from the National Health Fund showed a systematic increase in knee arthroplasty volume until 2019 but decreased in 2020 and 2021 by 68% and 51%. Of the total number of patients in the public system operated on for knee arthroplasty, 856 (9%) belonged to group A1, 12 806 (60%) to group B, 2044 (10%) to group C, and 4421 (21%) to group D. The expenditure incurred by these patients was estimated to vary between 24.4% and 27.2%. The historical proportions of access to this surgery in private institutions are 7% in group A, 13% in group B, 24% in group C, and 52% in group D. Conclusion Fifty percent of knee arthroplasty surgeries are performed in public institutions, and two-thirds are performed on patients of the National Health Fund. Forty-six percent of the C and D groups were operated in the private system. The pandemic has increased the access gap, leading to a substantial increase in the proportion of patients from the National Health Fund of the B, C, and D groups who have migrated to the private system to access this surgery.

Similar Patient Satisfaction and Quality of Life Improvement Achieved with TKA and THA According to the Goodman Scale: A Comparative Study

“…The OECD uses the number of arthroplasties performed per 100,000 inhabitants as a health indicator [ 26 ]. For example, in Chile, only access to THA is guaranteed by law [ 27 ], leaving the population requiring TKA relegated to significantly prolonged waiting lists [ 28 ].…”

Efficiency and productivity of the Chilean public health system between 2010 and 2019

“…En Chile este uso es de 4,9 horas (54,4%) versus 6,4 (71,1%) en el Reino Unido, ambos respecto de una disponibilidad de 9 horas [19]. Barahona et al, exploraron el rendimiento de los pabellones destinados a cirugías electivas, destacando que en 2019 fue de 2,5 cirugías, mientras que en 2018, 2020 y 2021 el rendimiento bordeó las dos cirugías por pabellón habilitado para cirugía electiva, concluyendo que existe ineficiencia en el uso de pabellones [20].…”

“…En este contexto, dado que el componente demográfico y epidemiológico de demanda seguirá su curso ascendente y con una producción de atenciones con crecimiento moderado, sin perjuicio de los logros obtenidos mediante políticas públicas en salud orientadas a cambios de envergadura, como intervenciones dirigidas a la alimentación y a la disminución del consumo de sustancias nocivas como tabaco y alcohol, es muy probable que a futuro se observe una mayor presión sobre las listas de espera públicas [20,21,22].…”