From instinct to evidence: the role of data in country decision-making in Chile

Abstract

BackgroundThe Chilean health system has undergone profound reforms since 1990, while going through many political upheavals, and faced demographic, health, and economic transformations. The full information requirements to develop an evidence-informed process implied the best possible use of available data, as well as efforts for improving the information systems.ObjectiveTo examine, from a historical perspective, the use of data during the health reforms undertaken in Chile since 1990, and to identify the factors that have determined its utilization and improvement.DesignA qualitative methodological approach was followed to review the case study of the Chilean experience with data on decision-making. We use as the primary source our first-hand experience as officials of the Ministry of Health (MOH) and the Ministry of Finance during the reform period considered. Second, a literature review was conducted, using documents from official sources, historical accounts, books, policy reports, and articles about the reform process, looking for the use of data.FindingsThe Chilean health care reform process was intensive in utilization and production of information. In this context, the MOH conducted several studies, from the burden of disease, efficacy of interventions, cost-effectiveness, out-of-pocket payments, and fiscal impact to social preferences, among others. Policy and prioritization frameworks developed by international agencies influenced the use of data and the studies’ agenda.ConclusionsHealth systems in Latin America have struggled to adapt to changing health needs caused by demographic transition and economic growth. Health reforms in Chile provide lessons of this sustained effort, based on data and scientific grounds, with lights and shadows. Tradition, receptiveness to foreign ideas, and benchmarking with international data determined this approach, facilitated by the political influence of physicians and other technocrats. Besides, internationally comparable statistics are shown to play a significant role in policy debate.

Global estimates of country health indicators: useful, unnecessary, inevitable?

“…Technocrats in countries that perform badly compared with countries with similar socioeconomic profiles can use global rankings to needle politicians into action, improving both data systems and programme implementation (historically in Chile, more recently in South Africa and Iran). The most positive views of global estimates are expressed by countries such as Brazil [18], Chile [26], Mexico [18], South Africa and Thailand [22] that have been stimulated to bring the estimation process home by taking on the global estimates and producing their own country estimates based on country data and nationally determined assumptions.…”

Under five and infant mortality in Chile (1990-2016): Trends, disparities, and causes of death

“…The past progress in child mortality coincides with a period of unprecedented economic growth and poverty reduction that followed the recovery of democracy in Chile. Public expenditures on social programs increased significantly, including investments in the health sector that, among others, supported hospitals' infrastructure and technology, including the creation of neonatal intensive care units [6,26]. Improvements in social determinants and expanded access to care were related to the accelerated progress observed during the 1990s and the slower but steady improvement in this century [1,6,26].…”

“…Public expenditures on social programs increased significantly, including investments in the health sector that, among others, supported hospitals' infrastructure and technology, including the creation of neonatal intensive care units [6,26]. Improvements in social determinants and expanded access to care were related to the accelerated progress observed during the 1990s and the slower but steady improvement in this century [1,6,26]. The 2005 health reform introduced a regimen of explicit health guarantees, known as AUGE, embracing, among other priorities, the leading causes of child mortality.…”

Bridging the data gaps: do we have the right balance between country data and global estimates?

“…An introductory paper considers the usefulness of the expanding volume of global estimates [9]. Three country-specific papers consider the role of estimates in the specific contexts of Chile, Bangladesh and Thailand, respectively [10–12]. Pisani and Kok reflect on the need to socially contextualise estimates in order to make them locally useful [13].…”