Schizophrenia Treatment Coverage Provided by the Public and Private Health Systems of Chile

Minoletti, Alberto; Soto-Brandt, Gonzalo; Toro, Olga; Irarrázaval, Matías; Zanga, Rosendo; Alvarado, Rubén

doi:10.1176/appi.ps.202000018

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Even so, it seems that in the case of depression and bipolar disorder, the decrease in the use of the GES plan occurred before the pandemic. The opposite is true for schizophrenia, which continued to be used, which may be associated with the fact that, in this case, the GES plan succeeded in improving coverage and financial protection, especially for the most vulnerable ( 9 ). The case of increased care for Alzheimer's disease may be associated with the fact that it was the first year of implementation of the GES plan and many people who were already in treatment saw an opportunity to guarantee access and quality of treatment, thanks to the GES plan.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the GES plan covers 85 health problems, among those that are linked to mental disorders are as follows: schizophrenia, depression, bipolar disorders, and Alzheimer's disease, called “GES mental health plan” in this study. It has been argued that the principle of universal coverage of the GES plan has contributed to access to care for schizophrenia, especially for the most vulnerable population ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 pandemic and mental healthcare: Impact on health insurance with guaranteed universal access in Chile

Toro-Devia

Leyton²

2023

Front. Public Health

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BackgroundUniversal health coverage (UHC) is a goal of the member states of the United Nations. The negative impact of the COVID-19 pandemic on mental health, inequalities in access to care, and financing gaps set a problematic scenario for universal mental health coverage. In Latin America, depression and anxiety disorders have increased by more than 30%. Chile implemented a reform for UHC in 2005 generating a mandatory guaranteed plan for health insurance (GES) that covers schizophrenia, depression, bipolar disorders, and Alzheimer's disease. We assume that the pandemic increased cases of mental illness in GES of public and private insurance.ObjectivesThis study aimed to explore the effects of the pandemic on the use of the GES mental health plan of public and private insurance.MethodsA descriptive analysis of secondary data from public and private insurance on the use and expenditure of the GES plan in mental illness between 2005 and 2020 was carried out. An aggregate analysis of the use of psychiatric consultations without a guaranteed plan and sick leave was performed.ResultsBetween 2005 and 2020, 18.5% of GES cases corresponded to four mental health illnesses (1,682,021 cases). Public insurance covered 80% of cases. In the pandemic, cases of mental illness fell by 10.5% in public insurance and 28.7% in private ones, reducing spending by 33 and 6.2%, respectively. Psychiatric consultations without using the GES plan doubled in 2020 in private insurance, and medical discharges due to mental illness also increased. Leave due to mental illness increased by 20% in both types of insurance.ConclusionThe results suggest that the demand for mental healthcare increased during the pandemic, but public and private health insurance reduced admissions to the GES universal plan for schizophrenia, depression, and bipolar disorder. A universal guaranteed plan in an individual contribution system can have essential weaknesses for people when the principles of social security are not complied with, especially concerning the solidarity of the health insurance system.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19 pandemic and mental healthcare: Impact on health insurance with guaranteed universal access in Chile

Toro-Devia

Leyton²

2023

Front. Public Health

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“…MHS have developed since the 1990 Caracas Declaration (See Table 1). Since 2005, Chile has prioritized first episode psychosis (FEP) services, providing universal coverage and regulations to promote MHS quality (Minoletti et al, 2021). However, promoting human rights and social inclusion of people with mental disabilities remain priorities (Minoletti, 2016).…”

Section: Culture and Stigma In Chilementioning

confidence: 99%

Stigma toward psychosis in urban Chile: Engaging “what matters most” to resist stigma through recovery-oriented services.

Becker¹,

Blasco²,

Burrone³

et al. 2023

Psychiatric Rehabilitation Journal

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Objective: Stigma jeopardizes recovery and successful implementation of mental health services (MHS) globally. Despite cultural variation in how stigma manifests, few studies have examined how culture fundamentally impacts the concept of "personhood" in Latin America. Chile has expanded MHS, providing universal coverage for evaluation and treatment of first episode psychosis (FEP). We applied the "what matters most" (WMM) framework of stigma to identify culturally salient factors that shape or protect against stigma in urban Chile, identifying potential implications for MHS and recovery. Methods: In-depth interviews (n = 48) were conducted with MHS users with psychotic disorders (n = 18), their family members (n = 15), and community members (n = 15), from two urban regions in Chile. Interviews were coded and analyzed to identify WMM, how WMM shapes stigma, and how MHS can influence achieving WMM. Results: Traditional values emphasizing physical/social appearance, gender roles, family, and social connectedness are highly valued. Socioeconomic transitions have engendered capitalistic variations on traditional values, with increasing emphasis on professional careers for men and women, individualism, and independence. Psychotic disorders interfere with fulfillment of both traditional and capitalist values, thereby reinforcing stigma. However, MHS are seen as partially effective in enabling fulfillment of some goals, including employment, appearance, and independence, while often remaining insufficient in enabling capacity to achieve marriage and having a family. Conclusions and Implications for Practice: MHS that facilitate recovery by engaging users in services, such as pharmacotherapy, education/vocational rehabilitation, and family-centered care aligned with cultural values can mitigate stigma and facilitate recovery by enabling users to fulfill WMM.

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“…Chile is one of the first countries in the Global South to provide universal access to FEP services (10). Historically, the Chilean healthcare system has consisted of public and private financing, insurance, and delivery, with the wealthiest of the population concentrated in the private sector (11). Consequently, the publicly insured often have inadequate access to and quality of care; namely, considerable proportions of people with FEP and schizophrenia were left untreated due to minimal coverage and high treatment costs (11).…”

Section: Fep Care In Chilementioning

confidence: 99%

“…Historically, the Chilean healthcare system has consisted of public and private financing, insurance, and delivery, with the wealthiest of the population concentrated in the private sector (11). Consequently, the publicly insured often have inadequate access to and quality of care; namely, considerable proportions of people with FEP and schizophrenia were left untreated due to minimal coverage and high treatment costs (11). In 2005, Chile underwent a comprehensive public healthcare system reform in which the Garantías Explícitas en Salud (GES) program was implemented, guaranteeing universal free access for the diagnosis and treatment of schizophrenia, including FEP (12,13).…”

Section: Fep Care In Chilementioning

confidence: 99%

Initial adaptation of the OnTrack coordinated specialty care model in Chile: An application of the Dynamic Adaptation Process

Choe²,

Burrone³

et al. 2022

Front. Health Serv.

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BackgroundIn 2005, Chile became the first country in Latin America to guarantee universal free access for the diagnosis and treatment of schizophrenia. A cluster randomized control trial utilizing the Dynamic Adaptation Process framework is underway to adapt and test the OnTrack coordinated specialty care model to provide recovery-oriented, person-centered care by a multidisciplinary team for individuals with first episode psychosis (FEP) in Chile.MethodsA qualitative formative research study was conducted to inform the initial adaptation of the OnTrack Chile (OTCH) program. We conducted key informant interviews (n = 17) with various stakeholders (policymakers; directors/managers of community mental health centers; mental health professionals) and focus group discussions (n = 6) with individuals with FEP and caregivers (n = 35 focus group participants total). Data was analyzed using thematic analysis, organized by participants' perspectives on the benefits, barriers, and recommendations for the key principles, multidisciplinary team, psychosocial components, and the training and supervision model of OnTrack.ResultsParticipants expressed enthusiasm and support for OnTrack's recovery-oriented and person-centered principles of care. While many participants lauded the emphasis on shared decision-making and family involvement, some reported reticence, citing that it is culturally normative for patients and families to adopt a passive role in treatment. Peer specialists, and the family psychoeducation and support and supported education and employment components were perceived as aspects that could encourage the promotion of personhood and autonomy development. However, implementation challenges, including the prevailing biomedical approach, professional hierarchy, and the lack of infrastructure, human, and financial resources necessitate some modifications to these aspects. Some mental health professionals further conveyed reservations regarding the perceived hierarchical structure of the supervision model.ConclusionOnTrack represents a shift from a biomedical model to a valued, aspirational, person-centered and culturally responsive model that focuses on recovery, shared decision-making and psychosocial care. With the appropriate governmental and agency-level provision of resources and modifications to some of the program components, particularly regarding the shared decision-making framework, peer specialist, family engagement, and the training supervision model, OTCH could be a transformative program for a more comprehensive, evidence-based care for individuals with FEP in Chile.

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Schizophrenia Treatment Coverage Provided by the Public and Private Health Systems of Chile

Cited by 7 publications

References 9 publications

COVID-19 pandemic and mental healthcare: Impact on health insurance with guaranteed universal access in Chile

COVID-19 pandemic and mental healthcare: Impact on health insurance with guaranteed universal access in Chile

Stigma toward psychosis in urban Chile: Engaging “what matters most” to resist stigma through recovery-oriented services.

Initial adaptation of the OnTrack coordinated specialty care model in Chile: An application of the Dynamic Adaptation Process

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