La falta de perspectiva sanitaria en el sistema de salud chileno / The deficient public health perspective in the Chilean health care system

This reflection aims at strengthening public health teaching for undergraduate students of health care careers. Public health teaching is feeble and incomplete, especially in medical schools. However, this deficiency has not hampered the interest in post graduate training in the area. In health care careers, the academic program is heavily inclined towards clinical skills training and there are few courses devoted to teach and introduce public health concepts early in the training of health care professionals. This shortcoming can be related to some problems observed in the Chilean health care system such as the public/ private dichotomy, the driving importance of the market on health care and the preponderant reliance on hospital rather than primary health care. All these deficiencies in health care contribute to ignore the bio-psychosocial health care model.

Instituciones y licencias Médicas en Chile

In Chile, sick leaves serve the extra purpose of filling social protection gaps. Therefore, in practice, their operation range extends beyond health care regulations. In our institutional framework, sick leaves are used to fill social protection gaps and to accomplish an assortment of other purposes that justify an absence from work.

Conceptualización y método para revisitar la gestión de la salud pública y la provisión de servicios de salud en los municipios de la Región Metropolitana

An appropriate conceptualization process, consisting of an in-depth reflection about the role of organisms responsible for primary health care, which in Chile are the municipalities, should be carried out. Such exercise should enable the development of an analytical method aiming to understand management problems and bottlenecks in a determinate territory or region. Thus, changes to improve resource use effectiveness, with an impact in population health, could be proposed.

Competencias esenciales para la gestión en red / Essential competences for the management of health care networks

We suggest that in order to fulfill the health needs of the majority of the Chilean population, which is beneficiary ofthe public health system, essential organizational skills should be developed for network administration among Self-administered Hospitals, Network Manager and Primary Health Care facilities. Self-administered Hospitals should be competent in managing service options according to their strategy for development, reference and counter-reference mechanisms and waiting lists, to optimize queuing. The Network Manager should be competent in demand management that is regulated, investments management that determines future development in terms of population needs and stakeholders' management, which is a political viability type of management. Finally, the Primary Health Care manager should be competent in demand management as a strategic partner of the Network Manager, community participation and management of interlinked areas, articulating social networks and sanitary impact management. At each level and within levels, there are crossroads that promote synergies. Based on the development of essential skills, a practice with strategic intentions, organization managers will develop team work skills.

Gobernanza sistémica para un enfoque de derechos en salud: Un análisis a partir del caso chileno / Systemic governance for a human rights approach to health: An analysis based on the Chilean case

El artículo analiza los nudos y desafíos organizacionales, de gestión e institucionales de la construcción de gobernanza sistémica en la implantación de políticas con enfoque de derechos. Adopta como caso la reforma sanitaria chilena iniciada bajo ese enfoque en el año 2004. La metodología integró un análisis cualitativo de normas legales, de instrumentos de gestión y de 40 entrevistas en profundidad efectuadas en 2009 a directivos de salud de distintos establecimientos en tres regiones de Chile. Los hallazgos muestran que en la reforma prevalece una conexión entre incentivos, cálculos privados de beneficios personales y mediciones que no favorece la gestión de las interdependencias y tiende a debilitar los valores de ayuda y cooperación mutua necesarios para alcanzar la integralidad en la solución de las problemáticas que los derechos interpelan. Se concluye, entre otros aspectos, que una aceptación acrítica de los modos de gestión y organización heredados de reformas institucionales previas, genera contradicciones con la necesidad de construir gobernanza para un enfoque de derechos.

The article analyzes organizational, managerial, and institutional challenges in the development of systemic governance for the implementation of policies with a human rights approach, taking as a case study the Chilean health reform initiated with that approach in 2004. The study integrates a qualitative analysis of legal norms, of managerial instruments and of 40 interviews conducted in 2009 with health executives in three regions of Chile. The findings show that in this reform there is a close connection between incentives and calculations of personal benefit that does not favor agency interdependence. The prevalence of this trait tends to undermine the values of mutual aid and cooperation needed to achieve the integral solutions to social problems that a human rights approach demands. The conclusions reached state, in part, that an uncritical acceptance of management and organization methods inherited from previous institutional reforms often creates contradictions in the development of a governance structure conducive to a human rights approach.

Autogestión hospitalaria en red I: competencias esenciales para la gestión / Self management hospital network I: essential skills for managing

Este documento hace referencia al Programa de Acompañamiento de Hospitales que la Subsecretaría de Redes Asistenciales del Ministerio de Salud de Chileimpulsó para laautogestión hospitalaria en red. Dice relación con el programa de la Escuela de Salud Pública de la Universidad de Chile, diseñado para facilitar el desarrollo de tres competenciasesenciales, que los hospitales requerirían para la implementación de una política pública con enfoque de derechos (el Plan Auge), en unescenario competitivo. A partir de los elementos centrales de la reforma sectorial y del marco teórico utilizado, se definieron dichas competencias: desarrollo de la cartera de servicios, gestión de lareferencia y contrareferencia de pacientes y gestión de las listas de espera.