Comparison of the healthcare system of Chile and Brazil: strengths, inefficiencies, and expenditures.

BACKGROUND: Governments in Latin America are constantly facing the problem of managing scarce resources to satisfy alternative needs, such as housing, education, food, and healthcare security. Those needs, combined with increasing crime levels, require financial resources to be solved. OBJECTIVE: The objective of this review was to characterizar the health system and health expenditure of a large country (Brazil) and a small country (Chile) and identify some of the challenges these two countries face in improving the health services of their population. METHODS: A literature review was conducted by searching journals, databases, and other electronic resources to identify articles and research publications describing health systems in Brazil and Chile. RESULTS: The review showed that the economic restriction and the economic cycle have an impact on the funding of the public health system. This result was true for the Brazilian health system after 2016, despite the change to a unique health system one decade earlier. In the case of Chile, there are different positions about which one is the best health system: a dual public and private or just public one. As a result, a referendum on September 4, 2022, of a new constitution, which incorporated a unique health system, was rejected. At the same time, the Government ended the copayment in the public health system in September 2022, excluding illnesses referred to the private sector. Another issue detected was the fragility of the public and private sector coverage due to the lack of funding. CONCLUSIONS: The health care system in Chile and Brazil has improved in the last decades. However, the public healthcare systems still need additional funding and efficiency improvement to respond to the growing health requirements needed from the population.

Factors explaining the fear of being infected with COVID-19.

BACKGROUND: The prevalence of COVID-19 has a social and economic impact on people, leaving them distressed and fearful of getting infected. OBJECTIVE: To determine the variables attributable to the fear of contracting COVID-19. DESIGN: This is a quantitative study based on an online cross-sectional self-administered survey in Chile between 10 July 2020 and 10 August 2020. SETTING AND PARTICIPANTS: A sample of 531, comprising over 18-year-old participants from middle- and high-income levels, was selected. OUTCOME MEASURES: Estimations were obtained using a probit regression model with marginal effects. RESULTS: Fear prevailed mainly in women. It has a positive relationship with variables such as chronic illnesses, infectious family or relatives, reduction in economic activity and perception of bad government response to a pandemic. Fear has a negative relationship with knowledge about COVID-19, education level and ageing. Moreover, those who consider socioeconomic impact less important than health care do not fear a COVID-19 infection. DISCUSSIONAND CONCLUSION: The socioeconomic and health aspects help predict fears. Thus, the government should prioritize these variables in implementing policies. The government's credibility and communication systems can also reduce fears of contracting COVID-19. PATIENT OR PUBLIC CONTRIBUTION: A pilot focus group of COVID-19-recuperated individuals and some members of our interest groups were consulted in the design stage of the study; this helped in constructing the survey questions. Additionally, three independent individuals volunteered to read and comment on the draft manuscript.

Hesitation and Refusal Factors in Individuals' Decision-Making Processes Regarding a Coronavirus Disease 2019 Vaccination.

Introduction: Considering the global prevalence of coronavirus disease 2019 (COVID-19), a vaccine is being developed to control the disease as a complementary solution to hygiene measures-and better, in social terms, than social distancing. Given that a vaccine will eventually be produced, information will be needed to support a potential campaign to promote vaccination. Objective: The aim of this study was to determine the variables affecting the likelihood of refusal and indecision toward a vaccine against COVID-19 and to determine the acceptance of the vaccine for different scenarios of effectiveness and side effects. Materials and Methods: A multinomial logistic regression method based on the Health Belief Model was used to estimate the current methodology, using data obtained by an online anonymous survey of 370 respondents in Chile. Results: The results indicate that 49% of respondents were willing to be vaccinated, with 28% undecided or 77% of individuals who would potentially be willing to be inoculated. The main variables that explained the probability of rejection or indecision were associated with the severity of COVID-19, such as, the side effects and effectiveness of the vaccine; perceived benefits, including immunity, decreased fear of contagion, and the protection of oneself and the environment; action signals, such as, responses from ones' family and the government, available information, and specialists' recommendations; and susceptibility, including the contagion rate per 1,000 inhabitants and relatives with COVID-19, among others. Our analysis of hypothetical vaccine scenarios revealed that individuals preferred less risky vaccines in terms of fewer side effects, rather than effectiveness. Additionally, the variables that explained the indecision toward or rejection of a potential COVID-19 vaccine could be used in designing public health policies. Conclusions: We discovered that it is necessary to formulate specific, differentiated vaccination-promotion strategies for the anti-vaccine and undecided groups based on the factors that explain the probability of individuals refusing or expressing hesitation toward vaccination.

Willingness to Pay for a COVID-19 Vaccine.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has considerably affected the lives of people worldwide, impacting their health and economic welfare, and changing the behavior of our society significantly. This situation may lead to a strong incentive for people to buy a vaccine. Therefore, a relevant study to assess individuals' choices and the value of change in welfare from a COVID-19 vaccine is essential. OBJECTIVE: This study aimed to estimate the willingness-to-pay (WTP) value for a vaccine for COVID-19. We also identify the variables that influence individual vaccination decisions, which could be used in the design of vaccination promotion strategies. METHODS: We use the contingent valuation method in its double-bounded dichotomous choice format. The estimation coefficients are calculated according to the maximum likelihood method under the assumption of a probit distribution. The sample consisted of 531 individuals, mainly from middle- and high-income socioeconomic groups from Chile between enrolled between 10 July and 10 August 2020. RESULTS: The results show a high WTP for the COVID-19 vaccine, with a value up to US$232. Income and education levels and having family members with COVID-19 increased the likelihood of persons paying for a vaccine. There is also a greater fear as the pandemic progresses that people will get sick from COVID-19. CONCLUSIONS: The high WTP value creates an opportunity for formulating public health policy. The results of this study suggest that governments can provide the vaccine free to low-income groups and allow those with higher incomes to acquire the vaccine through the private sector by paying. This will be useful especially for countries with economic difficulties.

Contingent assessment of the COVID-19 vaccine.

The COVID-19 pandemic has not only had a negative impact on people's health and life behavior, but also on economies around the world. At the same time, laboratories and institutions are working hard to obtain a COVID-19 vaccine, which we hope will be available soon. However, there has been no assessment of whether an individual and society value ​​a vaccine monetarily, and what factors determine this value. Therefore, the objective of this research was to estimate the individual's willingness to pay (WTP) for a hypothetical COVID-19 vaccine and, at the same time, find the main factors that determine this valuation. For this, we used the contingent valuation approach, in its single and double-bounded dichotomous choice format, which was based on a hypothetical market for a vaccine. The sample used was obtained through an online survey of n = 566 individuals from Chile. The main results showed that the WTP depends on the preexistence of chronic disease (p≤0.05), knowledge of COVID-19 (p≤0.05), being sick with COVID-19 (p≤0.05), perception of government performance (p≤0.01), employment status (p≤0.01), income (p≤0.01), health care (p≤0.05), adaptation to quarantine with children at home (p≤0.01) and whether the person has recovered from COVID-19 (p≤0.10). According to our discrete choice model in double-bounded dichotomous format, it was concluded that the individuals' WTP is US$184.72 (CI: 165.52-203.92; p < 0.01). This implies a social valuation of approximately US$2232 million, corresponding to 1.09% of the GNP per capita.