Aplicación de sistemas fuzzy para la toma de decisiones del Plan Paso a Paso: análisis de los indicadores para la comuna de Valdivia / Artificial intelligence fuzzy system for the design of confinements during quarantines

BACKGROUND: Different modalities of quarantines were one of the main measures implemented worldwide to avoid the spread of SARS-CoV2 virus. AIM: To analyze and compare retrospectively the implementation of the Step- to-Step plan devised by the Chilean Ministry of Health during the pandemic. To propose a decision-making path based on an artificial intelligence fuzzy system to determine confinements in specific territories. MATERIAL AND METHODS: The Step-to-Step Plan threshold values such hospital network capacity, epidemic spreading, testing and contact tracing capability were modeled using fuzzy numbers and fuzzy rule-based systems. RESULTS: Ministry of Health's decision-making opportuneness were unrelated with the Step-to-Step Plan indicators for deconfinement. Such disagreements undermined epidemiological indicators. CONCLUSIONS: Using an artificial intelligence system could improve decision-making transparency, emergency governance, and risk communication to the population.

[Artificial intelligence fuzzy system for the design of confinements during quarantines]. / Aplicación de sistemas fuzzy para la toma de decisiones del Plan Paso a Paso: análisis de los indicadores para la comuna de Valdivia.

BACKGROUND: Different modalities of quarantines were one of the main measures implemented worldwide to avoid the spread of SARS-CoV2 virus. AIM: To analyze and compare retrospectively the implementation of the Step- to-Step plan devised by the Chilean Ministry of Health during the pandemic. To propose a decision-making path based on an artificial intelligence fuzzy system to determine confinements in specific territories. MATERIAL AND METHODS: The Step-to-Step Plan threshold values such hospital network capacity, epidemic spreading, testing and contact tracing capability were modeled using fuzzy numbers and fuzzy rule-based systems. RESULTS: Ministry of Health's decision-making opportuneness were unrelated with the Step-to-Step Plan indicators for deconfinement. Such disagreements undermined epidemiological indicators. CONCLUSIONS: Using an artificial intelligence system could improve decision-making transparency, emergency governance, and risk communication to the population.

The 2019 crisis in Chile: fundamental change needed, not just technical fixes to the health system.

Chile has been viewed as an exemplar of social and economic progress in Latin America, with its health system attracting considerable attention. Eruption of widespread civil disorder marred this image in 2019. We trace the evolution of Chilean health policy and place it in context with developments in other sectors, pensions and education. We argue that much has been achieved, but further progress will necessitate politicians tackling the enduring power of elites that has prevented reform of a two-tier system enshrined in policies of the dictatorship.

Tracing New Clinical Manifestations in Patients with COVID-19 in Chile and Its Potential Relationship with the SARS-CoV-2 Divergence.

PURPOSE OF REVIEW: In this review, we discuss the current implications of the changing genomic epidemiology of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), etiological agent of the Coronavirus Disease 2019 (COVID-19) and its potential relationship with the change of clinical manifestations in patients with confirmed infection. RECENT FINDINGS: Over the course of the current pandemic, the virus has been found more diverse in new countries. Simultaneously, also new clinical manifestations are observed, particularly more prominent gastrointestinal and neurological findings. SUMMARY: SARS-CoV-2/COVID-19 is changing not only its epidemiology, but also its genomic diversity and clinical manifestations, both aspects coupled, needs to be considered in the study of this ongoing pandemic.

Crisis social y política en Chile: la demanda por acceso y cobertura universal de salud

[RESUMEN]. En Chile se ha producido un desarrollo económico que no ha resuelto profundas desigualdades. Hoy en día, se intenta resolver una intensa crisis política y social que irrumpe de modo explosivo en octubre de 2019 motivada por un alza del transporte público. Una década después de que se iniciara la implementación de la última reforma al sistema de salud, este sigue siendo un ámbito prioritario en la preocupación de la población y parte de las actuales demandas ciudadanas. Desde el movimiento social, se proponen nuevas reformas que requerirán de consensos para ser viables desde un punto de vista técnico y político. Los cambios necesarios en el ámbito de la salud son impostergables. Entre otras medidas, es preciso implementar transformaciones en el sector prestador, tanto público como privado, en la lógica de un modelo estructurado en redes integradas y basado en la estrategia de la atención primaria de salud. Esto permitirá la consecuente alineación de los recursos humanos y financieros con el acceso y cobertura de salud universal y, de esta manera, resolver de manera efectiva y eficiente las necesidades de salud de las personas y sus comunidades.

[ABSTRACT]. In Chile, economic development has not resolved deep inequalities. Today, attempts are being made to solve an intense political and social crisis sparked in October 2019 by a hike in public transport fares. A decade after initial implementation of the last health system reform, this continues to be a priority area of public concern––and part of what citizens are now demanding. This social movement is proposing new reforms that will require consensus in order to be viable from a technical and political standpoint. The necessary changes in the health field cannot be postponed. Among other measures, it is necessary to implement transformations in health providers in both the public and private sectors, toward a model that is structured around integrated networks and based on a primary health care strategy. This will make it possible to align human and financial resources with universal access to health and universal health coverage, effectively and efficiently meeting the health needs of people and communities.

[RESUMO]. O crescimento econômico alcançado no Chile não foi capaz de resolver as profundas desigualdades. O país tenta hoje encontrar uma saída à enorme crise política e social que irrompeu com violência em outubro de 2019 contra o aumento no preço da passagem do transporte público. Passada uma década desde a última reforma do sistema de saúde, a saúde continua sendo um tema prioritário que preocupa a população e figura entre as demandas atuais dos cidadãos chilenos. As novas reformas propostas pelo movimento social exigem o consenso técnico e político para serem viabilizadas. As mudanças necessárias em saúde são impreteríveis. Entre outras medidas, é preciso transformar o setor de prestação de serviços, tanto público como privado, criando um modelo estruturado em redes integradas baseado na estratégia de atenção primária à saúde. Isto possibilitará o consequente alinhamento dos recursos humanos e financeiros com o acesso universal à saúde e cobertura de saúde universal e, assim, atender com efeito e eficiência às necessidades de saúde das pessoas e suas comunidades.

Regulating self-selection into private health insurance in Chile and the United States.

In the 1980s, Chile adopted a mixed (public and private) model for health insurance coverage similar to the one recently outlined by the Affordable Care Act in the United States (US). In such a system, a mix of public and private health plans offer nearly universal coverage using a combined approach of managed competition and subsidies for low-income individuals. This paper uses a "most different" case study design to compare policies implemented in Chile and the US to address self-selection into private insurance. We argue that the implementation of a mixed health insurance system in Chile without the appropriate regulations was complex, and it generated a series of inequities and perverse incentives. The comparison of Chile and the US healthcare reforms examines the different approaches that both countries have used to manage economic competition, address health insurance self-selection and promote solidarity. Copyright © 2015 John Wiley & Sons, Ltd.

Rights and duties policy implementation in Chile: health-care professionals' perceptions.

OBJECTIVE: To explore the perceptions of health professionals in an integrated network of public provision of health services regarding the implementation of the Law on Rights and Duties of People in Chile. METHOD: Qualitative descriptive study. A stratified qualitative sample of 53 professionals from five low complexity centres and one from a high complexity centre, all part of the integrated network of health services in Valdivia, Los Rios Region, Chile, were selected according to the criteria of an overall saturation of the explored dimensions. The information was gathered through a semi-structured, in-depth interview carried out after signing the informed consent. Data were analysed using an inductive approach of content analysis. RESULTS: Three categories emerged from the interviews: conceptualization and knowledge, factors influencing the implementation and recommendations for strengthening the implementation, and seven subcategories. It was highlighted that health professionals in the health-care network perceived difficulties in implementing the Law on rights and duties of patients. Among them were the lack of knowledge about the Law, poor exposure and a lack of resources for its implementation. They suggested adapting the infrastructure of the institution and offering training as recommendations to improve the implementation of the Law. CONCLUSIONS: There are hindering factors for the implementation of the Law related to organizational and professional gaps in the institutions providing health care.

Universal Health Coverage: A Political Struggle and Governance Challenge.

Universal health coverage has become a rallying cry in health policy, but it is often presented as a consensual, technical project. It is not. A review of the broader international literature on the origins of universal coverage shows that it is intrinsically political and cannot be achieved without recognition of its dependence on, and consequences for, both governance and politics. On one hand, a variety of comparative research has shown that health coverage is associated with democratic political accountability. Democratization, and in particular left-wing parties, gives governments particular cause to expand health coverage. On the other hand, governance, the ways states make and implement decisions, shapes any decision to strive for universal health coverage and the shape of its implementation.

Implementing Hospital Self-Management Policy in Chile: Health Professionals' Perceptions / Implementando la política de autogestión hospitalaria en Chile: percepciones de profesionales de la salud / Implementando a política de autogestão hospitalar no Chile: percepções de profissionais da saúde

Context of the problem: Hospitals have been considered a main component for health systems success. Objective: To describe perceptions from hospital staff regarding the implementation of the hospital self-management policy in two highly complex facilities in Chile. Justification: A successful policy implementation demands aligned health professionals regarding policy changes. Methods: Descriptive and exploratory qualitative study based on semi-structured interviews for health professionals from two hospitals in southern Chile. A convenience sample of nineteen health professionals was selected for interviewing. The interviews' analysis was thought as the content analysis technique in its conventional approach. Results: For health professionals, a hospital's self-management policy is conceptualized from financial autonomy. Human resources for health and organizational capabilities still remain as weaknesses of the implementation process. Conclusions: Overcoming gaps between design and implementation processes are crucial for success in hospital reform implementation.

Contexto del problema: los hospitales son considerados claves para el éxito de los sistemas de salud. Objetivo: describir las percepciones de profesionales de la salud sobre la implementación de la política de autogestión en red en dos hospitales de alta complejidad en Chile. Justificación: una implementación exitosa demanda profesionales alineados con los cambios. Métodos: estudio cualitativo descriptivo y exploratorio basado en entrevistas semiestructuradas a profesionales de la salud de dos hospitales complejos del sur de Chile. Se seleccionó una muestra por conveniencia de diecinueve profesionales. Los datos se analizaron mediante análisis de contenido en su aproximación convencional. Resultados: para los profesionales, la política es conceptualizada desde la autonomía financiera. Como debilidad de la implementación persiste la ausencia de capacidades organizacionales y competencias de los recursos humanos en salud. Conclusiones: superar las brechas entre el diseño y la implementación es crucial para avanzar en la implementación de reformas a los hospitales.

Contexto do problema: os hospitais sao considerados chave para o sucesso dos sistemas de saúde. Objetivo: descrever as percepções de profissionais da saúde sobre a implementação da política de autogestão em rede em dois hospitais de alta complexidade no Chile. Justificação: uma implementacao exitosa demanda profissionais alinhados com as mudancas. Métodos: estudo qualitativo descritivo e exploratorio baseado em entrevistas semiestruturadas a profissionais da saúde de dois hospitais complexos do sul de Chile. Uma amostra por conveniencia de dezenove profissionais foi selecionada. Os dados analisaram-se mediante análise de conteúdo em sua aproximacao convencional. Resultados: para os profissionais, a política é concebida a partir da autonomia financeira. Como fraqueza da implementacao persiste a ausencia de capacidades organizacionais e competencias dos recursos humanos em saúde. Conclusoes: superar a fenda entre concepcao e implementacao é crucial para o progresso na implementacao de reformas aos hospitais.

Global health politics: neither solidarity nor policy: Comment on "Globalization and the diffusion of ideas: why we should acknowledge the roots of mainstream ideas in global health".

The global health agenda has been dominating the current global health policy debate. Furthermore, it has compelled countries to embrace strategies for tackling health inequalities in a wide range of public health areas. The article by Robert and colleagues highlights that although globalization has increased opportunities to share and spread ideas, there is still great asymmetry of power according to the countries' economic and political development. It also emphasizes how policy diffusion from High Income Countries (HICs) to Low- and Middle-Income Countries (LMICs) have had flaws at understanding their political, economic, and cultural backgrounds while they are pursuing knowledge translation. Achieving a fair global health policy diffusion of ideas would imply a call for a renewal on political elites worldwide at coping global health politics. Accordingly, moving towards fairness in disseminating global health ideas should be driven by politics not only as one of the social determinants of health, but the main determinant of health and well-being among-and within-societies.

Health care privatization in Latin America: comparing divergent privatization approaches in Chile, Colombia, and Mexico.

The public-private mix in Chile, Colombia, and Mexico was very similar until the early 1980s when Chile undertook health care privatization as part of comprehensive health care reform. Since then, health care privatization policies have diverged in these countries. In this study we characterize health care privatization in Latin America and identify the main factors that promoted and hindered privatization by comparing the experiences of these countries. We argue that policy elites took advantage of specific policy environments and the diffusion of privatization policies to promote health care privatization while political mobilization against privatization, competing policy priorities, weak market and government institutions, and efforts to reach universal health insurance hindered privatization. The privatization approaches of Chile and Colombia were classified as "big-bang," since these countries implemented health care privatization more rapidly and with a wider scope compared with the case of Mexico, which was classified as gradualist, since the privatization path followed by this country adopted a slower pace and became more limited and focalized over time. We conclude that the emphasis on policy-driven privatization diminished in the 1990s and 2000s because of increased public health care financing and a shift in health care reform priorities. Health care privatization in the region, however, continued as a consequence of demand-driven privatization.

Redes Integradas de Servicios de Salud: El desafío de los Hospitales

El contexto socio económico de los países de Latino América y el Caribe (LAC) se caracteriza por la inequidad y la exclusión social. Persisten grandes grupos poblacionales en la pobreza y un marcado incremento de la urbanización de esta, con una concentración de la riqueza cada vez mayor y con crecientes indicadores de desocupación y de aumento del empleo informal. Aún subsisten carencias en el aprovisionamiento de agua potable y en los sistemas de saneamiento, persistiendo también vulnerabilidad en los sectores medios. Los sistemas de salud han sido reflejo de los procesos sociales, presentando un origen y un desarrollo histórico caracterizado por la segmentación y fragmentación de la provisión de servicios de salud y de los sistemas de seguridad social, lo que se ha mantenido en las últimas décadas por la influencia de los contextos políticos de las dictaduras militares y de reformas económicas de carácter neo liberal, que han reducido el tamaño y papel del Estado en muchos de nuestros países.

[Hospital self-management policy in Chile: perceptions of decision-makers]. / Política de autogestión hospitalaria en Chile: percepciones de los tomadores de decisiones.

OBJECTIVE: To learn the perceptions of decision-makers concerning the imple-men-t-ation stage of a hospital self-management policy in two highly complex hospitals in southern Chile. METHODS: A descriptive, exploratory, qualitative study based on semi-structured in-depth interviews of decision-makers at the Regional Hospital of Valdivia and the Hospital San José de Osorno from August 2010 to December 2011. A convenience sample of 26 decision-makers was selected. The 26 interviews were recorded and transcribed verbatim. The information was analyzed using inductive content analysis. RESULTS: The interviewees consider the concept of self-management to be determined by autonomy in decision-making about resource allocation and the financing of health service delivery in the hospitals. They also stated that human resources and financing policies should be included to improve the implementation stage. They related weaknesses with the lack of organizational capabilities and managerial skills in the health teams implementing the changes. CONCLUSIONS: Conceptually, the hospital self-management policy is based on financial autonomy, and implementation is affected by persistent capacity gaps in policy design.

Política de autogestión hospitalaria en Chile: percepciones de los tomadores de decisiones / Hospital self-management policy in Chile: perceptions of decision-makers

OBJETIVO: Conocer las percepciones de los tomadores de decisiones respecto de la etapa de implementación de la política de autogestión hospitalaria en dos hospitales de alta complejidad del sur de Chile. MÉTODOS: Se realizó un estudio cualitativo descriptivo y exploratorio basado en entrevistas semiestructuradas en profundidad a tomadores de decisiones de los hospitales Regional de la ciudad de Valdivia y San José de la ciudad de Osorno, durante el período de agosto de 2010 a diciembre de 2011. Se seleccionó una muestra por conveniencia de 26 tomadores de decisiones. Las 26 entrevistas fueron grabadas y transcritas en forma literal. El análisis de la información se hizo utilizando la técnica de análisis de contenido, en su aproximación inductiva. RESULTADOS: Para los entrevistados, la conceptualización de la autogestión está determinada por la autonomía para la toma de decisiones respecto de la asignación de recursos y el financiamiento de la provisión de servicios de salud en las instituciones hospitalarias. También manifestaron que para mejorar la etapa de implementación se deben incluir políticas de recursos humanos y de financiamiento de la función de provisión de servicios de salud. A las debilidades, por su parte, las relacionaron con la ausencia de capacidades organizacionales y competencias gerenciales de los equipos de salud para la implementación de los cambios. CONCLUSIONES: La política de autogestión hospitalaria es conceptualizada desde la autonomía financiera, y su implementación está determinada por las brechas de capacidad que persisten en el diseño de la política.

OBJECTIVE: To learn the perceptions of decision-makers concerning the imple­men­t­ation stage of a hospital self-management policy in two highly complex hospitals in southern Chile. METHODS: A descriptive, exploratory, qualitative study based on semi-structured in-depth interviews of decision-makers at the Regional Hospital of Valdivia and the Hospital San José de Osorno from August 2010 to December 2011. A convenience sample of 26 decision-makers was selected. The 26 interviews were recorded and transcribed verbatim. The information was analyzed using inductive content analysis. RESULTS: The interviewees consider the concept of self-management to be determined by autonomy in decision-making about resource allocation and the financing of health service delivery in the hospitals. They also stated that human resources and financing policies should be included to improve the implementation stage. They related weaknesses with the lack of organizational capabilities and managerial skills in the health teams implementing the changes. CONCLUSIONS: Conceptually, the hospital self-management policy is based on financial autonomy, and implementation is affected by persistent capacity gaps in policy design.