Carla Castillo-Laborde

Background: Access to medicines remains a persistent global challenge. In Chile, several policies have sought to strengthen pharmaceutical coverage within the health system. Among them, the Explicit Health Guarantees (GES) and the Pharmacy Fund (FOFAR) represent major policy milestones. Objective: This study assesses the impact of GES and FOFAR on access to medicines for diabetes, dyslipidemia, and hypertension among beneficiaries of both public and private subsystems. Design: A contribution analysis approach was applied using a mixed-methods design. Methods: Quantitative analyses combined descriptive and quasi-experimental difference-in-differences methods based on repeated cross-sectional data from national health surveys (2003, 2009/10, 2016/17), focusing on medicine use and effective coverage. The qualitative component included ten semi-structured interviews with key informants involved in policy design and implementation. Results: Results show that both GES and FOFAR substantially contributed to improving access to medicines for hypertension, diabetes, and dyslipidemia. Quantitative findings revealed marked increases in medicine use and effective coverage, particularly between 2010 and 2017, while qualitative evidence highlighted their complementary and reinforcing policy roles. Conclusions: Taken together, our findings suggest that GES and FOFAR were likely important contributors to improvements in contact coverage and effective coverage for these chronic conditions in Chile, although these changes occurred alongside ongoing health-system strengthening efforts and should therefore be interpreted accordingly. Overall, incorporating medicines into social protection schemes—especially through enforceable guarantees—plays a key role in expanding access. Sustained impact requires adequate resources, robust logistics, and strong implementation capacity for chronic disease management.

Background: Rare diseases (RD; enfermedades poco frecuentes , EPoF, in Chilean policy terminology) collectively affect 3.5–5.9% of the population and are associated with long diagnostic trajectories. Chile lacks a reproducible national operational definition for identifying RD in administrative hospital data. Methods: We conducted a retrospective observational analysis of Chilean GRD-IR events (IR-29301 version) for 2019–2024 released through FONASA Datos Abiertos, covering hospital discharges and major ambulatory surgery reported by 72 public establishments for FONASA-covered persons. The canonical analytical cohort contained 5,779,482 DRG events in 4,027,921 linked patients. We constructed a Chilean Orphanet–ICD-10 homologation and audited it through an agentic human-in-the-loop pipeline, yielding a conservative RD operational catalogue (434 final ICD-10 codes in the KEEP + MAP_TO_SPECIFIC_ORPHA scenario). RD-coded DRG events were labeled as observed inpatient odysseys when at least one prior DRG event existed for the same patient. We quantified prior events, DRG-observed inpatient trajectory time, nonspecific prior diagnoses, DRG weight, and bridge-code associations. Bridge-code enrichment was estimated using patient-level Fisher exact tests with Benjamini–Hochberg false-discovery correction; event-level estimates were retained as sensitivity analyses. Results: The audited conservative catalogue identified 55,284 primary-diagnosis RD-coded DRG events in 45,784 patients and 374,866 RD-coded events in any diagnostic field. We characterized 63,685 observed inpatient odyssey cases in 25,648 unique patients across 371 audited RD ICD-10 codes. Median DRG-observed inpatient trajectory time to RD-coded diagnosis was 241 days, and mean prior events per odyssey was 8.1. Bridge-code analysis identified 616 associations with support ≥ 10 patients and 390 with q < 0.05; 350 significant associations were no-same-code administrative trajectory signals. These signals varied in interpretation, including clinically plausible precursors, diagnostic refinement, and care-process bridges. The Odyssey Index reordered conditions relative to raw prior-event counts, separating high-volume entities from stronger trajectory signatures. Conclusions: To our knowledge, we provide the first nationwide audited and reproducible characterization of inpatient RD diagnostic odysseys in Latin America using administrative hospital data. The framework supports trajectory surveillance, registry design, quality-control analyses, and prioritization of candidate signals for prospective clinical validation under Chile’s Law 21,743. Bridge-code associations should be interpreted as statistically enriched administrative signals, not as validated causal or clinical pathways. Abstract Figure: Graphical Updated canonical FONASA DRG/GRD-IR 2019–2024 cohort, audited RD catalogue, odyssey cohort, and bridge-code signal summary.

The COVID-19 pandemic highlighted deep-rooted health inequities globally, with marginalized populations showing disproportionate disease burden. We employed Serfling regression models and multivariable analyses to estimate excess mortality across geographic, demographic, and poverty groups from 2020 to 2022 in Chile. Elderly populations (80+ years) experienced the highest excess mortality (267.35 per 10 000 population), more than 8 times higher than those under 80 years (30.80 per 10 000 population). Multivariable linear regression models showed both Indigenous proportion (coefficient = 53.66, P < .001) and elderly population proportion (coefficient = 5.68, P < .01) as the strong predictors of comuna level excess mortality. Poverty correlated significantly with excess mortality (r = 0.23, P < .001) but this association weakened after adjustment for other covariates in multivariable models. Excess mortality peaked in 2021 rather than in 2020 for most groups, with males initially experiencing higher rates during early pandemic waves. Spatial analyses revealed statistically significant clustering (Moran’s I = 0.119, P < .001) with identifiable hotspots in northern Chile and parts of the south. These findings indicated persistent mortality disparities by age and Indigenous status, independent of poverty, and highlight the urgent need for equity-focused pandemic preparedness. An effective pandemic response should integrate biomedical measures, such as vaccination, with culturally grounded strategies that address structural barriers and the broader social determinants of health.

Este artículo da cuenta de las experiencias y expectativas de personas mayores, cuidadores y familiares con respecto al uso de tecnologías digitales para el cuidado de la salud en Chile, asumiendo como perspectiva de análisis la Teoría de Usos y Gratificaciones. Para la realización del estudio se utilizó un enfoque cualitativo con 9 grupos focales y 16 entrevistas individuales. Llevado a cabo entre marzo y noviembre de 2022, la investigación abordó aspectos como competencia digital, accesibilidad y usos. Los resultados indican que las personas mayores tienen una relación tardía con la tecnología, con barreras como miedo a la obsolescencia y falta de habilidades digitales. La tecnología es percibida como útil para las tareas cotidianas y la asistencia sanitaria, aunque existen preocupaciones acerca del fraude y el mal uso de información personal, lo que amplía la brecha digital. La alfabetización digital en personas mayores es sobre todo adquirida a través del apoyo familiar y de procesos de formación informales. La salud digital es vista como multifacética, beneficiando la gestión administrativa y el acceso a la información médica, aunque se requieren estrategias más efectivas de inclusión digital para mejorar la autonomía y la integración de las personas mayores en el entorno digital.

Arsenic chronic exposure, particularly in its inorganic form, represents a significant public health concern. This study was conducted in Arica, the northernmost city in the country, whose inhabitants have been exposed to inorganic arsenic both naturally through drinking water and anthropogenically due to a toxic waste disposal site. We explored changes in inorganic arsenic levels in a cohort of pregnant women and their children over a decade, identifying exposure trends and their determinants. We used data on arsenic exposure through maternal urine samples during pregnancy, collected by the Health Authority between 2013 and 2016 (measurement 1), and followed up with assessments of their children in 2023 (measurement 2). Temporal changes in inorganic arsenic concentration were analyzed using the Wilcoxon Signed-Rank test, and a mixed linear regression model was employed to determine which factors contributed to urinary inorganic arsenic levels. We did not observe significant differences in mean arsenic concentrations between the two-time points (p = 0.4026). The mixed linear regression model revealed that children consuming bottled water had 8.3% lower urinary inorganic arsenic concentrations than those drinking tap water (95% CI: −15.36 to −0.54%). Additionally, children from ethnic groups had 8.64% higher inorganic arsenic concentrations (95% CI: 0.49 to 17.5%), while those with caregivers with higher education showed a 13.67% reduction (95% CI: −25.06 to −0.56%). Despite mitigation efforts, these findings underscore the ongoing risk of inorganic arsenic exposure among vulnerable populations. They further emphasize the importance of addressing natural arsenic contamination in water and implementing targeted interventions to reduce disparities associated with socioeconomic and demographic factors.

Background: Access to medicines is a serious problem globally and in Chile. Despite the creation of coverage policies, part of the population with chronic conditions of high prevalence, still does not have access to the medicines it requires and disease control continues to be low. The objective of the study was to estimate the medication use and effective coverage for diabetes, dyslipidemia and hypertension in Chile, analyzing them according to sociodemographic variables and social determinants of health. Methods: Cross-sectional analytical study with information from the 2016–2017 National Health Survey (sample = 6,233 people aged 15 years or older, expanded = 14,518,969). Descriptive analyses of medication use and effective coverage for hypertension, diabetes and dyslipidemia were carried out, and multivariate logistic regression models were developed to analyze possible associations with variables of interest. Results: 60% of people with hypertension or diabetes use medications and only 27.7% in dyslipidemia. While 54.2% of those with diabetes have their glycemia controlled, in hypertension and dyslipidemia the effective coverage drops to 33.3% and 6.6%, respectively. There are no differences in use by health system, but there are differences in the control of hypertension and diabetes, favoring beneficiaries of the private subsystem. Effective coverage of dyslipidemia and hypertension also increases in those using medications. The drugs coincide with the established protocols, although beneficiaries of the private sector report greater use of innovative drugs. Conclusion: A significant proportion of Chileans with hypertension, diabetes or dyslipidemia still do not use the required medications and do not control their conditions.

Introduction: We tested if tobacco impressions were delivered differentially to prime-time TV watching minors by sex and socioeconomic status. Methods: Programs aired during prime-time for three random weeks in 2019 from the 15 highest audience channels in Chile were content-analyzed for...

Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives.Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed.Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education.Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.

Using levels of neutralizing antibodies (nAbs), we evaluate the successful Chilean SARS-CoV-2 vaccine campaign, which combines different vaccine technologies and heterologous boosters. From a population-based study performed in November 2021, we randomly selected 120 seropositive individuals, organized into six groups of positive samples (20 subjects each) according to natural infection history and the five most frequent vaccination schemes. We conclude that the booster dose, regardless of vaccine technology or natural infection, and mRNA vaccines significantly improve nAbs response.