Press Release- The CNEP updates and prioritizes recommendations for Primary Healthcare for consideration in the 2025 budget discussion

Press Release- The CNEP updates and prioritizes recommendations for Primary Healthcare for consideration in the 2025 budget discussion

  • To contribute to decision-making in the 2025 budget discussions, which began
    this week in the National Congress, the National Commission for Evaluation and
    Productivity (CNEP) reviewed and assessed the degree of implementation and
    relevance of the 36 recommendations it had proposed in 2022 to improve Primary
    Healthcare (PHC). The CNEP has now submitted the details of this updated work
    to the Joint Budget Committee of Congress.

  • Based on the country’s current reality and the healthcare sector’s context, the new
    proposal includes adjustments to 14 recommendations and the prioritization of 13
    others (for the short term) out of the 36 initially proposed in 2022.

  • According to the analysis, the level of compliance with the 2022
    recommendations stands at approximately 36%. When broken down into 56
    specific actions, 52% have not yet been significantly addressed, 36% have seen
    partial progress, and only 13% have been fully implemented.

  • The CNEP’s executive secretary, Rodrigo Krell, emphasized that “this work aims
    to guide and optimize the allocation and use of public resources in primary
    healthcare, focusing on improving efficiency, coverage, and infrastructure. These
    measures address current challenges and prepare the health system for the future,
    advancing the overall quality of life for Chile’s population.

  • Krell further explained, “It’s important to recognize that improvements in PHC
    management yield significant efficiencies in the medium and long term, as timely
    primary care reduces the need for emergencies, hospitalizations, and surgeries.
Thursday, October 3, 2024:
The study titled “Efficiency in the Management of Primary Healthcare (PHC),” by CNEP
in 2022, identified several urgent areas for improvement, particularly in access, quality,
and efficiency. At that time, the CNEP noted that PHC had a 40% shortage of doctors,
coverage in vulnerable areas reached only 40%, and the system needed more digital
infrastructure for efficient functioning. In response, 36 recommendations were proposed
to address these deficiencies, focusing on improving access, supporting Information and
Communication Technologies (ICT), and increasing clinical and technological equipment
use.
The key recommendations were implementing a national digital Teletriage care strategy,
developing a clinical digital repository, conducting preventive screenings in areas with
high transient populations, reforming the per capita funding process (the primary funding
line for municipal PHC), and revising PHC indicators and goals. The CNEP also proposed evaluating the feasibility of using public-private partnerships (PPP) to develop primary
and secondary health infrastructure, as evidence suggested that this approach could
enhance access and efficiency.
Implementing some of these recommendations would improve PHC capacity, potentially
covering up to 36% more individuals and increasing coverage from 50% to 68%.
Although the Universal PHC policy began its implementation by the Ministry of Health in
2023, its associated strategies align with many of CNEP’s 2022 recommendations:
1. Implementing a virtual appointment scheduling system (TeleHealth)
2. Preventive screenings at workplaces
3. Creating a clinical data repository
4. Incorporating new management indicators
5. Improving health goals
6. Addressing infrastructure gaps
In this context, Krell explained, “Given the relevance of these findings and
recommendations, we updated the 2022 proposals and submitted them to Congress as
input for decision-making. It is crucial that health policies align with current needs and
that resource allocation is efficient. Maximizing the impact of the public health budget
will significantly improve people’s quality of life.”

Updated Recommendations and Progress
Krell highlighted that the updated recommendations are vital in guiding the discussion of
the 2025 Budget Bill, as they provide evidence-based guidance on optimizing resource
allocation in the healthcare sector. Adjusting policies to meet current needs and
anticipating future challenges aims to maximize the budget’s impact on public health.
The updated report breaks the original 36 recommendations into 56 specific measures, as
some recommendations encompass multiple actions. For instance, a recommendation like
“Improve technology at health centers and train staff” is split into two measures: (i) update
technology and (ii) provide staff training.
Of these measures, 57% focus on improving the efficiency of healthcare services,
ensuring that resources and processes are more effective. Meanwhile, 14% target
improving access, enabling more people to receive timely care.
Analysis of the 56 measures shows that 52% have not been significantly addressed, 36%
have seen partial progress, and 13% have been fully implemented. Overall, the average
compliance rate for the 2022 proposals stands at around 36%.
The report notes considerable variability in the progress of the original 36
recommendations. Two recommendations have been fully implemented (100%), 18 have
an average progress rate of 50%, and 16 have seen no progress (0%).
While the system has seen improvements, significant challenges remain. In response, the
CNEP has adjusted 14 recommendations and prioritized 13 of the original 36 for short-
term implementation, aiming to optimize the use of public resources in primary
healthcare.
 
Interoperability and Appointment Management: Keys to Efficiency
One of the major updated recommendations is expanding the TeleTriage system, which
has already demonstrated positive outcomes in pilot centers. This tool has allowed
medical care to be prioritized based on clinical urgency, reducing wait times for 70% of
patients. The CNEP now recommends integrating this platform into the TeleHealth
system—offering various remote medical services such as consultations, diagnoses, and
follow-up—at a national level to increase coverage and improve appointment
management.
Additionally, for the recommendation on the operational implementation of TeleTriage at
the PHC level, the CNEP proposes ensuring adequate human resources, training, and
technological support through the Local PHC Management Support Program (PRAPS).
To secure long-term financial sustainability, the CNEP recommends involving the
National Health Fund (FONASA) and the Ministry of Finance to define a funding
mechanism and assess the strategy’s impact.
Appointment management remains a critical area. Between 10% and 20% of scheduled
appointments are missed due to no-shows, leading to inefficiency equal to 6% of the PHC
budget. The CNEP recommends strengthening the use of proven appointment
management tools, such as the system used between 2015 and 2018, which reduced no-
shows by 5%.


Key Data:

  • TeleTriage improves care by prioritizing based on clinical need, with 70% of
    patients treated within seven days.
  • Missed appointments: 10-20% of scheduled appointments are missed, leading to a 6% inefficiency in the PHC budget.


Health Infrastructure: An Unresolved Issue
To address the recommendation to evaluate the application of the Public Works
Concession Law for constructing, maintaining, and managing healthcare infrastructure
and equipment at primary and secondary levels, the CNEP suggests involving the
Ministry of Finance to ensure financial viability. Long-term contracts and public-private
partnerships (PPP) should be evaluated as mechanisms to improve infrastructure and
clinical equipment distribution.
The CNEP report emphasizes that more than 40% of Chile’s healthcare beneficiaries
struggle to access primary care due to a lack of infrastructure and resources, with the
infrastructure gap estimated at one billion dollars. Moreover, constructing health centers
like CESFAM takes 121% longer than initially projected.
The CNEP proposes considering public-private partnerships for constructing and
maintaining primary care centers, which would improve the geographic distribution of
establishments and their clinical equipment.


Key Data:

  • Infrastructure gap: 40% of healthcare beneficiaries face challenges accessing
    PHC.
  • Construction timelines: CESFAM projects take 121% longer than initially planned.
  • Proposal: Evaluate PPP concessions for improving infrastructure and equipment.

Financing: Adjusting for Greater Equity
The CNEP also addresses the need for financing reforms. It proposes strengthening the
recommendation to reform the basic per capita funding (the primary funding mechanism
for municipal PHC), including more transparency in the PHC Activity Index, which
outlines evidence and relevance for national indicators and goals. Furthermore, the CNEP
suggests creating an official list of healthcare services eligible for per capita funding,
including standards, assumptions, coverage, personnel requirements, and performance
metrics for each service, as well as a cost breakdown for the resources used in calculating
the funding.
Disparities in healthcare personnel salaries were also identified as a critical issue. In some
municipalities, salaries differ by as much as 50%, affecting human resources’ availability
and quality. This disparity is tied to each municipality’s financial capacity and the
shortage of healthcare professionals.

Key Data:
 
  • Basic per capita funding: CNEP proposes adjustments based on more accurate
    indicators (e.g., FONASA-A beneficiaries, municipal poverty rates).
  • Salary disparities: Differences of up to 50% in salaries between municipalities
    affect the equity and quality of healthcare services.


Implications for the 2025 Budget Discussion
Krell emphasized that these recommendations not only address current challenges but
also offer a strategic approach to strengthening the health system in the long term. “The
country will benefit if we can maximize the impact of the public health budget, ensuring
that resources are directed toward the areas of greatest need,” he said.
He further explained that the goal is to guide and optimize public resources in primary
healthcare, focusing on improving efficiency, coverage, and infrastructure. These
measures aim to tackle current challenges while preparing the healthcare system for future
needs, ultimately enhancing Chile’s population’s quality of life.
Krell concluded by highlighting that the CNEP’s 2022 study showed that improving PHC
management would result in significant efficiencies in fiscal resource use over the
medium and long term, as timely primary care reduces the need for emergency services.