Primary health care in Chile and ther role of physicians. New objectives in 2010

Abstract

The stages through which primary health care (PHC) has gone en Chile are described on the basis of documents dating from 1942 onwards. Initially, PHC was provided by teams that included medical specialists. In 1979, municipalization of PHC and other reforms of the public system of health care took place, the teams were disintegrated and the place of specialists was occupied by general practitioners. The latter did not belong in the tradition of the Chilean medical institutions. Between 1990 and 2007 the Ministry of Health was mainly concerned with recovering the number of doctor-hours required in order to face the spontaneous demand of the (uninformed) population, and with preventing the formation of queues at an early hour outside the clinics. During these two stages both the doctor- patient relationship and the doctor-team relationship were lost, as well as most of the problem solving capability of PHC (reflected in the increasing utilization of emergency services) and the nexus between the peripheral clinics and the hospitals. Primary Care was isolated in the system and its doctors were isolated in PHC. Since 2008 the Ministry and several universities and municipalities are implementing a Post Graduate Educational Program aimed at generating Specialists in Internal Medicine, Pediatrics, Obstetrician-Gynecologists and Psychatrists during six years; the students work half time in PHC clinicsof the corresponding areas. This Program is described elsewhere. One of its outcomes is a deeper and more precise understanding of the problems to be solved in order to truly place people and their families and communities at the centre of primary care and of the entire public care system. The relevant specific objectives for the current stage –with its emphasis on quality – are presented, together with indicators for evaluating the Program.