The Chilean AUGE healthcare guarantees from a patient perspective: a survey of access to healthcare in rural central Chile

Objectives: In order to improve the care provided at a rural consultorio, we obtained patients’ perspectives on the successes and failures of the Chilean healthcare system under the AUGE (Acceso Universal de Garantias Explicitas, Universal Access with Explicit Guarantees) plan. Background: In 2000, Chile’s AUGE Plan established a set of guarantees for specific medical conditions. All citizens are now guaranteed access to appropriate treatment, quality care, and financial protection for what are currently 80 conditions. All registered members can access either public or private healthcare; insurance payments are based on income. However, while Chile has been successful in increasing access to care, the system still faces challenges. Methods: In order to understand the patient perspective on access to healthcare, a survey was administered in a rural general medical clinic in the public sector. The questions covered general demographic information, measures of health, satisfaction with care, and access to care. Results: Fifty patients responded to the survey. 64% of patients reported not being able to afford their preferred treatments for their illness(es) and only 59% reported knowing their rights under the national health plan. 61% reported having a doctor who knows them well. Patients reported not taking their prescribed medications due to forgetfulness (42%), not feeling sick (34%), or a belief that they were not necessary (22%). Wait times for non-urgent specialist care of up to two years were reported. 8.8% of women reported not feeling comfortable discussing domestic abuse with their physician and/or felt they would have problems finding resources elsewhere. 84% of women age 21-75 reported receiving their screening Papanicolau smear and 80% of women between age 50-75 reported receiving their screening mammogram in accordance with government guidelines. Discussion: The rural site studied has been successful at implementing women’s health screening, providing preventive care for chronic disease patients, and maintaining general patient satisfaction. However, despite explicit guarantees to quality medical care, many survey respondents indicated perceived deficiencies in the care they are receiving in the public sector clinic. Lack of patient education, preference for natural remedies, and long wait-times for specialist care appear to be challenges faced by this population. Work still remains in assuring the full delivery of AUGE’s promises and in increasing patient awareness of their rights under the national health plan.