Long waiting lists are a historical problem affecting Chile’s health system caused by inefficiencies within internal workflows, particularly when it comes to patient interaction and decision-making processes. The resulting late diagnosis and treatment increases in order to prevent disease burden and mortality and has huge impacts on patients’ quality of life (Martinez, D.A., 2019). Due to the high growth of technology solutions in Chile and the potential for implementation (given the institutional interest in increasing the use of data in decision making), data science and digital solutions could be used to reduce waiting lists in Chile. The Chilean government has made reducing waiting times for cancer care a particular priority in its overall plan to address national treatment delays. Thus, Movement Health 2030 is working with the Instituto Nacional De Torax (National Thorax Institute, INT) and the Centro Nacional de Sistemas de Información en Salud (CENS) to develop an integrated pilot solution with four start-ups to improve the INT’s lung cancer waiting list times. The long-term goal is to scale up the solution to cover other pathologies and treatment centres.
Long waiting lists for specialist care are a historical problem affecting Chile’s health systems. The resulting late diagnosis and treatment of health conditions increases preventable disease burden and mortality and has huge impacts on patients’ quality of life.
• In 2020, almost 2 million people in Chile were waiting for a medical, dental or surgery consultation; waiting lists have increased year on year at a rate of 365% (MINSAL, 2020).
• The problem with waiting lists has also been exacerbated by the COVID-19 pandemic: in the first months of 2020, elective surgeries were down by 43% and specialised consultations by 38% (Bastias et al., 2020).
THE APPROACH: HOW DID WE IDENTIFY THE CHALLENGE?
The Movement Health 2030 team followed a 3-step approach to identify the central challenges facing Chile’s health system:
Roundtable analysis involving former Ministers of Health, current representatives from the Ministry of Health, CTOs from the health services and private hospitals, patient organization leaders, the national president of HL7, and representatives from digital infrastructure companies.
The establishment of a partnership between CENS (Centro Nacional de Sistemas de Información en Salud), the INT (Instituto Nacional De Torax), Endeavor, CIFS (Copenhagen Institute for Future Studies) and Roche.
Open innovation challenge: high growth startups were invited to co-create a solution with the network that would not only cover the patient experience and transform processes inside the INT, but also be scalable to similar healthcare institutions.
THE APPROACH: HOW DID WE IDENTIFY THE CHALLENGE?
The Movement Health Team engaged in a 5-step process to identify Peru’s main healthcare challenge and create a plan to address it. This involved:
High level policy meetings with key stakeholders, including representatives from the National Ministries of Economy and Health and the National Assembly of Regional Governments.
In-depth interviews with high level officials involved in healthcare (17 senior officials, who were or had been Ministers of State, vice ministers, directors of the sector in both the central government and the regional governments).
A literature review of research on budget execution in Peru and Latin America.
Cross-analysis of the information by a multidisciplinary local team and a comprehensive budget review. From this, the team formulated recommendations to improve the efficiency of planning and health spending at the legal, programmatic, and operational levels from 2021 onwards.
Open and closed events to validate key findings with key stakeholders, opinion leaders and national/subnational authorities.
Implementation of a regional government pilot to validate the impact of these findings and improve indicators within key specific health care areas, such as early childhood development and average waiting times.
The partners involved in this process were: the Camara de Comercio de Peru, the Regional Government of Cusco, Copenhagen Institute for Future Studies, Civium (the local partner), Delivery Associates, Dr. Rifat Atun (global board member of Movement Health 2030), and Roche.
AMBITION AND VISION: HOW ARE WE ADDRESSING THE CHALLENGE?
Entrepreneurs from startups Snabb, Pegasi, Entelai and Aim Manager are currently working together with the INT and CENS to integrate their solutions into one systemic solution and tailor it to the INT’s specific needs. The selected solution will likely be a platform that integrates patients’ data from diagnosis to recovery, creating a constant communication flow that keeps healthcare actors connected and contributes to clinical decision-making, while reducing administrative tasks.
PROJECTED RESULTS AND DELIVERABLES:
An improved overall healthcare experience for patients, specialists, nurses, and administrative personnel, including:
Earlier detection and diagnosis
Reduced time to treatment: a 30% faster route to effective treatment for underserved lung cancer patients by tackling absenteeism and delays on diagnosis and treatment, especially of critical cases, due to the availability of real time data for timely decision making and prioritisation.
Increased life expectancy
Reduce inefficiency costs
Baseline data on local health system inefficiencies (generated through this pilot) that
can be used to further develop solutions
NEXT STEPS: HOW COULD THE APPROACH AND SOLUTION BE SCALED?
Short-term: Assess the potential for the solution’s impact at the INT via measuring the impact that the individual solutions have had in other institutions.
Medium-term: Replicate the solution in the other 6 national specialist hospitals within the public network; replicate the solution to cover other pathologies beyond lung cancer (given its overarching focus on patient experience and hospital management).
Long-term: Create national standards for minimal centralized data requirements; create a national digital health institution to manage processes, protocols and databases.
Ministerio de Salud de Chile, Subsecretaría de Redes Asistenciales. (2014). Plan Nacional de Tiempos de Espera No GES en Chile en Modelo de Atención en RISS (Redes Integradas de Servicios de Salud) 2014-2018 [online]. Available at: https://www.minsal.cl/wp-content/uploads/2018/03/Plan-nacional-de-tiempos-de-espera-No-GES.pdf.
Bastias, et al. (2020). ‘Propuestas para desconfinar la espera en la salud pública’, TEMAS DE LA AGENDA PÚBLICA, Año 15 / No 132, Centro de Políticas Públicas UC, Pontificia Universidad Católica de Chile, ISSN 0718-9745 [online]. Available at: https://www.lipuc.cl/wp-content/uploads/2020/12/Temas-agenda132_VF-1.pdf.
Ministerio de Salud de Chile, Subsecretaría de Redes Asistenciales (2021). Informe Glosa 6 Minsal 2018-2020 [online]. Available at: https://www.minsal.cl/wp-content/uploads/2021/02/ORD-353-DIGERA-Glosa-06.pdf.
Martinez, D.A., Zhang, H., Bastias, M. et al. (2019). ‘Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions’, BMC Public Health 19, 233 [online]. Available at: https://doi.org/10.1186/s12889-019-6526-6.