3.2.1 Absenteeism
The data available in the official report ‘Boletín Estadístico 2018’ (statistical bulletin) made by Fondo Nacional de Salud - FONASA (National Health Fund) provides useful information about the level of absenteeism per region and the total indicators for the country (Fonasa Chile, 2020). But it does not provide a comparable absenteeism ratio that could be used to compare the performance among different locations. Nonetheless, it was possible to calculate that ratio ‘Days-off due medical license’. The calculation is based in the total days-off per year and is compared with the total of persons covered by the national health fund, this logic is explained in the Figure 16 below.
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Figure 16 Calculation for ' Days-off due medical license', Author's Illustration
The results of this exercise can be considered as an indicator for absenteeism and can be freely compared as the same logic were used to calculate the national indicator performance. With the above, the region of Antofagasta has an absenteeism level of 3.31
‘Days-off due medical license’ compared to 3.98 as national average. This is illustrated in the Figure 17.
Figure 17 Days-off due medical licence, comparison Antofagasta- Avg. Chile. Author's Illustration
The lower level of absenteeism in Antofagasta, that has one of the largest Health care centers in the country, allows to provide better care of their population. Therefore, the working population in Antofagasta have a higher productivity of 0,67 days (in average) compared to the rest of the country, because they will be less time unavailable to work due the available health care services in the region. This comparison provides some empirical
𝐷𝑎𝑦𝑠 − 𝑜𝑓𝑓 𝑑𝑢𝑒 𝑚𝑒𝑑𝑖𝑐𝑎𝑙 𝑙𝑖𝑐𝑒𝑛𝑠𝑒 = 𝑇𝑜𝑡𝑎𝑙 𝑑𝑎𝑦𝑠−𝑜𝑓𝑓 𝑝𝑒𝑟 𝑦𝑒𝑎𝑟 𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑖𝑛𝑠𝑢𝑟𝑒𝑑
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evidence that the hospital as a ‘place builder’ organization brings benefits not only to the patients but also, in this case, to the industries and working labour force by making it more productive than other places.
3.2.2 Unemployment
The unemployment rates are national measure to determine what is the percentage of the population that even when is able to work is not currently working, the unemployment reasons consider various and different reasons. Despite this the indicator provides a good source of estimation about the dynamics of the local economy. The unemployment data is informed to several international organizations such as OECD or WHO where is stored as a yearly indicator from all the country member (https://data.oecd.org/). Nevertheless, the detailed information per month, trends, and, most important, per region is only available in the public data center of the ‘Banco Central de Chile’ (Chilean Central Bank) that jointly works with the ‘Instituto Nacional de Estadísticas’ (National Statistics Institute) (Banco Central de Chile, 2021). Due this indicator is already available in the official data sources, there was no calculation required.
As it was mentioned before, for comparison reasons and considering the effects of COVID-19, in this case data from December 2019 will be considered for this indicator. The indicator to compares the total number of unemployed people and the total of the labour force available according to the Figure 18 that shows the definition provided by OECD (OECD, 2021c).
Figure 18 Calculation for ' Unemployment rate', Author's Illustration - Based on OECD definition
The results for this indicator may suggest that economies are better off or possess better dynamic if the occupation level is high or the unemployment rates is low. With the above,
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Antofagasta has a level of unemployment of 6.68% compared to 7.85% as national average.
This is illustrated in the Figure 19Figure 17.
Figure 19 Unemployment rate, comparison Antofagasta- Avg. Chile. Author's Illustration
The lower level of unemployment in Antofagasta that is certainly, as the literature suggest, explained by several factor. It is also benefited from having a very large hospital considering the direct jobs that are generated there such as health professional, health employees and administrative staff. In addition to this it can be considered the entire indirect labour demand that the hospital generates for services, goods and other, for these cases it is possible to mention all the outsources resources such as laundry services, food preparation, housing for parents of the patients, external recovery therapy services, etc. Finally, it is also possible to establish a relation between the different number of services and activities that the city can offer to their direct or indirect employees. Some examples could be restaurants, galleries, fitness activities or leisure activities that those employees demand in their free time.
Therefore, the working population in Antofagasta have more occupation up to 1,2%
compared to the national average indicator, being benefited from industrial activities and organizations such as the hospital. This comparison provides some empirical evidence that
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the hospital as a ‘place builder’ organization brings benefits not only to the population but also boosting the economy and productivity performance of the region, making the place more attractive than other places.
3.2.3 Number of doctors and nurses
Contrary to the previous analysed indicators, the number of doctors and nurses per country and per region is a straightforward indicator that is usually based in the total of each professional duly registered and working in a certain place calculated in a ratio per 1,000 persons.
For the national indicators, the data could have been collected from the official OECD’s annual report ‘Health in a Glance 2019’, sadly this reports only considered the aggregated indicator per country and the OECD does not provides any specific indicator per region of the country members. This is especially important for the case of Antofagasta because since September 2017, as it was described in the section II, it operated under a concession model making private all their performance and economic indicators. Therefore, for these calculations the official report ‘Boletín Estadístico 2018’ (statistical bulletin) made by Fondo Nacional de Salud - FONASA (National Health Fund) (Fonasa Chile, 2020)were used because it provides useful information that is the last open source of information for this regional indicator. As follow for the regional indicator the total registered number of doctors and nurses provided by the national health fund were divided by the total of population insured as illustrates.
Figure 20 Calculation for ' Doctor or nurses per 1.000 population', Author's Illustration - Based on OECD definition
The results for this indicator may suggest a region is more likely better to offer health services due the higher availability of healthcare professionals. With the above, Antofagasta has a rate of 1.21 doctors per 1.000 population compared to 1.39 as national average. This is illustrated in the Figure 21Figure 19Figure 17.
𝐷𝑜𝑐𝑡𝑜𝑟𝑠 𝑜𝑟 𝑛𝑢𝑟𝑠𝑒𝑠 𝑝𝑒𝑟 1.000 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛= 𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑜𝑐𝑡𝑜𝑟𝑠 𝑜𝑟 𝑛𝑢𝑟𝑠𝑒𝑠 ∗1000 𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑠𝑢𝑟𝑒𝑑 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
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Figure 21 Doctors per 1.000 population, comparison Antofagasta- Avg. Chile. Author's Illustration
On the other hand, Antofagasta has a rate of 1.80 nurses per 1.000 population compared to 1.64 as national average. This is illustrated in the Figure 22.
Figure 22 Nurses per 1.000 population, comparison Antofagasta- Avg. Chile. Author's Illustration
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The results on these indicators suggest different outcomes, on one hand the higher ratio of nurses per 1.000 persons in Antofagasta compared to the national average that reaches a difference of 0.16 more nurses per 1.000 persons could indicates that the city possess a robust staff able to provide proper health care and therapy once the diagnose is already made. On the other hand, the lower ratio of doctors compared to the national average that reaches up to minus 0.18 doctors per 1.000 persons may indicates that there is not the proper amount of specialist and general practitioners to provide adequate diagnosis in time and quality. This is a common phenomenon in developing countries that faces the centralization of some high qualified services where the capital cities have the highest availability of a certain service leaving the regions with lower offer of it. For this situations, the literature suggests (Ministerio de Salud de Chile et al., 1995) that other indicators should be checked and altogether may provide a better conclusion that each indicator isolated.
Consequently, evaluating of only these indicators is not possible to determine that the population in Antofagasta is better compared with the average national. Despite this, industrial activities, and the general population are certainly better off even when these indicators, even when are lower than the national ones, than having these indicators in zero in the hypothetical case that there will be no hospital in the city.
3.2.4 Average Salary
The last criteria to consider in the comparison between city and country’s average is the
‘Average Salary’. This indicator represents the average income per working person in a certain place and is a relevant indicator to determine the quality of living as well as the cost of living a certain place. For the case of Chile, the country has one of the higher (several years the highest) GDP in South America for the past 30 years. Nonetheless is it not necessarily it cannot be easily perceived in the disaggregate indicators due the large inequalities and inequities within the nation (Durán Sanhueza et al., 2014).
Values for national indicators as well as the regional ones were obtained directly from the official data sources of the ‘Instituto Nacional de Estadísticas’ (National Statistics Institute) through the report ‘Sintesis Nacional – ESI 2019’ (National Synthesis – ESI 2019).
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The average salary per region, may also vary and been influenced by the diversity of economic activities that the region host. Among those activities it is possible to include the health care sector as well as the entire network structure that hospitals hold. Hence, the average income per region is also influenced by health professional and health employees’
incomes. Usually, the range of payments per their contributions are on the top of the pay scale and increases more quickly than the other average (“WHO | Health Workers Salaries in Low and Middle Income Countries,” 2008). Hence, the results of the region should tend to be higher than other regions that does not have a large health care centers.
It’s relevant to mention that the current national currency in Chile is Chilean pesos (CLP) and these values were converted to Euros according to Chilean Central Bank exchange rate of 884,16 CLP/€, value observed on May 31st, 2021. Consequently, using the data provided a converting the values to Euros, in Antofagasta workers have an average salary of 880
€/Month compared to 702 €/Month as national average. This is illustrated in the Figure 23Figure 21Figure 19Figure 17.
Figure 23 Average salary per person, comparison Antofagasta- Avg. Chile. Author's Illustration
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The results for this indicator suggest that workers in Antofagasta have a better purchasing power compared to the national, this difference reaches 179 €/Month and therefore the inhabitants can purchase more and better goods and services than citizens of other regions.
As it was stated before, health care workers also contribute to increase the average wages in the regions, especially in middle income countries like Chile.
Thereupon, it is possible to declare that the population in Antofagasta are better compared with the average national because the health care industry is contributing directly or indirectly to increase the average wage in the region.