This study is based in the comparison of two the realities from different regions that belongs to the Organization for Economic Co-operation and Development (OECD) group. OECD group is an international organization that seeks for the better development of countries by promoting the best-practices, knowledge, analysis and public policies that will help to improve the development of countries around the world (OECD, 2021a). Specifically, the regions to be considered for this study will be the city of Antofagasta - Chile, who joined OECD on 7 May 2010, and Innsbruck - Austria who is one of the founder nations of the organization signing the convention on 14 December 1960 (OECD, 2021b).
Historically, Chile has been stated as a model follow in Latin-American countries due the good performance in macroeconomic terms among the last decades and the consequent development of further public policies that tries to position Chile in the path of a developing country to become a full developed country. This leadership within the region is also displayed in health services where the administration of the healthcare system boosted the country to become one the first Latin American country to adopt the western European models for healthcare system (Candia, 2016). Chilean Health Care system is still in developing stages to become a solid social support for the country, but it may be mentioning the increasing policies that looks after improvements in infrastructure and technology that has been supported by large investments during the last 20 years (Bitran, 2013). However, the main weaknesses of the Chilean Health Care system are the strong dependency between high quality health care services and high incomes required to afford these expensive services, therefore if citizens are able to afford their own insurance and medical bills it’s highly probable that the service provided will achieve all your expectations but the solidarity of the entire system is not able to respond adequately to those citizen that may struggle with the payment due their acquisition power and the large inequalities that the country exhibits.
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On the other hand, Austria is one of the strongest members of the European Union (EU) with a consistent growth during the last 20 years, positioning themselves as the 6th richest economy among the EU in terms of Gross Domestic Product (GDP). The Austrian federal republic is formed by nice different states and is led by a chancellor that represents the government and a president that represents the state, within the country regional and federal governments in addition to the parliament, which is composed by the lower chamber (Nationalrat) and the upper chamber (Bundesrat); are the responsible for the implementation of regulations across the country (European Union, 2016).
Austrian citizens enjoy great levels of satisfaction regarding their national healthcare system, most of the general national healthcare indicators such as life expectancy or life quality are above the average of the OCDE. During the last years, the country has implemented two big modifications for their healthcare system within the constants efforts for improve the services that are offered to the insured population; a proper explanation about their healthcare system is provided by the European Observatory on Health systems and Policies (Bachner et al., 2018) as follow:
“The Austrian health system is complex and fragmented:
1) responsibilities are shared between the federal and the Länder(State) level
2) many responsibilities have been delegated to self-governing bodies (social insurance and professional bodies of health service providers)
3) health care financing is mixed, with the state (federal and Länder level) and social health insurance (SHI) funds contributing to different parts of the budget”
Given these particular characteristics of the healthcare social system, most of the reforms have been focused in optimizing resources, reduce of overutilization, better allocation of funds, and mutual cooperation agreements among the different states but also in various levels of cooperation among each local state authorities and federal government, pushing the current health system to a federal structural system that will collectively establish their financial resources and health objectives for their entire population.
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1.4.1 Global health indicators of the proposed countries
Countries that are part of the OECD share their policies and initiatives as an effort to replicate the better practices around the world. Hence, these countries share a relevant amount of data that helps them to compare to each other in almost every area involving economics, politics, education, environment, health, etc.
“Health at a Glance” is an annual report published by OECD where is establish the comparison of key health indicators for population health and health systems performance for all OECD countries members, partners, and candidates. This document provides key overview about the health care systems and the analysis among for different countries and realities making interesting comparison about the performance, staff, expenditures among others, beyond the comparison the overall goal is to stablish a framework of analysis for different countries regarding the different management systems behind their health care system (OECD, 2019). According to the available literature some variables such as ‘Size and Scope of the Health Economy’, ‘Health Care’s Share of GDP’ and ‘Labour in the Health Economy’ can be considered as the common indicators to measure health economics performance (Folland et al., 2013). In order to provide further details to make a proper comparison of the countries involved in this study, an overview of the performance in health for both nations is shown in the Figure 8 .
Figure 8 Comparison of health indicators for Chile and Austria (2019). Author's illustration, data retrieved from Health at a Glance - OECD, 2019
Health spending share % of Gross Domestic Product 8,9% 10,3% 8,8%
Doctors /per 1,000 population 2,5 5.2 3,5
Nurses /per 1,000 population 2,7 6.9 8.8
Life expectation years 80.2 81.7 80.7
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The challenges for public health are mostly the same around the world, higher smoking rates, drugs, and alcohol consumption, ageing of the population, increasing levels of obesity and pandemic situations, to note some of them.
Nevertheless, the infrastructure, workforce, and resources, that every country can gather from their citizen and from the national budget, to face these challenges may provoke differences for these two countries, the health spending of Austria is 2.4 times the spending of Chile, this provides larger capital and funds to the healthcare system to be expended into their population. In addition to this, the gap in infrastructure, projects, technology, and management is large, even though both systems require improvements.
1.4.2 Hospitals and reality of the regions
The regional Hospital of Antofagasta is situated in Antofagasta, the capital of the second region of Chile, and is the biggest public health care center in the north part of Chile that considers from the national north limit with Perú still La serena region located in the fourth region, comprising a total of 1.534km as can be seen in the Figure 9.
This health care centre was built in 1966 and was replaced for the new hospital compound of 114.000 m² in 2017 (Gobierno de Chile, 2018) through an open tender which was awarded to a private company that obtained the rights to build, operate and maintain the health complex for a total of 50 years. Although this concession includes the supervision by the national ministry of health. But at the same time, it considers that the main Hispanic arm and the maximum reference point in the great north of the country will be administered by a private sector. The new compound is labelled as a high complexity center, that includes oncology, geriatrics, pediatrics along with other specialties and is expected to satisfy the health demand of approximately 607,534 inhabitants (Government of Chile, 2020)considering the city of Antofagasta and the surroundings provinces. On the other hand, the old building was renewed and given as a loan for 50 years to the University of
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Antofagasta, for the creation of the university hospital as subsidiary of the national health care system.
Figure 9 Map of Antofagasta, Chile (Chile Maps, 2021)
Innsbruck Regional Hospital is located in the very center of the Alps, in the capital city of the state of Tyrol located in the most east side of the Austrian Federal republic as can be seen in Figure 10, and is supported by the Innsbruck Medical University that provides large workforce to their processes and pushes their development through constant research for innovative solutions to the problem of their population. The hospital is located in a key location that is able to fulfil the requirement to the entire population of Tirol, Innsbruck itself is counting about 181,000 inhabitants (Tyrol Kliniken, 2021) and as a whole the Tirol region it was estimated, for 2021, a total of 760,105 inhabitants (“Österreich - Bevölkerung nach Bundesländern 2021,” 2021).
The hospital of Innsbruck has been service to the community along the history for several centuries, beyond their current reality where is closely engaged to university development providing a transformational and integrative perspective of the possible services that can be offered to the population. The first healthcare establishment was made in the early 14th
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century, then the University of Innsbruck was founded close by in 1669 with its medical faculty since that date. The history of this hospital is related how the small settlement were evolving still be positioned as a relevant agent among the country providing quality services and standing for international recognition, shortly it was still 1888 when the ‘New City Hospital’ arises as a whole. Afterwards, in 1948, the building was renamed as the general hospital of the Tyrol area and becomes property of the state of Tyrol. The most recent history points out that in 1991 this public organization were transferred to private holding, this company was founded under the name, "TILAK GmbH", later in 2015 it was renamed
"Tirol Kliniken GmbH" and from this year it has been owned by the state of Tyrol (Tyrol Kliniken, 2021).
Figure 10 Innsbruck location on the Austria Map (On the World Map, 2020)