Browsing by Author "Arreola-Ornelas, Hector"

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    Bridging gaps to universal palliative care access in Chile: serious health-related suffering and the cost of expanding the package of care services
    (2023) Perez-Cruz, Pedro E.; Undurraga, Eduardo; Arreola-Ornelas, Hector; Corsi, Oscar; Kwete, Xiao-Xiao Jiang; Krakauer, Eric L.; Rosa, William E.; Knaul, Felicia M.
    Background The Lancet Commission on Palliative Care (PC) and Pain Relief quantified the burden of serious health-related suffering (SHS), proposing an Essential Package of PC (EPPC) to narrow the global PC divide. We applied the EPPC framework to analyze PC access in Chile, identify gaps in coverage, and provide recommendations to improve PC access. Methods Total SHS and population in need of PC was estimated using official 2019 government data. We differ-entiated between cancer and non-cancer related SHS given guaranteed Chilean PC coverage for cancer. We calculated differences between the Chilean PC package and the Lancet Commission EPPC to estimate the cost of expanding to achieve national coverage of palliative care. Findings In 2019, nearly 105,000 decedent and non-decedent Chileans experienced SHS with a lower-bound estimate of 12.1 million days and an upper-bound estimate of 42.4 million days of SHS. Each individual experienced between 116 and 520 days of SHS per year. People living with a cancer diagnosis had PC access with financial protection, accounting for almost 42% of patients in need. People with non-cancer diagnoses-about 61 thousand patients- lacked PC coverage. Expanding coverage of the EPPC for all patients in need would cost just above $123 million USD, equivalent to 0.47% of Chilean National Health Expenditure. Interpretation Achieving universal PC access is urgent and feasible for Chile, classified as a high-income country. Expanding PC services and coverage to the EPPC standard are affordable and critical health system responses to ensuring financial protection for patients with SHS. In Chile, this requires closing large gaps in PC coverage pertaining to patients with non-cancer conditions and treatment of symptoms that go beyond pain. Our research provides an empirical approach for applying the Lancet Commission SHS framework to estimate the cost of achieving national universal PC access anchored in a package of health care services. Funding This research was partially funded by the Chilean Government through the Fondo Nacional de Ciencia y Tecnologia (Fondecyt Regular) grant number 1201721, the U.S. Cancer Pain Relief Committee grant AWD-003806 awarded to the University of Miami and by the University of Miami Institute for Advanced Study of the Americas. We acknowledge NIH/NCI award P30CA008748. Copyright & COPY; 2023 The Authors. Published by Elsevier Ltd.
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    Learning from Latin America: Coordinating Policy Responses across National and Subnational Levels to Combat COVID-19
    (2023) Touchton, Michael M.; Knaul, Felicia Marie; Arreola-Ornelas, Hector; Calderon-Anyosa, Renzo; Otero-Bahamon, Silvia; Hummel, Calla; Perez-Cruz, Pedro; Porteny, Thalia; Patino, Fausto; Garcia, Patricia J.; Insua, Jorge; Mendez-Carniado, Oscar; Boulding, Carew; Nelson-Nunez, Jami; Velasco Guachalla, V. Ximena
    We provide policy lessons for governments across Latin America by drawing on an original dataset of daily national and subnational non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic for eight Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru. Our analysis offers lessons for health system decision-making at various levels of government and highlights the impact of subnational policy implementation for responding to health crises. However, subnational responses cannot replace coordinated national policy; governments should emphasize the vertical integration of evidence-based policy from national to local levels while tailoring local policies to local conditions as they evolve. Horizontal policy integration across sectors and jurisdictions will also improve coordination at each level of government. The Latin American experiences with policy and politics during the COVID-19 pandemic project glocal health policy recommendations that connect global considerations with local needs.