Seeing health care disparities firsthand in Chile

Senior Elisheva Blas reflects on lessons from a 10-day Nursing Study Abroad winter break trip, which offered a holistic view of the South American country’s health system.

A group of college students sitting on a street between colorful buildings.
On a Nursing Study Abroad winter break trip, a group of students in the course Health and the Health Care System in Chile got to see health care disparities in the South American country firsthand. Senior Elisheva Blas (seated farthest to the right) discusses the experience visiting run-down facilities with long wait times used by people on public insurance, and five-star spaces and services for those on private insurance.

In Chile, citizens can pay for private health insurance or receive public coverage through the National Health Fund, known as FONASA from its Spanish name, Fondo Nacional de Salud. The two systems operate separately and tend to offer different levels of care at facilities on opposing ends of a quality spectrum. 

Penn senior Elisheva Blas got to witness the disparity firsthand, on a 10-day Nursing Study Abroad winter break trip with peers in the course Health and the Health Care System in Chile co-taught by the School of Nursing’s Eileen Lake and Marta Simonetti. In the fall of 2019, the course will be offered as a Penn Global Seminar.

Blas, a health and societies major in the College of Arts and Sciences, is concurrently doing a master’s degree in Behavioral and Decision Sciences through the College of Liberal and Professional Studies. She’s interested in comparative health systems, and the journey to South America offered the chance to holistically view another country’s health care arrangement. Penn Today spoke with Blas about what stood out to her and how it compares to what happens in the U.S. 


What’s the difference between the two health care systems in Chile?

In Chile, people with public insurance receive care in different settings than people with private insurance. That’s one of the main differences. That leads to a huge disparity in access to and quality of care. If you’re on public insurance, you go to the more run-down centers. You have to wait a long time for care, and you have to get a referral. If you’re in the private sector, you have a lot more benefits. 

Were those differences visible in the places you visited?

Our first site visit was to a public hospital. It’s summer in Chile, and there was no air conditioning, so we were walking around the hospital sweating. The children’s ward was downstairs through this back alley. The lighting was poor, and the ward was crowded.

The next day we went to a private hospital, called a “clinic,” which was a few years old, and it seemed like a five-star hotel. In the maternity ward, every woman got a room with a bed and an additional couch with a pullout bed for the spouse, a private bathroom, and a closet with everything she needed. The hospital felt almost empty because there is much less demand. In the public hospital, we felt very much in the way; the private hospital was spacious and without people waiting for appointments. 

Why did you want to take a trip like this?

I’d like to work in the health care system in the United States, and I’ve learned the ins and outs of our system from my classes at Penn. I learned about the Israeli health system during a summer internship there after my freshman year, and about the Australian system when I studied abroad last year. I think that learning about foreign systems gives me a better understanding of where our country stands, how other countries can learn from the U.S., and how the U.S. can learn from other countries. Obviously, no system is perfect. There’s a lot to learn. 

Did you get to do any sightseeing while in Chile?

For the first few days, we were mostly touring. We were in Viña Del Mar, on the coast, and got front-row seats to the amazing New Year’s Eve fireworks overlooking the Pacific Ocean. After that, we went to Santiago, where we met with nursing students and professors at the Universidad de Los Andes in the mornings, and went on site visits in the afternoons. We saw both public and private hospitals, a primary health center, and a geriatric center. We also got to do some sightseeing in Santiago, including visiting the presidential palace and going on a hike.

What’s your biggest takeaway?

The whole time, I was thinking about what we could take back to America. I was particularly struck by our visit to the geriatric center. It’s a public facility, but the quality of care was above and beyond anything we had expected. This center has what they call a patient-centered model of care, which places a big emphasis on doing little things to make the patient experience better: When you walk in, you look everyone in the eye, you say ‘hi’ to each person, you smile. The patients can keep on their regular clothing and sit in the outdoor space. They give patients care packages of hearing aids or a walker so they don’t have to scramble to find these items when they leave. 

There’s a beautiful appreciation for elderly individuals that I thought the American system could learn a lot from. This was a public hospital, they’re very busy, they get a lot of patients. They’re not doing this because the residents are paying exorbitant amounts of money. They’re doing it because this is the right way to treat people. It definitely gave me a little bit of hope.