¿Más recursos, menos espera? Una mirada empírica al gasto hospitalario y los tiempos de espera en Chile

The efficiency in the use of public health expenditure is crucial for all countries, specially those that, as Chile, face great challenges in timely and equitive access to health care. Congas of waiting exceeding the actable standards, exceeding 3 years for quotations surgical interventions, an essential question arises: more public spending implies less soup?

Context: waiting times, pandemic and health reorganization

The study starts from a shared expansion diagnosis: delays in elective care – programs or non -urgent – do not generate generate citizen frustration, but also affect health. Studies indicate that these delays were associated with mortalid mayor (Martínez et al., 2019) and general health deterioration (Santos-Jaén et al., 2022), I special when the systems do not prioritize adequate according to clinical gravity.

Chile stands out negative in this amit. According to the Organization for Economic Cooperation and Development (OECD), Chile is among the countries with the highest medium waiting times for surgeries and pigs of patients of patients of three -month remains patients of three months of three replacement surgery surgeries Ream hip and knee -replacement tremates.

The Covid-19 Pandemia aggravated the situation of waiting lides, forcing elective attention in favor of the emergencies and causing delays a worldwide (Findling et al., 2020) .In respect, the Chilean Ministry of Health implemented reactivation plans that include an increase in public spending a personnel of already services, from now on «current expense». From this arise the objective of this work: assess whether variations in current spending flowed in waiting times in public hospitals.

Methodology: a robust and multidimensional look

The analysis was based on a panel of 124 public hospitals between 2019 and 2023. The variables of the average and medium waiting day for surgeries and specially New New Surgeries and consultations.

The explanatory variable was the effective current expenditure by hospital, adjust at constant prices of 2023. The media media hospital of the stay of the stay media is included.Siciliani et al., 2009) -, in addition to the number of expenditures, surgeries and consultations, surgical complexity, the volume of emergency care and the attention made in private providers.

Models of ordinary minimums grouped together and fixed effects were used in prrenities differences (Siciliani et al., 2009; Chen et al., 2015; Brindley et al., 2023), Together with dichotomous variables per year to cappar transversal effects such as pandemic.

Results: Expenditure does not reduce on their own

The study challenges one of the most common beliefs in health policy: more expense implica less exceeds. The results show that hospital current spending is not significant with the variance in waiting times, neither for surgeries nor for consultations.

This suggests that an increase in hospital current expenditure alone is not enough to reduce waiting lists, a less that institutional reforms are applied that align spending with objective ise. Institutional design, therefore, is key.

Fragmented Institutionality: The Achilles heel

One of the main conclusions is that the lack of effect can be due to the fragmentation of the fragmentation of the institutional system. The National Health Fund (FONASA), a Public Chilean Institution in charge of finance the public health network, assigns hospital current expenditure as a whole, without considering waiting times in elective or scheduled care as a guide guideline to defend to defend the presentation. On the contrary, it managed the waiting lizas falls to hospitals, generating a disconnection between who assigns resources and who manages the AcSo.

This lack of alignment Introduction Introduction Distortions that weaken any direct relationship that could exist between hospital current spending and Esera’s times, in addition to the incentives for hospitalized hospitalized hospitalizers. Effect these waits.

Figure 1. Care flow, waiting time and hospital expense in Chile.

Source: Own elaboration. FONASA: National Health Fund

The evidence also supports that, if you try to reduce the half lists of specific resource injections, sin structural changes, the effect is temporary: delays reload when financing ends (Kreindler, 2010).

What does influence: operational capacity and efficiency

Although the non -resulting hospital expenditure determining, other variables yes. The number of surgeries carried out is a negative relationship with the waiting times: a mayor surgical activity, less delay. This points to the operational capacity has a specific impact.

On the contrary, the average hospital stay, efficiency indicator, mass a positive relationship: less efficient hospitals (that is, with longer average stays) tend to have greater waiting times, coincide -with studies that vingulate the delay delay delays of like antero (like of the antero (CintPalter et al., 2020).

Post covid dynamics: a transverse phenomenon

The variables per year reveal that, in 2020, the year marked by the health emergency, waiting times aumonon significantly. On the other hand, the years 2021, 2022 and 2023 Sample reductions, which suggests a non -gradual recovery and coordination efforts for accumulated cases that I do not tend relationship with variations in spending.

Additional considerations: the private officer and the patient selection

The analysis also included the «free choice» program, which allows Fonasa beneficiaries to go to private health providers. However, a robust effect of its use on waiting times in public hospitals was not found.

The literature indicates that public-private coexistence can have mixed effects: in some cases it relieves the demand for public health atnnon, in others, private health cautures public resources or selection less composed patients, leaving the most demanding public sector (more demanding public sector (TUOHY et al., 2004; Pita Barros and Olivella, 2005).

Policy impliances: Beyond Financing

This work reinforces a crucial lesson: Health policy cannot be based solely on the injection of economic resourcesIt must consider institutional design, incentives, and management capabilities. SEN modifications in the budget allocation criteria, in clinical prioritization and, in the accountability structure, the increase in spending (at least the hospital current) will be insufficient to reduce waiting times.

The recommendations of this study aim to strengthen the links between budget allocation and health indicators, improve operational efficiency and design followimian mechanisms that permeate redirect resources based on performances.

There are proposals that advocate explicit criteria for clinical prioritization and set maximum waiting times (Siciliani and Hurst, 2005). In Chile, however, there is already Law No. 19.966, which created the regime of explicit guarantees in health (GES), which sets guaranteed deadlines for the delivery of benefits associated with a prioritized set of 85 health problems. Since these defined legal deadlines are, no tales of stories are generated; Instead, delays translates into «breeding guarantees.» Therefore, the real discussion revolves around whether to expand the number of the conditions covered by the GES or develop a parallel prioritization system for the subtraction.

Future limitations and proposals

The study recognition quotations limitations. The waiting time information system began operating in 2018, so there are a few years with comparable data. In addition, the database without permission of the aspects of the aspects of cases such as clinical prioritization, the entral differences in hospitals or the type of pathologies. Nor does it include socio -economic factors of demand or other cross effects that may exist between the public and private sectors.

Future research lines should have a higher temporary series and incorporate these absent factors to allow more robust estimates. It will also be to include disaggregated analysis by type of diagnosis, territorial approaches and the evaluation of financial incentives species on efficiency and access.