US Hospitals: strengthening healthcare in Chile

For a number of years, certain Chilean clinics have been working with leading American hospitals to train medical staff and develop a collaborative working relationship in patient care. Private US funds have even been invested in local healthcare centers. According to industry experts, these practices could have a significant impact on improving patient care in Chile. 

By Claudia Marín 

The final few months of 2017 marked the 20th anniversary of one of the longest standing agreements between a Chilean and US healthcare center. The agreement in question is the one signed between Clínica Alemana and Mayo Clinic, which currently tops the annual U.S. News Best Hospitals & World Report 2017-2018 ranking of leading hospitals in the United States.

A separate but similar agreement has also been entered into between Clínica Universidad de los Andes and Massachusetts General Hospital, which sits in fourth place in the aforementioned ranking. Likewise, in 2013 the US-based CHRISTUS Health network also invested in the Red de Salud UC network which forms part of the Pontificia Universidad Católica de Chile.

These developments have been inspired by a spirit of collaboration, based on shared values and outlooks, and have directly impacted on the standards of Chilean healthcare centers, with resultant benefits for patients.

The Commercial Director of Clínica Universidad de los Andes, Arturo Zúñiga, compares this situation to Chile joining the Organisation for Economic Co-operation and Development (OECD), at which point the country ceased to compare itself with its Latin American neighbors.

At that juncture, he states, “we began to see that our productivity, per capita income, level of education and a whole host of other international indicators had progressed significantly and, as a result, the country had achieved more positive outcomes. In comparative terms regarding health, it is a good idea to replicate the best practices of internationally renowned healthcare institutions”.

According to the General Manager of Sanofi, Henry Ordoñez, Chile possesses the technological capabilities and professionals to deliver superior healthcare compared to its Latin American counterparts. However, he stresses the need to improve certain processes to streamline efficiency in resource investment, as well as closer monitoring of those resources in order to identify not only short-term, but also medium- and long-term answers. All of which could be framed within a context of cross-cutting initiatives that aim to enhance care and expand coverage.

Therefore, the significance of these types of agreements goes beyond just possible investment opportunities and relates more to the improvement of procedures or standardization of protocols, which gives rise to improved ways of comparing local standards to international standards.

Consolidated collaboration

The scientific-teaching collaboration agreement signed two decades ago between Clínica Alemana and Mayo Clinic arose out of the interest of the Chilean entity to forge links with its American counterpart, one of the most prestigious hospitals in the United States, with over 150 years of history and experience in the field of medicine.

The similarity in values and principles of the two institutions was also a contributory factor behind the agreement, according to the Jefe del Departamento de Medicina Interna (Head of the Internal Medicine Department) of Clínica Alemana, Dr Luis Miguel Noriega. The main similarity in this regard is the common outlook of both entities whereby the patient is viewed as the core element within the establishment, and that the establishment, in turn, assumes the duty of medical education.

“This exchange of knowledge and search for new information has a significant and mutual value. We and our colleagues in Chile are working to advance medicine in the United States, Chile and the wider world”, says Dr Alfredo Quiñones-Hinojosa, Head of Neurology at Mayo Clinic in Jacksonville (Florida) and also President Consultant for projects and initiatives in Latin America for the same institution.

The relationship between Mayo Clinic and Chile began more than a century ago when the cofounder of the American group, Dr William Mayo, visited the country and formed working relations with a number of local doctors and hospitals. However, the idea to formalize this particular agreement was born out of another visit, this time by a group of Mayo Clinic directors, to Latin America.

During that trip, Dr Claus Krebs, then-Director Médico (Medical Director) at Clínica Alemana initiated contact. Soon after, and thanks to the support of Dr Salvador Álvarez, who was then in charge of international affairs at the US clinic, the introductions had been transformed into a formal agreement. One of the most noted initiatives arising out of the agreement has been the Actualización del Board de Medicina Interna (Internal Medicine Board Review) program. This particular scheme has been jointly implemented since 2005 on a biannual basis and its objective is to prepare Chilean doctors for their board certification and recertification exam in the United States.

The institutional and personal ties that have been created over 20 years of collaboration have, explains Dr Noriega, enabled Chilean patients to receive second opinions from medical professionals at the American clinic. Likewise, Chilean patients have been introduced to medical teams from Mayo Clinic to receive diagnostic and therapeutic assessments and suggestions.

In turn, professionals from Clínica Alemana have visited the United States to learn about the models applied in that country and to gauge their applicability to the Chilean market. For example, one of the most significant aspects in this regard was the implementation of electronic records in the Chilean entity. This came about due to the fact that numerous professionals, whether doctors or individuals from other fields, were able to experience how these worked in practice during their  trips to Mayo Clinic, witnessing first-hand the associated problems and benefits of their use.

“Mayo Clinic has opened its doors to show us its patient care model, its different areas of work, its mistakes and its successes”, explains Dr Noriega. “This has significantly impacted certain aspects of our decision-making in terms of strategic planning”, he adds.

Second opinion

One of the most recent mutual agreements entered into by a Chilean and US health provider is the aforementioned arrangement announced in October 2017 between Clínica Universidad de Los Andes and Massachusetts General Hospital (Mass General), the original university hospital of Harvard University.

According to the Director Comercial (Commercial Director) of Clínica Universidad de los Andes, it was representatives of Mass General who initially approached the Chilean institution, on the basis that both healthcare entities are nonprofit clinical campuses in which research and teaching are key priorities.

The agreement enables Chilean patients to request their medical records to be sent to Boston for review by doctors from Mass General, in order to obtain a second opinion. Within just weeks of this process getting off the ground, more than 10 patients with complex conditions have already requested the use of this service. Their medical records are currently undergoing review by a multidisciplinary team of specialists in order to determine whether they should be flown to the United States for further treatment.

With regard to the Chilean specialists, the agreement enables them to interact with global leaders in the field from a diverse range of specialties, including the opportunity to share techniques and exchange medical opinions.

“The biggest impact that institutions like Mass General can have on Chile is to further strengthen the country’s healthcare systems, in addition to supporting doctors to provide the highest quality of care to patients at the local level”, says the Chief Marketing Officer and Senior Director for International and Specialized Healthcare Services at Massachusetts General Hospital, Misty Hathaway.

In her opinion, Chile has a robust system of healthcare with top-class clinics and hospitals. However, in line with many other countries, certain disorders are growing in prevalence among the Chilean population, including stomach and lung cancer, kidney disease and diabetes, and these are the consequences of lifestyle choices, diet and environmental factors. As a result, experts from Mass General see this as an opportunity for Chilean doctors and other healthcare professionals to improve education in terms of risk factors. “No country has a perfect healthcare system, not even the United States!” Hathaway points out.

Innovation and standards 

General nationwide conditions, a stable economy, and the opportunity to form a partnership with a like-minded institution in terms of mission and values were the main reasons that attracted CHRISTUS Health to Chile, within a wider context of its strategic objective to position itself in Latin America.

The Texas-based healthcare center, which forms part of the Sisters of Charity of the Incarnate Word, had already established operations in Mexico prior to its venture into Chile. These moves into Latin American markets fit with the institution’s goal to identify countries in the region where it is possible to grow and provide high-quality care services. In terms of its expansion into Chile, in 2013 CHRISTUS Health acquired a 40% stake in Red Salud UC, with the new entity subsequently becoming Red Salud UC CHRISTUS. Later, the US entity acquired 50% of the Clínica UC San Carlos de Apoquindo, having purchased that institution’s stake in the Isapre (private healthcare insurance provider), Colmena.

The Gerente de Desarrollo de Nuevos Negocios (New Business Development Manager) at Red de Salud UC CHRISTUS, Thomas Leisewitz, believes that one of the key benefits brought to Chile by US healthcare centers, such as CHRISTUS Health, is a greater exposure to different ways in which health-related challenges are confronted in other parts of the world. This, he states, includes an expedited incorporation of new innovation, practices and technology.

These new relationships have also allowed Chilean healthcare centers to compare themselves with others in the region as well as to the reality of the health sector in the United States. “The same thing will happen for other care providers that form agreements with large international organizations. This helps to make competition more dynamic and generates an interesting space to improve the quality of patient services”, he notes.

Likewise, Leisewitz highlights the new emphasis that has been introduced following the arrival of CHRISTUS Health in terms of patient outcomes, which is based on compliance with strict quality and efficiency standards.

Accordingly, he explains that access to services is merely the first step, and that the most important aspect is that these services add value to and genuinely benefit the patient. This, he points out, can be achieved by aligning incentives between the patient, the provider and the insurer.

Since innovation and ongoing improvement are part of the systematic practices introduced by CHRISTUS Health, the network prepares a series of steps that include enhancing information systems to integrate the clinical information of patients and enable them to interact more efficiently with clinical teams. In addition, Red de Salud UC CHRISTUS anticipates growth in outpatient services and the development of innovative care models to offer improved access to their medical centers.

“Certainly, comprehensive collaboration between both countries is important due to exchanges in the field of research, in which Chile is also providing significant material that, undoubtedly, will help to improve prospects moving forward”, concludes Ordoñez from Sanofi. 

Room for improvement

After having signed its agreement with Mayo Clinic, Clínica Alemana formed new accords with a range of diverse healthcare specialists in the US, including the Cleveland Clinic Foundation, the Children’s Hospital of Philadelphia, the MD Anderson Cancer Center, the Hospital for Special Surgery, the Chest Disease Center-Beth Israel Deaconess Medical Center, and the Nicklaus Children’s Hospital. The Chilean healthcare provider also has agreements with a number of hospitals in Germany, Belgium, Argentina, Italy and Spain. And thanks to the competitive system of healthcare that exists in Chile, there are still many new opportunities to explore.

According to Bruno Indelli, Managing Director of MSD Chile, while local care exceeds the Latin American average, there is still room for improvement in terms of comparisons with other OECD nations. In his opinion, the major pending challenges in Chile relate to access to modern care, as well as a lack of specialists and beds in public hospitals.

Indelli believes that “the exchange of best practices with American partners will probably raise the level of service of healthcare treatment in Chile”. Nevertheless, he points out that the impact is difficult to measure due to significant differences between the two national health systems and because of the sheer volume of sales in the United States. With regard to this latter point, he argues that their presence in such a substantial market means that US players, without a doubt, hold more weight when it comes to negotiating agreements than their Chilean counterparts.

“y los volúmenes del mercado de Estados Unidos, que seguramente aprovechan un poder de negociación mayor que el que tienen los centros chilenos”

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