Chilean Reform Research Articles

From drug-oriented curriculum to patient-oriented curriculum in Chile: Alumni satisfaction as a quality indicator for a pharmacy programme

Background: In 2005, a Health Care Reform in Chile established the role of pharmacists as contributors to achieving therapeutic goals. To fulfil the needs of the country in 2007 the pharmacy programme at Austral University of Chile started transiting from a drug-oriented to a patient-oriented curriculum. Objective: Monitoring this transition process using alumni satisfaction as a quality indicator. Methods: A questionnaire to assess alumni satisfaction with the pharmacy programme was designed and validated in its content and reliability. Subsequently, cross-sectional surveys over samples of graduates from both, drug-oriented and patient-oriented curriculum alumni were conducted. Satisfaction scores of both samples were statistically compared. Results: Cronbach´s alpha for all six dimensions of the final questionnaire was ≥ 0.70. The patient-oriented curriculum generated higher satisfaction scores (p < 0.001), noteworthy in dimensions ‘Design and organisation’, ‘Teachers’ and ‘Emotional bonding with the program/university’. In three out of 34 items the patient-oriented curriculum was less satisfactory than the drug-oriented one. Conclusions: Alumni satisfaction assessment is a useful source of feedback for quality assurance and continuous improvement of programmes. Considering this indicator, the transition of the pharmacy programme at Austral University of Chile to a patient-oriented curriculum was essentially successful.

Access to the Emergency Contraceptive Pill and Women's Reproductive Health: Evidence From Public Reform in Chile.

We examine the sharp expansion in availability of the emergency contraceptive pill in Chile following legalized access through municipal public health care centers. We study the period 2002-2016 and a broad rollout of the emergency contraceptive pill occurring between 2008 and 2011. By combining a number of administrative data sets on health outcomes and pharmaceutical use, and using event-study and difference-in-differences methods, we document that this expansion improved certain classes of women's reproductive health outcomes, notably reducing rates of abortion-related morbidity. These improvements were greater in areas of the country where the rollout of the emergency contraceptive pill was more extensive. We also document some evidence that refusal to provide the emergency contraceptive pill upon a women's request was linked with a worsening in reproductive health outcomes. These results point to the importance of contraceptive access as a determinant of women's reproductive health and well-being and relates to a growing body of work documenting the importance of women's autonomy as a determinant of health.

EL DERECHO A LA ALIMENTACIÓN ADECUADA EN CHILE Y SU NECESARIA CONSAGRACIÓN COMO DERECHO FUNDAMENTAL EN LA NUEVA CONSTITUCIÓN CHILENA

Amid the process of constitutional reform in Chile, this article addresses the historical, factual and international human rights arguments that justify the incorporation of the right to adequate food as an autonomous right in the new Constitution. Subsequently, the body of this text assesses the impact of this new constitutional right on Chilean private law, especially regarding the consumer protection regime and the right to be informed. The text argues that, ultimately, a constitutional right to adequate food will allow to extend the current norms on truthful and adequate information for consumers, contributing to a better guarantee of other human rights intrinsically related to food, such as the right to health.

Double/debiased machine learning for logistic partially linear model.

We propose double/debiased machine learning approaches to infer a parametric component of a logistic partially linear model. Our framework is based on a Neyman orthogonal score equation consisting of two nuisance models for the nonparametric component of the logistic model and conditional mean of the exposure with the control group. To estimate the nuisance models, we separately consider the use of high dimensional (HD) sparse regression and (nonparametric) machine learning (ML) methods. In the HD case, we derive certain moment equations to calibrate the first order bias of the nuisance models, which preserves the model double robustness property. In the ML case, we handle the nonlinearity of the logit link through a novel and easy-to-implement 'full model refitting' procedure. We evaluate our methods through simulation and apply them in assessing the effect of the emergency contraceptive pill on early gestation and new births based on a 2008 policy reform in Chile.

NEOLIBERALIZMO IDĖJŲ ĮGYVENDINIMO YPATUMAI ČILĖJE

In the article there is analysed the significant historical period in Chile, when after overthrowing of the democratically elected socialist president S. Allende, and taking power by military Pinochet regime, for the first time in the world history there were created the enabling conditions for the reforms based on neoliberal ideas. The reforms in Chile are significant, because they became the political laboratory for the further modernization reforms in Latin America and the whole world. Together with Chicago university (by M. Friedman) educated Chilean economists there were begun to implement the programmes of privatisation, depolitization, deregulation and decentralization, there was devaluated national currency and significantly reformed the spheres of education, health and social policy. In the last part of the article the authors evaluate the present situation in Chile and the perspectives of its development.

Collective Action and Policy Implementation: Evidence from Salvador Allende’s Expropriations

The Cold War triggered the appearance of U.S.-sponsored re-distributive policies in Latin America with the goal of decreasing the influence of the Soviet Union. We study how organized groups of workers increased the intensity of one of the largest programs of the time, Salvador Allende’s land reform in Chile (1970–1973). Using original data in an event study research design, we find that the local political actions of workers—proxied by land invasions—affected the intensity and location of expropriations. We argue this result can be explained by a threat of political unrest.

Social Rights and Constitutional Reform in Chile: Towards Hybrid Legislative and Judicial Enforcement

This essay suggests that the Chilean constitution-making process should not pre-determine the social policies that political institutions should implement to respond to existing social demands. Instead, the authors argue that constitutional designers should aim to guide and facilitate those policies’ approval. The authors’ proposal provides an alternative to adopting a strong model of social rights enforcement by suggesting a ‘weak-strong’ social rights model. The model includes a mandatory ‘by law’ clause, a specific timeframe for adopting legislation, constitutional principles guiding the social policy reforms, and providing for the possibility of a particular form of judicial review.

Praxis y herramientas del psicólogo/a en equipos psicosociales y visita domiciliaria escolar: Nuevos desafíos en educación

Schools are faced with new challenges in school life and comprehensive approach to the student from the educational reforms in Chile. Some schools incorporate Psychosocial Teams (PT) to adopt this new approach, being supported by governmental and municipal funds. In Chile, information on PT in a school context is limited, so there is an interest to give a first approximation of the practices and role of the PT in the school and the use of the School´s Home Visit (SHV). Through a qualitative research design of descriptive type, six semi structured interviews and a group discussion were elaborated. Eleven psychologists and social workers from San Joaquin district, Santiago of Chile participated in this study. For the analysis, thematic coding was used. Finally, the results show the potentialities and challenges of PT and SHV for the integral well-being of children.

Counter-reforming through reactionary populism: a failing attempt to restrain a major school admission reform in Chile

ABSTRACT In 2019, the right-wing Government of Chile was expected to implement a substantial reform regarding student assignment to schools that had been passed by the previous administration (the School Inclusion Law). While implementing this policy, in 2019, the former minister of education directed a populist campaign aiming to change policy directions coined the Just Admission Project (JAP). Such policy debates have critical implications regarding the functioning of school choice in Chile. This paper analyzes the JAP as a case study of reactionary neoliberal populism. Framed by such conceptualization of populism, this paper develops a statistical analysis to model the potential influence of the JAP bill on school choice opportunities while comparing with the recently implemented new assignment system from the Inclusion Law (NSAS). We show the results of simulations representing how students would have been assigned to schools for the 2019 school year had the admission procedure been the JAP instead of the NSAS.

Participación social en los sistemas de pensiones y reformas: Chile, España e Israel

Los países de la OCDE comparten una creciente preocupación tanto por la idoneidad de sus sistemas de pensiones como por su capacidad para proporcionar pensiones decentes a los beneficiarios tras su jubilación. La participación de los futuros beneficiarios en la gestión de los fondos, así como en el proceso de reforma, puede servir para mitigar esas preocupaciones, al tiempo que da legitimidad a los sistemas en cuestión. En el presente estudio se analizan las formas de participación en los sistemas de pensiones y las reformas en Chile, España e Israel. Encontramos que existe la participación en diferentes formas y contextos en los tres países. No obstante, en los tres países es necesario aumentar la participación de los futuros beneficiarios en la gestión de los fondos, así como en las reformas de las pensiones.

Policy Debates on Pension Reform in Chile: Economists, Masculinity and the Mobilization of Strategic Ignorance

AbstractIn 2016, nationwide protests in Chile demanded a major reform to the privatized pension system. However, experts saw protesters’ demands as not a viable policy option. In this study, I demonstrate how a group of free-market economists acquired authority as experts in pension policy by gendering their expertise. As a result, they have been able to deny, suppress, and dismiss knowledge on topics and views aligned with citizens’ demands. First, my research shows how experts, through gender relations, create knowledge and ignorance in policymaking processes. Second, I demonstrate how free-market capitalism is legitimated through the hegemony of masculinity.

The 2008 Chilean pension reform: household financial decisions and gender differences

ABSTRACT We evaluate the effect of the 2008 pension reform in Chile, applying a difference-in-difference estimation method to longitudinal survey data representative of the Chilean population. Our evidence suggests that those who started to receive a basic pension increased their debt more than their assets. We interpret this as an indicator of debt sustainability. The debt ratio increased significantly more for women, who may be particularly exposed to financial crises. The results raise concerns about the potential financial vulnerability of the population targeted by the reform, due to over-indebtedness.

Implementing a Food Labeling and Marketing Law in Chile

ABSTRACT In 2012, Chile passed a law intended to reduce obesity in the country. It included several novel features, such as a front-of-package label, limitations to marketing and advertising, and policies targeting schools. The law required the creation of a regulation to address its implementation. Between 2012 and 2015, a process was carried out to generate this regulation that finally came into force in June 2016. This process confronted several difficulties: the involvement of multiple actors, political changes in national government, and endless negotiations to define the operational details of the regulation. The end result was one of the most discussed health policies of recent years in Chile. This article tells the story of the process defining this regulation, carried out between 2012 and 2015. It describes its evolution from a legal perspective but also reveals the trade-offs faced by the team in charge of providing the operational definitions for the implementation of the law. The article presents the main challenges as well the strategies used by the team at the Ministry of Health to overcome the many difficulties that arose during the process of implementing Chile’s food labeling and marketing law. The experience of the Chilean reform may provide practical information and lessons for other countries and policy makers embarking on the task of preventing and reducing obesity. Although the Chilean experience has its own particularities, it also suggests common difficulties for similar reform processes in terms of technical challenges—such as the definition of concepts and the scope of regulation—and political challenges—like the opposition of the food industry and conflicts of interest among governmental institutions.

Medical and midwifery students\u2019 views on the use of conscientious objection in abortion care, following legal reform in Chile: a cross-sectional study

BackgroundIn August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman’s life, 2) lethal fetal anomaly, and 3) rape. The new law allows regulated use of conscientious objection (CO) in abortion care, including allowing institutions to register as objectors. This study assesses medical and midwifery students’ support for CO, following legal reform.MethodsFrom October 2017 to May 2018, we surveyed medical and midwifery students from seven universities located in Santiago, Chile. Universities included 4 secular (2 public and 2 private) and 3 private religiously-affiliated universities; all offering medical degrees with a specialization in obstetrics and gynecology (ob-gyn) and five offering midwifery degrees. We used generalized estimating equations (GEE) to identify characteristics associated with student support for CO, intentions to use CO to refuse to care for someone seeking abortion, and support for CO at the institutional level.Results333 of the 413 eligible students who opened the survey, completed the questions on conscientious objection; 26% were seeking medical degrees with an ob-gyn specialty, 25% were seeking midwifery degrees, and 49% were seeking medical degrees and had not yet decided their specialty. While nearly all endorse requirements for conscientious objecting clinicians to inform (92%) and refer (91%) abortion-seeking patients, a minority (18%) would personally use conscientious objection to avoid caring for a patient seeking abortion (12% secular and 39% religious university students). About half of religious-university students (52%) and one-fifth of secular-university (20%) students support objections at the institutional level.ConclusionsMost students support the regulated use of CO which preserves patients’ access to abortion care. Religious-university student views on the use of conscientious objection in abortion care are discordant with those of their institutions which currently support institutional-level objections.

Longer School Schedules, Childcare and the Quality of Mothers’ Employment: Evidence from School Reform in Chile

Ample empirical evidence has shown that access to childcare for preschool children increases mothers’ labor-force participation and employment. By estimating the causal effect of a school schedule reform in Chile, we investigated whether increased childcare for primary school children improved the quality of the jobs that mothers found. Combining plausibly exogenous temporal and spatial variations in school schedules with a panel of mothers’ employment between 2002 and 2015, we estimated a fixed-effects model that controlled for unobserved heterogeneity. We found a positive effect of access to full-day schools on several measures of the quality of mothers’ jobs, which were correlated to working full-time. We also found small, positive effects on the quality of fathers’ jobs. Our evidence suggests that the mechanism driving the effect was the effect of the reform’s implicit subsidy to the cost of childcare on the opportunity cost of mothers’ time. We also found that less-educated mothers benefited most from the reform. Childcare can increase household welfare by improving parents’ jobs and, thus, can play a role in reducing inequality.

The political in the technical: understanding the influence of national political institutions on climate adaptation

ABSTRACT A growing body of research shows that local and international institutions as well as party politics affect climate adaptation. Yet few studies have considered the role of political institutions at the national level. Comparative political institutional theory argues that a country's party system, executive-legislative arrangement, and electoral rules affect elected officials’ incentives and behaviour. This study utilizes this theory to explain how Chile's national elected officials responded to the country's extreme drought in 2010–2015. Results indicate that ideologically distinct alliances, a strong president, and legislators’ competing incentives to cater to different interests resulted in adaptive policy solutions that only partially addressed the shortcomings that drought exposed. The findings of this study show how politics can underlie technical decision-making on climate change, help to account for the continued inadequacies of Chilean water reform even in the face of new climate extremes, and demonstrate the utility of the comparative political institutional lens for explaining national strategies for climate adaptation. Applying this lens to other country cases and climatic events will advance knowledge on how differences in electoral incentives and policy processes systematically shape climate adaption policy.

Misja uniwersytetu. Walka o reformę na Universidad Católica de Chile

University mission: The fight for reform at the Catholic University in ChileThe author asks about the mission of the university understood as an axiologically defined way of life. She follows the history of the university reform in Chile in the 20th century, its two key moments from the point of view of university reflection: the strike in 1949 and in 1967. She notes that the strike phenomenon, although contrary to the idea of the university, is a tool for the disclosure of the university community. Both strikes were organized by architecture students at private Catholic universities in Santiago and Valparaíso, respectively, hence the demands for total reorganization, research autonomy, modernization and democratization can be regarded as radical. The author describes the research and teaching practice of the so-called School of Valparaíso, which can be considered the most important source and largest beneficiary having been granted the Open City area of the university reform in Chile. The ideas of architect Alberto Cruz Covarrubias and poet Godofredo Iommi Marini are also a good case for analyzing the problem of university autonomy the issue of apoliticality and questions about when the university fails in its mission.

Evaluation of the effectiveness and equity of the maternity protection reform in Chile from 2000 to 2015.

IntroductionAccording to the International Labor Organization, Maternity Protection (MP) policies try to harmonize child care and women's paid work, without affecting family health and economic security. Chile Law 20.545 (2011) increased benefits for economically active women and reduced requirements for accessing these benefits. The goals of the reform included: 1) to increase MP coverage; and 2) to reduce inequities in access to the benefits.MethodThis study uses two data sources. First, using individual data routinely collected from 2000 to 2015, yearly MP coverage access over time was calculated. Second, using national representative household surveys collected before and after the Law (2009 and 2013), coverage and a set of measures of inequality were estimated. To compare changes over time, we used non-experimental, before-after intervention design for independent samples. For each variable, we estimated comparative proportions at 95% confidence interval before and after the intervention. Additionally, we included multivariate and propensity score analysis.ResultsBetween 2000 and 2015, MP coverage grew from 24.4% to 44.8%. Using comparable 2009 and 2013 survey data, we observed the same trend, with 31.6% of estimated MP coverage in 2009, escalating to 39.5% in 2013. We conclude that: 1) after the reform, there was an increase in MP coverage; and, 2) there was no significant reduction of inequities in the distribution of MP benefits.Discussion/ConclusionFew scientific evaluations of MP reforms have been conducted worldwide; even fewer including an equity analysis. This study provides an empirically-based evaluation of MP reform from both a population-level and an equity-focused perspective. We conclude that this reform needs to be complemented with other policies to ensure maternity protection in terms of access and equity in a country with deep socioeconomic stratification.

Transnational Capitalist Classes and the State in Chile

ABSTRACT Chile is one of the first countries to adopt, what later became known as neoliberal policies, and is therefore one of the most cited examples in critical IPE literature. The adoption of these reforms in Chile tended to be explained largely as an outcome of interplay between transnational ideas/culture embodied in Chicago-trained economists and domestic coercion (armed forces). Far less attention was paid to the transformation of domestic material interests and the complex domestic legitimation process which involved material concessions. The article pays attention to the emergence and strengthening of transnationally oriented fractions of capital within Chile during the dictatorship and their articulation within the state apparatus. It shows that internationalisation of Chile was a highly contested process, which although occurred in the context of the emergence of powerful global transformations and forces, essentially depended on the outcome of struggles within the domestic setting.

Gubernamentalidad y somatocracia en el Régimen de Garantías Explícitas en Salud en Chile

Among the different technologies of neoliberal government emerging during the XX and XXI centuries, those that have attracted greater attention and reflection probably refer to those related to the processes of life, and the conception of it as a field for politics. This paper addresses the neoliberal governmental rationality involved in the development of the last major health reform in Chile: the Regime of Explicit Health Guarantees (GES), considering the implications of their epistemic aspects in understanding of corporeality. We consider as material for analysis several accounts of experts who have participated in the design of the regime, professionals involved in its implementation, legal and technical documents, and ethnographic observations. We analyse such information considering the notion of enactment proposed by Annemarie Mol. Results expose the processes of epistemic ordering, biopolitical acceleration, and biocitizenship prescription, linked to the enactment of the body as an assemblage of different spaces of government. We call such process as somatocracy, using the notion created by Michel Foucault. We conclude by integrating some components to think biocitizenship from emerging aspects in the work.