Cancer and AGE: Between promise and reality

Chile’s Ministry of Health announced plans to include all types of cancer under the country's public health guarantee system, known as AUGE/GES, by 2031. The announcement was made during the minister’s first public address and has sparked both optimism and skepticism among healthcare professionals, patients, and analysts. Cancer kills approximately 30,000 Chileans annually and is already the leading cause of death in several regions. While the promise of expanded access and financial protection sounds urgent and necessary, concerns remain over whether this expansion will be cost-effective and feasible given existing challenges within the national health system. The GES program was originally designed with a clear technical principle: prioritize diseases that offer the greatest health benefit at the lowest possible cost. Not all cancers are equal in terms of treatment outcomes or resource requirements. For instance, early-stage breast cancer has high survival rates, whereas advanced pancreatic cancer has less than a 10% five-year survival rate. Some cutting-edge treatments exceed $100 million per patient with only modest results. Incorporating such therapies without rigorous evaluation could jeopardize the sustainability of the entire system. A more pressing issue lies in the preparedness of the current system to meet these new commitments. Chile faces serious structural deficits, including a critical shortage of oncologists, inadequate infrastructure unevenly distributed across the country, and long waiting lists that have already overwhelmed the system before expanding guarantees. The recent implementation of the Oncological Alert was necessitated by the collapse of the existing framework. Creating a legal guarantee without addressing these underlying issues risks turning promises into frustration and avoidable deaths. For the new AUGE oncológico to become reality, specific conditions must be met. First, automatic activation of a second provider is essential. Currently, when the public system fails to meet GES deadlines, patients must personally manage their referrals, an unacceptable burden in oncology. The state should immediately refer patients to an alternative network, either public or private, without requiring individuals to fight for their rights during their most vulnerable moments. Second, true integration of the public-private network is needed. Private clinics in Chile possess unused capacity while public hospitals struggle with overcrowding. A unified network with shared protocols, interoperable records, and cross-financing would allow resources to be used based on patient needs rather than their affiliation with a particular system. Third, decentralization of treatment is crucial. Specialized centers are concentrated in Santiago and some regional capitals. Patients from areas like La Araucanía or Aysén face insurmountable barriers if they need to travel hundreds of kilometers to access care, leaving behind work and family. Guarantees must reach the territories, not require patients to travel to them. Fourth, accelerated training of specialists with tangible incentives for the public sector is vital. Without sufficient oncologists, radiation therapists, and pathologists, any decree remains meaningless. Lastly, rigorous sanitary technical evaluations must precede each inclusion, ensuring not all cancers enter the GES equally or simultaneously. While the direction of the announcement is correct and the injustice it aims to rectify is real, a decree without a functioning system behind it is merely a promise.