Analysis of Occupational Therapy services included in the regime of explicit health guarantees (GES)

Abstract

Introduction: Chilean Law 19.966 states a regime of Explicit Health Guarantees for access, quality, opportunity and economic protection of treatment coverage in 80 health problems. This law extents in a national level and is a milestone in the health care reform in Chile. However, there is no specific information on how occupational therapy is incorporated in this institutional modality of health coverage. Aim: To identify occupational therapy services included in the regime of Explicit Health Guarantees and describe services by frequency in health problems, and their levels of evidence and grades of recommendation. Methods: Documentary review of Specific Health Benefits 2016 List, and Clinical Practice Guides for 80 health problems covered by the Explicit Health Guarantees regime. Results: One service was identified, named “Integral Care by Occupational Therapy”. This health service is included in 12 health problems referred in Specific Health Benefits 2016 List. Occupational therapy is included 10 Clinical Practice Guides, with differing grades of recommendation, mostly C and D. In relation to the incorporation of occupational therapy services, there is a mismatch between what is declared in the Specific Health Benefits 2016 List and the Clinical Guidelines. Conclusions: Occupational therapy has limited supporting evidence and grades of recommendation in the regime of Explicit Health Guarantees. These findings reinforce the need of a deeper analysis of the supporting evidence of occupational therapy for health problems covered by this policy, in order to strengthen the dialogue with policy makers and enable its coverage expansion to other health problems when corresponding.