Cojas in Chile

According to some boosters of Government health insurance, Chile provides a better system of medical care for its people than the U.S. This week an able Chilean, who should know, flies home from Manhattan after a visit to U.S. medical centers. Young, vivacious Dr. Eduardo Cruz Coke (rhymes with coke), author of Chile's national health law, told reporters how Chile watches after the health of its 5,000,000 citizens. Some hows:

> All Chilean workers are obliged to belong to autonomous Cajas, or occupational guilds, through which medical care is administered. There are 20 to 30 such guilds in the country. Largest is the laborers' Caja, with a membership of 1,200,000. Each worker contributes from 3 to 10% of his wages to his Caja every month. Employers match or exceed this payment, and in some cases the Government adds a small percentage. For this fee a worker gets not only medical care but insurance against several or all of the following (according to the rules of his Caja): 1) sickness and invalidism; 2) old age; 3) accidents; 4) maternity; 5) unemployment; 6) loss of life.

> A model Caja is run by young Dr. Raul Morales, who also visited the U.S. last month. In this group are 100,000 white-collar workers of banks, shops, etc. They are treated by a staff of 300 doctors, who are paid about 20 pesos an hour (80-c-) for their work. Dr. Morales, a syphilologist, is most concerned with preventive medicine. Every member is X-rayed once a year, given a tuberculin test, a complete clinical examination, a Wassermann and Kahn test for syphilis. Whenever a member is found to have tuberculosis, syphilis, rheumatism or heart disease, he is immediately given treatment, paid his full salary from the Caja. Under law, his employer must hold his job for him until six months after he is pronounced cured.

> All hospitals, with the exception of a few small clinics, are under Government control. Cajas pay hospital bills for their members, although some operate their own sanatoriums. Every town has a hospital. Of Chile's 3,000 doctors, less than 600 practice private medicine exclusively. All the others are in some way connected with the Caja, but are allowed to maintain small private practices among the well-to-do in their spare time.

> Compulsory vaccination* has wiped out smallpox in Chile. Diphtheria has likewise been practically eliminated. Insanity is not common. Greatest health problem in Chile is a high infant-mortality rate. According to Dr. Cruz Coke, the trouble is not the medical care in hospitals but the conditions in the home, because of low standards of living.

> At present, Chile spends about 280,000,000 pesos a year on medical care. At least one-third of this total is spent in treating the early stages of tuberculosis, syphilis, diseases of the heart and circulatory system. By stressing prevention rather than treatment, Dr. Cruz Coke claims that the "health yield" of a given amount of money is increased five or six times. Said he: "The State must spend money not primarily to give a man who is ill more felicity, but to produce a healthy worker."

* Six States in the U.S. have never enacted any type of vaccination laws. Last year there were 2,462 cases of smallpox throughout the country.

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