A Systematic Review on Equal Access to Treatment for Hearing Loss in Chile: Do All People Have the Same Opportunities to Receive Appropriate Treatment?

OBJECTIVES: Hearing loss (HL) can occur or progress at any stage of life exposing hearing impaired to different forms of inequities in their health care trajectory. We aimed to review the existing literature on health care treatment in Chile to identify local social determinants of hearing health and barriers that contribute to any stratification of hearing health fruition.

METHODS: Articles were identified through systematic searches in EMBASE, Medline, Cochrane and a manual search. Studies that provided evidence or explore access to healthcare in the Chilean population were included and narratively summarized.

RESULTS: Review of the latest literature revealed that Chilean national health care system has undergone continuous efforts in the direction of equity in recent decades. Concerning HL problems Chile can boast a good representation of specialized personnel distributed throughout the territory (Bright 2022). However, neonatal hearing screening occurs only in presence of risk factors (Albertz 2013). Treatment of HL is publicly financed always if total deafness is diagnosed (CI-candidates) or for small children and elderly (>65 y) in the Plan AUGE-GES. However, individuals who acquire various degree of HL after the age of 4 and before 65 years are still not part of the public reimbursement, therefore treatment of HL in this population might occur out-of-pocket or even be inaccessible. A planned survey among ENT professionals will be oriented on answering the questions if the health system explicitly favors certain HL Indications or age groups and if age might be a local social determinant of health in Chile. Moreover, which changes/actions might be implemented to warranty each group of the population equal access to hearing health.

CONCLUSIONS: Age might be the greatest determinant of hearing health in Chile, a survey amongst ENT specialists will help to clarify this issue and suggests further steps to warranty equity in HL treatment.