Members of the Continuous and Palliative Care team at Chile's Clinical Hospital (L-R): Paula Rodríguez (nurse), Érica Brasil (psychologist), Tamara Retamal (physician), and Valentina Riquelme (nurse). Photo used with permission.
Palliative Care in Chile: 90% coverage achieved for cancer patients, but gaps remain
Chile is characterized by its unique geography: a narrow, 4,300 kilometer strip of land between the Andes Mountains and the Pacific Ocean that culminates at the southwestern tip of South America. Classified by the World Bank as a high-income country with an advanced emerging economy, Chile is a member of the OECD and is recognized for its health system achievements.
National program successes,
but some challenges remain
University Hospital physicians Tamara Retamal and Alejandra Palma. Photo used with permission.
Since 1994, Chile has implemented a National Program for Pain Relief and Palliative Care for Cancer, with guaranteed public funding since 2014. Thanks to this program, by 2019 the country had achieved over 90% palliative care coverage for cancer patients. Chile also stands out in the region for opioid provision, currently reporting a Distributed Opioid Morphine Equivalent (DOME) of 2,404 mg per patient, covering 114% of the estimated population need.
However, significant challenges remain regarding inequality and access gaps, particularly in areas with only primary care, such as rural areas.
Gaps in less populated regions
Chile has an estimated population of 20 million people, with 40% residing in the Metropolitan Region in the center of the country. That region comprises six provinces, including the capital, Santiago, and others with both urban and rural populations. One such province is Chacabuco, which includes the municipality of Tiltil, home to approximately 22,000 people.
Tiltil has a strong agricultural tradition, particularly olive and cactus fruit cultivation. Local healthcare is provided by a community hospital and a primary healthcare center (PHC). Oncology patients receiving treatment for cancer/palliative care must travel to the region’s urban center—specifically, to the National Cancer Institute or Hospital San José—both located at least a one-hour drive away. These tertiary-level hospitals have specialized palliative care teams responsible for clinical care and ensuring access to medications, such as opioids and oxygen therapy. This situation is a significant geographic barrier for patients in Tiltil, who often must travel themselves or rely on relatives to help them access medications and care—even at the end of life.
University hospital tasked with care
The Clinical Hospital of the University of Chile (HCUCH), where I have worked as a palliative care physician for more than 10 years, is a university hospital located in the Metropolitan Region. In 2024, with the implementation of Law No. 21.621, the hospital officially became a public health provider, while retaining its academic role and autonomy. This law formally links HCUCH with the national public health network, and assigns it responsibility for delivering care to specific territories, including the municipality of Tiltil.
An urgent need for local care
This scenario—a rural population, even if located within a metropolitan area—highlights the urgent need to strengthen palliative care provision at the local level, through collaborative care networks and ongoing professional education. This is especially important in order to allow terminally ill patients to remain at home, accompanied by loved ones and cared for by health professionals from their own community, ensuring timely and quality care.
A training session with Tiltil primary healthcare team members Photo used with permission.
Collaborative model launched
In this context, our team has launched a collaborative model between HCUCH and the clinical and management teams of the community hospital and the PHC in Tiltil. The goal is for HCUCH to serve as a facilitator and capacity-builder for community-based palliative care, optimizing palliative care delivery for Tiltil residents. Current strategies include: a professional training plan, implementation of teleconsultations between clinical teams, and timely provision of medications and oxygen therapy for cancer patients at home.
Primary care providers trained
As part of this process, we conducted a six-week virtual multiprofessional training, attended by 22 primary healthcare team members from Tiltil, including nurses, physicians, pharmacists, a nutritionist, social workers, and physical therapists. This was followed by an in-person training session on June 13, 2025, focused on clinical case discussions and deepening the content previously covered online. This initiative was highly valued by participants, who emphasized the importance of collaborative work and relationship-building to support the long-term sustainability of the model.
Conclusion
Achieving universal coverage of timely and quality palliative care is an ongoing challenge, even when national coverage figures are high. Populations in rural and/or geographically distant areas are particularly vulnerable, which is why it is in our interest to evaluate the feasibility and impact of collaborative network-based work models that apply educational strategies and information technology applied to palliative care.
Read Dr. Alejandra Palma's bio.
Editor's note: Dr. Palma is lead author of an article, titled "Opioid use in Latin America: a vital challenge for health systems," published July 1, 2025, by the Journal of Public Health.
Read more of this week's issue of Pallinews
Palliative Care in Chile
Even high-income countries have gaps in care. A report by Dr. Alejandra Palma.
Guidance for Policymakers
An introduction to the WHO guideline on controlled medicines, by Professor Julia Downing, who co-chaired its development.
A Trans-Atlantic First
The 2025 International Seminar on Public Health Palliative Care Research, a report by Dr. Luc Deliens.