[Medical subspecialities and health policies: Health Ministry view].

Since the condition of subspecialty medicine in Chile has not been thoroughly studied, little can be said on an objective basis. From a standpoint of national health policies, the Ministry of Health wishes to establish a mixed system in which participating subsystem can define its own goals as means to meet the populations' health demands. The National System of Health Services (SNSS), in accordance with its social objectives, has decided to implement the delivery of integral health care, emphasizing health promotion and disease prevention. The epidemiological priorities of the populations will guide the action of the SNSS. The more complex and expensive medical actions will be delivered at pre-established points of the patient care network. The desirable profile of physicians working in this setting includes philosophical as well as technical characteristics. The type of patient care to be delivered must emphasize preventive and promotional actions. Problem-solving abilities will not ascribed to a particular type of institution but to where they may be more efficacious, in a context of quality and efficiency. Most activities will be carried on on an outpatient basis, and primary care clinics will be strengthened by becoming Health Centers. The model of patient care devised by the SNSS will require 6 different types of physicians: an undifferentiated generalists, a family-oriented physician, a specialist in one of the four major disciplines of Medicine, a specialist in other primary specialties, a subspecialist and a specialist in specific techniques. To determine the number of physicians required to make the SNSS work, a methodology is needed that will consider its character of executer of Ministry-defined policies, along with the peculiarities of each health service. Health care givers must define periodically their needs in view of their own development plans and their beneficiaries requirements. Nevertheless, it is impossible to predict with certainly for the long or medium term how many physicians will be required at any level of patient care. The role that the SNSS may ascribe to specialist will condition the number of them that Chile will require.