Abstract

Chile’s public health system is characterized by fragmentation, which hinders continuity of care. The referral and counter-referral (RCR) process plays a key role in ensuring coordination between levels of care, and several digitalization policies have been implemented to improve it. Aim: To analyze the impact of three digitalization policies implemented in the RCR process of Chile’s public health system on continuity of care. Methods: A case series study was conducted on the following policies: the Healthcare Network Information System (SIDRA), Digital Hospital (HD), and Single Referral Channel (CUD). A documentary review of official documents and press releases was carried out. To characterize each policy, an adaptation of the pragmatic case study approach and a typology of public health digitalization policies were used. The Continuity of Care Questionnaire Between Levels of Care was applied to assess the impact of each policy on continuity of care. Results: The policies analyzed reflect different digitalization models: digitization (SIDRA), digitalization (CUD), and digital transformation (HD). All three promoted the informational dimension of continuity of care. Regarding the longitudinal dimension, SIDRA’s impact was marginal; HD improved continuity by expanding communication channels between care levels and covering the entire RCR cycle; and CUD went further by enhancing access to patients’ medical records and automating communication between levels. Conclusions: Digitalization policies in the RCR process have strengthened the informational dimension of continuity of care, but their impact on the longitudinal dimension remains heterogeneous. Advancing digitalization in health does not necessarily lead to proportional improvements in continuity of care. © Copyright 2025 Medical Journal of Chile. This work is licensed under a Creative Commons Attribution 4.0 International License. https://creativecommons.org/licenses/by/4.0/