GOBERNANZA ROBUSTA EN SALUD DIGITAL: EL CASO DE TELESALUD EN LA ATENCIÓN PRIMARIA CHILENA [2020 – 2025] .105ROBUST GOVERNANCE IN DIGITAL HEALTH: THE CASE OF TELEHEALTH IN CHILEAN PRIMARY CARE [2020 – 2025]

Abstract

The challenges associated with the management of demand in primary health care (PHC) serve as a structural impediment to achieving equity and optimizing public expenditure. This article analyzes the implementation trajectory of the «Telesalud» strategy (2020 – 2025), examining its evolution from a local (bottom-up) innovation to a national policy of state modernization (top-down). The present study utilizes a single case study design that employs a mixed approach, encompassing both descriptive and evaluative elements. The research triangulates the documentary analysis of regulations and institutional agreements with quantitative data on implementation (9.2 million requests) and qualitative evidence obtained from key actors at the central and local levels. The evidence indicates that the implementation of a clinical risk prioritization model, augmented by information technologies, has resulted in the liberation of medical hours for complex cases and a reduction in transaction costs for users. The strategy was expanded on a national scale, resulting in the establishment of a unified data network to facilitate evidence-based decision-making. The case substantiates the «Robust Governance» theory in crisis contexts, demonstrating that institutional flexibility, public-private coordination, and the formalization of knowledge assets as public goods are effective mechanisms for generating public value and ensuring the sustainability of health reforms.