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Transmits. The government of El Salvador. All channels and stations must link to the national radio and television network.
Next, the launch of the second phase of Doctor SB with His Excellency President Nayib Bukele.
How are you? Very well, Mr. President. President, welcome again. Good afternoon. How are you, doctor? How are you? Very well, please.
Well, thank you again. When we started this great Doctor project that we have been working on together, well, you know it better than I do, I think, but when we launched it to the population 5 months ago, there was a technology and it is surprising that, well, now that we are launching this second stage or second phase, the surprising thing is not only that we have incorporated new services, which has been the main objective, but that we found new technology and technology that did not exist 5 months ago already exists not only now, but it existed at the moment we started developing this second stage, because first it was developed, then it was tested, then a pilot was launched, then the results were studied and then now we are launching it to the population. But in these 5 months all that happened, including the invention of new technology. So, what it tells us is that for the third stage we will probably have new technology already. Let's hope so. And it is the most surprising thing, I think, in addition to the fact that the plan to launch this second stage was already there, even if we didn't have the new technology that has been developed in these last months, but this new stage of Doctor SB is going to cover a large universe of patients that honestly excites me a lot because I think we are creating the best health system in the world.
That's right. If you remember, in November we launched Doctor SB, the application, and it was something spectacular because citizens could already have access 24 hours a day, 7 days a week to medical care. And that was for the first instance. And if you remember, at the time something you asked for was a survey at the end to see how the doctors, the laboratories are evaluated, well, in those 5 months we have results.
Yes, because we had a benchmark that was very important, which was the accuracy level. But there was another benchmark that perhaps scientifically is less important, but for public policy is equally important, which is satisfaction, right? Of the people in use, how they felt. And that's exactly it. So, when all that is available, there are more than 400 pharmacies and laboratories affiliated with the program. There were more than 1.1 million Salvadorans who registered in Doctor SB and from that we have one and a half million appointments that have already been made. Now, imagine with all that. I don't know if you remember how much the accuracy was before in El Salvador.
Yes, it was around 50%, it was almost like flipping a coin, heads or tails, right? Heads they got it right, tails they didn't.
That's right. That's right. And that was exactly the difference. At this moment the results are giving us 93% accuracy in Doctor SB with that program. So that is basically the highest, I think.
It's very high. Now, add to that that with the surveys you requested, they are at 97% user satisfaction with this system for the laboratories and how the doctors treat them. And knowing politics, having 97% approval in a public policy is almost impossible, because you will always have complaints or someone who was treated badly or someone who felt they were treated badly or didn't feel totally satisfied or even dislikes the public policy or has another affinity. We measure other types of policies in education, health, security, public works, economic policies, etc. Almost always achieving 97% in something is breaking the ceiling. Very high. So, between this and even internationally, I think, correct, speaking internationally, if you remember recently the CEO of Google even spoke about this program at the World Artificial Intelligence Forum in India. So it is an important reference case. Now with that we go to the next stage. And what is the next stage? With those results, Doctor SB also evolves to treat chronic patients. What is a chronic patient? Someone who has hypertension, diabetes, kidney issues, it can be everything metabolic, it will be treated here and the program will evolve because before it was by incident and now it is to accompany the patient in their treatment and artificial intelligence will be used to the next level with agents that follow up throughout the process, which is the technology that didn't exist before.
That's right. To really have a way to follow the patient throughout that path that there isn't normally the human way to have so many hands to be able to accompany throughout this process.
Yes, right now there are 1,100,000 users. I don't know how many there will be in chronic patients, but it will keep growing, well we can assume there will be hundreds of thousands of chronic patients and it would be impossible to give personalized follow-up to each one, call them by phone or remind them, look, you have to take your pill. And that is what they were explaining to me a little before when they were launching the pilot, they told me that when we launched Doctor, which was relatively recently, it was 5 months, the artificial intelligence that supported the doctor still didn't have proactivity because agents like the ones we have now didn't exist.
But now artificial intelligence can be proactive and even complete tasks without human intervention, call the patient and remind them that they have to go get a test or send them a message and tell them, 'Remember to take the medication.' And imagine, today they are handling 18,000 calls a day. When this program expands, remember we have up to 30,000 capacity today. When the program expands, well it will have this access, but there will be many more and that is where the intelligent agents support and just help us because the agents are outside of those 30,000 because those 30,000 appointments per day are doctors, they are humans who are attending to patients with the support of artificial intelligence and the whole system, but they are humans.
But here this will be done by agents separately or in parallel on the side and on top.
And we are just going to see this chronic population that Dr. Edgardo will talk about, how many are in each group and why it is such a large part of the population that is why we have to start covering in this next way. And there is an important issue, I think you know it, doctor, and especially here in El Salvador it happens and will happen in many countries, especially developing countries or underdeveloped countries even more. And it is that there are three issues. First, poor health care, that sometimes I go, they didn't treat me, I was waiting two, three, four, five hours or they treated me badly, that happens. Then there is also the effect of personal irresponsibility, I didn't take my... that happens in the first world and third world and everywhere. All over the place. Sure. My responsibility, I didn't take the pill, which... I forgot, I didn't do the diet they told me, exactly, I consumed, that I am diabetic and I consumed alcohol, sugar, etc. And then there is the other which is sometimes the lack of medications. We see sometimes there are many complaints on social media that there wasn't such medication or they didn't give me such medication and it is crucial for a diabetic or hypertensive person. Medications cannot be missing, that is, they have to be there, yes or yes or yes.
Absolutely. In fact, the country has, according to the statistics we have, about 3 million people who already live today with one or more chronic diseases. And the problem is not only the number of people we have with chronic diseases, but that many don't know they have chronic diseases, because they are diseases that evolve silently and when they manifest, they manifest with a serious event that can be a heart attack or the amputation of a foot in a diabetic or a stroke. Therefore, the approach we have with Doctor SB and using precisely the entire system of artificial intelligence agents is first to be able to identify who they are. So the application in a first stage tries to identify each of the patients because let's keep in mind that only six out of ten people know they are hypertensive or diabetic. Six out of ten hypertensives know, meaning there are four hypertensives who will never find out they are hypertensive and will find out when they had a heart attack. With the issue of high cholesterol, four out of ten know, meaning 60% of the population with high cholesterol doesn't know. And with kidney disease it is much more serious. There is only one person out of ten who knows they have kidney disease. The rest is evolving and will end up on dialysis.
Yes. Nine out of ten don't know.
Don't know. Only one person out of ten knows they have it and that statistic is from here in El Salvador.
That statistic is actually from the region. El Salvador doesn't have exactly precision in that statistic, but in the region nine out of ten people who have a kidney problem don't know it.
They don't know it and they are advancing to end up needing dialysis.
Exactly. So that is why the strategy is first to identify who are the people who have the disease and for that, as I was just saying, artificial intelligence will help us a lot because it will evaluate the risk factors that are today in the clinical records to know which are these people who have the diseases. And also a questionnaire has been incorporated into the application that Salvadorans have so that we know through filling out that questionnaire what are the risk factors we need to attack. Now, not only are we doing it, but the other principle we are putting into practice is ease. A questionnaire is very simple, it is intuitive. One can fill in common data, what is the weight, what is the height, what type of diet they have, if they smoke, don't smoke, which are the most important risk factors.
Sure. Artificial intelligence takes all this information and is already classifying where the patient's disease would be and puts together a package of studies that it puts in the application automatically without the patient having to go to the doctor or have to make an appointment for a prescription, not even a teleconsultation, not even a consultation through the application, because artificial intelligence based on what the patient or user is putting in the application is already determining what the package of studies is and already releases an order and that patient goes to the laboratory with that order to get the studies done and those studies are what will enable them to have a consultation with a doctor who is trained to treat chronic diseases after the studies.
After the studies. So instead, let's say, in public health here in El Salvador or even private health, yes, I have to transport myself, whether by bus, car, Uber, I have to get to the doctor, make an appointment, tell him, 'Look, doctor, I have this and this and that.' The doctor is going to ask me some questions and then the doctor is going to tell me, 'Look, we are going to do this blood test, an electrocardiogram, a test, I don't know, all that, right?' And then I have to go to the laboratory to get the blood drawn. If it's private, well I have to pay. Sure, apart from paying the doctor, I have to go pay the laboratory. There they will probably give me the results in an hour or I don't know a day or the next day. I have to go the next day to get the result. Let's say they can send it to me by email. Then I have to go back to the doctor and say, 'Here are the results.' And wait for a turn too. Oh no, sure. And in public health sometimes that turn is 6 hours waiting and then the doctor is going to see and is going to see the results for the first time and is going to analyze them there. Sure. And that's it. And then so he can tell me all that is done beforehand.
All that is done beforehand and artificial intelligence also already suggests to the doctor what the diagnostic classification would be for this patient based on what they filled out in the form and based on the studies they did afterwards. When the doctor sees the patient for the first time in the application, in the application, sure, on the cell phone the doctor is seeing the patient for the first time, but he already has all the answers, the entire questionnaire with all its answers and has all the laboratory results and has the artificial intelligence suggestions about what the patient has.
Exactly. And that way the patient is already enrolled in the chronic patient program. Now, while the problem is that there are many and the problem is that many don't know, another problem is added which is even more serious and which you just spoke about, which has to do with the fact that these diseases last a lifetime and need lifelong treatment and sometimes are pills in the morning, afternoon and night and the patient needs to have healthy habits, lose weight in the case of being overweight, or have to do physical activity or change their type of diet. So, it is very common for patients to abandon treatment. It is calculated that adherence to these types of programs in general does not reach 60%, meaning 10 diagnosed and treated patients, there are only six who will follow the treatment and the other four we say it's like they fall out of the system. Artificial intelligence has allowed us through this whole process that we are doing with your government and all the agents to create a whole series of mechanisms where the patient doesn't fall out. Let's say, when the patient doesn't go to get their tests, artificial intelligence warns us that they are not going to get the tests. That is, it makes permanent follow-up of the patient to warn the doctor that they haven't gone. But also, in parallel it automatically generates messages that it sends to the patient to tell them, 'You have abandoned your treatment or it's time to get the tests and 4 days ago you had the appointment, it hasn't happened.' And if it doesn't work, well, this message saying this is being generated by artificial intelligence. Absolutely no human intervention in all this.
And the, sorry, doctor, and the... so basically we are talking like every Salvadoran has a person, I'm going to call the artificial intelligence people a person, has a person dedicated 24/7 to be aware of them, of their chronic disease.
Exactly. Exactly. Exactly. Look, you have to go tomorrow to get the test, right? Exactly. What time can you go? No, I'll go in the afternoon. Oh, okay, then. Or remember that you have to take medication. And it sends you a message once, sends it twice, sends it three times and if you don't answer or don't go get the test or don't go get the medication, then we call you by phone and try... the artificial intelligence calls you or a human calls you? Not yet in this stage. The next stage is that an intelligence calls you directly. Now a human calls you. Now a human is going to call you. Well, but for the Salvadoran it's the same. Maybe they even prefer a human to call them. Sure. So artificial intelligence sends you a message. Let's assume it should respond and sure. Yes. [laughter] But let's say stubborn and doesn't do it. Then it reminds you again, doesn't do it. Reminds you again, doesn't do it. Artificial intelligence alerts the human doctor and says, 'Look, this person, I already told them three times, they're not going, you call them.' Better not... And then the human doctor calls them and says, look, we're calling you from Doctor SB, please go.
Yes, that is something not even in private health. Sometimes maybe if you have a doctor who is a very close family friend or something like that they might worry like that, but not even that, I think, to worry like that about you.
We, the entire cycle that has been done in artificial intelligence from the first moment to the end is always governing the cycle. It is following, it is saying, 'Now we have to do this and now we have to do the other.' That is, and it keeps telling the patient what they have to be doing so they don't fall out of the system.
Sure. So this tool is a very powerful tool that is very little developed in other countries. This country... is there any country that has something like what we have? The whole complete system, no. There are countries that have worked artificial intelligence for chronic diseases, but done what we call in vertical lines, for example, an artificial intelligence system that warns the patient and the doctor that their glucose is bad because they have a glucose device, nothing more than for glucose. There are other systems that warn that a patient is going to decompensate with kidney disease because they have all the kidney disease values, but only for kidney disease. A horizontal, longitudinal, end-to-end system that begins with patient identification and then follows the patient for life with adherence, this is the first one in the world.
In the world. I always try to relativize when we talk about something we are doing, for example, because if we build a road, for example, beautiful, new, and we publish it, this is the new road and people like it because they relativize it, well, what was there before? What is there now? But I am sure that any other developed country comes, China, the United States, and puts a 32-lane road for us, right? And there, well, here is your road, it's beautiful, but at a global level it's nothing, right? Yes, no. And generally what one tries to relativize, well, for El Salvador it's a good road, necessary, etc., but there has only been one issue where we have managed to position ourselves globally. We are number one in the entire hemisphere. In the other hemisphere there are some who beat us, but we positioned ourselves globally, which is the security issue. Yes. Correct. With all the confidence in the world. We can say walking in El Salvador is safer than walking in Santiago, Chile, which are relatively safe cities in Latin America, or walking in Montevideo or anywhere else. We can say it in Canada, in Ontario, in Montreal, in Toronto. With confidence it is the only issue where a developed country cannot come and tell us, 'We are better' and at most if they are better, well there we are competing. But that in health we can say, 'This system no one in the world has.' That is another big issue. We did research, we did research to see how artificial intelligence is being applied in the world, because we always do prior research, especially in chronic diseases, right? Sure. And this end-to-end, longitudinal system, right? This is the first one.
Yes, this is the first one and we understand that it will be scalable and as new challenges appear in the evolution of everything that is the chronic patient who gets complicated and very often we will keep following with our system, scaling it, because Doctor SB has all the capacity and possibility to accept and take on those challenges.
If this is the second stage. It's exactly... well, the first was 5 months ago, we took a few weeks to open all age groups, then it was launched completely, then some mini-stages were launched, mental health was included, another series of little things were included, mini-stages, let's say, how is it? 1A, 1B, 1C, but this is the second stage which is for patients with chronic diseases and that we are already talking about a totally different level from simply basic consultation or a cold, an allergy, a migraine pain, right? Here we are already at another level, we are talking about diabetes, hypertension, kidney diseases, etc. But then third stage, fourth stage, at some point we will be treating cancer, we will be doing surgeries, that's where we are going.
Sure, towards other stages. The other thing that is interesting is that the protocols we are using for the treatment of chronic diseases are clinical protocols made in the context of El Salvador, with the reality of El Salvador and with the tools that the laboratory has and that it has in images and the possibilities that El Salvador has. Therefore, this is an absolutely realistic system, it is a system that is applicable and that is adapted to the possibilities our country has. Within those protocols, what we have are the addition of new medications like insulin, for example. We are going to treat, we are going to have insulin to treat diabetics, we are going to have antihypertensives with medications for blood pressure, for patients who have arterial hypertension and also complemented with new functionalities of the network. Let's remember as Gay was just saying that we have more than 400 providers in a private care network where we have laboratories, images, pharmacies. Well, now we are adding in-person care for services of a bit more complexity that chronic patients need. So, I mean, the doctor in person, right? The doctor in person, I mean, the doctor and other professions that are not medical but that in chronic diseases are crucial. For example, a podiatrist, the diabetic foot and the amputation of the diabetic foot produce a lot of impact and in reality if one takes care of a diabetic person's foot in time and prevents it from getting infected, it won't end in an amputation. So, we have cardiologists, we are going to have podiatrists, we are going to have specialized nursing in person.
In person. The doctor is going to send them to go see the office of...
Yes, because this is something important what you mention, because there are people who say, 'Doctor, that is a telemedicine system,' but it is not a telemedicine system. It has telemedicine, but in the same way it has laboratory tests, which is not telemedicine, it has medications, which is not telemedicine, it has images which are not telemedicine, it has artificial intelligence which can go very well with medicine, with telemedicine, but is not necessarily part of...
Telemedicine, right?
And now it will even have, in some cases, in-person health personnel, doctors or other types of personnel who are also not in telemedicine. Or, in other words, it is becoming a complete health system.
Absolutely. That's how we will continue to complement it with the specialties we need so that the care we provide is complete.
And what is necessary to keep in mind is the economic impact that complications from chronic diseases have, not only on the health system, from the event itself like a heart attack or a stroke, but also everything that costs afterwards in rehabilitation practices for these patients who have been left with half their body paralyzed or who have lost a foot. So, all the economic and human effort made on these patients has a huge economic impact on the system, but it's not just on the system. Think about a family that has a young person at home who didn't know they had the disease and who had a stroke at 55 and was left with half their body paralyzed. From there, the economic burden for that family, beyond the health benefits, the burden, there always has to be someone taking care of them, there always has to be someone doing tasks for them, there always has to be someone mobilizing them, so the economic impact is huge.
And the person who can't work.
And the person who can't work.
Exactly. So, the economic impact that chronic diseases have on society is very high in the patient's own pocket for issues that go beyond health. So, that's why, to conclude a bit, what we say is that the spirit of this program is that no Salvadoran with a chronic disease remains unaware of it, and that no one who knows about it remains without treatment. That is the spirit we have within this program, and artificial intelligence has been of great help and great value so that we can do this. And we are on our way, and we are also doing it with a lot of research support, which Dr. Estela will talk about later, because we are doing it with scientific foundation.
There is an important issue to mention because in the traditional system, let's say, there are also always problems, right? Only one in ten knows they have a kidney problem, six out of ten, I think, in the case of diabetes, four out of ten in the case of cholesterol. But then that percentage, which is small or even tiny in the case of kidney disease, of that percentage, the ones who receive, who adhere to treatment, is an even smaller percentage. There is still a large part of that small percentage that does not adhere, for whatever reason. And then there is another problem that happens, especially in developing countries like ours, that sometimes it's not the patient's fault, but the health system's fault, that there is no medication, that there is, but they didn't give it to me on time, they gave it to me late.
All of that disappears here. Absolutely. Here, a medication is never missing, an exam is never missing, the care is always timely, fast, on time, and adding to that, you have an agent reminding you and trying to support you in the individual responsibility you have regarding your discipline in adhering to your treatment.
That's right. That's right. That's why we think this program will have a very high impact on the country's general health. Chronic diseases represent the most important disease burden the country has at this moment. And basically, this program can treat 100% of that. Everyone who adheres, everyone who enters the application and fills out the form will be covered. But also, those who don't fill out the form and have had a consultation for something else, and in their analyses, in their exams, have some variation in their glucose, for example, much higher than expected, we will capture those through artificial intelligence, reviewing medical records and seeing who is at risk. And we will contact them through artificial intelligence.
So it's two things, right? Either they come because they themselves filled out the questionnaire, took the exam, or consulted for a headache and they found they had a cholesterol issue.
Exactly. They asked for tests and, let's say, they asked for tests, they have high cholesterol and the patient didn't come back, the headache went away and they didn't come back.
Yes, the acute pain went away and they didn't care anymore.
So they didn't go back to check their cholesterol.
Artificial intelligence will realize they had high cholesterol.
And achieving that personalized follow-up with human health personnel is humanly impossible, literally.
Of course, it would require tens of thousands of people just to be aware of whether they arrived on time, if they took the medication, if they did the exam, if they came back for a consultation, if they went to get an electrocardiogram, how it turned out, if it reached the doctor. It would be practically impossible to achieve that.
Correct. That's why chronic diseases are not only, but continue to be the most serious problem in countries. Today, when you look at the health systems of countries and what is the disease burden that has the most impact, chronic diseases continue to be it because they are very frequent and because they are very complicated to manage. What we are building right now, what we have developed, is a whole system of humans and artificial intelligence that makes this management automated and that we can really manage this. We believe that this model of care will be a regional model that will be seen as the path to follow to treat chronic diseases. That is what we are almost sure will happen.
Excellent. Excellent. Thank you for having me here again today. Thank you for coming. I've been very surprised about the results of this program. Happy that we have achieved so many things in a very short period of time and we actually launched this new stage that is going to cover a whole lot of new diseases and problems. We're advancing really fast.
Well, I think you have a lot to be happy about and we can talk a little bit more about the global relevance of what's happening in El Salvador. And I'm very happy to tell you that Dr. SV is already part of the international conversation on healthcare and integrating AI into healthcare. As you know, our first commentary on Dr. SV has been published in The Lancet Regional Health, and that means that the program is being studied and discussed beyond the borders of El Salvador right now. So that's great news and there's a lot of interest because, as my colleagues said, this is a unique program in the world. So a lot of countries are looking for their own novel ways to treat the growing burden of chronic disease. And so they're looking to El Salvador. But anytime we introduce something novel, something innovative into healthcare, we have to be careful and we have to ask, well, does it actually help people or does it harm them, right? We say in medicine, do no harm. That's an important tenet. So to answer that question, we're currently conducting a clinical trial and we chose that study design because it generates the best quality evidence for whether or not something works. So this randomized design allows us for a fair comparison and it allows us to actually determine what is the effect of AI support on the doctor's diagnostic accuracy. And that kind of evaluation is especially important now because other countries are also experimenting with AI and healthcare, but not all of these experiments, unfortunately, are being carefully evaluated and the results are not always being published. So by doing this trial, El Salvador is helping establish a higher standard for evidence in healthcare.
It's a full clinical trial.
It's a full clinical trial. That's right. It's in progress right now. And normally those are not done here. Usually you will read about those done elsewhere.
Well, you can read about it right now. It's already been registered on clinicaltrials.gov, which is a website for global clinical trials. So, we're doing it using the most rigorous methods, using approval from the ethics committee here in El Salvador. So, we're quite excited about the upcoming results and we really think that again this goes beyond just having a strong national program. It can be a reference point for how digital health can be implemented and also evaluated and eventually scaled. And I'm very happy to see regional institutions like CAF are following us closely and because they're considering Dr. SV as a model for other countries as well. It's the first time El Salvador is going to be discussed at a global scale in something that's not security, in a positive way. We do a lot of things in terms of infrastructure or whatever, but economics and stuff, but it's never at the top of the world like world quality. In this case, I really think that we can achieve results that are not going to be only way better than what we had before or even the region, but even, you know, even developed countries. And we're committed to transparency.
Mr. President, the truth is that this, as you well know, when it was launched in November, Dr. SV, was a bombshell at the regional level. I know many people have called you, and me too, about how you did it and how it's going to be. And there was an enormous fervor awakened. And at that launch, we had said that it had a fundamental value because of the social equity it generated, because of the same quality of health care for everyone, no matter what class you are, and territorial equity, whether you live in a rural or urban area, you will have the same quality and the same promptness of care, and that is an enormous value. Now that phase two is being launched, I believe this has an enormous value, which is the state taking care of its people. This is a system of care that no one has, that everyone talks about needing, but that no one had found how to do. El Salvador is the first to find the how, because it was already on its way, because it already had a primary care system through Dr. SV, and on top of that, it achieves...
But that was 5 months ago.
I mean, relatively little time.
Exactly. And this is launched: the state is going to take care of your health when you have these chronic conditions, that is, of severity and long-term, and that you will have a disease that may accompany you for life, and the state will take charge and take care of you. And one could say, well, but everyone's health, let each person take care of it. Why should the state have to get involved in taking care of one's health? And it's because there are people who are very conscious of their health and take care of themselves and their diet. You, Mr. President, are fit, you are in Uruguay, let's say, you are impeccable. But there are others of us who are a bit more capable of not being so attentive to health, more gluttonous, we don't take care of ourselves so much in the recommendation that those next to us give, 'Hey, watch out for not letting go of the pupusa,' right? And so the state says, 'Well, and why should I worry about this person?' And to guess if they have it or not, to find out if they already have that disease, they already started with obesity, but they already have high cholesterol and are heading towards diabetes. Why should I take care of them? Why should I treat them? It's because of the consequences it brings later for my health, as Dr. Edgardo said today, for the family, because any health problem that comes from these problems generates many problems in the family and for the health system, it generates an enormous cost burden. And so it is logical that the State worries and says, 'Well, if we can do it, let's take care of them.' And there is another area where the State has been doing it for a long time, for example, which is traffic safety. Before, on a motorcycle, you rode without a helmet.
Yes, each of us could say with that same logic, well, you didn't put on the helmet, you were the one who fell.
The seatbelt, if you drank alcohol or not was your responsibility and your consequence, and if something happened to you, it was your... But the state didn't... My libertarian friends will say, 'Yes, no, let him wear the helmet because it's his real problem.'
Exactly. And at first there was resistance, and it has its logic, right? It has its logic. And on all sides, putting on the seatbelt when getting in the car, and maybe we held it and didn't put it on.
Of course, but you have to be practical, if something works, you have to do it, it doesn't matter if... that's why I don't have an ideology, because sometimes ideology kind of ties you down, right? So sometimes if something isn't in the canons of the ideology that was invented 250 years ago, it should be this way, but the reality is that if something works and is within logic and common sense, why not do it?
Because I understand that the responsibility of taking the pill every day is mine, it's not anyone else's. But before, if we had to hire 50,000 people, make calls every day, maybe it wasn't worth it, but having artificial intelligence agents that can do it and can multiply infinitely, why wouldn't we do it? If we can help people more, and if the State can help citizens and be aware of them. In fact, we already do it in other things. You already mentioned traffic things, but we also do it in education. If the student isn't studying, the teacher says, well, let each person see if they study or not, but the teacher tells them, you have to study or behave well and read the book, right? So the state has always been, parents have always been present in trying to... But in these cases too, because of the consequence, the severity of the consequence. What we have studied is that the consequences of this are very serious. When someone has a motorcycle accident and didn't have a helmet on, for their health, for the family that will have to start taking care of them because they will be invalid, and from then on it will generate conditioning and a family member will have to stop studying or working, sorry, to take care of that person, and so the consequences for the family are serious and for the cost of the system they are very serious. A person one day costs $14,000. So, the cost consequence for the system is also enormous. So, just as in traffic, the state generates codes of conduct, in health, it is logical that now that it can, it also generates a code of conduct. It was generated at one time with tobacco and it was said, well, that each person is free to smoke wherever they want. At one point it was said, 'No, no, in closed public environments, right?' But there is a difference in this, and it is that while the State is being productive in taking care of you, it is not forcing you.
That is, yes, I call you three times and if you don't do it, I send three messages and if not, well, the doctor is called, but if you don't want to take it, no one is going to come and force you to take it. That is, your freedom not to take it is always preserved, but the state is being proactive in recommending that you follow and adhere to the treatment that will save your life.
And then we reach a level of social awareness where we say, how did we not demand this before? How did we not demand before that people not smoke in closed places? How did we not recommend before, or how did we not recommend that even in your house, if you better go out to the garden to smoke, better for your children. Think of your children. There is more information about the damage caused by those diseases or those behaviors or those distractions in personal health care when I have a certain cholesterol level, when I have hypertension problems. The consequences of not adhering to that treatment and continuing to take the pill every day are serious consequences, and so it is logical that the state promotes it, and when we assume it, and we already use the seatbelt, it seems crazy, before when we didn't use it, how crazy before when we smoked anywhere in any way. How crazy. And so we generate a new stage, and that's why this is a cutting-edge public policy, because it moves forward to those cares that in a few years we will say, 'Hey, how come they didn't take care of us before.' What comes now is this country taking care of its people. Look at the quality of life results. Because medicine has managed to stretch life by 20 years, but not the quality of life in those final 20 years. With these measures, we are going to ensure that your last years of life are of full health and not of health conditioned by a vascular accident, by an invalidity, by a disability generated by some of these diseases that generate disability in the last 20 years of life. And you are going to have a last 20 years of very full life. And then that is what we are going to say. How good now that we have these last 20 years with this quality of life thanks to this follow-up they did, that they detected early that we had something we didn't know, and on top of that they followed us, they insisted until I became aware and took the pill every day.
