Here in Panama there are three options for health care: Private, Insured, and Public. I thought in light of the current ideas in the U.S. I would share a bit of our world here, with socialized medicine.
Private Hospitals cater to those who have accessible cash. The hospital has a contract with an insurance company that offers a hospital/ clinic only policy that is affordable to approximately 3% of the people in Chiriqui. However, should I ,one of the fortunate who have this insurance, need to enter the hospital on an emergency basis, have tests, X-rays, or bloodwork, I will need to pay cash, and then be reimbursed. The service is better than other options, because, of course, it costs a lot more.
Insured workers, that is, people who work for larger companies - store chains, or big building companies, have a different clinic where they can go and be seen as an outpatient for a small co-pay. There are approximately 10% of the people here in Chiriqui who are insured. But at these clinics they can get prescriptions, X-rays, and other exams. The quality of the care will be lower than that in the private hospital or clinic, and the wait time can be upward of 3 days for an appointment. The ‘insurance’ is taken from their check by the government, and used to sponsor the government run clinics. Regarding wait time, you can get an appointment earlier in the week, but will be seen in the order that you arrive at the clinic. So, with an appointment at 9:00, you arrive at 8:30 and can expect to be seen around 2:00 in the afternoon because every fool knows to arrive at 3:30 in the morning if you want to be seen by 9:00 am.
Then there is public health care – the other 87% of the people. It generally costs from $.50 to $5.00, and is available to the entire public. In the hospital you will sleep 12 to a room, one duty nurse and one aid per 4 rooms. They will provide you with absolutely no essentials, including toilet paper, washcloths, and towels. They will expect a family member to take care of your every non-medical need- food, clothing, help to the bathroom, change bedding – everything. Besides the conditions in the public hospital, you will be put on a waiting list for any non-life-threatening surgery or treatment. Should we have opted for the public hospital Yari would have waited an average of 12 days to have her foot put back together. They would have sent her home with the compound fracture to wait for her appointed time. We have a friend now who is waiting to have a DNC. She is bleeding profusely – to the point that her hemoglobin is at 7 - and her surgery is scheduled for late May – 3 months from now. Should you need to go in for a test, or just see a doc for a small problem, the most time-sensitive approach is to arrive at the clinic before 4:00 am to get a ticket to be seen, then wait for 6 or 7 hours for your turn to see the doc or technician.
Of course the public health system also provides folks with (mostly) free medications, that are very limited in supply, so more often than not you are turned away because they do not have what you need, and will not substitute without you going back to the doc and asking for a different drug, which, of course, will take you another day of getting up at 3:00 am to get another appointment. And there are only certain types of prescription papers that the pharmacy will honor. Wrong paper = no meds. If you get your prescription from a doc who treats insured patients, and he forgets to give you the right paper, you are out of luck. It isn’t that you have to pay; they just won’t give it to you. Loads of red tape and hoops to jump in order to get this, less than average quality medical care. We had a friend who went to David for an appointment last year at the public hospital (Regional). Two weeks later she finally returned. When we asked what happened, this was the story. She needed a surgery, but to have the surgery she needed to donate a pint of blood beforehand. She was left alone, the IV came loose and she poured out too much blood onto the floor while the nurse had gone to another room. She passed out, they put her in the hospital. She only had money to go to David and return, with nothing leftover to buy food, but she had to stay the night, so she had to buy food. She then had no money to return home, so was stuck sleeping in a chair in the hospital for 4 days before she could get money to come home. I know these people are poor, but for a system that is supposed to take care of the poor, somehow there has got to be a better way.
So, I guess, when it is all said and done, I question whether the U.S. really needs to be going in this direction. On the bright side, there are little if any mal-practice suits.
We continue to live and learn with Yari’s medical problems. Thanks to God, she is doing well. Her mom has insurance that would not help her have the surgery unless we were willing to wait the 12 days, but it will cover x-rays and therapy, we think. It did cover the x-ray in the Insured Clinic. We arrived there at 9:00 am for an appointment that actually took place at 1:45 that afternoon. There were (and this is not an exaggeration) over 350 people waiting for X-rays or tests when we arrived. I counted, and that was only one half of the building. The staff was nice, but overworked.
At any rate her X-ray looks good and we return to her surgeon on Tuesday to see if she is ready to begin therapy. Another adventure, just around the corner!
God is very good.