While the United States stares into the abyss of the fiscal cliff Jan. 1, the Social Security universal health care system (Caja) faces another chasm — a medical one.
The University of Costa Rica (UCR) has given the Caja notice this month that, due to a ¢5.3 billion colon deficit in the past several years, it will terminate its contract to run 45 routine medical treatment centers in three of the most populous cantons the the Central Valley.
The closures will not only strain the resources of the Caja, just recovering through strenuous administrative reorganization and careful austerity measures to bring its house in order.
The EBAIS are contracted out and serve as special clinics. They serve such illnesses as diabetes that need routine treatment. The more complicated ills are taken on in Caja clinics.
The idea is surprisingly creative for a large bureaucracy — EBAIS serve to keep clinics from being overwhelmed with routine patients, leaving those clinics free to treat more challenging conditions.
Also, the EBAIS tend to be placed closer to their patients, cutting down travel time and serious hardship in transportation. In some rural areas, clinics for most patients are a long, hard trek on foot or, if they are lucky enough to have livestock, on horseback.
This does not mean that EBAIS are either primitive or that their medical help is in any way less competent. It is a different structure for a specific need.
The EBAIS that UCR rector Hennings Jensen would close are located in Montes de Oca, Curridabat and La Union. Jensen calls them “unsustainable.”
The Caja is pleading with UCR to give the health care system a chance to plan for a smooth transition — they are asking eight months, not just a matter of days. They have three choices: take the EBAIS over themselves, contract them to a cooperative or to private enterprise.
The crisis is more than just for patients. Although no one openly acknowledges it, Costa Rica has an overabundance of doctors, especially general practitioners. The EBAIS employ a great number of them and closing them would mean an even greater glut in the field,
Right now a mixed committee of various disciplines is trying to wrap a collective head around the problem. But Miguel Guzman, UCR coordinator, says that if the university extends its supervision “we must know the actual costs with zero deficit of running them.”
Meanwhile, EBAIS medical staffs are caught in a web of uncertainty. “Nobody knows anything, there are fellow staff members who cry every day,” nurse Nidia Sanabria told the national newspaper La Nacion, “Most of us haven’t even bought Christmas presents with our holiday bonuses for fear of being jobless.”
(There is no ready safety net of unemployment insurance in Costa Rica. Only savings, severance pay and the alguinaldo (Christmas bonus) stands between them and ruin. Closure would mean throwing 400 medical staff into the street.)
At that, Sanabria may be in better position than the more highly trained doctors. A trained nurse with experience is in higher demand often than a less experienced physician unless he or she is a specialist.
Some staff members mounted a protest against the closures last Monday, but “We can’t stop giving patents basic service when they’ve waited up to a year for an appointment,” nurse Olga Quiros told La Nacion.
Besides providing thousands a patients with care, the EBAIS serve a valuable service not often seen in Western medicine — prevention of illness. They handle obesity, alcoholism, mental health and treat more minor illnesses that might well turn vicious with neglect.
The country has 991 Ebais and each one treats an average of 4,000 patients. In the three cantons mentioned above, more than 166,000 persons know that medical aid is close — until Dec. 31.