As an unabashed liberal in the Costa Rica sense of the word, far too many articles and news items that I hear or read focus on the faults as well as failures of adequate public health care for all. My innate liberalism just might be wrong.
Perhaps it is the nature of socialized medicine itself that fosters laziness and corruption which makes it not work for the common person?
Most recently we have the once proud U.S. Veterans Administration (VA) health services funding scandal regarding patient care, the U.S. government admitting that a patient waits, on average 115 days for an appointment with a physician and untold days more for testing and hopefully only 25-50 days longer for results.
“No,” the veterans are not given acceptable medical care, no more are than the thousands of Ticos who have paid into our public health care system only to be lost, or put on a long waiting list that can take years for an appointment, especially if specialized testing is required.
It seems that in both cases, death of the patient is the government’s solution to the wait line.
I read that in one single V.A. hospital in Arizona, 40 military veteran patients have died while on that wait list….just waiting to see a physician. In Costa Rica we do not keep these kinds of records but a single trip to Hospital San Juan de Dios will instill a reality check far greater and suggest far more deceased numbers than forty.
“I am sick, in pain,” but it takes three hours to stand in an endless line just to present the doctor’s prescription and another two hours for it to be filled. “Have a seat!”
I have COPD of the lungs and it takes 13 months for an appointment, and then another six months for some kind of treatment. (I hope it is in the afternoon because ICE is scheduled to install our land line in the morning.”)
In the mean time, the busy docs are outsourcing tests to companies they own or a family member owns for personal profits and paid for by the government. For years a group of docs have quietly been running an export business of organs for sale right out of a public care hospital. Getting in on the plunder, a tech-doc combo more recently registered and collected money from the Caja itself for patients who have as yet to see a doctor but, “must need some sort of prosthetic device, right”? Then there is the cardiac surgery at Children’s Hospital on an infant boy where the lead surgeon just left the OR room for a far more lucrative surgery at a for-profit, private hospital. (The boy at Children’s Hospital died on the table.)
How much more are nations such as the puritanical U.S.A. and its soldiers, the paid in insurance of our very own health care system (Caja) able be allowed to rape, pilfer and plunder, with impunity, those who are in need? Most of these patients do not have the economic means to buy into private hospital care but they can and do pay monthly premiums for public health care and have the absolute right of expectation to receive reasonable medical attention and not die waiting.
And those who violate codes of ethics need to be fired, not put on paid leave. Those who blatantly break the law should be in prison, not probation and their licenses to practice should be yanked, not in one or two years, but immediately.
As a Canadian, I’m very familiar with socialized medical care. The biggest problem that I see in the delivery of socialized medical services, both in Canada and Costa Rica, is that there is no minimal user fee imposed to keep the medical system honest. If users are able to merely show-up at a clinic or hospital and receive medical services and prescriptions filled without a minimal user fee to be paid, there will be abuses both as to imprudent use of the services and the filling of unnecessary prescriptions. If a user has to dig into their pocket for 5,000 colones as a user fee, they will think twice before using the services, especially, if the intent is to merely avail themselves of services for imprudent reasons. In Canada, it is common place for some of the elderly to make appointments with their doctor merely for someone to talk to for 30 minutes because they are lonely and there is no additional costs associated with doing so. This leads to unnecessary expenditures to support a medical system which is overburdened for a matter that should be dealt with in a different manner. I believe that a minimal user fee would make the delivery of socialized medical services more cost effective and efficient.
Hi Richard!
Here we do have a monthly premium to be paid which might become more expensive. From a low of USD$20 to as much as $200 per month are the premiums.
The system is out of control Costa Rica.
I know of a Ukrain national with a U.S, passport who sent his wife for medical treatment to Canada: The cost was well over $25,000 but she received treatment free of charge by Canadian law. It was a fraud, but the country can do little to avoid such things and if one’s love or life is at stake…why not?
In CR, all of those 90 Day Wonders and tourists never pay into the system. Because they tend to be young, they only use public healthcare as a last resort.
The Caja premiums here in Paradise are moderate compared to any other country. We each should chip in to keep the Caja alive despite its faults and incompetency. (Those can be worked out.)
For me, personally what Cima has to offer is the best Club Sandwhich in Costa Rica.
I will wait, and with family support stand in line to receive solid medical care with my Caja payments. The visual conceptual environment is ugly, but it works.
For surgery, I met Dra. Madeline Centano who is a cosmestic sugeon but she also performs simplistic operations such as, in my case, carpal tunnel. I paid her nothing as a person and $20 to the Caja, plus neither of my two hands are in pain any longer and I can sleep for eight solid hours.
“Yes” I waited a long time, but once in the system, a carring person like Dra. Centeno is one of CR’s best, the follow up….great. It all comes down to a person who “cares.”
We need to make major adjustments to the Caja system, but that means eliminating the sale of organs, surgery for profit at the private hospitals, having tests reviewed by competent technicians,
having nurses who are not educated in the craft and most of all having an administration that is competent and…..digitalized rather than lugging around carts loaded with patient folders which have just been picked up off the floor.
Actually Juan – one of your better posts – at least its stays on subject – and I like you indignation
– I love Pura Vida – but there is a time to turn it off and on. Ticos seem not to do that well as when one is seen as indignant it is viewed by many other Ticos as incivility.
And it is, but at times justifiably so.
The gringos make a career out of playing the “incivility” card. Sad really – so much farmed anger. But we Ticos must learn to play that card – but only as needed – and the health system is appropriate place to play the card.
I have seen such filth in Caja hospitals I stopped going there unless its an emergency. Also the lackadaisical attention at some clinics is worthy of Tico indignation. Yet no one says anything as clerks socialize endlessly and some doctors merely go through the “paper work” motions with out truly “caring” for the patient. Yet we patient just look at each other is disbelife and remain silent…” Pura falta huevosita!” This is not the hardware store where joking around and socializing is hardly threatening to our national physical health.
Our medical system is different. There is no time for jackassing around – and here I whole heartedly agree with senor Juanito!
The problem is cultural in many cases as quite a few Ticos think that just because they have paid for their medical education they have earned a degree. They basically cheat their way through school and we get many of the incompetent medical workers that are only considered professional because they are getting paid – for sham service/expertise.
I love gringos for their expertise and dedication to their professions – but their social culture leaves so much to be desired – it is said the term “US culture” is an oxymoron. However, IS IT POSSIBLE to blend dedication to expertise and working to live rather than living to work? I don’t know.
Can we still be cultural icons (pura vida) to the world if we dedicate our lives to professional expertise?
I just don’t know – but I hope so, as when it comes to medical care we need to be, do I dare say it, “militaristic” in its administration and execution, while sympathetic as la abuela with recovering campaneros.
I am lucky enough to have world wide private insurance and used for surgery in the US. I realize that all people are not so fortunate – but after much investigation I received no nonsense squeaky clean and caring service – serious doctor, serious anesthesiologist, obviously well trained and passionate about their work. Not one joke did I hear – never – and that level of seriousness is not what I want when dealing with my mundane daily mandatos – no I prefer the jovial Tico and a hand shake and happiness/smile – but, when it comes to my families health – well I want serious attention as I think all will agree that our health is no joking matter.
Well done don Juanito for bring this up.