Tuesday, 24 November 2020

Does Public Healthcare (Caja) Deserve to Survive?

(QBLOGS) The Caja (Caja Costaricense del Seguro Social – CCSS) has tried and tried to provide quasi-public healthcare for 70 years only to face an insurmountable deficit, long lines, a shortage of doctors, much needed medical equipment, and minor league patient care.

The original intent was or is admirable, but reality is not. Why not start over again and kill this sacred cow for the good of humanity.

I am a paid in member of the Caja as should be everyone else who lives in this country. No proof of insurance, no legal residency of any kind. By law everyone who resides in Costa Rica must pay the Caja’s monthly insurance premium even if you have health insurance with a private carrier and never intend to use our public services.

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This begs the question, “How can this pure government monopoly be broke?”

It is easy to target the Caja because the mistakes are pretty obvious and overruns are just part of life. The lack of premium collections (even the central government is delinquent) and most of all a staff that cannot and will not accommodate even the basics of public health. After all, law created this Frankenstein monster, now the government needs to keep it under control which so far, like almost every bureaucracy,can not.

For example, La Nación, arguably the most important Spanish-language newspaper, reported that there are 40,000 patients waiting for an ultrasound. Accordingly, if one was pregnant she would deliver before her turn in line.

Why? Lack of reliable equipment, lack of reliable personnel and lack of physicians to read the results. And most of all, the lack of people who care including anemic management.

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A 78 year old man needs to wait until the year 2022 just even to see a urologist. Chances are he’ll be dead by then. (As macabre as it might seem, you might even be able to wager on one of our many sport books.)

A brand spanking new Ebais (community primary care health clinic) which is totally modern with two minor surgery rooms has no x-ray machine. You break or sprain a hand; it is down to the chaos of Hospital San Juan de Dios in central San Jose for two days. One day to make the appointment and another day to wait with at least 100 other patients also needing an x-ray. Then back to the Ebais for treatment. Perhaps a week or two goes by.

You might be treated at Hospital San Juan de Dios and the doctor prescribes something for your migraine, broken leg, etc. However the pharmacy is not on the hospital premises, as to be expected, but rather it is a good three block walk away and you do need to walk. No shuttle, just tough it out.

Here is a little trick to speed up healing.

Most physicians of the Caja also have a private practice at a private a hospital. Like magic, for their standard fee you can be examined and “squeezed” in to obtain medical treatment at the Caja. The private physician visit might cost about $100 on top of your Caja premium, but if you are ill in enough, in pain or scared; it is worth it.

Like most everything else in the land of Pura Vida, It is a question of working the system.

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The Caja needs to survive, but it must also must recognize the value of “paid-in” patients as “clients” and it must streamline the ever increasing administrative staff who see numbers and not people in need of health.

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Juan Sebastian Campos
An expat from the U.S., educator and writer in English and Spanish since 1978 with a doctorate in business administrations (DBA) from the United States and Germany. A feature writer for ABC News, Copley Press and the Tribune Group with emphasis on Central America.

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