In my post titled “Reflections upon a return to Boquete” I stated.
“ It fascinates me that in Panama workers can have a month off from work each year, that Social Security in a third world country can cover medical care and medicines. Agreed the system is flawed, it is imperfect, but I have friends working solely so they can get medical insurance in the US.”
This section prompted some comments about Social Security in Panama. In my statement I did say “the system is flawed” it is but it is better than the working poor have had in much of the US in the past, it is possibly better for many in the US now with new Affordable Healthcare changes.
I want further explore the good and the bad about Panamanian Medical Care, public and private. All that I will write about the Public system is anecdotal, I have personal experience only with the private system.
In Panama workers pay about 10% of gross earnings into Social Security, more than the 6.2% employee contribution in the US. Employers in both countries also pay about the same amount as employees. In the US Social Security only covers retirement, Medicare is separate and partially covers healthcare for those over 65, who often need to purchase supplemental insurance to fill the holes in Medicare. In Panama Social Security covered both medical care for them and their families, as well as retirement. Employees can, if they wish, also purchase private health insurance.
Panama has three parallel systems, often with the the same doctors crossing between public and private. Anyone can pay for healthcare in either the private or public system. The public system includes a network of clinics and hospitals operated by both the Ministry of Health (MINSA) and the Caja de Seguro Social (CSS). Anyone can use either system and if they are covered by Social Security, care is free. Care is not always available, medicines are not always available, many procedures require long waits. The last part sounds a lot like what I hear from Canadians about their system.
My experience with the public system is listening to friends, both expat and native who have used it and some first hand observations. I have been in the CSS Regional Hospital in David as a visitor, not a patient. In two circumstances where people were in immediate need of attention, one a serious motorcycle accident, the other a stroke, the CSS system worked as designed. They were triaged and admitted quickly and received in their words, very good care. In another that spanned both the public and private system, Papa Ricco and his hernia. Ricco had surgery in Hospital Chiriqui, private, and after having complications and infection he went to the CSS Regional in David. Rico, shortly before his death in a traffic accident, told me he thought the care he received in CSS Regional was good and they did not ask for payment, which was minimal, until he left.
I have interviewed doctors and nurses who work for both MINSA and CSS, they all say the same thing. They do their best with inadequate facilities and too many patients. I have been in consultations with doctors in their private offices and when an expensive test of procedure is discussed they ask if I am eligible for Social Security in Panama. They try to move some of the major costs into the public system. I again know from anecdotal experience that in a non life threatening procedure or test, the wait can be brutal, that makes sense with limited resources and priorities of triage.
My employee has Social Security, I pay it. I have driven his mother to the clinic in Boquete and to the CSS regional hospital in David. She would have no healthcare without his Social Security; something is certainly better than nothing. The system on paper is excellent, the system in practice is inadequate for the population and needs of the country.
In my time in the US, I needed emergency room care for myself and others at times. I preferred University Hospital at the University of Arizona. They had some of the best doctors in the city and in some specialties some of the best in the country. Waiting in the emergency room was often a long tedious event unless you could convince a nurse that life was in immediate danger, waiting for a doctor in a clinic either public or private here in Panama is no worse. I have spend hours waiting for routine appointments in Hospital Chiriqui, a private hospital. I have also been treated in minutes in the same facility in an emergency.
If you put my observations into a summary, they system here is perfect, on paper, imperfect in execution. On paper, workers and their families have healthcare and retirement covered by payments made by themselves and their employers into Social Security. Everyone who qualifies for underwriting has an option to buy either national or international private health insurance, if they can afford it. If people are not able to qualify for Social Security and cannot afford or qualify for health insurance they can use the public system at a low cost.
If you need to use the public system you need to have an angel (please read this post by Don Ray), a Spanish Speaking advocate to push your priority or you might indeed die in the waiting room because of the lack of staff, facilities and inability to communicate. But I am not so sure this is different in a public hospital in other countries including the US.
Since my knowledge is limited to my experience, I welcome more comments from others who read this and have had experience in the Public healthcare system. I know there will be both positive and negative experiences, that is inevitable. Medicine is imperfect and although we all hope for a positive outcome, ultimately we all meet our maker, just best when it is not premature.