My wife and I live on a small farm in a fairly remote, rural area of Panama, up in the mountains. This article is based on several years of observation of the health care system here. For people who have insurance and/or sufficient funds, health care is excellent, and in many respects superior to that in the U.S. It is also dramatically less expensive, and for that reason there has been some medical tourism. However, this article is not about that. It is about the health care provided to people who have neither private insurance nor much money.
The public health care system is available to all residents, Panamanian or not; an eighty year old Canadian friend who lives nearby lacked health insurance but needed a month of chemotherapy treatment; he received it at the public oncology hospital in Panama City. His total costs, including daily hospital visits, chemotherapy, a modest hotel room, transportation to and from the hospital, food, etc., came to less than $1,600. He survived, and is doing quite well.
Most people who are employed full time are covered by the Panamanian social security system. With very few exceptions, those who are not covered are not covered because the employer is breaking the law. The system is funded by employer payments (15.96% of salary) and employee payments (9.2% of salary). People who are self employed are not automatically covered by the social security system, but can be if they wish by paying a modest amount into the system. Unlike the system in the United States, health care is provided to all people covered by the system and to their immediate families, during their working years, as well as following retirement.
Within a twenty-five minute walk from our farm, there is a social security medical clinic in Potrerillos Arriba (population 1,165) which is open daily. The clinic is staffed by a nurse six days per week and, once or twice a week, by a physician as well. Care is provided to patients covered by the social security system at no charge, and is provided to others at minimal cost, roughly $3.00 for a routine visit. People perceived to have serious health problems are seen promptly, others have to wait a bit. If adequate care cannot be provided at the local clinic, the patient is transported, by ambulance if necessary, to the next level of care, in Dolega (population 1,843), roughly twenty minutes away. A physician is either there, or available at all times. Should care unavailable there be required, the patient is transported, by ambulance if necessary, to the social security hospital in the nearby large city, David (population 124,500), roughly twenty minutes away from Dolega. All of this is done without charge to those covered by the system and their families, and at very low cost to others. Some quite costly medical procedures, such as major organ transplants, are not available at the hospital in Dolega. Some procedures not available in David are available at a social security hospital in Panama City (population 708,738), a six hour bus ride away. The ambulance which is used to transport people to the clinic in Dolega and to the hospital in David is also used to transport people without transportation from their homes to the local clinic.
Care at the social security hospital in David is pretty good, but the families or friends of patients are expected to do their part by bringing food, changing bed linens, and doing other things of that sort normally done by hospital staff at private hospitals. Since extended families are common here, that is not so bad and obviously saves money. The public health care system here is basic, but is probably about as good as it can be with the resources available. To the best of my knowledge, there is nothing comparable in the United States.
The system here certainly has flaws: There are some very remote and sparsely populated areas where the closest clinic is hours away and bus transportation (very available and inexpensive in most parts of the country) is unavailable. Neither, to a great extent, is cellular telephone service. Those seriously ill and unable find a ride or to walk are out of luck. Recently, there was a scandal concerning tainted cough syrup distributed by the health clinics, which resulted in some deaths. Ingredients had been imported from China, and mislabeled; ethylene glycol had been used instead of glycerin. All medical care systems have deficiencies, but despite the occasional lapses, the system in Panama is pretty good.