Tuesday, December 2, 2008

Private Health Care Under Stress In Venezuela As Patients Abandon State Health Service

Under ever increasing siege as people with the means to do so abandon Venezuela's ramshackle state health system, private sector clinics and hospitals are creaking at the seams. And, fuelled by soaring inflation, seeking refuge in the private sector is getting more costly by the day.

Once was when private medicine was largely about status and comfort or non-essential services such as plastic surgery, a lucrative market raged in a self-conscious society where looking good comes at or near the top of quite a few people's personal agendas. But that stopped being the case quite some time ago.

More and more people are turning to the private sector for emergency treatment, such is their lack of faith in the state's ability to put them right. In Caracas alone, about 6,000 people turn up for such treatment every month.

Even poorer people recognize that private medicine offers them a better chance of getting proper treatment. According to the Venezuelan Insurance Chamber (CAV), an estimated 21% of people on low incomes say they have health insurance and are willing to pay around eight percent of their incomes to have it. Not so long ago, the comparable figure was 9%, and many of them were insured by their employers.

The heath insurance business is booming. The reckoning at CAV is that the value of new collective health insurance contracts has risen by 60% since 2005. But providers of private medical services haven't been able to keep up with demand.

The result is that the private sector has begun to take on some of the aspects of the state sector. Patients outnumber the limited number of cubicles where they're attended, and they can find themselves waiting for hours.

This is not a good thing for a people who are scarcely renowned for patience, and all the more those who reckon they're not getting what they paid for. Less than drastic cases can end up getting treated in corridors even in swanky establishments.

Tempers get frayed on both sides. That, too, is reminiscent of what's become all too commonplace in the state sector. Meanwhile, the bills are piling up – and some clinics have gotten in to the habit of charging by the hour for facilities, and then there are the doctors' and specialists' fees on top.

Figures from the Venezuelan Central Bank (BCV) show that the cost of being seen by a doctor in the private sector and then paying for items such as laboratory tests, ex-rays and so on leapt by 36.5% during the first 10 months of this year.

The government, aware of its seeming inability to get a grip on inflation, has pointed the finger at greedy, exploitative doctors raising the bills at the expense of long-suffering patients. It's not that simple: The increase in medical charges roughly mirrors inflation in the country as a whole.

Just why the government has equally been unable to put things in order at state hospitals nobody seems to know. But there's no shortage of anecdotal horror stories of medical waste and other garbage piling up in corridors, uncollected by anyone, dirty walls, stinking washrooms, unchanged beds, staff treating patients roughly or not at all, and perhaps worst of all, shortages of basic medical supplies such as bandages and so on.

It seems just about everybody has a grim tale to tell about experiences inflicted on relatives or themselves, including he who writes. A few years back, this reporter ended up in a large state hospital in south east Caracas with cracked ribs and a collapsed lung after an accident.

It took four doctors to push a tube through the ribcage to drain the lung; three to hold the patient down and one to do the job. There was no anesthetic, but there was a lot of yelling during this Dickensian bad dream in the wee small hours of a nightmare.

Once in the relative safety of a ward, there was no warmth, no blanket, only the clothes he came in. There was nothing to eat or drink. Nobody, least of all the torture squad of doctors, came and took a temperature or the other little rituals that reassure patients somebody's looking after them.

Hauled off to a freezing cold shower because "you stink" after three days on inattention, a gaggle of crone-like harridans in nurses' uniforms gathered to cackle at the unfortunate's shriveling manhood. No soap, no towel, but finally a surgical gown to put on.

Food and painkillers? That's up to your family. They're on the other side of the Atlantic? So what? Go Home or words to that effect. Luckily, by then a colleague had tracked the patient down.

On the fourth day, a doctor who had nothing to do with the case suddenly turned up, evidently worried about what was or was not going on. Told that enough was enough, he reluctantly agreed, removed the tube and the fluid collection bottle to which it was attached, found a phone on a desk just outside the ward, and signed the patient out to be taken home by a friend who'd been wondering where he was.

Be warned. If you're visiting Venezuela, don't believe you can busk it on health insurance. Unless, that is, you want to risk learning the hard way. It's enough to make one miss Britain's National Health Service.

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