Judithe and I met with Dra. Uribe, an adolescent medicine specialist who works with CFHI, on Monday night. We will meet with her each Monday night for a lecture on a varying topics. She is so much fun to work with and I am already looking forward to next Monday! Our first lecture was on Bolivian healthcare. She does not speak English so the lecture was in Spanish, but she was very easy to understand. She also gave us our rotation schedule (we got to choose which areas we wanted to work in) – 1st week infectious disease/clinic with Dra. Salete, 2nd week pediatric surgery, 3rd week neonatology, 4th week nephrology/adolescent medicine. Exciting!
I learned from Dra. Uribe that every child under 5 years old, all pregnant females, those with disabilities, people over the age of 65, and those with certain infections (HIV, TB, and Chagas) get free healthcare from the government. The only requirement for this insurance is that you have to be a Bolivian citizen, otherwise you are not eligible. There are three tiers of patient care: the first tier = primary care clinics/urgent cares; second tier = local general hospitals; and third tier = specialized hospitals, like Hospital del Niño or the Womens hospital. They started a new initiative last year to try to get patients to start using the first tier (ie. going to their family doc or pediatrician) when they have minor illnesses rather than going straight to the second tier hospital (a very prevalent problem in the United States and apparently here as well!). If they go to the second or third tiers (hospitals) when they could have gone to the clinic, they are required to pay rather than getting their care for free. The idea is that this will free up the hospital resources for the patients who really need them. If the local hospitals cannot diagnose or treat a patient, they will then refer that patient to a specialty hospital (the third tier). Each separate municipality pays for the first and second tier, but since patients come from all different municipalities to the specialty hospitals, the federal government pays for those.
Every doctor who works in a public hospital is paid by the government and they all have the same salary regardless of specialty (a pediatrician makes the same as a plastic surgeon here!). My understanding is that family doctors receive the lowest pay. Doctors who work in public hospitals are required by the government to work 6 hours a day, 5 days a week in order to receive their salary. Last year the government tried to change their work hours to 8 hours a day for the same salary (no extra pay for working overtime on nights or weekends, either). However, the doctors went on strike for a whopping 54 days to protest this. Only the emergency rooms and hospitals were open during this strike- no clinics or unnecessary things. They eventually won (Dra. Uribe excitedly told us) and they are now compensated properly if they have to work overtime.
I think the tier system makes perfect sense and it seems to be working well for Bolivia. Healthcare and health insurance is changing so much in the U.S. right now so it will be interesting to see where all these changes take us in the next few years!