Insight into Colombian Healthcare

Through the help of a family friend, Jerry and I were able to sign up as independents within the Colombian healthcare system. We pay roughly $35/month for both of us, and our co-pays are only $1. I must admit, we are somewhat cheating the system - we applied as people who make minimum wage, keeping our costs down. But hey, that's what happens when you have connections.

It has been interesting getting to know a system that is completely different from the US. Appointments are hand-written in a book. Jerry reminds me it wasn't that long ago when it was like that in the US. When I called to try to schedule an appointment a month ahead of time, they wouldn't let me - "our calendar doesn't go that far into the future." So different from needing to schedule appointments in the US up to several months in advance. On the other hand, it means that there is usually no problem scheduling a same-day or next-day appointment.

One wonderful thing about our health insurance (I can't speak for the whole system, only for my experience) is that birth control is free. $0. I have to go once a month to the nurse to check in and make sure everything is going OK and pick up my birth control pills. For me, a monthly check-up isn't exactly necessary considering I've been with the same stable partner for years, and at first I was annoyed to need to schedule appointments every month. But for those women and girls who have no one to talk to honestly about their sexual activity and birth control, it's actually pretty brilliant. Not to mention, if all it takes is 10 minutes a month for free birth control, I'll take it.

The other day I went for my monthly appointment and ended up asking the nurse tons of questions about women's health in Colombia. She told me that abortion is illegal here, except in the cases of rape (she specifically mentioned rape of minors) and if the baby/mother is seen to have major problems within the first trimester. She quickly added that, of course, there are casas (houses) that perform abortions, many of them in that same neighborhood. Pregnancy amongst young teenagers (13, 14, and 15 years old, and as young as 11 or 12) is not uncommon. According to this nurse, amongst some poor populations where the teen pregnancy rate is very high, many young women choose to have kids at a young age because they don't want their children to view them as old. I had never heard such a point of view before and my jaw dropped. She talked extensively about how the strong influence of the Catholic Church in Colombia (and elsewhere) prevent the promotion of real sex education and the legalization of abortion.

On top of all of this, a scandal within the Colombian healthcare system has recently unfolded with our insurance company, SaludCoop, as a central player. In order to explain it to you, first you need to know a little bit about how the healthcare system works (according to Mauricio, one of my English students who gave me the run-down today). There are 4 main actors: 1) The patients, 2) The service providers, 3) The insurance companies, and 4) A government fund established in 1993 that subsidizes healthcare throughout Colombia. Patient goes to service provider to receive treatment. Service provider bills the insurance company. Insurance company gets reimbursed from the government fund.

The scandal (at least as far as my understanding goes - hell it'd be hard enough to understand a scandal like this in the US in my native language and in my own culture) is as a result of the insurance companies telling the government fund that they paid a lot more than they did, and thus getting reimbursed for way more than necessary. AKA money going directly to someone's pocket. According to Mauricio, some guy within the insurance company and some government official had been doing dirty deals together - which is bad enough - but on top of that, they then started a business together to counsel insurance companies on how to ask the government fund for reimbursement. Some people are going to jail, but who knows if things will change.

Mauricio explained that people like him (with money) pay more and subsidize people who can't contribute much or anything to the system. He agrees with that practice, in theory, but with all the corruption that exists, it's not actually effective at providing people with the best treatment.

He then asked me to explain to him how the healthcare system in the US works, and I realized that I know next to nothing about the new healthcare law, except for that some of my friends could now be on their parents' insurance again. And you can't deny someone coverage due to pre-existing conditions. I think now I need a student in the US to sit me down and explain the system to me in layman's terms.