Development & Aid, Headlines, Health, Latin America & the Caribbean

PARAGUAY: Public Health Care Free of Charge

Natalia Ruiz Díaz

ASUNCIÓN, Jan 6 2010 (IPS) - “Did you have to pay for anything?” is the obligatory question these days in the waiting room at the Mother and Child Hospital in Fernando de la Mora, on the outskirts of the Paraguayan capital, where people still have doubts that the public health services are free of charge, as the government had announced.

“They took great care of me. I had my baby by cesarean and the operation was free, and so was the medicine,” Gloria Ramírez, who gave birth on Christmas – the day nearly all public health service fees were eliminated nationwide – told IPS.

The measure was one of the campaign promises of centre-left President Fernando Lugo, a former bishop who took office in August 2008.

“Before I was admitted to hospital, I had planned on paying the fees. But luckily it was all practically free,” said Ramírez.

Seven percent of Paraguay’s population of 6.1 million currently have private health coverage, 20 percent are covered by the health services of the social security institute, the Instituto de Previsión Social, and the rest depend on the public health system.

But an estimated 40 percent of the population were unable to afford health care of any kind.

“What we are doing is making health care a right, regardless of a person’s ability to pay,” Diego Gamarra, director general of health services in the Ministry of Public Health and Social Welfare (MSPBS), told IPS.

There are some 1,000 public health hospitals and health clinics in Paraguay.

“It is still necessary to improve the quality of health care, and the way patients are treated in public hospitals,” said political scientist Milda Rivarola. “But without a doubt, free health care is the best thing that has been done so far in the democratic transition period, and is the measure that has had the most positive impact in terms of public services.”

Lugo was sworn in shortly before the 20th anniversary of the collapse of the dictatorship of late Gen. Alfredo Stroessner (1954-1989). His election as the candidate of a centre-left alliance of opposition parties and social movements put an end to 61 years of rule by the right-wing Colorado Party.

But Rivarola stressed that reforms are needed, to make free health care sustainable in the long term.

“There is too much informal economy, and very high levels of evasion of social security payments. It’s the state that ends up paying, and in this scenario, free health care will not be sustainable,” she said, calling for an efficient fiscal policy as well.

Gamarra said the measure will cost around six million dollars a year.

The total public health budget for 2010 is 385 million dollars, seven percent higher than last year’s, but only just over five percent of the entire state budget, which makes it one of the most underfunded sectors.

“A central aim is to make the public health issue a question of national debate,” said Gamarra.

In his view, until spending on public health is increased from the current low level of 2.8 percent of GDP, adequate coverage will be impossible, even if people receive health care free of charge.

“The tax system has to be reformed to make that possible. But we had to start somewhere,” he said.

The MSPBS gradually began to make some public health services free in September 2008, when fees for office or outpatient visits and emergency room visits were waived. Later, hospital admission fees were eliminated, along with charges for intensive care, post-op incision care, nebulizer treatments, treatment in an infant incubator, oxygen therapy, surgery and other services.

In late 2009, fees were removed for diagnostic tests in all specialties, and for dental and ophthalmological services.

In his Christmas message, Lugo mentioned the steps taken to make public health care free of charge, as one of the main achievements of his government.

But Rivarola said that “when a government dedicates a large part of its time and efforts to staving off collapse, it is impossible to advance much in terms of state policies.”

She was referring to the conservative opposition’s majority in Congress, which has undermined governance, as well as constant threats of impeachment that have come from the opposition, mainly the Colorado Party. In addition, the Supreme Court is made up of magistrates appointed over decades by that party.

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