Savings in healthcare

Aruba is sluggishly following the reform implementation agenda, and will ALMOST meet all deadlines for the third quarter of 2021. However, the lack of progress in structural reforms in health care, partly caused by the standstill of the General Health Insurance (AZV) target, is worrying, says an October 6th masterpiece, by our favorite, Knops, the State Secretary for the Interior and Kingdom relations.

We were supposed to SAVE 60M, but were only able to squeeze 40M, by cutting services, and postponing treatments, NOT by making structural changes.

In Aruba each family physician has his own practice, with a secretary, and in some cases, an intake nurse, but most of the time the doctor sees patients directly, without any previous screening – that saves time. Each physician is the ruler of his own kingdom, and he gets paid per patients assigned to him by AZV.

Each house-doctor is assigned about 2,000 to 2,500 patients, and he collects for each and every one of them, whether they come to see him or not.

Imagine, I visited my house doctor once in 2020, and never in 2019 – thank you Lord.  Yet he got paid every month for his availability and willingness to see me. He got his money whether I use his services, or not.

The pharmacists, on the other hand, get refunded for the prescription cost they provide, plus a set administrative fee. If you do not visit the pharmacy, the pharmacist doesn’t make any money off you.

Why can’t they do the same with doctors, so they get paid for the patients who do come to see them — then they actually have an incentive to work.

In the current system, many doctor practices make it impossible to set an appointment, they have a first-come-first-serve policy, ahead-of-time appointments are not available, and you have to catch them at certain times, otherwise, nada.

In the old day, before AZV, we all had private insurances. Those working were insured via their employer. But the retired elderly and the kids, were not automatically covered. Instead of just creating a program where kids and retired elderly are insured, the ruling party at the time, AVP, threw the baby out with the bath water by creating a monster, AZV, a fantastic idea, that can never work, because we can’t afford it.

AVP only had a challenge to insure kids and retired elderly, yet they opted for an impractical political maneuver, and here we are 20 plus years down the road, victims of populism, broke.

Think about the upcoming co-pay on medications, for example: In order to save on health care costs, we will be asked to shell out Awg 5 per prescription, which will not be a big hurdle for working folks. But again, think about kids and retired elderly. Working parents will have a difficult time shouldering co-pay for their children’s medications, and the retired elderly will have to choose between food or medication.

Why not just exempt these two demographics from co-pay??

Let the middle demographic pay, exempt both ends of the spectrum.

The endless procrastination regarding co-pay is fear motivated. Our politicians are afraid to implement the decree.

Also, why not try to merge medical offices, instead of each doctor reigning over his private kingdom, merge them all into large clusters, with shared services, from cleaning, to nursing to security, based on European and South American models, why not create medical collectives?

These would be structural changes that save healthcare money.

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October 09, 2021
Rona Coster