Health Insurance Coverages: The struggle with

the public services

By: Angie Martínez | pursuing a degree in bilingual executive communication | Student
of the Universidad Tecnológica de Panamá, Regional Center of Chiriquí

E-mail: angie.martinez@utp.ac.pa

SUMMARY

In this research, an analysis of the coverage framework of the public and private
insurance services provided in the Republic of Panama is carried out, in order to
understand what is keeping the Panamanians from receiving decent medical care.

Surveys and analysis of each of the results were carried out, where certain data such as
the diseases suffered by the respondents and / or their relatives were determined,
revealing that the most common diseases among them are Cardiovascular / Pulmonary
disease and Diabetes; It was also revealed that, on average, for every family of 3 there
is one person with obesity. Therefore, since they do not have the money for private health
care, these people are more likely to use public health services. Most of them used the
survey to leave less than encouraging comments about this type of care.

Keywords: private health insurance, MINSA, medical coverage, surveys

ABSTRACT

En esta investigación se realiza un análisis del marco de cobertura de los servicios

públicos y privados dados en la República de Panamá, con el objetivo de entender qué
está impidiendo que los panameños reciban una atención médica digna.

Se realizaron encuestas y análisis de cada uno de los resultados, donde se determinaron

ciertos datos como las enfermedades que padecen los encuestados y/o sus familiares,
dando a conocer que las enfermedades más comunes entre ellos son las
Cardiovasculares/Pulmonares y la Diabetes; por otra parte, en promedio por cada familia
de 3 hay una persona con obesidad. Por ende, al no contar con el dinero para la atención
medica privada, estas personas son mas propensas a utilizar los servicios públicos de
salud, utilizando, en su mayoría, la encuesta para dejar comentarios poco alentadores
hacia este tipo de atención.

Palabras clave: seguro de salud privado, MINSA, cobertura médica, encuestas

 1. INTRODUCTION
Having a good medical care has always
been the priority, and having a backup for
health emergencies coverage seems like
the smartest idea in order to avoid
financial catastrophes in extreme
situations.
In 2010, the rough estimate of the
number of people suffering a financial
catastrophe represents almost 90% of
the world's population. In some
countries, up to 11% of citizens suffer this
type of serious financial difficulties every
year and up to 5% of them are dragged
into poverty because they have to pay for
health services at the time of receiving
them. (Garriga & Cont, 2013)
The research carried out shows the
severe struggle that Panamanians faces
every day in terms of medical care, even
though the majority of the population
has public coverage, many times these
same people have had to bear medical
expenses in private entities due to the
lack of attention and delay that is
provided to them by the Caja de Seguro
Social and MINSA.
The analyzes given in this research are
based solely on the answers given by a
surveyed population in Panama between
the ages of 18 and 77 years old, in order
to understand the different situations that
both, families and single people, live in
this tini tiny fragment of the world, asking
them pertinent questions such as if they
has suffer from some chronic illness and
if so which one, types of insurance
coverage they own, Income and
percentages paid at a household, etc.
Obviously, the surveyed population was
asked to please rate the type of health
service they have, whether it is public or
private, in order to be able to make a
comparison and understand how, why y
which one of these works better and
provides more, concluding with which
one would be a better investment.
Finally, with the help of graphs and
tables, the results obtained under the
applied research approach will be
supported.
2. STATE OF ART
“What they call paramedics down here
are not paramedics; they strictly transport
you to the hospital. They cannot
administer drugs…. Their first aid training
is very basic, and they have no
requirement to get annual updates.” The
availability of blood supplies in the event
of an emergency was also cited as a
cause for concern. (Sloane, Cohen,
Haac, & Zimmerman, 2013)
It is urgent to take action on the quality of
public health in Panama, since, if we
refer to the Performance Evaluation of
the Essential Public Health Functions of
the Ministry of Health, in 2001, the
"Quality Assurance" was the function that
posted the worst performance. Although
it improved in 2014, it still maintains a
value that classifies it with a medium-
lower performance. (Roa)
As we can see, it is the poor quality of
care provided by public services that
keeps us in extremely low positions
compared to other medical services,
whether in the country or abroad. There
is a great lack of preparation and in case
tragedies occur we do not have the
professionals properly prepared to
respond to them, this being one of the
causes for which we suffer losses.
100 patients with diseases such as
myeloma, chronic lymphocytic leukemia,
multiple sclerosis, severe hemophilia and
rheumatoid arthritis are still waiting for
their medication. They even specify that
two of them died while waiting for their
drug. (Jaramillo, 2021)
The Caja de Seguro Social (CSS) is in a
state of emergency due to the lack of
medicines despite having a supply
percentage higher than 80% that most
hypertensive patients use, there are
three medicines that are not available, as
they are: perindopril, andoriplina and
ibesartan (Fernández, 2021)
The lack of medicines is a never-ending
struggle when it comes to the Social
Security Fund, since, even in times of a
Pandemic, they fail to deliver the proper
drugs.
3. MATERIALS AND METHODS
In the week of October 5 to 12, an online
survey was developed where twenty-
seven classmates from the
Comunicación Ejecutiva Bilingüe course
called Banca y Finanzas distributed the
pertinent questionnaires for the research
problem to a hundred different people
each. This survey was carried out
through the Microsoft Forms platform
with a total amount of fifty-seven
questions through which it has been
possible to establish valuable information
for this research.
A review of secondary bibliographic
sources was made through the internet
where relevant information for this
research was obtained.
A) Type of research
Descriptive Research: it describes
situations and events, that is, what is it,
how is it and how certain situations are
manifested. Descriptive studies seek to
specify the important properties of
people, groups, communities, or any
other phenomenon that is subjected to
analysis. (Dahnke, 1986)
The research carried out is descriptive in
nature, as we will be in charge of
specifying the characteristics of the
population we are studying.
B) Population
The population on which this research
was based is made up of two thousand
and sixteen people between the age
ranges of 18 and 77, most of them, with
79%, belonging to Chiriquí, Bocas del
Toro and Ngöbe-Bugle, while the
remaining 21% is distributed among the
rest of the country.
 The household income of the
Lives in: respondents is approximately 1400
dollars, money that is used to pay the
Chiriqui Colon P. centrales Panamá expenses of the 4 estimated people in
each household, which would give an
equal of 350 dollars to cover all kinds
6% 13% of needs of each one.
2%

64% of the surveyed population has

suffered or suffers from a chronic
79% disease, making constant use of any
of the health services, whether is
private, Caja de Seguro Social or
MINSA.
Ilustration 1. Residency

Diseases that you or

4. RESULTS your relatives has
891
900
The survey carried out to two thousand 800
and sixteen people of which 62% were 700 647
women, 37% men and 1% reserving their 600
500 455
answer, different data could be collected,
400 282
and we will be analyzing it below
300 207
200
 Respondent profile 100
0
Most of the surveyed population is in CARDIO CANCER DIABETES OTHER NONE
their thirties, with a coefficient of
variation between ages of only 43%. Ilustration 2. Diseases
Considering that this is a fairly low
percentage, it is safe to assume that
the two thousand and sixteen people  Private health insurance coverage
are very close in age. The households
of these people are in average Only 7% of the surveyed population
inhabited by four people, the has private health insurance, either
minimum number of people living in with a local or international plan. Most
the same household is 1, meaning of these people rate the service
that that one person lives alone, and offered to them impeccably; however,
the maximum number of people living in the questions “How much you pay
together is 10. It is statistically proven now for your service” and “how much
that at least one of four people in a is the maximum you WOULD pay for
household suffers from obesity. the service” some discrepancies were
noticed in the responses, since some
said that the maximum, they would
 pay is curiously below of the amount
that they are currently paying. This
may be due to the fact that MINSA ratings
involuntarily, as a result of their job,
giving them a direct discount prevents
the person from having control over 8% 16% Good
how much they want to invest in their 2%
23% Excellent
health.
Regular
 Current coverage of the Caja de Poor
Seguro Social Very poor
51%
Only 45% of the surveyed population
have a public health coverage
service, either as contributor or
beneficiary. Ilustration 3. Ratings
Despite having the freedom to use
emergency room services,
When they were asked for the
medications, x-rays and laboratories,
reasons of their qualifications, the
people do not use them, or they
vast majority responded that it was
hardly use it, and this is due to the
due to the long delay they take to
lack of speed that is given to these
provide the pertinent care, the lack of
procedures, having to wait very long
tact that the staff has towards patients
periods of time to be able to get the
and how impossible it is for them to
pertinent attention.
get their medicines. Some even
pointed out that during the SARS-
 Other coverages of health expenses
CoV-19 pandemic, having been
infected, they followed the protocols
In this section we learned about the
dictated by the MINSA and called to
opinions that the entire population
notify and request the medicines,
surveyed has about the health
which were delivered to them on the
services offered by the MINSA, and
thirteenth day of their quarantine,
although the ratings were not entirely
which means they had to bear these
negative, they were not positive
expenses out of their money.
either, with a total of 51% of the
participants thinking that the service
80% of the surveyed population have
they offer is simply average, 23%
been treated or one of their relatives
think that the quality of their attention
has been treated in a private clinic or
is poor, 16% think they do a good job,
hospital in the last five years, and
8% say that it is terrible and the
95% of them are positive that their
remaining 2% claim that the care
experience in the private sector was
received could not be better.
better than in the public sector, while
the other 5% are almost entirely
people who have not been treated in
public clinic or hospital. 90% also
agree that the service offered in the
private sector is better than that
offered by MINSA or Caja de Seguro Average 126.50
Social STDEV 339.02
On average, what a person is willing C/V 268%
to invest to hire a personal private MIN 0.00
health service is an approximate of MAX 8,080.00
100 dollars, having a coefficient of
MODE 0.00
variation between responses of 313%
which indicates that there is a large MEDIAN 50.00
difference between the responses,
being $ 10,000.00 what maximum Table 2 (Money that you would spend
that someone is willing to pay. The for a private health insurance for you
most common budget the and your spouse, 2021)
respondents have is $ 50.00

Average 93.19 In the last stage of this part, it is

STDEV 291.50 questioned how much money would
C/V 313% you be able/willing to invest in order
to have you and your entire family
MIN 0.00
(children and spouse) a private
MAX 10,000.00
insurance service, and the average
MODE 50.00
response was approximately $200.00
MEDIAN 50.00
with the variation coefficient
Table 1 (Money that you would decreased by one. again to 233% due
spend for a private health insurance to the fact that a situation similar to
for yourself, 2021) the one shown above happens, and
that is that lonely people do not see
this investment as something
The data changes a bit when you necessary, therefore, as expected,
rephrase the question to how much they are not willing to invest more
you are willing to invest for private than for their own person; however,
insurance for you and your spouse.
the most repeated answer between
First, the average of what they are the respondents on this occasion was
willing to invest increased to $ 100.00.
approximately $ 130.00, with a
coefficient of variation lower than the
Average 194.50
previous one with 268%, this is
STDEV 452.54
probably due to the fact that since
C/V 233%
most of the people surveyed are
MIN 0.00
single, none of them find it necessary
to do this investment, that is also the MAX 10,000.00
reason why the most common answer MODE 100.00
was $0.00 and the maximum of what MEDIAN 100.00
they are willing to pay is $ 8,080.00 Table 3 (Money that you would
spend for a private health insurance
for you and your family, 2021)
  Family lifestyle
Finally, the respondents were asked
a series of questions to find out the
lifestyle they lead. The majority, with
73%, affirm that both their health and
their relative’s health are in a good
condition, 14% are indifferent on the
subject, and only 13% strongly differ.
When asked if they were concerned
about the health of their family, the
majority (97%), as expected, agreed,
however 2% showed indifference and
the remaining 1% said they were not
concerned at all.
The next questions were if they ate
healthy and exercised daily and that
resulted in 72% eating healthy, but
only 43% exercising daily and the
vast majority of comments were
indifferent, indicating that or no one
do exercise, or the person doing the
survey does not do it and does not
know if the others do. 10% do not
have good eating habits and 29% do
not claim to never exercise.
Most of the respondents would be
willing to allow devices to monitor
their eating habits, exercise, alcohol
consumption, etc. to lower your
monthly health insurance costs.
5. DISCUSSION
According to my interpretation of the
results presented in this research taking
into account the average number of
people who live in the same household,
and in turn the average amount of
income that each family has, it is safe to
assume that even though you are not
struggling to get to the end of the month,
they are not having a lot of money left
over, which could cause problems when
facing a crisis.
A minimum percentage of the surveyed
population answered that they do have
private health insurance; However, I can
infer that this is a benefit granted by the
companies in which they work at,
especially those that affirmed that they
have an international plan. Another
reason I infer this is because some of
these people responded that they would
pay for private insurance LESS than what
they are currently paying; This may be
due to the fact that this type of service is
being discounted directly, making it
impossible to prevent the investment.
It is known that 45% of the surveyed
population have the Caja de Seguro
Social health insurance and 7% have
private services, thus giving a total of
52% of the population, which would
mean that 48% do not have any kind of
backup in case some medical emergency
occurs, thus leaving them prone to
ending up in financial catastrophe.
The ratings given to both public services
(MINSA / Caja de Seguro Social) and
private could not be any more different.
Public services are strongly criticized
while private services are praised. This
might be because people tend to feel
safer and more respected in places
where they think their money is being
better invested. This has a lot to do with
the way they are treated by staff and the
speed with which they are given proper
care. By improving these aspects, public
services and private services would only
be a name since the care and security
would be the same.
 6. ACKNOWLEDGEMENTS
To the Two Thousand and Seventeen
people who help filling the survey, getting
this outcome would not be possible if it
were not for you. To my friends and
family who helped me in the beginning of
this project to spread the word about the
survey. To my classmates for sharing
their contributions towards achieving
this.
7. BIBLIOGRAPHY
insurance for you and your
family.
(October de 2021). Money that you
would spend for a private health
insurance for you and your
spouse.
(October de 2021). Money that you
would spend for a private health
insurance for yourself.
Roa, D. A. (s.f.). ¿Cómo mejorar la
calidad de los Centros de Salud?
OPS Panamá.

Sloane, P. D., Cohen, L. W., Haac, B.

Dahnke, G. L. (1986). Comunicacion E., & Zimmerman, S. (2013).
humana: ciencia social. En G. L. Health care experiences of U.S.
Dahnke, & C. F. Collado. México, Retirees living in Mexico and
D.F. Panama: a qualitative study.
Springer Link.
Fernández, S. (2021). Caja de Seguro
Social en estado de emergencia
por falta de medicamento.
Annex
Panamá America.

Garriga, M., & Cont, W. (December de Civil status of the

2013). Importancia de los
seguros de salud y cobertura de respondents
enfermedades catastróficas. La
Plata, Buenos Aires, Argentina.

Jaramillo, O. A. (2021). Pacientes 30%

crónicos denuncian falta de solteros

medicamentos en la Caja de casados

70%
Seguro Social. La Prensa.

(October de 2021). Money that you

would spend for a private health
insurance.

(October de 2021). Money that you

would spend for a private health
 Do you use medicines from
the Caja de Seguros
DAILY 96
ANNUALLY 289
I DON'T KNOW 34
MONTHLY 210
WEEKLY 37
NEVER 188

0 50 100 150 200 250 300

Your health and your relatives health

is currently optimal
800 754

600
462
400
205 236
200 19

0
AGREE DISAGREE INDIFFERENT TOTALLY AGREETOTALLY DISAGREE

Do you eat healthy?

1% Agree
27%
45% Disagree
Indifferent
18%
9% Totally agree
Totally disagree