Sometimes Caja medical care shines and sometimes not

Jo Stuart is taking a week off. In this space she has generally praised the Caja Costarricense de Seguro Social for the medical service she has received.

Ms. Stuart has been lucky enough and personable enough so that she easily makes good contacts at Caja hospitals and clinics. She believes in state-supported medical care, and from her experiences she is justified in doing so.

This column is really a report on the good and the bad in the Caja system as experienced by staffers of A.M. Costa Rica and family members.

At worst, the Caja system is inconsistent.

For trauma care, there is nothing better. If you look down and find a knife in your chest, Hospital Calderón Guardia or Hospital San Juan de Dios are the places to go. They have a lot of practice. For major accident and trauma issues and complex surgeries, Hospital México in la Uruca is as good as it gets.

Many say that Costa Rica has free, universal coverage. Neither is true. A.M. Costa Rica gladly pays around $1,500 a month for health and other coverage of employees. Everyone who works at A.M. Costa Rica full time is an employee and covered. The payment also includes pensions and some other fees.

Jo Stuart and others have affiliated with the Caja system independently. All expats with residency now are required to affiliate with the Caja, and there are several ways of doing so. An independent contractor, like a part-time maid, a plumber or gardener should have his or her own coverage as a service provider. They also should have their own riesgo de trabajo or workmen’s comp insurance, but that is another story.

A.M. Costa Rica gladly pays the Caja bill every month because the health system has cured the tiny daughter of an employee of childhood leukemia. For that, the Hospital Nacional de Niños wins high praise and deep respect. It is the best children’s hospital in Latin America, we believe.

The path to a cure was rocky initially. The little girl experienced problems walking, and parents took her to the local Caja clinic. A physician there who apparently slept through most of his diagnostic classes said the girl had arthritis. He ordered aspirin.

That did not sit well with the parents, who took the child to a private physician at Hospital Clinica Biblica. Apparently trouble walking and joint problems are red letter signs of leukemia, and it took this doctor a short time to remand the tot to the Hospital Nacional de Niños. From there on the treatment was first-class. Many private physicians here also are affiliated with the Caja and have full access to the state system.

Two other events loosely related to A.M. Costa Rica staffers did not reflect favorably on the Caja hospitals.

In one case a staffer’s sister-in-law was giving birth to her
first child at the Hospital de Mujeres, otherwise known as La Carid. The staff at this hospital has never heard of pain management, and mothers give birth without any spinals or other methods to diminish the pain of delivery.

This woman, however, ran into trouble. The husband was in a panic and eventually picked the woman up from her bed and carried her to a taxi and then to Hospital Clinica Biblica. Mother and child were fine, but the private physician said the situation was a close one and that both were at the point of no return when they came in. The bill was about $2,000.

Another staffer did deliver successfully a child at La Carid after a prolonged labor. She paid nothing.

In another case, the relative of a staffer became enraged when he was told a biopsy could not be done for a year. He feared he had testicular cancer. Police escorted him from the hospital.

A private physician fixed the problem with an outpatient procedure in his office in a half hour. There was some blockage of fluid, which seems to be frequent with men who sit most of the time at work. This man drives a taxi.

Other staffers have complained about long waits at Caja clinics and the inability to see a physician rapidly. There also is the problem that physicians are not always the same during repeat visits to the same facility.

Staffers also have made use of the Caja pharmacies when they have prescriptions written by private physicians who also have Caja privileges. The medications basically are free, although sometimes the Caja has been accused of having outdated products or products from an unusual source.

None of these problems are unknown to Caja officials. They try to do more with less. But not always.

A former head of the Caja, a political appointee, is on trial for engaging in a $9 million kickback scam in the purchase of $39 million in unnecessary equipment.

There also are occasional complaints that individual physicians are extorting money from patients. So corruption is possible as with every big institution.

Those injured in work-related events usually only visit the Caja for emergency care. The Instituto Nacional de Seguros maintains a chain of its own hospitals. This is the same state company that writes the workplace insurance. They emphasize rehabilitation.

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