Beach and Health Insurance – what a wonderful combination

23 03 2011

I’M SO SORRY IT’S TAKEN ME THIS LONG TO WRITE A NEW POST! But I have to say, time has suddenly sped up and I am having a hard time wrapping my head around all of the things I have done and still have yet to do in during my time here. Daily life is going well, I feel like a true Santiaguero. I have the concho routes down, know where the best (and cheapest) food is, and probably most importantly I know which stores have frequent sales 😉 Classes are going well, I have gotten to the point with my language that I can zone out for a second and zone back in and not have missed much, in other words I am understanding everything without having to be clenching my jaw and straining my neck muscles in constant attention (not that I’m doing any zoning out in class…). My research is going very well, I have started working in la Zona Sur with a health promoter and I am finally all knowledgeable about the health systems here and will be starting interviews next week! More to come on the research later on in this post.

First, let me tell you about the BEACH. I skyped in to one of my sorority’s chapter meetings the other night and one of my sorority sisters said “Gabriella, just so you know it was snowing outside of my window while I was looking at your pictures on the beach. I was not happy.” I have come to realize how much I really do enjoy warm weather. I never really disliked the snow/winter but I have noticed that I do not miss it at all. So I have been taking advantage of my current residence on a Caribbean island and have been to the beach at least once per week. I think I’ve got just about all of the beaches under my belt with the exception of Punta Cana which I will be visiting this coming weekend to see Alana who will be here for her spring break!

My host father’s sister, so my aunt, has a BEAUTIFUL apartment in Sosua- a town in the providence of Puerto Plata which is about an hour and a half from Santiago. She invited the family for a weekend. I can’t even describe how excited Alejandro and Marco were to be on the beach. It reminded me of our “beach week” each summer in Ocean City. I’m pretty jealous of my brothers, I don’t think Ocean City MD really compares to this Caribbean beauty, the pictures tell it all. I spent Saturday and Sunday enjoying the pool and the beach with my aunts, uncles, cousins, grandmother, parents, and brothers. Wonderful company, good dominican food, and a beautiful beach- enough said!

The pool just yards away from the apartment patio

The view of the ocean

 

With Alejandro on the beach

Sosua - probably my favorite beach on the Northern coast

This past weekend I took a three day trip to the south with a group of Dominican and American friends. There were 14 of us in total, we camped out on the beaches, cooked over fires, bathed in rivers, and enjoyed arguably the most beautiful vistas in the country. We traveled in a bus with a driver that we hired and we went from Santiago to the capital, Santo Domingo, then through Bani to Bahía de las Aguilas. To give you an idea, it took us from 10:30am until 10:30pm to travel from our last stop back to Santiago. (Check out the map to see our route!). Let’s just say, my camera got a great workout. It was quite an experience camping on the beach. I was blessed with a wonderful group who planned well and provided great company. We all pitched in and returned to Santiago with about 800 pictures and countless stories. I was happy to return to my bed and shower, but I secretly missed the fun sleeping in tents on the beach and stopping the bus whenever we found a river to all jump in with bathing suits and soap. The pictures tell the story 🙂

 

The blue line and flags represent our route

Group pic!

Las Dunas de las Calderas

From the lookout at the Dunes

The guagua

Salinas de Bani - salt mine

 

A view of San Rafael

Unloading the guagua to set up camp

San Rafael - a river flowed into the ocean

What a beautiful place to sleep!

Woke up to see the sunrise over the ocean

The way the river flowed into the ocean was beautiful

En route to Bahía de la Aguilas

 

A quick stop at Pozos ecologicos

 

Almost there...

On the boat to get to Bahía de las Aguilas

 

Another view from the boat

 

The amazing vista was worth the long trip!

 

The sunset at Bahía de las Aguilas

My favorite picture of the trip!

The view from my tent when I woke up 🙂

We really enjoyed our baths

 

One last amazing vista to top it off

And now for my research. I have learned so much that I want to share and I have realized that it is impossible to do so without a conversation. HEALTH SYSTEMS ARE INCREDIBLY COMPLEX. Why, you might ask? Here’s my opinion: Health care exists at the intersection of business and public service. Health is seen as a human right and therefore should be guaranteed but quality of health care is dependent on resources that are available in the health market. There are questions of finance, accessibility, and quality. Health care is also a very interesting mix of goods and services. So, the challenge is combining the aspects of business markets and public service institutions to provide health care.

An update on my paper: it is now about 20 pages (phew!) and I am also working on a powerpoint presentation. I promise to print a copy for whoever wants one 🙂 My paper first compares a sampling health insurance systems from different countries then explains the demographics of the DR, the health situation here, and then the insurance law. I have done most of my research in Spanish but am writing my paper in English. I will probably write parts of it in Spanish as well as the presentation because on of my professors would like to use the material for her class. My Spanish has improved so much in terms of vocabulary from my research! It’s actually getting challenging to express myself in English sometimes. I find myself using the grammatical structure in Spanish or only thinking of the Spanish word to explain something.  I am writing interview questions that plan to target the financing structure that is in place and education that medical professionals and patients receive about the law because these are two areas where I have noticed there to be gaps in the logic of the system. The financing system is such that the employee ALWAYS gets a percentage taken out of his/her paycheck regardless of the amount he/she makes. But, the government will help the employer cover the rest of the health insurance expense. Is this guaranteeing the employee quality heatlhcare? Another interesting observation is that this insurance system pulls from MANY governmental, non-governmental, public and private organizations. The network of services and financing is complicated. Seems as though instead of pooling resources, they are pulling a little bit from here and there. I am curious to know how this actually plays out- do the hospitals who care for patients with this public insurance really get paid?

Of course this is a very complex topic and I learn more and more everyday and cannot wait for interviews to come to some conclusions! So for now, here is my outline of the Social Security law that guarantees (apparently) every Dominican with health insurance. I would love to read the law in the States…although that might take me a few years (and I thought this 70 page law was a lot!).

Ley No 87-01

Sistema Dominicano de Seguridad Social

Key of Acronyms:

–       SDSS: Sistema Dominicano de Seguridad Social

–       DIDA: Direccion de Informacion y Defensa de los Afiliados

–       ARS: Administradora de Servicios de Salud

–       PSS: Prestadora de Servicios de Salud

–       AFP: Administradora de Fondos de Pensiones

–       SESPAS: Secretaria de Estado de Salud Publica y Asistencia Social

–       CNSS: Consejo Nacional de Seguridad Social

–       SNS: Seguro Nacional de Salud

–       SSRL: Superintendencia de Salud y Riesgos Laborales

–       AMD: Asociacion Medica Dominicana

–       CONEI: Consejo Nacional de Estancias Infantiles

–       SFS: Seguro Familiar de Salud

Objective of the law: To establish the system of social security in the Dominican Republic to regulate and develop rights of the citizens and finance the protection of the population against risks of old age, disability, survival, sickness, motherhood, infancy, and job risks.

Goal: Have the entirety of the Dominican population enrolled in the social security system within 10 years of implementation. (Implemented in 2001, planned complete enrollment 2011)

Principles of the law:

1.     Universality – the law protects all Dominicans living in the Dominican Republic and abroad

2.     Obligatory – participation is obligatory

3.     Integrative – everyone has the right to sufficient protection that guarantees satisfactory life

4.     United – the benefits of social security are coherent

5.     Equal – access to all services is guaranteed to everyone benefiting from the system

6.     Solidarity – everyone will have access to all services for a cost that is determined based on salary

7.     Free election – the right to select the health facility that is accredited

8.     Separation of functions – administration, finance, planning, and assignment of resourced from SDSS are exclusive to the state and are autonomous

9.     Flexibility – the subscribed members select health benefits

10.  Participation – all social sectors and institutions involved in SDSS have the right to participate in decisions made about the system

11.  Gradual – the development of the social security system will be progressive and constant with the objective of covering the population with quality health care

12.  Finance equilibrium  – there will be correspondence between guaranteed benefits and financed benefits

Beneficiaries of SFS include:

–       the worker inscribed in the insurance program

–       the family of the worker: life partner, children 18 and under, children 21 and under if they are students

Education about social security system: The Secretary of State of Education is required to include an educational segment in the basic and medium level public schools about the social security system in order to explain the characteristics, rights, and options of the social security program.

Financial Regimens and Benefits

1.     Contributive: financed by the workers and employers, including the State as an employer

a.     How payment is delivered: the employer pay SDSS within the first three days every month

b.     The base contribution is the minimum national salary multiplied by a factor in accordance with the level of social status of employer

c.     10% of the salary is spent on health insurance- 3% from the worker and 7% from the employer

d.     Benefits

i.     Basic health plan

1.     Promotion of health and preventative medicine

2.     Primary health care, including emergencies, ambulatory services, maternity and infant care, and pharmaceutical assistance

3.     Diagnostic exams

4.     Dental preventative pediatric care

5.     Physical Therapy and rehabilitation when prescribed by doctor

6.     30% of medicines are covered

ii.     Infant care services (CONEI)

1.     Diet education appropriate for age and size

2.     Maternal and infant health services

3.     Pre-school education

4.     Activities for psychosocial development

5.     Recreation

6.     Subsidies for illness and maternity care

iii.     In the case of an illness that is not caused by work, worker has the right to a monetary subsidy for temporary inability to work

e.     Any services not included in the basic health plan are covered by the patient

2.     Subsidized: financed by the Dominican government

a.     Budget will be determined by SESPAS

b.     CNSS determines the criteria and indicators of the population that classify for this Regimen

c.     Benefits

i.     Basic health plan

1.     Promotion of health and preventative medicine

2.     Primary health care, including emergencies, ambulatory services, maternity and infant care, and pharmaceutical assistance

3.     Diagnostic exams

4.     Dental preventative pediatric care

5.     Physical Therapy and rehabilitation when prescribed by doctor

6.     Essential medicines are free

ii.     Infant care services (CONEI)

1.     Diet education appropriate for age and size

2.     Maternal and infant health services

3.     Pre-school education

4.     Activities for psychosocial development

5.     Recreation

6.     Financed by SFS through SDSS, resources from the state, resources from institutions and private businesses, and donations

d.     Any services not included in the basic health plan are covered by the patient

3.     Contributive-Subsidized: partially paid for by the worker, the employer, and what cannot be covered by the employer is covered by the government

a.     CNSS determines the criteria and indicators of the population that classify for this Regimen

b.     CNSS determines the distribution of cost per worker for the basic health plan between the worker, the employer, and the state

c.     Benefits

i.     Basic health plan

1.     Promotion of health and preventative medicine

2.     Primary health care, including emergencies, ambulatory services, maternity and infant care, and pharmaceutical assistance

3.     Diagnostic exams

4.     Dental preventative pediatric care

5.     Physical Therapy and rehabilitation when prescribed by doctor

6.     30% of medicines are covered

ii.     Infant care services (CONEI)

1.     Diet education appropriate for age and size

2.     Maternal and infant health services

3.     Pre-school education

4.     Activities for psychosocial development

5.     Recreation

6.     Financed by SFS through SDSS, resources from the state, resources from institutions and private businesses, and donations

d.     Any services not included in the basic health plan are covered by the patient

System of organization

1.     CNSS: public, autonomous entity that is the superior of the system

a.     Includes representatives of SESPAS, AMD, health professionals

2.     Tesorería de la Seguridad Social: responsible for the collection, distribution and payment of the financial resources of SDSS and the administration of the information system

3.     DIDA: defends the rights of the workers

4.     SSRL: public autonomous supervising group

5.     SNS: public and autonomous entity

6.     AFP: entity of public, private, or mixed character

7.     ARS: entity of public, private, or mixed character

8.     PSS: entity of public, private, or mixed character

Minimum requirements to be accredited as ARS or SNS (public or private entities that administer the basic health plan under the SSRL)

1.     employees who follow the social security law

2.     administration and financial stability cabably of administering the services set forth by the law in efficient, competitive and economically solvent conditions

3.     organize a network of local service providing the basic health plan

4.     guarantee employees a salary

5.     install a system of information including formal reports and statistics

6.     accredit capable supervisors of PSS

7.     accredit periodically the minimum level of technical finance established by SSRL

8.     determine an operative capital paid in cash proportional to the benefiting population

Levels of attention required of ARS or SNS

1.     primary attention with an entrance and network of services and professional attention

2.     a level of ambulatory attention with capable professional attention

3.     the ability to place patients in hospitalization care and sufficient human resources to attend to the demand of patients

4.     system of reference from primary attention to other levels of necessary attention, specialized attention or hospitalization

5.     preventative services and recourses provided and financed by SESPAS

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2 responses

24 03 2011
Dad

Pride and love and admiration gather in my heart at the person you are becoming. Thank you for so honestly and deeply sharing this with us.

24 03 2011
MIMI

Reading your blog has been a wonderful trip away from this dreary day in Timonium! Your ability to transport us to your wonderful world through words and beautiful pictures is astounding! Keep up the amazing work, and you absolutely look beautiful and happy!!!! Love you and miss you—xxxooo

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