Thursday, November 5, 2015

Public vs. Private Healthcare Disparities by Cindy Wang

            Once again, I am reminded about the value of healthcare; we spent the large majority of last week traveling the roads of Nicaragua with the Vida organization (, visiting and learning about aspects of their public health care system. In Nicaragua, unlike its Costa Rican counterpart, public healthcare is free and mandatorily dispensed to anyone in need. The public clinics were overcrowded, over-heated, and underwhelming. In our tour of this facility, similar to our experiences in Costa Rica, we were allowed to walk into the rooms of patients who appeared before us exposed and vulnerable. We were told that this invasion of privacy was “okay” because we were students and we were there for academic purposes. In absolutely no healthcare facility in the United States would this be permitted as it undermines the most fundamental ethical code of patient privacy. Did being allowed in by local officials somehow make this ethical? Or was it perhaps more unethical of me to be in there because these practices are not accepted in my country? As much as I admire the efforts of the government to attend to the health of its people, in walking through those halls I could not help but feel guilt in comparing my standards of health care to theirs. I have never been packed into a waiting room so full that people had to stand against the walls and still find themselves touching. I have never had groups of visitors, even students, walking through the halls gawking at the facilities and the patients. And unfortunately, because I can afford it, I may never have to.

Inside an empty patient’s room in a private hospital.


As part of our experience in Nicaragua, we also visited a private healthcare facility and the disparity between the two hospitals could not have been greater. The clinic mirrored those found in the US both in appearance and efficiency: the building was fully air-conditioned, every inch was immaculate, the staff was well trained (and English speaking) and all of the facilities were modernized. The biggest difference? The waiting rooms, and a seemingly large number of patient rooms were empty. We were given a tour of the grounds and the codes of privacy that I am accustomed to seemed to be re-established. While we were allowed to walk through patient recovery rooms in the public clinics, our guide told us that we were not permitted to enter any patient rooms to protect their privacy. Where people seemed to be lined up for treatment in the semi-urban facilities, waiting rooms and treatment areas in this hospital were next to empty. In walking through these vastly different halls, I became very aware of how much the value of a dollar truly is and how great the disparity between the classes is perpetuated. I agree that healthcare is a fundamental human right and your ability to pay should not affect your quality of care, but what possible solution is there? I admire Nicaragua and Costa Rica for their efforts to make healthcare universal; however, I think that Nicaragua, Costa Rica, and the US alike have different yet great strides to make on this front.
Inside the endoscopy examination room, also in the private hospital

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