Is Universal Healthcare Truly Universal? by Keaton Stoner

            This past week, the group traveled north from the OTS Palo Verde Biological Station to Nicaragua to both renew our Costa Rican visas and to learn a bit more about the culture and healthcare system in “The Land of Lakes and Volcanoes.” During our stay in Nicaragua, we received tours, lecture, and experiences from staff members from Vida, a volunteer organization that helps to organize medical mission and service learning trips in Central America. Despite its troubled past due to its bloody revolution in the latter half of the 20th century, Nicaragua has progressed mightily to where it is today, often being referred to as the Costa Rica of a decade ago. While its healthcare system is not quite as developed as that of Costa Rica, the two systems resemble each other greatly, most notably as universal healthcare systems that strive to maximize coverage with strong primary care. I strongly believe that healthcare access should be a human right, rather than a luxury. While in theory, universal healthcare coverage is the best means to provide this natural right, I sometimes wonder whether a differently structured system would prove more efficient in a country like Nicaragua.

            Universal healthcare only refers to universal insurance for healthcare; it implies nothing about citizen’s actual access to quality care. In the two rural, massive, autonomous regions of Nicaragua, despite having free healthcare insurance, the citizens often have to travel great lengths for the most basic healthcare services. When they do finally arrive to areas where health posts, clinics, and hospitals are more widely available, a citizen in need of healthcare often has to wait hours upon hours to get even the most basic attention at a public hospital. I suppose that this is largely due to the fact that because there is no cost to getting medical treatment, there is no disincentive to dissuade those with very minor conditions from seeking attention. Especially in a country that has fewer than one doctor per 1,000 residents (and even less in rural areas), can Nicaragua hospitals really afford to give medical attention to every nick and scratch that comes through the door? The Nicaragua Ministry of Health, we learned, is also incredibly underbudgeted, and charging a small, flat fee for a consult may help provide more resources to the medical community and a greater incentive for doctors to work in understaffed areas.

            This however, is certainly a very fine line to walk, as around 46% of Nicaraguans live below the poverty line, and even a small fee for a consultation may be too much for many people. While I do not have the answers to this problem, it is certainly worth considering a reevaluation of the best way to provide universal healthcare, not just insurance, in Nicaragua.