Abstract
In the Republic of Panama, both the public and private institutions provide health care. The healthcare system comprises national health care, social security, and a low-cost system. The quality of health care varies depending on the institutions proving the care. The private sector boasts of quality services provided by highly trained doctors. In order to ensure that comprehensive and quality care is provided, the Panama patients’ bill of rights has provisions that cover the rights of the patients and the role of the health care providers. The bill of rights synchronizes the ethical requirements for healthcare providers. However, there are challenges that arise in relation to advance directives mainly due to the cultural and religious orientation of patients and healthcare professionals. The resulting challenges lead to ethical issues in medical treatment. Despite the challenges, the Republic of Panama has taken strategic steps to ensure that the healthcare system is holistic and affordable.
Keywords: Panama healthcare system.
Introduction
The Republic of Panama has a comprehensive health care system provided by both the private sector and public institutions (Panama Ministry of Health, 2013). Panama has been experiencing economic growth and has become a top contender of medical tourism in Latin America. The Panama government considers an elaborate health care system as a strategic priority (Romero & Quental, 2013). The healthcare system in Panama is a three-tier system composed of National Health Care, Social Security System, and Low-Cost System for the poor. The social security system comprises a scheme in which both the employers and employees contribute to an elaborate Private System (Panama Ministry of Health, 2013). The public health care system in Panama is composed of the ministry of health that covers 60% while the social security fund covers 40% (Yala, 2014). In public institutions, the quality of health care varies depending on the hospital and the region. Most of the middle class, upper class, and medical tourists prefer private sector facilities.
Panama Patients’ Bill of Rights
Non-communicable diseases are the leading cause of death, cardiovascular diseases, diabetes mellitus, and cancer account for over 74% of all deaths (Panama Ministry of Health, 2013). In order to provide holistic health care for various patients, the Panama patients’ bill of rights provides guidelines for the provision of health care. The health care framework that governs the healthcare system in the general scope is contained in the health code of 1947; it covers the responsibilities of health institutions in Panama and the aspects of health that relate to health. The Panama patients’ bill of rights provides for affordable care in which health insurance is a necessity for all citizens and non-citizens (Sadana & Pang, 2010). All citizens are required to enroll in one of the three systems. The patient’s bill of rights provides that each patient be treated with courtesy, respect, and dignity. The bill also stipulates that patients should have access to medical treatment and accommodations irrespective of their religion, nation of origin, race, and physical status. The patient should have access to information that concerns the planned course of treatment, diagnosis, risks, and prognosis.
Ethical Issues Associated with Medical Treatments
Medical treatment and the general health professions are governed by ethics all over the world (Docker, 2011). The prescribed code of ethics results in ethical dilemmas in carrying out some procedures. For instance, doctors face an ethical dilemma that relates to participating in some procedures that though lawful, there are cultural and patient issues that may limit their implementation. For instance, in the execution of advanced directives for patients in critical conditions, health professionals have to consider the cultural and legal implications of the decisions. Ethical issues also arise in relation to life end decisions in which provision of some patients’ requirements and information may be in line with the legal requirement but not culturally accepted. Doctors in the private sector are also faced with challenges in the provision of holistic health care. For instance, the bill of rights provides that no person should be denied healthcare; however, the low-cost system covering poor citizens cannot be applied to private institutions, and thus doctors are faced with the challenge of treating poor patients presenting themselves in the private hospitals in critical conditions.
The complexity of Advanced Directives and End-of-Life Decisions
The ‘advance directives’ refer to the legal documents that relate to living a will or provision of health care of an attorney (Docker, 2011). In relation to healthcare provision, there are legal and cultural complexities that relate to the implementation of advanced directives. For example, in the patients’ rights, health care providers should ensure patients’ right to privacy and confidentiality. The patient’s bill of rights provides that in case of patients’ requests for advance directives, the patient should get assistance from the administration of the hospital and the healthcare staff (Sadana & Pang, 2010). However, legal provisions of providing information that may be confidential become a challenge in determining whether a patient has a provision for health care of the attorney. In relation to the end-of-life decisions, in Panama sanctity of life is a spiritual issue. As such, there is a shared belief that only God has the right to end an individual’s life (Docker, 2011). Therefore, for patients with critical conditions, assisting patients on matters relating to end life decisions becomes an ethical dilemma for health care providers due to the cultural and spiritual implications.
Conclusion
Universal health coverage that is affordable and non-discriminative is a strategic priority for the Panama Republic. In line with the priority, Panama has an elaborate health care system. The system comprises of three systems of National Health Care, Social Security System, and Low-Cost System for the poor that allows citizens to access health at either public or private institutions. The healthcare system ensures that all people have access to quality health care as provided in Panama patients’ bill of rights. In adhering to health rights, there are ethical challenges faced by doctors such as the complexities that relate to advanced directives and end life decisions. The challenges are due to religious, moral, and cultural affiliations.
References
Docker, C. (2011). Advance directives/living wills: Contemporary issues in law, medicine, and ethics. Journal of the American Medical Association, 274(20), 1591-1598.
Panama Ministry of Health. (2013). National health policy and strategic plan 2010–2015. Panama. Web.
Romero, L. & Quental, C. (2013).The Panamanian health research system: A baseline analysis for the construction of a new phase. Journal of Health Research Systems and Policy, 11(1), 3-16.
Sadana, R. & Pang T. (2010). Interim final rule on the patients’ bill of rights. Panama, Panama City: Departments of Health and Human Services.
Yala, C. (2014). Panama: WHO country cooperation strategic agenda 2007-2011. World Health Organization. Web.