The Bent Page

Aruba enjoys one of the highest standards of living in the Caribbean, summed up by the motto, “One Happy Island.” Tourists and natives alike enjoy the virtually unlimited sunshine and wide beaches, not to mention the fine restaurants, fantastic Carnival celebrations, and action packed water sports.

However, many Arubans are less than pleased with their single-payer health care system known by the initials AZV. A payroll tax funds AZV, which disburses payments to care providers. While every citizen is eligible for coverage, many do not utilize the benefits. In effect, they pay twice: once in the taxes assessed on their wages, and again through cash payments to providers or in premiums for supplemental insurance policies.

But why would someone pay extra when they are supposed to have coverage under AZV?

Long waits are one of the biggest factors. One fellow, Paul, answered, “My son had a respiratory problem. How long was I supposed to wait?” His son was not able to see a specialist without first consulting a primary care physician. This delay, which could have been a week or longer, was unacceptable. Paul took his son to nearby Venezuela where he was seen by a doctor within a few hours of stepping off the plane. Thanks to a private medical insurance policy Paul maintains in Venezuela for just such emergencies, the cost was minimal. As for the care, he couldn’t be happier. The doctor personally called several times to see how the boy was doing as well as to inquire about the effectiveness of prescribed medications.

Similarly, Donato was unhappy with substandard treatment of various skin lesions. For several years, his doctor in Aruba told him he had nothing to worry about. Finally, at his brother’s behest, he visited a specialist in Colombia who informed him that a dozen growths needed to be removed immediately. Although confident in the Colombian doctor’s diagnosis, Donato sought an independent second opinion in that country to be sure. He had one the next day and it concurred with the first. His surgery took place before the week was over. Now he flies to Colombia every year for checkups. The most expensive part is the airfare, but Donato doesn’t mind. He makes a vacation of the trip, taking his wife and children who also see doctors for regular checkups while he visits his dermatologist. “If you let it go,” Donato says, “this is the kind of thing can be very bad.”

There are doctors in Aruba who operate strictly private practices. They do not accept AZV payments, which are considerably lower than fees charged to patients outside the system. One doctor said, “My practice does not operate on sunshine. There are bills to pay, supplies to purchase, and my time is worth something more than the [AZV] board budgets.” These practitioners take some of the pressure off the public clinics, but they are also operating at full capacity. “I want to give them my best,” the same doctor reflected. “That means I can see only so many people each day.”

Hence, Roberto also goes to Colombia for treatment of a chronic nerve condition. He would prefer to avoid the extra expense and get the full value of his tax payments to AZV. Nonetheless, he simply can’t get the care he needs nor the medicine required to control his pain. “AZV takes too long and sometimes my private doctor can’t see me,” he says. “So when I have a flare up, I get on the plane.”

Direct cash payment may have something to do with the quick response times of these physicians in other countries. Paul (mentioned above) commented, “I know the doctor in Venezuela charged me more to look at my son than he earned seeing his regular patients all day. Still, it is affordable to me.”

The Arubans who travel off-island for healthcare generally describe their experiences in glowing terms. They speak of the doctors as caring, honest, and sincere. They frequently mention that the cost of treatment is affordable, although last minute airfares sometimes break the budget as in Roberto’s case.

When asked their opinion on healthcare reform in the United States, they shake their heads and shrug. “Maybe see what we have here and think about what you’re doing,” Roberto comments, adding, “Learn Spanish in case it doesn’t go so good.”