In any discussion of healthcare, the term “accessible healthcare” is frequently used, especially in the context of developing nations. While this is no doubt an important aspect in building a healthy population, it is not the only one. It is not enough that services be available. To make a difference, they must be provided in an efficient and effective manner.

 

The summer between my freshman and sophomore years I studied with the University of Virginia’s Hispanic Studies Program in Valencia, Spain. Specifically, I participated in the global health tract and took the course, Comparative Healthcare Systems. In class we were introduced to the many strategies countries around the world employ to manage their healthcare systems. Most importantly, we explored in detail how Spain’s healthcare system functions.  

 

I learned that in Spain every citizen has free access to the national public health system. Many individuals however still choose to purchase private insurance that grants them access to private hospitals and doctors. It is also common for companies to offer private insurance to their employees as a benefit. Interestingly, the Spanish government also provides private insurance for their employees. That didn’t make sense to me. The state already funds a healthcare system that supposedly works for everyone. However, Spain gives governmental employees access to private providers by paying for their insurance. It is as if the government is paying twice for their healthcare. The question that arises then, is why do some individuals, corporations, and lawmakers feel it is necessary to hold private insurance in a country in which healthcare is a free public service? The conclusion I arrived at was that those groups believe the national health system is grossly inadequate.

 

As part of the class we toured both public and private hospitals and saw firsthand the differences of each. The shortcomings of public facilities and the superiority of private ones are highlighted by the journal reflections we were assigned to write after each tour. It was obvious from our trips that state hospitals were much more inefficient. The staff simply did not work with the same vigor to meet the needs of their patients as their counterparts in the private hospitals. This led to long wait times, disgruntled patients, and delayed care. This was the first time I realized that although a patient might literally be in a hospital, it did not necessarily mean they are receiving the care they need.

 

A couple of years later I was  researching background literature for a study on maternal mortality in the Dominican Republic. Despite increasing availability of healthcare services and medical technology, the number of maternal deaths in the country remained high. Citizens had access to health services but it did not seem like they were receiving adequate care and attention. It was reminiscent of what I had learned in Valencia. Many times a complication, especially as a result of pregnancy, needs to be taken care of swiftly. When this doesn’t happen, either because a patient is not seen quickly enough or is not given adequate attention, then the condition can become more severe. In Spain, they have the resources to ensure a patient is eventually treated until recovery. However, in an undeveloped country such as the Dominican Republic the consequences can be much graver. Medical professionals with the appropriate training to deal with extreme or emergency cases can be scarce. It also might be hard to acquire the equipment necessary for treating the patient. These factors illustrate how complications exacerbated by delayed treatment can lead to conditions that can’t be sufficiently treated with the limited resources in the Dominican Republic. Once again, it appears that access to care is not the only important factor in ensuring a healthy population. Patients must actually be adequately treated within a reasonable time.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This lack of efficient and adequate care is not an issue

limited to the third world. It is a problem that permeates the

health systems of developed nations too. No matter where

in the world you are, making healthcare accessible is not

enough. We must also focus on the timely delivery of effective medicine. Simply having access to care does not mean a population is receiving the services they need. It is up to the institution and medical professionals to ensure they do. As I begin my medical education and career as a physician, I will make sure to remember this important lesson and always provide care to the best of my ability.