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Aruba Healthcare

The most far-reaching healthcare reforms in Aruba involve the reorganization of the Department of Public Health and the health services under its jurisdiction and the introduction of a general health insurance plan. The Department of Public Health has provided direct healthcare services through the operation of a medical centre, a psychiatric service, ambulance services, the public health laboratory, and an occupational health centre, and by retaining medical doctors in its payroll. Reforms plan to gradually privatise all of these services, and most medical doctors will be removed from the payroll. Furthermore, there are plans to reorganise and expand the medical centre, expand the occupational health department to include services to private companies, improve healthcare inspection services, enhance mental healthcare services, automate the public health laboratory and construct a new building, and improve overall hospital care. Some existing services will merge as a way to gain in efficiency.

The planned introduction of a general health insurance plan intends to achieve equal and universal access to the healthcare; achieve and maintain high quality, cost-effective care; reach more uniformity in the financial management of the medical costs; and develop the means to control healthcare expenditures. The new general health insurance plan would entitle the insured to a basic package of services, including primary medical care provided by general physicians; secondary care provided by medical specialists, obstetricians, and physical therapists, and coverage for prescription drugs, hospitalisation, home nursing, dental care, and ambulance transportation.

The Department of Public Health falls under the jurisdiction of the Ministry of Public Health, Social Affairs, Culture and Sport. It is charged with promoting overall public health; it also operates the Dr. Rudy Engelbrecht Medical Center, the psychiatric ward, and the public laboratory. The Department embraces about a dozen services with which it carries out prevention, inspection, and medical activities.

Aruba 's single hospital, the Dr. Horacio Oduber Hospital, is a private, non-profit hospital with 264 inpatient-care beds and 41 beds in its psychiatric ward. In 2000, there were 11,718 admissions, for an occupation rate of 92%. The hospital has a 24-hour emergency room, and also provides outpatient care among other services. Deliveries are normally carried out in this hospital, but women also can opt to give birth at home. There is no breast-feeding promotion policy in Aruba. When a patient needs medical treatment or diagnostic services that are unavailable on the island, arrangements can be made to refer the person abroad. In 1999, 41.8% of these patients were referred to Venezuela. Four institutions offer programs for rehabilitation for drug addicts, in which people from 22 to 59 years are attended.

Although the island has a wide range of medical specialists, it does not have sufficient nurses. In the last few years, nurses have been recruited from abroad, especially from Philippines, where nursing education is similar to Aruba's. Most physicians obtain their degrees at accredited institutions in the Netherlands, followed by medical schools in the United States, Costa Rica, Colombia and Venezuela. Most who want to obtain a graduate nursing degree go to Curaçao or to the Netherlands.

Every citizen of Aruba has compulsory medical insurance, and Aruba has an old-age pension program designed to guarantee a minimum income to senior citizens.

Since 1990, healthcare has taken an increasing share of the Government's budget. In 1998, the proportion of Government's expenditures allocated to health was close to 5.3 % of total expenditure. Between 1990 and 1998, government expenditures in health grew from $47 million to $81 million, with an average annual increase of 10%. Population growth and ageing, as well as an enormous increase in the use of medical facilities, are the main reasons for the increase in healthcare expenses.





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