In El Salvador, one finds two parallel health care system. The first uses state-of-the-art technology, qualified doctors, and physician spend ample time with patients. The second employs third world technology, treats severe illnesses superficially, and doctors are overworked. Which of these systems is run by the government? Which of these systems serves the poor?
As you probably guessed, the first healthcare system described above involves doctors in private practice with a fee for service (FFS) provider payment system. Using the private physician and medical facilities is expensive; only the wealthy can afford these procedures. The poor are relegated to using the free government hospitals and clinics. These facilities do an adequate job of providing immunizations, prenatal care and educational material, but do not have the funds or the staffing to perform surgical procedures which in the U.S. would be considered routine. Many Salvadorans I spoke with complained that doctors in the public hospitals treat all serious diseases the same: they give patients an aspirin and tell them to grin and bear it since surgery or other complicated procedures are not available.
Also, one notes a distinct difference between urban and rural clinics serving the poor. Both provide only the most basic of services, however, rural physicians do have more time to spend with patients due to the lower population density. One physician in the village of Isla de Mendez told me he only saw about 25-30 patients per day and about half of these were educational prenatal visits. The residents of Isla de Mendez, however, do not have access to medical care on weekends because the physician returns to his home three hours away in the city of San Miguel. In an urban clinic, patient volume is much higher and wait times of many hours is common, but physicians are available on weekends for emergencies.
The central government also employs promotores, workers who visit villages (such as Ciudad Romero) who do not have a clinic and educate the population about public health risks. Unfortunately, it seems that the promotores are not very effective since the villagers do not hold these workers in as high esteem as physicians. Further, since the promotores travel from village to village, they rarely establish a strong bond with the community to make sure that the educational information they impart is implemented.