Health care in Ventora

Hospital Lacasa de Lora, a large tertiary teaching hospital in Lora owned by Salud Lacasa SCa

Health care in Ventora is overseen by the Directorate General for Health (Ventoran: Dirección General de Salud, DGS), part of Ventora's Commonweal Commission. Ventorans enjoy universal health care, as guaranteed by the 9th stipulation of the Canon of Obligations, part of Ventora's body of constitutional law known collectively as the Fundamental Law of Ventora. Health care is funded through a number of health care trusts financed largely by a combination of employer subsidies and compulsory worker subscriptions. A tiered service co-pay scheme designed to encourage personal care and responsibility for individual health conditions covers some health care costs. Certain taxes, such as excise taxes on alcoholic beverages, fumivrea and fimivrea products, and other unhealthful products also support health care services.

Health care delivery

The health system is geared toward wellness and preventive care with the intention of ensuring all Ventorans lead healthy, productive, and enjoyable lives. This also helps to minimize health care costs through efforts to avoid chronic conditions and treating health issues in their less serious early stages. The Directorate for Healthcare (Dirección de Atención Médica, DAM) establishes minimum expectations and common practices for the provision of health care services.

Primary care

Primary care includes basic diagnostic services, such as x-rays

Each citizen has a primary health care team for physical examination, health check-ups, wellness visits, and initial, non-emergent injury and illness care. The team includes a physician, physician assistant, or nurse practitioner, and a nurse or medical assistant. These health care teams live in or near the communities they serve and occasionally conduct home health care visits to understand the environment in which their patients live. The health care team also visits sick patients in their homes when they are not ambulatory but do not require emergent or in-hospital care.

Typically, the physician, physician assistant, or nurse practitioner have certifications in family medicine or general practice. For children to age 18, however, the team lead may be a pediatrician. For older adults, the primary care provider may specialize in geriatrics. A visit to most other specialties requires a referral from the primary healthcare team. Services of an optometrist and routine dental care do not need a primary healthcare provider referral.

Secondary care

When the primary health care team is unable to provide appropriate treatment they refer the patient to a specialist. Health care professionals can specialize in over 100 different specialties. Some examples include allergies, cardiology, dermatology, internal medicine, neurology, obstetrics and gynecology, oncology, ophthalmology, psychiatry, urology, and many others. Specialty and acute care may take place in a hospital setting or on an out-patient basis.

Emergency care

File:Ambulancia centro.jpg

Ambulancia Centro emergency ambulance in Lora

Pre-hospital emergency care in Ventora consists of qualified emergency medical technicians, usually associated with emergency ambulance providers. These professionals see to initial treatment at the scene of an accident, injury, or illness, providing stabilization, bandaging, oxygen, resuscitation, and transport to the nearest hospital emergency care department by means of specially equipped vehicles. Advanced medical technicians may, on medical provider's advice or within medical guidelines, administer heart defibrillation, medications, and other life-saving interventive treatments pre-hospital.

The hospital emergency care department is organized and equipped for the efficient treatment of severe injuries and serious emergent illnesses. Larger hospitals have specialized care areas within the emergency department, which may include such conditions as cardiac, pediatric, or trauma cases. Although considered secondary care, its emergent nature exempts emergency care from needing a primary care provider referral.

Chronic care

Many chronic conditions require on-going or long-term care. As much as reasonably possible, this care takes place at the patient's home or polyclinic. Some care, such as hemodialysis, occurs in a specialty center for the specific condition or treatment. Other care, such as hospice, may take place in whatever setting is medically appropriate for the patient.

When patients need more care than is feasible in the home yet not requiring hospitalization, they may be placed in an intermediate care facility, sometimes referred to as a nursing home. Most patients in an intermediate care facility have suffered a debilitating injury or illness or are elderly and no longer able to care for themselves and for whom home care is inadequate.

Typical surgical procedure in a hospital

Tertiary care

In-hospital and most surgical procedures comprise the third level of care known as tertiary care. Burn treatments, cardiac surgeries, neurological surgeries, and other complex treatments and advanced diagnostic procedures take place as tertiary care. Such care usually takes place in a large or specialty hospital setting as a result of a referral from the primary care team or medical providers at a smaller hospital. Many large tertiary care hospitals are also teaching hospitals.

Quarternary care

Highly specialized, uncommon, and experimental treatments fall under quarternary care. This level of care can be found in a university hospital and is often associated with medical research.

Health care facilities

Private firms or medical practice associations own and operate the majority of health care facilities in the country. Public entities at all levels of government own and operate less than ten percent of hospitals in Ventora. All health care facilities must be registered with the Bureau for Facilities Accreditation. The bureau sets minimum facility equipment and staffing standards depending on the level of care and types of procedures and services offered.

Polyclinics

Clínica Montpellier, a typical polyclinic

Primary and some specialist care takes place in a polyclinic (policlínico). The polyclinic is the main point of non-emergent access to health care and is the setting for most primary care providers. Every polyclinic has basic diagnostic services, such as x-ray imaging, and most have a basic medical laboratory. Most polyclinics also house a pharmacy (farmacia) for providing medications and medical equipment. The polyclinic's shared diagnostic and laboratory services help contain costs while making their important health care resources more widely available to the point of care.

Most polyclinics include an urgent care center (atención de urgencias) for seeing to minor sudden illnesses or injuries. The urgent care center facilitates medical treatment without impacting the efficiency of the primary care provider's practice while also keeping minor care out of the hospital setting when not warranted. In many polyclinics, the urgent care is open for extended hours; some urban polyclinics maintain 24-hour urgent care centers. If the urgent care center is not open around the clock, the polyclinic has a duty roster of health care teams that can be called in for urgent care services.

Specialists with offices in a given polyclinic vary but often include gynecologists, pediatricians, and dentists. Large polyclinics may have a wide variety of specialist providers. In less urban areas, however, some specialists may be grouped in regional specialist clinics, sometimes co-located with a polyclinic. The polyclinic's integrated delivery of health care in a team-oriented fashion generally yields better patient outcomes at lower costs. Most services at a polyclinic take place on an out-patient basis. Some large polyclinics with specialists providing minor surgical procedures have in-patient care suites similar to the level of care found in a hospital.

Consultorios

Some individual or small groups of healthcare providers operate small offices known as a consultorio. Such an office may be independent or an extension of a polyclinic to bring healthcare closer to populations, either in rural or urban areas. A consultorio usually does not include any ancillary services such as x-rays or lab work other than collecting blood or urine samples, but may have a co-located pharmacy.

Hospitals

Hospital Clinica de Ascara, a large teaching hospital in Ascara

In a serious emergency, people may go straight to a hospital emergency care department (departmento de emergencia). In other cases they must attend the polyclinic's urgent care or be referred by their primary health care team.

Complex medical care, including most surgeries and highly specialized care, generally takes place in a hospital setting. Hospitals in Ventoraa range in size from small 150-200 bed community hospitals to large teaching and research institutions. Hospital Clinica de Ascare, affiliated with the University of Ascara in Ascara, has 1,705 beds with specialists from practically every field in medicine. Hospitals include surgical suites, basic and advance diagnostic imaging, extensive laboratory services, and serious illness, injury, and trauma emergency departments.

Although smaller hospitals typically have general medical and surgery departments, medium and large hospitals incorporate more extensive varieties of departments. These may encompass endocrinology, cardiac care, pediatrics, oncology, and comprehensive care units (unidad de cuidados integrales, UCIs) which have higher staff-to-patient ratios and specialized equipment for the most serious cases.

Large teaching hospitals have affiliation with nearby universities and technical schools. These affiliations provide the clinical setting, with seasoned professional oversight and mentoring, to ensure the well-rounded education of physicians, nurses, medical technicians, and other healthcare professionals in training.

While some patients visit the hospital on an out-patient basis, most patients remain in hospital for some number of days. Outside of some minor surgical procedures, typically offered at a large polyclinic, many surgical procedures require a recovery period of a few days to several weeks or longer. Patients in such cases remain in hospital and their care includes physical and emotional therapies, as appropriate, along with the necessary medical care. Outside of calls at the emergency care department, most out-patient trips to the hospital involve more advanced diagnostic services, such as specialized imaging, not available at a conveniently located polyclinic despite some large polyclinics having such services on offer.

There are 1,250 hospitals across Ventora, the vast majority of which are privately owned. The country has 254,204 hospital beds in total, including 6,778 UCI beds.

Accredited hospitals

Facility ownership type	Facility count	Beds	Beds per 100,000	UCI beds 100,000
Private, non-profit	667	164,340	203.68	6.17
Private, for-profit	177	29,482	36.54	0.36
Health care trusts	283	37,852	46.91	0.81
Public	116	21,303	26.40	0.99
Military	7	1,227	1.52	0.07
Total	1,250	254,204	315.05	8.40

Health care professionals

A physician examining a patient's leg in a polyclinic

The Bureau for Professional Standards establishes the minimum qualifications for health care professionals, including educational and practical skills requirements. Following initial fitness to practice, health care professionals must attend periodic seminars and practica to ensure they remain current with emerging medical science and to ensure their continued competence.

Physicians, physician assistants, nurses, and other health care professionals must be a member of one or more professional societies related to their field of practice. The professional societies manage records for qualifications and attendance at appropriate educational in-service events according to government specifications. While the government does not license health care professionals, they must be registered through their societies which pay a fee for such registrations. In 2019, the country had 369.77 registered physicians per 100,000 population

Registered health care professionals

Type of society	Males	Females	Total	Per 100,000
Physicians	165,951	132,405	298,356	369.77
Physician assistants	37,852	37,475	75,327	96.36
Nurse practitioners	24,907	52,091	76,998	95.43
Nursing professionals	106,409	531,599	638,008	790.73
Pharmacists	40,694	51,115	91,809	113.79
Dentists	26,023	21,181	47,204	58.50
Total	401,836	825,826	1,227,701

Public health

A nurse administers a vaccination

Ventora's health system has its basis in strong preventive efforts followed by early access to medical services in order to reduce the severity of illnesses and injuries. The Directorate for Public Health has the lead role in overseeing societal preventive efforts, disease tracking, and research.

Prevention

Primary care, such as annual medical evaluations and routine vaccinations against diseases, form some of the most obvious efforts at preventing illness. The Bureau for Preventive Healthcare, which recommends schedules for wellcare visits, also concerns itself with public health education and matters of sanitation, food safety, and promoting healthy lifestyles.

Because obesity, poor diet, using fumivrea, and excessive alcohol consumption all have negative health consequences, the government levies an excise tax to discourage behaviors contributing to health issues. There are also excise taxes on indoor tanning, foodstuffs with excess added sugars and saturated or trans-fats as well as those high in sodium, processed meats, certain snack foods, and sweetened beverages. These products are all implicated in negative health consequences such as obesity, type 2 diabetes, cardiovascular disease and several cancers.

The Bureau for Epidemiology conducts disease outbreak investigations and surveillance, environmental studies, and disease screening. Their efforts focus on identifying early indicators of potential illnesses of public health concern in order to prevent or minimize their spread. The epidemiologists collect the data, statistics, and information necessary to monitor and understand a public health disease situation as well as implement practices to contain and disrupt the spread of the illness.

Research

Medical researchers at work in a laboratory

Large universities, especially those with medical faculties, and the large hospitals affiliated with them engage in medical and health care research. Pharmaceutical companies and medical device manufacturers also engage in research programs. The Bureau for Health Research serves as a coordinating body and clearinghouse for much of the work in the field. The country's supercomputing network is a major tool in supporting state-of-the art medical research in Ventora.

Research schemes are investigating a wide variety of medical and health care research areas and topics. Methods include pre-clinical and clinical settings. The former includes work in laboratories, often with specimens, as well as analytical, computational, and technical efforts. The clinical setting generally involves applied research to test and implement laboratory findings in practical, real-world environments. Such programs may involve animal or voluntary human subjects. Experimental surgeries and medications administration are both examples of applied research.

Funding

The cost of health care is paid largely through employer contributions and worker subscriptions to health care trusts. Some taxes, particularly excise taxes related to unhealthy products or consumption, and patient co-pays are another source of funding. Private insurance may be purchased to offset co-pays or cover costs associated with so-called cosmetic or elective surgeries or medical procedures not included in the funded health care scheme. The state, typically through university hospitals or medical research institutes, often funds experimental treatments or procedures with no out-of-pocket costs to participants.

Health care trusts

Employers contribute at least 11% and employees subscribe for a minimum of 5.4% of wages up to an annual wage ceiling of Ɇ 296,400 in 2022. Employers must offer a choice of health care trusts, of which there are several dozens. Employees choose the plan they wish to subscribe to at hire and then annually thereafter. The main differences between trusts involve the level of co-pays, the co-pay cap allowed, maximum coverage amounts, and the amounts of employer contributions and employee subscriptions. Although all health care trusts must cover the Schedules I and II of the Catalog of Medical Care, health care trusts may offer coverage plans for non-mandatory treatments.

Taxes

Template:See also Although some funding raised through general taxation is allocated to health care, most taxes in support of health care comes from excise taxes levies on certain products. The intent is to encourage healthy behaviors by discouraging some overconsumption or use of harmful products. The excise taxes help offset some health care costs of chronic illnesses that result from overconsumption, fumivrea use, and excess alcohol use. Excise taxes are distributed to health care funds on a per capita basis.

Co-pays

Citizens have no co-pays for wellness visits and preventive care (listed in Schedule I of the Catalog of Medical Care). In addition, there are no co-pays for many preventive medications, such as generic blood pressure and cholesterol medications. Any treatment attributable to a workplace injury is also exempt from co-pays.

The health care trusts establish other co-pay amounts and maximum annual co-pay sums. Co-pays and caps must be reduced for pensioners, the disabled, and persons with non-preventable chronic conditions. Co-pays and caps must be higher in the case of services for preventable chronic conditions, such as Type 2 diabetes, cardiovascular disease, chronic obstructive pulmonary disease, kidney disease, stroke, and several cancers, although exceptions may be considered.

Supplementary insurance

Persons may purchase private supplementary insurance if they wish. The insurance scheme represents a contract between the insurer and purchaser and its costs and coverages are not regulated by the state. Approximately 5.3% of the population has opted to purchase supplementary insurance. It is commonly used for elective and cosmetic procedures excluded from coverage under the standard health care regime, although some health care trust plans may include some coverage of such services, or to further reduce or eliminate co-pays.

Accessibility

Most people have suitable access to basic primary care, especially wellness and preventive services. They also have reasonably good access to typical standard secondary care services. Through access to higher-cost health care trust plans and supplementary insurance schemes, wealthier people have increased access to care if their medical conditions become more extensive or require additional services. Although the disparities in access to care are not clear, there is no doubt they exist and have an impact on treatment availability.

While most Ventorans are satisfied with their health care system and their ability to access it, they also consider the health care trust system to be overly complex. There are hundreds of plans, even if their employer only offers a half-dozen or so options.

Criticisms

The most frequent complaint concerns the sheer number of health care trust options. Although there are hundreds of health care trusts, many employers don't offer more than a half-dozen plans, a number many consider a good number of alternatives.

Numerous health advocates have raised concerns about higher co-pays for persons with chronic conditions. They claim the higher co-pays have little effect in reducing potentially contributing behaviors while penalizing people with medical conditions requiring more frequent care. Some advocates have also noted health-related excise taxes amount to a double-charge on what the government has decided are unhealthy behaviors, such as alcohol consumption or fumivrea use. Further, the combination of taxes and higher co-pays is regressive in that it affects the lower classes to a higher degree than the wealthy. In addition, wealthier people are better able to absorb co-pays or even pay for health care plans with lower co-pays than less affluent citizens.

Although scientific evidence suggests the sweetened beverage tax has some positive health-related outcomes, the industry obviously protests the tax. Sapocita has been particularly vocal in called for its rescinding. Similarly, snack food manufacturers oppose the so-called fat tax whose health benefits have been less studied.

See also

• Social welfare trust
• Welfare in Ventora