With less than 500 intensive care beds for around 11 million inhabitants, the Bolivian health system was already at its limits before the Covid-19. But the pandemic has made matters worse, exacerbating the lack of drugs, specialists and vacant positions in public hospitals.
Desperate, some families end up opting for the private system, with the risk of going into debt for years or even not being able to remove the bodies of their loved ones in the event of death.
With an average salary equivalent to R $ 2,000, Bolivia is one of the poorest countries in South America. A few weeks of hospitalization, the bill can exceed R $ 400,000.
“We had no choice. I hospitalized my brother where there was a vacant post,” says Irma. “We called friends, acquaintances, to see if someone could help us. When we get a bed available, we don’t think twice,” he recalls.
Despite a modest salary, she decided to place her brother in a private clinic, even though the daily rate exceeded the equivalent of R $ 5,000. The solution was to sell a car to pay the bill.
But not everyone has available assets like Irma. This was the case with Wilma, who lost her father after 36 days in hospital and was left with a bill of around R $ 400,000 to pay. “The clinic called me to let me know he passed away at 9 p.m. on Saturday. When I arrived, no one wanted to see me. The only thing they wanted was for us to pay the 75,000. $ “, says Wilma. , who, together with his five brothers and sisters, only managed to raise 20% of the sum. Result: the hospital did not release the body for four days. “We had to wait until Wednesday,” she recalls, still traumatized.
The “retention of corpses” is nothing new in Bolivia for families who cannot pay the bills of clinics or private hospitals. “A few years ago, this happened frequently. But now, it is rarer, because this practice is prohibited and there are sanctions ”, explains Nadia Cruz, of the Office of the Public Defender. “However, with the Covid-19 and the high values that represent the [longas] hospitalizations, some clinics have started again, ”he reports.
Scheduled prices, but not always respected
In an attempt to prevent abuse, a law, passed in February this year, limits fees for private clinics to around R $ 2,600 per day in intensive care. But not everyone obeys the rule.
“With the new law, we were able to verify whether the prices exceed the limit imposed by the government. But we cannot verify which drugs have been used in intensive care,” explains Nadia Cruz. This cost would explain the exorbitant bills presented at the time of discharge or, worse, at the time of the release of the body of a family member in the event of death. “When we have access to complete files, we receive 10 pages of processing which we have no way of evaluating if they were really necessary,” says Nadia.
Private facilities, which account for more than half of the intensive care beds in Bolivia, say the rates imposed by the government do not match the reality of the market. “A specialist will not want to work for 20, 30 or 50 Bolivians a day (between R $ 15 and R $ 40),” explains Dr Suxo of Clínica del Sur in La Paz.
To avoid bad debts or “removal of corpses”, some clinics ask family members to pay a deposit before hospitalization, even in an emergency. Or that a guarantee is presented, for example, the deed of a house.