Sr. Julio Rivera, Director General of Health of the Social Security Administration of the country of Ilobasco, sat down at his desk one morning, and began to open his mail. One of the first items he came to was a letter from Sr. Fidel Sanchez Hernandez. The letter read as follows:
Sr. Director General of Health
In a routine examine that took place last April 3, Dr. Magaña, the primary care doctor for my community, discovered that my son, Gabriel, suffered from a visual defect. Since it was necessary for him to be treated by an eye specialist, Dr. Magaña gave me a referral to go to the ambulatory care center in our county capital, Santa Ana, where all the medical specialists are located.
The 8th of that month, at noon, the hour specified for ophthalmology consultations, my son and I were in the clinic waiting to be seen by Dr. Duarte, the center's ophthalmologist. You can't imagine my surprise when, after a MINIMAL examination, the doctor gave me a referral so that my son could be seen in Hospital San Pedro, in Santa Tecla, since, as was patently clear, the center at Santa Ana DOESN'T HAVE THE MINIMUM REQUIRED FACILITIES NECESSARY TO CONDUCT AN EYE EXAMINATION.
That was the beginning of the Odyssey of a patient seeking to find and obtain a diagnosis.
On April 13, in the afternoon, I had to return to the center at Santa Ana so that the Inspector(1) could authorize the referral, so that I could go to the Hospital San Pedro, as we had been directed.
I was informed by his office that in San Pedro, specialist visits begin at 8:30 a.m. daily.
The following day, April 14, at 8:30 in the morning, accompanied by my son, I arrived at the facilities of Hospital San Pedro, and completed the administrative transactions related to my son's case. After ONE HOUR in line, they gave me a visit for the 4th of June, (ALMOST TWO MONTHS!), telling us that we should arrive at 8:30 in the morning. . . .
- Based on the information in Sr. Sanchez Hernandez's letter, prepare a flowchart for a patient in Ilobasco seeking a diagnosis for a medical problem. Make assumptions where necessary.
- How, if at all, does this assist you in suggesting ways to improve the country's health care delivery system?
- What should Sr. Rivera do?
(1) An Inspector is a Social Security Officer, always a physician, who, among other duties, is responsible for authorizing patients to be treated in contracted (i.e., non-Social Security) hospitals.