Ecuador’s Healthcare System: Analysis and Opinion

If in the good times the State has taken the option of a public-private healthcare system, what will happen in lean times like now?

Although the Ministry of Public Health has built new hospitals, few have the capacity to take in patients: the vast majority of them have no beds at all. At the same time, the IESS has been closing its small centres, especially in rural areas, a policy that leads to a concentration of the system.

Gerard Coffey wrote: A strong State. This is one of Rafael Correa’s successes: the return of the State as a major economic player. Such is the perception, and in the regime’s early years there probably was some reason for thinking that this was indeed the case. The reality today, however, is quite different and it does not match with what is, in fact, an increasingly irrelevant impression.

Let us take the national health system as an example. The evidence offered in a recent report by the Centro de Decrechos Económicos y Sociales (Economic and Social Rights Centre – CDES), Privatización de la Salud en Ecuador (Heathcare Privatization in Ecuador), suggests that while the healthcare system is outwardly public, the role of the private sector is increasingly a leading one, and its revenues are growing accordingly. Is this a contradiction? Maybe, or perhaps a tale of two realities.

It is an undeniable fact that since 2007 the Ecuadorian State has increased direct healthcare spending through the Ministry of Public Health and also, indirectly, through the Social Security Institute (IESS). It has been a sharp increase – from US $ 2.298 million in 2000 to US $ 6,760 million in 2013 – but it still falls short of meeting the requirements set in the country’s Constitution: an investment totaling 4% of the GDP and an annual increase of no less than 0.5%.

Another ambivalent fact is that while the Ministry of Health has been building new hospitals, the IESS has reduced its operating centers and increased contracts with private clinics and hospitals by one thousand per cent. Arguably, patients are now being concentrated in the new, larger hospitals, but whatever the explanation, the result is that the number of medical units is shrinking when it is still essential to decentralize healthcare coverage, especially in rural areas. Read Article

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