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Curacao Healthcare

In 1994, Curaçao initiated a process to contain rising health care costs. This process, known as the "New Policy," gave rise to a project to develop a new health insurance system. A Steering Committee for Health Sector Reform was formally established in October 1994. This Committee is composed of members of the Public Health Services of Curaçao, the Department of Finance of the Executive Council of Curaçao, the Welfare Services, and the Department of Public Health and Environmental Sanitation. Goals were established to ensure the provision of humane, effective, and efficient healthcare based on criteria of equality and on the real needs of the population.

The Government’s National Health Plan assigns priority to prevention and control of chronic non-communicable diseases as well as encouraging changes in lifestyles and habits that increase the risk of cardiovascular diseases, hypertension, and diabetes mellitus. The Ministry of Health has created three multidisciplinary working groups to develop intervention programs. It has been decided to conduct surveys similar to the Curaçao Health Survey on the rest of the islands in the Netherlands Antilles to better assess the health situation of each island and design appropriate intervention programs.

Curaçao has two general hospitals and one surgical hospital, with a total of 618 beds: Saint Elizabeth’s Hospital (540 beds), the Adventist Hospital (42 beds), and the Dr Taams Surgical Hospital (36 beds). There is also a maternity clinic with 23 beds, and the Institute Mon Verriet has a rehabilitation service with 12 beds. Curaçao has a total of 4.4 beds per 1,000 population. St Elizabeth’s Hospital, which provides hemodialysis, intensive care, and neonatal services, receives patients from the other islands in the Netherlands Antilles as well as Aruba.

The entire population has access to health services. At the primary care level, there are 90 general practitioners. The new general health insurance system and the new financing models are intended to improve the quality of care and enhance equity. Curaçao has 97 medical specialists, including 12 internists, four cardiologists, four neurologists, one gastroenterologist, 11 surgeons, rwo urologists, five orthopedists, one neurosurgeon, two plastic surgeons, 10 gynaecologists, three neurologists, three dermatologists, six anesthetists, and two pathologists. Health professionals are trained in the Netherlands and, occasionally, in other countries.

Prenatal care is provided by general practitioners, midwives, and obstetricians/gynaecologists. Only midwives use the perinatal information system, which includes information on prenatal care, childbirth, and the puerperium. In 1994 the system contained records on 1,144 women (37% of all births). From these records it can be concluded that only 25% of prenatal visits were made before the 20th week of pregnancy and that 52% of the women began prenatal care in the third trimester. As for care during childbirth, most births (99%) take place in clinics or in hospitals. Low-risk births generally occur at maternity clinics, and high-risk cases are referred to the General Hospital. As for maternal mortality, although only 13 maternal deaths occurred between 1986 and 1993, with an average of 3,000 live births per year, this number yields a maternal mortality rate of 54 per 100,000 live births. Among the causes associated with this rate are the high prevalence of sickle cell anaemia and pre-eclampsia.

There are five insurance modalities: the PPK ("pro-paupere kaart"), which is totally funded by the Government and is intended for the indigent and those who are not otherwise insured because of advanced age or the existence of a chronic condition; the public insurance program, which covers 100% of healthcare costs for blue-collar workers and 90% for personnel in higher categories of public-sector employment; the insurance fund for retired public-sector employees; private insurance plans provided by large private companies for their own personnel; and the social security fund, which covers employees of small private companies and other forms of private insurance. Given the substantial differences in coverage under the various modalities of insurance, one of the objectives of the insurance system restructuring process is to reduce differences in access and quality of medical care.





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