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DOCUMENTO Íntegro

Cable de la embajada de EE UU sobre el sistema de salud de Venezuela

ID: 176549
Date: 2008-11-03 18:28:00
Origin: 08CARACAS1522
Source: Embassy Caracas
Classification: CONFIDENTIAL
Dunno:
Destination: VZCZCXRO2019
PP RUEHAO RUEHCD RUEHGA RUEHGD RUEHHA RUEHHO RUEHMC RUEHMT RUEHNG
RUEHNL RUEHQU RUEHRD RUEHRG RUEHRS RUEHTM RUEHVC
DE RUEHCV #1522/01 3081828
ZNY CCCCC ZZH
P 031828Z NOV 08
FM AMEMBASSY CARACAS
TO RUEHC/SECSTATE WASHDC PRIORITY 2065
INFO RUEHWH/WESTERN HEMISPHERIC AFFAIRS DIPL POSTS
RHEHNSC/NSC WASHDC
RUMIAAA/HQ USSOUTHCOM MIAMI FL
RUCPDOC/DEPT OF COMMERCE

C O N F I D E N T I A L SECTION 01 OF 03 CARACAS 001522

SIPDIS

E.O. 12958: DECL: 11/03/2018
TAGS: ECON, EFIN, PREL, EINV, PGOV, VE
SUBJECT: OPEN UP AND SAY AHHHH: VENEZUELA'S HEALTH CARE
SYSTEM

Classified By: Economic Counselor Darnall Steuart for reasons
1.4 (b) and (d).

1. (C) Summary. Conditions in public hospitals continue to
deteriorate and private hospitals face a growing threat of
nationalization. Despite multiple 2008 budgetary
authorizations for increases in health care worker salaries,
labor actions continue by health care workers. One public
health doctor confided to EconOffs that only 60 of her
graduating class of 2010 physicians remain in Venezuela. The
Bolivarian Republic of Venezuela (BRV) has begun to
nationalize small private clinics and hospitals, leaving
fewer treatment choices for the public and the Embassy
community. End summary.

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INCREASE OF GOVERNMENT MONEY AUTHORIZED FOR PUBLIC HEALTH
--------------------------------------------- ------------

2. (SBU) On October 20, a national economic newspaper, El
Reporte Diario de la Economia (El Reporte), published an
analysis of BRV funding of public health care in 2008. In
addition to the 8.8 billion BsF (approximately 4.1 billion
USD at the official exchange rate of 2.15 BsF to USD) in
funding set forth in the 2008 budget, the National Assembly
(AN) has approved additional expenditures of 2.9 billion BsF
(1.35 billion USD.) The 2008 additional credits include
funding for the signature Chavez "mission" Barrio Adentro
(Inside the Barrio) and the Fondo Rotatorio de la
Organizacion Panamericana de la Salud, (the Rotating Fund of
the Pan American Health Organization); a first authorization
for an increase in the wages of health care workers, an
authorization for a 50% bonus of salary for health care
workers; a second authorization for a discretionary increase
in health care worker salaries; and a final authorization for
an additional discretionary salary increase announced by
President Chavez. In total, the authorizations for 2008 are
double the moneys approved for spending on hospitals in 2007.
El Reporte reported, however, that the funds authorized for
hospitals in 2007 have not yet been disbursed and it is
impossible to track what, if any, health care spending has
occurred in 2008. Reporte's analysis of 2008 spending which
targets the parallel Barrio Adentro institutions (not public
hospitals) and health care worker salaries, reflects concerns
EmbOffs heard in several meetings with Venezuelan medical
professionals in September.

----------------------------------------
CONVERSATIONS WITH HEALTH CARE PROVIDERS
----------------------------------------

3. (C) EmbOffs met with xxxxxxxxxxxxx, a pediatric surgeon at a Ministry of Health
administered hospital, Hospital General Guarenas-Guatire. On
September 12, EmbOf xxxxxxxxxxxx
xxxxxxxxxxxx, a private hospital nominally run by
the Sociedad Anticancerosa de Venezuela and Carmen J. Gosling
(strictly protect throughout), public relations director for
SenoSalud, a local breast cancer awareness foundation.

---------------------------------
A LOOK INSIDE ONE PUBLIC HOSPITAL
---------------------------------

xxxxxxxxxxxxx
Guarenas-Guatire, is a general care public hospital,
providing health care to approximately 185,000 local
residents. The hospital is small and lacks adequate staffing
and resources to service the community. xxxxxxxxxxxxx stated
approximately 72 physician positions are vacant in the
hospital. Surgeons are unable to operate because there is no
anesthesiologist on staff. In addition, doctors must manage
treatment programs carefully as no doctors work the overnight
shift. Although the hospital was renovated by the BRV in
2007, the renovations were poor and the air filtration and
air-conditioning systems do not work, stymieing patient care.
All patients at the public hospital requiring laboratory
tests or radiology work must seek care at other hospitals.

5. (C) The hospital treats many prisoners from the nearby
jail for tuberculosis. Teen pregnancy is high; girls as
young as 13 give birth. xxxxxxxxxxxxx stated that approximately
80-90% of women giving birth were below the age of 18. The
hospital does provide free contraceptives (birth control
pills, condoms, etc.); however, sex education is not a
concern for the local population. In xxxxxxxxxxxx words, "the
people are too worried about having food to eat: they don't
think about sex education or contraception." When doctors

CARACAS 00001522 002 OF 003


attempt to treat patients, they face additional hurdles to
effective preventive and diagnostic care. For example, the
supply of vaccines is never enough to inoculate all community
children and often, the vaccines are incompatible with those
previously administered. Compounding these problems, the
hospital does not have sufficient medical supplies for
emergency care. xxxxxxxxxxxx believes the hospital receives ample
funding for supplies, but the funds are diverted for unknown
use.

6. (C) In the public hospitals, the Ministry of Health pays
each specialized doctor 1500 BsF monthly (696 USD), residents
receive 1300 BsF monthly (604 USD), and nurses earn 1000 BsF
monthly (465 USD.) In addition to their salary, doctors
receive a food bonus and quarterly bonus of 3000 BsF (1395
USD) from the regional government. Most doctors who work at
the public hospital maintain private practices to augment the
meager salaries. In addition, many doctors and nurses
employed by the public hospital are older, nearing retirement
and there is no accountability for failure to show up to
work. xxxxxxxxxxxxx explained that of her graduating class of 2010
doctors, only 60 remained in Venezuela. The medical
professionals often take labor action, striking to obtain
better wages. In September, several labor actions have
occurred, including complaints against the Ministry of Health
for its alleged failure to comply with mandated salary
increases. In October, sporadic labor actions for
non-payment of wages by health care workers continue, coupled
with walkouts by medical professional to force the GBRV to
declare an emergency due to the shortage of surgical supplies
and deterioriating infrastructure.

-------------------
PRIVATE HEALTH CARE
-------------------

7. (C) Private hospitals also lack the necessary staff and
resources to attend to patients' needs. xxxxxxxxxxx
reported that xxxxxxxxxxxx lacks an
anesthesiologist and ICU specialist. There is, he said, no
record of where equipment comes from, there are no
technicians to operate or repair machinery and parts are
missing. Concerning oncology treatment, xxxxxxxxxxxx explained,
only generic drugs, produced in India and Cuba, of unknown
quality, are available. Furthermore, drug supplies are
neither constant nor reliable, hampering treatment.
Compensation at private hospitals, he added, is also not
competitive with salaries in Europe and the United States.

-----------------------------
A SNAPSHOT FROM THE VISA LINE
-----------------------------

8. (SBU) Post conducted an informal survey of NIV
applicants applying for visas for medical-related travel over
a two-week period in October 2008. Applicants hoped to
travel for a variety of reasons, from chronic illness such as
juvenile arthritis to life-threatening diseases, such as
brain cancer. A few trends stood out. Notably, the
applicants said the risk of medical treatment in Venezuela
was great, options were limited and generally, treatment was
deemed to be safer in the U.S. One applicant had been left a
quadriplegic after surgery in Venezuela due to a complication
with anesthesia. Whereas insurance covers medical treatment
in Venezuela, most applicants would pay for U.S. treatment
with personal funds or governmental support. Mission Barrio
Adentro and PDVSA (the state oil company) were providing the
necessary funds for at least two applicants.

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POSSIBLE NATIONALIZATIONS OF PRIVATE HOSPITALS LOOMS
--------------------------------------------- -------

9. (C) News reports indicate the BRV has quietly taken
steps towards government ownership of hospitals, including
one hospital currently used by Embassy personnel and their
families, xxxxxxxxxxxx
confirmed the reports, indicating that the BRV has started
buying small privately owned hospitals and clinics at
pre-negotiated prices. She believes that the owners, fearing
government nationalization, are choosing to get out while
they can. xxxxxxxxxxxx explained the BRV had offered to renovate
xxxxxxxxxxxx in 2004. The BRV did
renovate the hospital and at the same time renovated the
hospital's management, leaving BRV representatives in charge
of the private hospital.

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COMMENT

CARACAS 00001522 003 OF 003


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10. (C) Widespread problems in the public health care system
and nationalization of private clinics and hospitals may lead
to a further deterioration of health care. Post will closely
monitor future actions by the BRV to nationalize private
clinics and hospitals, particularly with regard to the impact
on access to medical care for the Embassy community.
CAULFIELD