Belize Healthcare System: Questions from U.S. Healthcare Volunteers

  1. What percentage of the total Belizean government’s budget goes toward healthcare costs?
    1. 9%
  1. What kind of care does the national system cover?
    1. It pays the entire costs of all doctor visits in the clinic setting (with non-invasive procedures); all OB and GYN care including contraception and prenatal care; all vaccinations (all standard vaccines given to infants in the U.S. plus BCG for TB)/ almost all of prescription drug costs (however, they only partially subsidize expensive treatments such as those for cancer); all tooth extractions; it also pays the cost of emergency transportation to the national hospital in Belize City for surgical emergencies (but not the return trip), and, in some cases, they reportedly may pay for transportation to Guatemala, Mexico, or even the U.S. for complicated treatments not available in Belize (complicated operations, cancer treatments, etc.).
  1. What kind of care does the national system not cover?
    1. Abortion is illegal in Belize and thus not publicly financed. The system does not pay for any elective surgeries. Many services are provided free-of-charge by volunteer doctors visiting from the U.S. or Europe, such as elective surgeries (including cleft palate repair, tubal ligations) and other surgeries which normally would only partially subsidized by the government.  Many studies such as MRIs and nuclear medicine simply are not available in Belize .  CT scans are available in Belize City, but the patient must pay out of pocket.
  1.  How is the national system funded?
    1. Though taxes (some income tax, high consumption taxes), and through international aid (especially from the United Nations/UNICEF and PAHO, and grants from the U.S. , Britain and other countries).
  1. How much total money does the government spend for healthcare in the Toledo district per year?
    1. Just over $1,400.000 BZ ($700,000 US) was set aside by the Ministry of Health to finance healthcare in the Toledo district for 2002.
  1. How much does an individual pay out of their pocket for outpatient clinic visits, hospitalizations, medications, labs, x-rays, surgery, emergency transportation (full costs, percentage, standard fee)?
    1. As mentioned above, medications, clinic visits, and emergency transportation to the hospital are free for the patient – paid for by the government.  The other services are subsidized by the government, but the patients still must pay for a portion of the cost (hospitalizations cost $4 - $20 BZ, labs cost $4 - $10 BZ per lab, x-rays $25 BZ, surgeries generally cost several hundred dollars BZ, but cesarean sections are free of charge).
  2. What type of healthcare funding is there (private, public, combination)?
    1. So far, all the services mentioned are publicly financed.  However, physicians and other healthcare providers also offer their services in the private sector, but this must be done after normal business hours by law (since the government pays their daytime salaries).  In this after-hours private system, the providers charge a fee for their services that the individual patient must pay out of pocket.  All dental work, other than tooth extractions, is done within this private system after normal business hours. There are also two new experimental “private” hospitals in Belize City, which are actually combination public/private programs.  The government pays for all of the employees’ salaries, and subsidized the building of the facility, but patients much pay for all services provided at the hospital. Private insurance can also be purchased or is provided by some employers (even the government offers such insurance to its high ranking employees).  Private insurance would cover all costs of healthcare not covered by government subsidies.  In addition, there are Non-Governmental Organizations (NGOs) which provide many healthcare services.  These NGOs include Belize Council for the Visually Impaired (BCVI) which provides optometry and occasionally some ophthalmology services at subsidized prices ($10 BZ for an exam and $100 BZ for glasses), and Belize Family Life Association (BFLA) offering family planning, gynecological exams and pap smears, and contraception at subsidized prices ($10 BZ for a visit, $4 BZ for a month’s supply of oral contraceptives).
  1. How are Belizean doctors educated – in Belize or foreign countries – and how many years goes into their training?
    1. All doctors currently practicing in Belize were educated in other countries.  Many go to Guatemala, Mexico or Jamaica , and some are educated in medical schools in the U.S. . A large number are graduates of Cuban medical schools – Cuba exports physicians to areas in need of physicians through the Caribbean, Central and South America (5 of 7 physicians currently practicing at PG hospital are from Cuba).  Recently, the medical school in San Pedro, BZ which was part of the Caribbean medical school system catering mostly to U.S. students, opened its doors to the Belizean citizens.  The amount of training depends on the country in which the physician was trained (most generally last four years).  All physicians practicing in the Belizean system are required to pass a Belizean medical licensing examination.
  1. Where does a Belizean go if they need emergency surgery and how do they get there?
    1. They go to the national hospital in Belize City.  They get there by air ambulance (helicopter and planes are available). The district health administration may also choose to pay for a commercial flight to Belize City instead.  They do not pay for transit home from Belize City.  If the surgery requires a specialist, the government subsidizes the cost of transport to a nearby country which can do the surgery, though a large proportion of the fees will be absorbed by the patient.
  1. Where are cesarean sections done and in what situations are cesareans performed?
    1. Most are flown to Belize City, but they may also be performed in Dangriga of Belmopan.  Cesarean sections are performed very rarely: only if the baby is in transverse lie, if the mother becomes eclamptic, or a few other rare occasions when it is determined that the mothers life is at risk (it is not done for breech or labor that fails to progress).
  1. Where do women get prenatal care in Toledo?
    1. They receive free prenatal care at the Maternal and Child Health section of the PG Hospital (care done by public health nurses).  They may also get prenatal checks in the villages by the village Community Health Worker (who may be assisted by a village Traditional Birth Attendant).
  1. How often do women get pap smears, and who pays for them?
    1. The vast majority of women rarely get pap smears, although it is encouraged.  They are done for a fee of $10 BZ at the Belize Family Life Association (BFLA) – but the fee is often waived.  PG Hospital’s Maternal and Child Health section also performs them for free.
  1. Where is pathology performed? Cytology for pap smears?
    1. At the government pathology facility in Belize City.
  1. What kind of cancer screening is done on a regular basis, and who pays for it?
    1. The short answer: little to none.  History and physicals are free of charge (but patients rarely if ever get preventative physicals).  They do not do any lab screening or mammography on a regular basis.  Women are encouraged to get annual pap smears – and they are free of charge – but most women do not get regular pap smears.
  1. If a Belizean were to get cancer, what kinds of treatments are available (surgery, chemotherapy, radiation therapy) and who pays for it?
    1. Treatment available in Belize is extremely limited.  The patient would have to go to the national hospital or one of the two private hospitals and chemotherapy could be ordered if deemed beneficial by a physician.  Pharmaceutical treatment would NOT be free of charge.  Surgery is also available in Belize City, and the cost is subsidized by the government (costing the patient $500 to $2000 BZ).  Complicated surgery (most cancer surgeries) and radiation therapy must be done outside of Belize in Mexico or the U.S. .  The government also usually subsidizes the cost, but this is still very expensive for the patient and thus not done very regularly.
  1. How long does someone in Toledo have to wait to see a doctor, get an x-ray, get blood draws for labs, and get surgery?
    1. Because most patients travel great distances in order to be seen and many do not have telephones, most patients simply show up at the hospital and/or clinic to see a doctor, are given a number, and wait.  The wait to see the doctor at PG hospital for non-emergencies may be long – maximum 1 ½ hours.  Once seen by a doctor and given an order for a lab draw or x-ray, the wait is usually much briefer – usually less than thirty minutes. Since almost all surgeries performed in Belize are emergent, the wait for surgery is generally very short,  although transport to Belize City for the surgery may take hours.
  1. Is there a difference in healthcare availability for a wealthy person versus a poor person (do wealthy people tend to have more surgeries and have better access to medications)?
    1. Because wealthier people can afford to see healthcare providers privately after hours, they do have better access, and, since the providers  are collecting an extra fee for the service (rather than a government salary), there is incentive for the providers to give enhanced personal service when done privately,  Also, wealthier individuals can afford the extra fees for various diagnostic studies and procedures or they are more likely to have private insurance which absorbs these extra fees.  In addition, wealthier people are more likely to be able to afford care at one of the private hospitals which supposedly offer superior care.  Therefore, wealthier individuals potentially have access to more and better care.  It still mush be emphasized though, that all people have access to free physician visits, free OB/GYN care, free vaccinations, and most medications are free through the national system.
  1. What kind of substance abuse rehabilitation is available and who finances it?
    1. There is only on AODA rehabilitation facility in Belize , located on the Placencia Peninsula.  It is a private organization that charges patients a large fee for services.