It is estimated that 40% of specialist appointments are to generate a prescription or see a follow-up patient, a responsibility that a general practitioner can handle. This general practitioner is supported by their healthcare team. This way, the doctor has comprehensive knowledge of their patients, plans their next appointment according to their health status, eliminates early morning queues, and, most importantly, maintains control over chronic patients. However, those 17 years left, among failures and successes, much knowledge and an institutional memory that today serves us as experience. With integration, we not only guarantee universal healthcare but also provide accessibility to all Panamanians to healthcare and continuity of care. Additionally, the health conditions of the insured are no longer the same, and their productivity decreases. These actions substantially reduce the time for specialist appointments. But the most important thing is that a correct Primary Health Care (PHC) strategy could be developed. PHC is based on a general practitioner (GP), who is a trained and updated general practitioner, capable of providing comprehensive family care. The family chooses their GP and subscribes to them. The fundamental element in the doctor-patient relationship is generated: trust. Today, in the emergency rooms of hospitals in Herrera and Los Santos, more than 90% correspond to healthy patients or those with chronic diseases that are not being treated correctly. If 30% of the population suffers from chronic diseases such as diabetes, hypertension, or heart conditions, losing their insurance also means losing their treatments, and their health status worsens. This is another situation that integration will help resolve. I just remind you that six years ago, during the pandemic, about 250,000 insured people lost their jobs. In all these areas, insured individuals and pensioners reside. It would be irresponsible for Caja to build facilities in all those areas, spending between 2,000 and 3,000 million dollars, when there are Ministry of Health (Minsa) facilities, which has more than 200, not counting sub-centers and health posts. This situation puts the future of healthcare at greater risk. The political will of the Executive and the shared vision of the minister and the Caja director regarding integration and the creation of a prevention-based care system are the guarantee to achieve it in this period and protect it. The author is a dentist and advisor to Minsa. There is no possibility of carrying out preventive care, control, or follow-up of the patient. The objective of PHC is to order care through the following actions: Sectorization: it is applied based on the accessibility and proximity of the residential area. Although they are different processes, to implement a correct PHC strategy, an integration system is needed between the public healthcare provider institutions. Half returned to Caja, but there were such complications in patients with diabetes and hypertension that they progressed to renal failure, and today there is more than 10% of dialysis cases than there should be. In addition to these advantages, both institutions would improve their efficiency by planning together, making joint purchases, and avoiding duplicating services. Additionally, it can efficiently care for the patient with a controlled chronic disease, in coordination with the specialist. CSS only has 78 health facilities nationwide. The other is to provide universal care to all Panamanians, regardless of their employment status. 30% of Panamanians, during their working life, become uninsured, mainly in the areas of construction, commerce, agriculture, and industry. Each doctor can attend to about 400 families, that is, no more than 2,000 people. Without the real political will of the Executive and with the two health leaders—minister and director general of the Social Security Fund (CSS)—with different visions, the process did not advance as it should. The current healthcare system is based on spontaneous care: “I feel bad, I'm going to seek a consultation.” This is the first great benefit of integration. So what happens? There are no Caja facilities between Santiago de Veraguas and David, Chiriquí, a distance of 182 km; there are also no CSS facilities on that stretch. Integration is an administrative process between two entities to enhance their strengths and reduce their weaknesses. In our country, the integration process that began in 1973 was suspended in 1990, and then resumed in 1995, but not with the necessary conviction. They return to work at 6, 12, or 18 months, they are affiliated again with CSS, but the institution is harmed because now they will need more costly treatments. The same happens between Villa Zaíta and San Juan de Colón; in Darién and in six districts of the Azuero peninsula.
