What is your name? Do you have insurance? What is your neighborhood? These three questions begin every clinical encounter in Riobamba.
The Ecuadorean health system has undergone an immense and impressive transformation over the last 15 years. Ecuador has become one of the leading countries in the region (and in the world) regarding healthcare efficiency spending (surpassing the U.S. by at least 30 spots on the world rank list). One of the reasons for this success is the strict adherence to patient centered medical homes. Each Ecuadorean is assigned a doctor/clinic based on his/her address and is expected to visit this clinic first except for in an emergency.
The clinic I’m assigned to this week reminds me of