Panamanian President Jose Raul Mulino has issued a direct order to merge the country’s two parallel public health systems. He delivered his forceful instructions during a public address this Thursday, demanding swift and tangible progress on a long-delayed reform. The president’s command signals a new urgency for unifying the Ministry of Health (Panama) and the Social Security Fund (Panama), institutions whose operational overlap has historically complicated patient care and driven up public costs.
Mulino’s message leaves no room for bureaucratic delay. He explicitly targeted the structural inefficiency of maintaining separate hospital networks in close proximity. The president’s firm stance represents a significant political push for a unification process that has been legally mandated for nearly two decades but has seen limited practical implementation.
“I want that health integration to work, and fast. Fast,” Mulino declared. [Translated from Spanish] He further questioned the logic of the current system, stating, “It makes no sense to have this duplication.” He then instructed the institutions to begin operating as a single entity, saying, “Work as if it were one hospital, one single institution, to truly integrate everything under one roof.” [Translated from Spanish]
The immediate next step involves activating a pre-established integration committee. This move is designed to translate the president’s directive into actionable policy and coordinated efforts between the two health giants.
Legal Framework for a Unified Health System
The foundation for this integration already exists within Panama’s legal code. The primary mechanism is the Commission for the Integration of Public Health Services, created by Executive Decree No. 290 on July 9, 2019. This commission provides the technical and operational basis for a gradual unification of the entire public health system.
The 2019 decree mandates that the functional coordination between the Ministry of Health and the Social Security Fund must occur gradually and in stages. Its stated purpose is to guarantee access to comprehensive health services that are public in their demand, management, provision, and financing. The commission itself is attached to the Ministry of Health and is tasked with coordinating and monitoring the integration process nationwide.
Its membership includes representatives from the Ministry of Health, who preside over the group, the Ministry of the Presidency, the Ministry of Economy and Finance, and the Social Security Fund. The commission’s mission is to optimize resources, coordinate services, and help separate and compensate costs between the two institutions. These are all essential prerequisites for any successful operational merger.
A Long-Standing Mandate for Change
The legal imperative for integration is not a new concept. The unified text of Law 51 of 2005, in its Article 142, is unequivocal. It states that the Social Security Fund and the Ministry of Health must execute the planning, coordination, integration, cost compensation, and functional unification of the health services they provide. This must be done without undermining the autonomy of the Social Security Fund.
This law goes beyond a simple suggestion to collaborate. It legally obligates both entities to structure and strengthen joint models. These models must include the development of comprehensive family and occupational medical care models and the appropriate hierarchical organization of hospitals. The law also demands the establishment of a national referral system, the reinforcement of teaching and research with unified criteria, and the implementation of policies guaranteeing specialist training, with special attention to the country’s interior regions. The mandate is for a complete transformation of how these institutions educate staff, treat patients, manage referrals, and utilize resources.
Recent events highlight the critical need for this reform. A recent news segment titled “The Daily Odyssey to Get an Appointment at the Social Security Fund” documented the struggles citizens face. One patient, Jose Angel Duarte, shared his futile search for a cardiology appointment. “There is no cardiologist. Everywhere they tell me the same thing, that they are giving appointments until the end of December to be seen next year, I don’t know in what month,” he recounted. [Translated from Spanish] Such reports of overwhelmed clinics and long wait times are common, underscoring the system’s current fragility. Some analysts have even pointed to potential seguro social system stressors that exacerbate these challenges.
Public Demand for a Cohesive Health Network
The pressure for a functional, unified system comes directly from the Panamanian people. In saturated waiting rooms and rural communities where patients travel for hours, the need for a single, efficient network is palpable. Citizens consistently report that when they seek medical attention, they do not distinguish between the Ministry of Health and the Social Security Fund. They simply expect to receive care that is rapid, high-quality, and humane.
This public demand gives weight to President Mulino’s instruction and elevates the strategic role of the integration commission. With the commission created, the legal framework active, and a clear presidential mandate, Panama appears to be entering a new phase. The integration of the Ministry of Health and the Social Security Fund is no longer a pending project. It has become a state exigency. The success of this initiative will be measured by its direct impact on the daily lives of patients seeking care without bureaucratic hurdles or institutional confusion.