Panama has officially begun a two year process to merge its two main public healthcare providers. The Ministry of Health (Minsa) and the Social Security Fund (CSS) will integrate services starting in the provinces of Herrera and Los Santos, with a goal of nationwide operation by late 2027. This ambitious reform aims to dismantle a fragmented system that has long created inefficiencies and unequal access for millions of Panamanians.
Technical teams from both institutions have already completed initial diagnostic visits in the pilot regions. They assessed available infrastructure, human resources, assigned populations, and installed capacity. This data will form the foundation for implementing a primary health care model, which is the central axis of the entire integration strategy. Officials stress the timeline is deliberate, designed to cement the change as state policy within the current government term.
Carlos Abadia, an advisor to the Ministry of Health (Panama) and a technical lead on the project, explained the urgency behind the two year framework. He pointed to lessons learned from previous failed attempts at integration that were derailed by political changes.
“We cannot plan this over five years. It has to be consolidated within this government period and be shielded as a state policy,” Abadia stated. [Translated from Spanish]
The immediate next step involves using the diagnostic information to roll out the new primary care structure in Herrera and Los Santos. This phased approach allows for adjustments before scaling the model to other provinces. The integration has legal backing from the National Constitution, executive decrees, and CSS law, providing a firm foundation for the sweeping changes.
Addressing a Legacy of Fragmentation and Duplication
The coexistence of two separate public health institutions has created a problematic legacy for Panama. With distinct planning, policies, and care networks, the system has bred significant inefficiencies. Duplication of functions and unequal access to services are common, ultimately driving higher costs for the state. The CSS operates approximately 72 facilities nationwide, while the Minsa manages more than 200. Gaps in coverage persist, however, particularly for CSS beneficiaries living in areas where the fund has no physical presence.
Abadia framed integration as a pragmatic solution to this infrastructural mismatch. Building entirely new, parallel facilities would be a massive and unnecessary expense. The plan instead seeks to leverage the existing strengths and coverage of both entities. This means a CSS-insured patient could receive care at a Minsa facility, and vice versa, based on proximity and need rather than bureaucratic affiliation. The budgetary responsibility for uninsured patients will remain with the Minsa, a point officials emphasize to address concerns about the Social Security Fund (Panama) absorbing new costs.
“It would be irresponsible to think the Social Security should invest billions of dollars in building new installations, often right across from Minsa facilities,” Abadia noted. [Translated from Spanish] “Integration allows us to take advantage of the strengths of both institutions.”
A New Model Centered on Primary Care and Family Doctors
The integration’s success hinges on a fundamental shift to a robust Primary Health Care model. This approach seeks to organize medical care around prevention and continuous management, displacing the current model based on spontaneous demand for urgent or specialist care. At its heart will be the “médico de cabecera” or family doctor, a general practitioner assigned to a defined number of families in a specific territory.
This doctor will provide continuous follow-up, especially for patients with chronic conditions like diabetes, hypertension, and cardiovascular disease. They will refer patients to specialists only when absolutely necessary. Abadia estimates that up to 40 percent of current specialist consultations could be resolved at this first level of care with proper patient management. The current system, where people seek care only when they feel ill, leads to early morning lines, appointment waits of months, and an unnecessary overload on specialists.
One of the most significant benefits cited is continuity of care for workers who lose their jobs and their insured status. Presently, when someone stops contributing to the CSS, they lose access to ongoing treatments. This causes health to deteriorate and leads to higher costs when they eventually re-enter the workforce. During the pandemic, Abadia recalled, about 250,000 insured people transitioned to uninsured status in just a few months, abruptly interrupting critical chronic disease treatments.
“With integration, the patient continues with their doctor and their treatment, regardless of whether they are contributing or not. That is a gain for the population and for the system,” Abadia affirmed. [Translated from Spanish]
Pilot Provinces and Technological Bridges
Herrera and Los Santos were selected as pilot provinces for specific strategic reasons. Their manageable size and distances, along with a history of prior coordination between Minsa and CSS offices, make them ideal testing grounds. A crucial technological advantage also exists there. The Minsa has already implemented electronic health records in all its facilities in these provinces, which will ease data interoperability during the transition.
The CSS is working on temporary technological solutions to bridge its own gap until a unified national system is achieved. The integration plan also explicitly includes the use of telemedicine. This will help optimize scarce specialist resources across both institutions. Progressive training for general health personnel, including doctors and nurses, is another key component. This addresses a global shortage of specialists by empowering the primary care level to manage more cases effectively.
For the residents of Herrera and Los Santos, the change will mean a more streamlined health experience starting in the near future. The goal is a system where a patient’s care pathway is determined by medical need, not by which public institution they belong to. If successful, this pilot could redefine public healthcare delivery for the entire nation, moving Panama toward a more efficient, equitable, and patient-centered model after decades of parallel systems.