How public/private medicine works in Nicaragua
We have had a few articles about specifics of medical care in Nicaragua but the big picture really hasn't been covered well. While not much different than many other places, Costa Rica being a good example, it is very different from the US or Canada. It's not just the pieces but how they interact that needs to be understood.
First, there is the government-supplied part which consists of health clinics and hospitals. There are multiple government hospitals in Managua and regional ones in other cities such as Estelí (San Juan de Dios). That infrastructure is supplemented by health clinics. For example, there is a clinic in Estelí but also one in the community of San Nicolas with a population of about 7000.
Service is free to anyone in the hospitals and clinics. There are, however, costs for supplies. Usually that means a trip to the pharmacy near the hospital or clinic. There is also free ambulance service supplied by the Red Cross. Blood is handled through the Red Cross where it is typical for them to encourage your friends and family to make donations.
There are some private but free clinics, usually run by some sort of non-profit. For example, there is a clinic at a catholic school (whose name I forget) in the south of Estelí. They are free (that particular one actually charges a one cordoba administrative fee) and typically staffed by volunteer doctors. Their particular approach is to have an assortment of doctors there on a schedule who will take a fixed number of appointments.
There are then lots of doctors in private practice as well as privately-run hospitals and other services. For example, while there is no MRI in the Estelí public hospital, there is a private company that has one in town.
Finally, there is INSS which is a government-run insurance plan that employees are supposed to be enrolled in. They have separate clinics in many areas and offer a higher level of care than the "free" options.
That pretty much covers the pieces but how they interact is what is typically not understood. First, many private doctors have "hours" at the hospitals. They also use the public hospital facility for their private patients. (I don't know how this works but I speculate the doctors contribute some hospital time and, in return, get some hospital time for their patients.)
As an example, Claudia Molina is a eye, ear, nose and throat specialist in Estelí (and a good doctor in my opinion). She has her private practice, works at the public hospital and volunteers in the clinic I mentioned above.
This "work together" situation goes even further. For example, my aunt was in the public hospital and needed an MRI. The hospital arranged for her to get it done at the private place in Estelí. Her only "cost" was transportation (which was me with my pickup). That same aunt needed to see a specialist at a different time. There wasn't one in Estelí so the hospital set up an appointment with one one for her in a public hospital in Managua. Her expenses, once again, were the cost of the bus trip.
I have another friend covered by INSS. The INSS clinic is a separate (from the hospital) building on the grounds of Hospital San Juan de Dios. It includes patient rooms and such but uses the hospital operating rooms.
As I said, there are no fees associated with the public clinics and hospitals. There does, however, seem to be advantages gained by knowing how the system works. I would call this "very Nicaraguan". Service can be improved by how you ask, who you ask and who you know.