The clinic I've been working with this past week is something of a rarity in Ecuador and doesn't fit cleanly in the aforementioned boxes. The "Fundación Médica Ecuatoriana 'Mosquera'" is a not-for-profit (?) organization that aims to provide affordable, high-quality care to children and the poor. Established in Quito 26 years ago, the Fundación now has several sites throughout Pichincha province (the region surrounding the capital) and a variety of specialty-care clinics, some of which are open 24 hours a day. Their main location is centered on the beautiful "Plaza del Teatro" in the historic district, or "Old Town", of Quito.
As far as I understand, the organization operates via donations, fundraising, fees from their medical courses (they run a school as well), and the relatively minimal charges for patient services. Patients pay a low, flat rate for seeing a physician, while their material expenses operate on a per use basis and are charged immediately. Most of the services are scattered throughout each building, so patients hop from department to department with each step.
A visit may go as follows:
1) A woman with gynecologic problems goes in to see the Ob/Gyn, where she is told she needs a colposcopy (cervical exam).
2) She pays for the consult and a disposable speculum (which she is handed) and goes next door for the exam.
3) The doctor makes a diagnosis, writes a prescription, and orders another test to rule out other issues.
4) The patient walks down the hall to the pharmacy to pick up the prescription (usually less than five dollars),
5) and then heads to the lab to have her blood drawn and give a urine sample (maybe around $2.50 in total).
6) The tests will be conducted in-house, and the patient will be contacted with the results when they come in.
While the operation may be time-intensive overall, the Fundación fills a niche in Quiteños' healthcare demands. They can get high-quality care for little money, and without the waits and limitations that sometimes accompany the Centros de Salud. For more information or history, feel free to check out their website.