Medical Insurance: What do most people use?

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I only know one couple living here who have health insurance.  In Guatemala City, there are excellent physicians trained in the US and other countries.  The reason most gringos do not have the insurance is because treatment is so inexpensive.
The lakeside village of Santiago has a growing clinic which does very good work and is very inexpensive.  Before we moved from the US my wife saw a surgeon about getting a hernia operation.  It was going to cost about $7K.  But the Santiago hospitalito did the entire procedure for less than $500.  The surgeon was a visiting volunteer from Guatemala City who specializes in hernias, the anesthesiologist was a visiting volunteer from Spain who did an excellent job, and the attending staff were indigenous Mayan employees.  There were no infections, complications, nor any other problems that often come from having surgery done these days in hospitals in the states.
There are many tales of gringos who find themselves in Emergency Rooms and unexpectedly under the knife around the country.  The common tales told include staying away from certain government hospitals that are known to be poorly run.  But overall the experiences are told as being surprisingly pleasant and efficient, as well as amazingly affordable.
Perhaps someday we'll loosen up our purse strings and by local health insurance as an added sense of protection.  But the circumstances for needing insurance in Guatemala are 180 degrees different from why a person must have health insurance when living in the US.