Healthcare in Ecuador

There are four levels of health care in Ecuador.

The lowest rung is free public healthcare provided by the government.  This is not set up for Expats and is generally not recommended for them.  However, there could be exceptions -- communities where fine healthcare is available under this program.

Next above is the Social Security or the IESS healthcare program, which was expanded last year to allow virtually all  Expats to join, regardless of age or previous conditions.  Expats can join for $73 per month this year, slightly more for a couple.  Results vary by community.  The big Maldonado hospital in Guayaquil was basically deemed a disaster in a recent investigation.   Cuenca IESS has had good reviews lately.  Quito:  not enough reports yet by Expats for a judgment.  In many venues, patients do not have the opportunity for a regular doctor.

Above that, private clinics/private hospitals/medical offices give patients a choice of doctors, appointment times and facilities.

The highest rung offers the premier-quality care through the top doctors associated with world-class facilities such as Hospitals Metropolitano and Eugenio Espejo in Quito, and various private clinics.

It is widely known that the top hospitals in Ecuador are in the largest cities.  Coastal areas have not caught up.   

In recent years, the government of Ecuador has been actively recruiting doctors and nurses from overseas, including those who had left the country.

The Maldonado report has put a spotlight on the ongoing need for improved medical services for the general public.

cccmedia in Quito

Julien wrote:

Is it recommended to purchase private health insurance in Ecuador?

Personally, I don't anymore.

When I first came to Ecuador two years ago, I signed up with Salud S.A. and was paying $240 per month in premiums for medical-dental, based in part on pre-existing conditions.  A perfectly healthy young man or young woman would pay much less.

Salud paid the lion's share for my routine doctor's office visits, but not a centavo for my meds.

So when IESS invited in more Expats (see Report #1 above), I dumped Salud and now pay $73 per month for IESS coverage.  FYI, IESS requires residency in Ecuador and possession of the national ID card or cédula to schedule any services.

There are no co-pays with IESS.  That $73 (or about $10 more for a couple) covers the bills.  IESS does not exclude new participants in the healthcare program based on pre-existing conditions.

I have not actually used IESS care.  I reserve it as a backup in case of emergency or serious, ongoing medical needs.

For routine care, namely periodic office visits, I prefer to choose my own regular doctor and have been with Dr. Dolberg for almost two years.  Originally, a Salud representative introduced me to him, and I now pay for my office-visits with him out-of-pocket since I am no longer with Salud.

I also pay for my meds out-of-pocket, even though they theoretically could be provided to me gratis by IESS.  I am one of those Expats who does not want to spend any more hours here than necessary navigating the complex medical bureaucracy and its frequent meds-shortages, even if it costs me hundreds of dollars a year to pay for my own medicines and buy them at my convenience.  By having Dr. Dolberg prescribe my meds, I have the continuity of keeping my excellent regular doctor and avoid having to see various IESS doctors over time.

I did not invent the concept of reserving IESS for emergency or serious problems and seeing a private doctor for routine care.  Many Expats prefer the convenience of using a private physician combined with urgent-care backup.

Now, would I trust any of the insurers operating in Ecuador to pay my expenses if I encountered a serious medical situation? 

I would not.  For starters, they typically do not cover you at the outset.   No, they expect the patient to pay upfront for his/her medical needs and then go through a recuperación application process -- probably filled with español medical jargon -- to seek potential reimbursement.  No, gracias.

cccmedia in Quito

My wife recently cut the tip of her finger off with a cloth cutting rotary razor. We took the piece on ice to the emergency room. They could not sew it back on so it went in the trash. The doctor sewed it together using 5 stiches. Next day we went back. She was not there, however a cuban doctor was on duty. He looked at it and was displeased to say the least with her work. My wife had to have  the stitches removed and he replaced them with 7 stitches. We had to come back every other day for a week to dress her wound. We finally bought the wound dressing at a local farmacia and did it ourselves because in my opinion our house is a lot more sanitary than that emergency room was. It has been three months now and her finger is healed although she still has a little discomfort. There was no charge for services but we had to replace anything they used in the emergency room such as gloves, stitches and ointment. We bought  the alcohol, gauze hydrogen peroxide and a tetanus shot. $20.00 usd.. If you live in Ecuador, you get what ecuador gives you. It is not at all like what you may be used to.

Hopefully, one would encounter better healthcare in one of Ecuador's largest cities than in Don Carlos's community in central Ecuador.

Was this situation brought to a government hospital or a clinic?

Either way, it's a cautionary tale for new arrivals.

The point is that arriving Expat retirees, especially those at risk with pre-existing conditions, need to think long and hard before choosing to live anywhere but Quito or Cuenca*, homes of Ecuador's best healthcare and emergency care.

When the porquería hits the ventilador, you'll want a quick route to one of the country's most reliable emergency-rooms, which is probably not easily accessed from Puerto López, Manabí, or Nalgas del Cerdo, Sucumbíos.

cccmedia in Quito


*Meaning Quito or Cuenca, or some other TBA city with excellent healthcare.

It was a hospital, I guess.  The old hospital is being renovated at this time so they use the old red cross building ? for a hospital and somewhere in the future they will move into the newly renovated hospital. I think they did a good enough job, considering their current circumstances. I am a viet nam vet and the healthcare system I have been accustomed to also has its shortfalls. The thing to do is just be careful. If you need a hospital, there's one nearby. They have ambulances that run into Ambato if you are in serious condition or need intensive care. I feel safe..........

Good job, Don Carlos.  From what you have posted, it is evident that your family managed to get the best conceivable result under challenging circumstances.

--

A medical emergency can be defined in many ways.

Under Ecuadorian law, any hospital in La República is supposed to treat any emergency patient at no charge, provided the patient presents a cédula, the national ID proving residency.

If you have IESS coverage but choose to seek urgent care at, say, Hospital Metropolitano, expect no-charge care only if it is a true emergency and not just heavy breathing.

As mentioned, this is subject to interpretation.

Once an IESS emergency patient is stabilized at an out-of-network facility, the patient is to be transferred to an IESS hospital if additional care is needed.

cccmedia in Quito

My experience in 4 years in Ecuador in Quito, now living in Cuenca for almost 4 months ---is limited. I use health care sparingly in the U.S. and here as well.  I have worked in acute care settings ( in hospital in small and very large hospitals incl major research institutions) and also done work in public health in the U.S. in addition to work in hospice and palliation (U.S. health care for 15 years in the States) and I think generally speaking people use health care systems too often. There is quite a bit of hard evidence for this psotion including some new research in the U.S> I am certain some folks will say --big generalization -- but it is true nonetheless. 

I am  in excellent health, over 65, no chronic disease or conditions, very active physically and mentally but have needed care for injuries(I was thrown) eg, accident on a public bus and a busted finger and many gastritis bouts until my gut settled down in EC. Recently I was very sick with a near pneumonia in March (not good)  but almost small stuff like what I earlier described.  In my experience --and the gringos with up to 60 years experience (!!) in QUito -- many have recommended and use Hospital Voz Andes in QUito for all their care.  I find it the the best in QUito for most people -- in/ out pt care is very high quality. It is a public/private partnership -- originally 75 years ago started as a missionary hospital.  Private hospitals like Monte SInai in Cuenca or Metropolitano in Quito are very expensive in comparison with others like IESS and public care available.  ANd I have heard very good things about the latter. At Monte Sinai, I had excellent emergency care in March for a bad respiratory illness but M.S. is not prepared for gringos and not catering to them, for sure -- IMO.   Overall I would give it a grade of B/C for pt care/ service , staff kindness and care etc.

Happy to help but not much to add.
Happy also to be very happy and healthy in Ecuador!!
SSchloth

sueb4bs wrote:

I find (Voz Andes) the best in Quito for most people -- in/ out pt care is very high quality. It is a public/private partnership -- originally 75 years ago started as a missionary hospital.

At Voz Andez, on several occasions over multiple years, I found good care for my minor illnesses. 

The doctors I met at Voz Andes spoke only Spanish to me as a rule.

Hotel Metropolitano is extremely well equipped for serious medical problems.  Yes, it is more expensive.

cccmedia in Quito

So smart to learn some Spanish sometime before getting ill, I guess...

Hi Everyone: My comments are limited to my personal experience and are therefore necessarily limited.

I agree with previous comments; health care varies with the best care in larger cities and the quality is often proportional to the size of the city or locality. The smaller the community, the lower quality of care. I lived in Loja where free care, especially the hospital, is shockingly inadequate. Lack of money is a major problem. On the other hand, the compassion, sincerity and effort of the staff are commendable.

In my experience, most health care needs are addressed through clinics. Both the clinics and the doctors are hit or miss. But, local residence can tell you which are best. Interestingly, one of the more impressive clinics in Loja is in fact expensive and horrible and there have been many cases of malfeasance. Others are less impressive, but provide good care. I had many positive experiences in the clinic I used. Interesting to note, medication is not directly available through the clinics. For example, I needed medicine administered which required injection. I would first go to the farmacia and purchase the medicine and a needle. Next, I would then go to the clinic and pay a dollar to have it injected. Waiting times were from a few minutes to 15 minutes at most. Again, for the most part, the staff was exceptional; only once was I disappointed by the the staff.

Doctors in Loja are below par in relation to what you might expect in first world countries. My general practitioner in Loja was an exception. I have serious and chronic problems with anemia. At one point my blood crit dropped to around 6. In the U.S., I would have been rushed to the hospital to have a blood transfusion (been there, done that many times). The doctor in Loja gave me an option. He recommended the medicine I mentioned earlier, the one that was injected. I was skeptical because it was really targeted for those with bone marrow issues while my problem was generally associated with malabsorption. It turns out, the medicine worked great and it was the first time I recovered from such a low blood crit without a transfusion. Good on him. A side note: the medicine costs 7 dollars per shot. In the U.S. that shot costs over a $1000 per injection, and I needed three a week.

In another instance, I begin having problems seeing from one eye. I went to an eye doctor in Loja−to his office rather than going though a clinic (usually a good choice). The doctor said that I had an infection and gave me medicine. It turned out this diagnosis was just plain wrong. What is even worse is that he totally missed the growth of cataracts which would have been a reasonable diagnosis, even though it too would have been wrong. More on this later. His charge was $35. This was within the normal range of from $20 to $50 depending on the specialty and reputation of the doctor. In summary: he had reasonably bedside manner, but was incompetent in this example.

In another instance, I had an opportunity to see a doctor that was introducing a general diagnosis technique to Loja for the first time. The cost was very reasonable−$40. It involved a small machine built in Germany that had a tube you held in your hand. It was connected to a windows computer that performed the analysis and printed a report. This situation, where there is a diagnostic tool connected to a PC is very common in Ecuador. This replaces very expensive machines, greatly reducing diagnostic testing costs. In a previous situation, I had this done for stress testing with another PC based diagnostic tool. It worked well. In the example I am describing in Loja, I believe the principle was the measure of electromagnetic energy, blood pressure, heartbeat, and conductivity of the skin. I had little faith that this was a valid technique, but for $40 I was curious. Also, since this machine was designed and used in Germany, there was reason to believe it was not nonsense. It turns out the report was remarkably accurate. Because of my many health challenges, I am very aware of my status and this report was accurate on a very wide range of parameters. There was only one measurement which I had doubt about. Pretty nifty and very helpful. At the end of the testing, the Doctor suggested ways I might address those parameters which were outside the normal range.

For the more serious issues, I typically traveled to Cuenca. The hospitals and doctors there are significantly better than those in loja, but there we still a few problems. Overall, I would rate the health care as good as you might find in most small cities in the U.S. The good news is that the cost is often less than 10% of typical costs in the U.S. Normally, I would visit the doctor (typically $40 to $50 for a specialist). Waiting time might be 10 minutes to 40 minutes (rare). If tests were needed, I would get a chit for the test, walk a few blocks (or take a cab) to a diagnostic center and have the test done. Then, return to the doctors with the results (often printed from a PC) in hand. This would take anywhere from 30 minutes to longer depending on the test. When I arrived back at the doctor's office, I was sometimes placed next in the queue. At other times, I had to wait, but the time was never more than an hour in the worst situation. It was informative to talk to the people in the waiting room, so I was never bored.  This experience was good and the immediacy of everything−everything done on a day−was a welcome change from my treatment in the U.S. Everything (mostly) was resolved within a four hour interval, a welcome outcome since the trip to and from Cuenca usually took 5 hours making multiple trips stressful.

My primary care doctor in Cuenca was good, very caring, and I had great confidence in him. If he wasn't sure, he would send me to a specialist he recommended and the outcome was generally satisfactory. The only problem I had was with an eye doctor who was recommend to me by someone I could trust. I believe he is, in fact, good. But this is an example of how the Ecuador system might fall short. This doctor correctly diagnosed cataracts but incorrectly gave it as the cause of my problem. This was a reasonable diagnosis, but more sophisticated diagnosis not readily available in Ecuador revealed nerve damage in the eye. Admittedly, this is rare. Even after finally pinpointed the problem in the U.S., no one can explained why this has happened, although some theories were presented. But, nothing conclusive.

In another example, I was diagnosed with a lump in my lungs in Ecuador (via X-ray). I was offered a procedure to examine and possibly remove this lump from my lungs. Since I was visiting the U.S. in a month, I decided to have this examined there. It turns out, the lump is in my breast bone, which by X-ray would appear to have been in the lung. What happened is that the doctors in Ecuador determined the problem without thorough diagnosis and had they proceeded with the solution, they would have found nothing in my lungs. This is understandable, but would have resulted in an unnecessary procedure. This is an example of how the care there is sometimes inadequate, especially in situations that are unusual. I eventually had this resolved in the U.S., but not without a number of expensive tests.

Hopefully, this gives you a broad understanding of health care in Ecuador. You can draw your own conclusion. In regard to health care insurance: First, consider how you feel about insurance; it is not always the best choice. It will depend on your income and how healthy you are and your age. Keep in mind that the cost of insurance in Ecuador depends on your age and, AFAIK, at a certain age, you are no longer eligible (someone correct me if I am wrong). Just ask lots of questions about the insurance so you fully understand what you are getting and what future costs will be. I know that if you have insurance in the U.S., it may cover care in Ecuador (that is, some percentage thereof). However, Medicare and Medicaid only cover care in the U.S. My personal opinion (this is an opinion and not necessarily truth) is that health care is a major point that you need to address if you want to move to Ecuador, (especially if you are older). One outcome is that you may need to live in one of the larger cities to have access to the best healthcare. Just something to consider. Also, factor in the issue of language. Describing health issues is best done is Spanish. Still, some of the Doctors in the larger cities do speak some English. Unfortunately though, this still leaves room for misunderstanding. I did not meet any doctors in Loja that spoke English, although I did not meet everyone so this assertion is a bit speculative.

I wish each of you the best in your research of Ecuador. It is a truly a beautiful country with remarkable people. I am so sorry that I had to return to the U.S.

sueb4bs wrote:

So smart to learn some Spanish sometime before getting ill, I guess...

True, Sue, but it's a different kind of learning in my experience.

When you encounter a medical problem, you seek to anticipate what words might be needed with regard to your malady or situation, and look those up in a two-language dictionary or at wordreference.com

These words may not come up in daily español conversation, but are useful in describing your situation to a doctor or answering his questions.

You might want to bring your dictionary along to the health facility, just in case.

cccmedia in Quito

Joseph K (Report #12 above), thank you for your comprehensive report on your medical experiences in Loja and Cuenca.

Joseph's report is compelling for its cautionary examples of apparently inadequate testing equipment.  A compelling reason for any arriving Expats with medical issues or advancing age to consider locating their residence with access to a top EC hospital. 

Here is a link to Expat.com thread Top Hospitals in Ecuador...

https://www.expat.com/forum/viewtopic.php?id=431525

If posters had a bad experience somewhere, please name the facility.

cccmedia in Quito

I am about to turn 69. Just before I turned 65, important for insurance rates, I took out a policy with BMI, an Ecuador based company serving Ecuador and a bit of Colombia. I currently pay $ 290 per month with a $400 deductible.

Here in Quito at the Hospital Metropolitano and Los Valles in Cumbaya, I have received superb treatment from excellent doctors. When I want to see a doctor I normally go to one of the clinics operated by Veris. There, I pay $ 4 and they bill the insurance company for the rest. I recently had a week in the hospital Los Valles. I had a private room. There was no shortage of attention by nurses and doctors.  The lady in charge of patient satisfaction stopped almost every day, I think she missed once, to ask if all was well. The dietician stopped by on the first day to plan my menu with me. I had choices. I paid $50 for the week and the insurance company paid the rest.

My only concern with my private BMI insurance, is not with the cost. It covers enough that would include something serious like a heart transplant - which I hope is never tested.  My concern is for if I chose to move to another country in Latin America or France to recoup my forgotten French language capability.  Now into my senior years, getting new insurance in another place could be a problem.

So long as we are on the subject of practical medicine, we  must include the local witch doctors and various medicine men [and women], curanderas, brujos and herbalists we live amongst. Very affordable rates and they are always open for business. Up in Salasaca, for example, there are many people who claim to have a cure for practically any malady you could incur while visiting Ecuador. They even have a cure for baldness, if you have that problem. Look around and you will find any level of expertise you may require. All healthcare in Ecuador is not on a level playing field, you might say Sometimes they don't even play with the same rules, and there are no referees.

Hi i am currently using public health care, i was private at first, but for me if it is good enough for an Ecuadorian then it is good enough for me, the only set back is certain things maybe slow, I can't complain though Portoviejo has some great doctors that also speak good English, they look after me and i trust them.the only issue i have is that i will need to go to Guayaquil for a certain treatment, which they do not do in Manabi, Public health care is not all free, you have to pay for certain medicines and also operations, but if you don't care about paying money into something every month, then i suppose private health would be ideal

I must not have explained myself well and may have mislead ccmedia. His summary of what I was saying is in fact the exact opposite of the point I was making. I think I need to clarify so that others will not be mislead. It might be helpful for all posters to note that asking a question (did you mean to say this… or have you considered...) rather than drawing a conclusion  could help avoid future problems of this type. We all have different experiences and views and asking, rather than asserting the meaning of a person's post, especially in regard to what one thinks is obvious might be a more effective communication too.

About the misunderstanding: To my knowledge, there is no apparent inadequacy of testing equipment in Ecuador. In fact, I explained the German instrument to make a point that Ecuador embraces a wide range of testing equipment that works well and is not available in the U.S. You can get any test you want in Ecuador, but might be required to travel to another city and the test might be conducted in a way foreign to you (pun intended). What follows is a little bit more detail about X-ray incident.

I was recovering from Pneumonia and in a follow-up X-ray a spot was discovered. This was a frontal X-ray and the spot appeared in the vicinity of the lungs, or so it seemed. The issue here, is the doctor concluded, from this X-ray, incorrectly that the spot was in my lungs. He then recommended a procedure that was somewhat evasive. I was about to make my annual trip back to visit the U.S., so I decided to have this done there.

Here is the issue: the doctor proposed a solution without making sure he understood the problem. I had no way of knowing this and was shocked when the U.S. doctors explained the discrepancy. The error was understandable, but shows the lack of insight and carefulness that medical attentions requires. Most expats would be pretty upset if they went through an evasive procedure only to find that the procedure was unnecessary. However, it might turn out they never know. It would be considered just part of the investigative process. The point of writing the previous, very long post was to give insight into the possible errors one might experience with doctors in Ecuador. It was not a cautionary examples (sic) of apparently inadequate testing equipment. The testing equipment is great; human error is the problem.

hughandrew wrote:

I took out a policy with BMI, an Ecuador based company....

Here in Quito at the Hospital Metropolitano and Los Valles in Cumbaya, I have received superb treatment from excellent doctors.....Now into my senior years, getting new insurance in another place could be a problem.

Good report with useful information, especially since the policy gives access to excellent care at the highly-rated Hospital Metropolitano.

$290 a month is above the average premium, but for a senior who is getting excellent care, it's probably fair, and probably worth it.

The issue of obtaining new insurance elsewhere after age 70 is definitely problematic.  You'd need some really good reasons to re-locate to France.

cccmedia in Quito

France.... Are you dreaming???......Almost impossible to expatriate there now with refugee problem. ....Probably some of the best socialized medicine in the world

A quick question for Joseph.....Did they have the equipment to do more definitive imaging MRI, CT or ultrasound?

In Cuenca, yes. Some of the hospitals are fully equipped with the a full range of diagnostic equipment. Never really looked in Loja; just automatically went to Cuenca for anything at that level. My primary care doctor in Loja was very good, but other doctors there seemed to lack critical diagnostic skills. If you have concerns about health care Loja is probably not a good place to settle in.

Does anyone have experience with the hospital and healthcare in the Salinas-Libertad area?    My husband is 73 and I am 63.   We are planning on retiring to Ecuador next year but are concerned about medical care.   Thank you.

If one has an EU passport, moving there is not a problem. 

Lucky for you
Maybe someday you will want to go there.
Always good to have a lot of options

Being Canadian I have admittedly been spoiled by our health care system, under which most things are free. Also, as a senior my expensive medications for diabetes are also covered. When I researched moving to Ecuador the government had removed the age limit of 60 and pre-existing conditions, under which I would not have qualified.

When I first arrived in San Rafael, here in the mountains, at a considerable altitude, I took very sick. For some unknown reason my landlady bypassed the public hospital in Otavalo and took me to a hospital in Ibarra. We spent a very short period of time with an endocrinologist who only spoke Spanish; however, I was admitted. My treatment consisted mainly of an IV and some soup for four days and the doctor visited me a couple of times for a few minutes, again talking to me in Spanish so I had no clue what he was saying. On being discharged I was shocked to learn that I was in a private hospital and I was presented with a $1,200 bill for my four days, with a request for my Visa.

On a subsequent occasion, as the result of living in a cabin with the need for a full-time fire going because it was freezing, I was the victim of carbon monoxide poisoning. This time I was rushed by ambulance to Otavalo's public hospital, where I was revived successfully. All I remember is that the doctor said I was twenty minutes from death.

For a number of reasons I then moved to Cotacachi. I took very sick the first day I was here and the staff at the hostel called for an ambulance. I was rushed to the public hospital within minutes and I received excellent care from the staff. It again appeared that I was extremely dehydrated and possibly suffering from the altitude. I then found an excellent doctor, Dr. Vega, who spent at least an hour talking to me about the possibility of altitude sickness and my diabetes, for which she charged me $15. She sent me to a lab in Ibarra for tests and although they charged me $121 for the tests, all of them came back normal, so I was fine. I have not been sick since and, in fact, feel great.

There have been issues with me filing for residency, primarily because of a screw-up with one of my pensions from Canada. Although my current Visa expires May 29th I am hopeful that I can still file before I am forced to leave the country. Even if I get my residency I will still have to wait the three months to apply for the national health care plan and I face the challenge of getting my meds, primarily my insulin, for that period. I remain hopeful that everything will work out and I will be able to stay in this wonderful country.

Hi Mark, see as follows from www. retire-in-ecuador.com for their excellent Healthcare section, as follows:
retire-in-ecuador.com/healthcare-in-Ecuador.html

It's a crapshoot.
Four stories:
1. My California Kaiser insurance opthamologist removed a dewflap (a small skin flap growth) in his office from my lower eyelid. My copay was $30. Several years later in Ecuador it came back. An opthamologist at Metropolitano wanted to reserve an operating theater for the same procedure and for me to give them an open credit card to pay. I declined and went to a private clinic my good doctor in Otavalo recommended. She did the same procedure in her office plus corrected a scratchy irritation in the other eye as well as gave me a thorough eye exam. The bill was $35 and she was a visual treat as a bonus.
2. A guest in Otavalo with a heart problem history felt something wrong. We took him to the public Otavalo hospital where he got PROMPT competent attention. It was a false alarm and he felt much better. The bill? Nothing. Another time, a visiting friend in Berkeley visiting us from France was, apparently suffering a miscarriage (confirmed by US women's clinic PA) but she phoned her French doctor who told her to go to the nearest ER. Waited all night, had some tests and was told it was a simple miscarriage. The bill? $7,000.
3. March 3rd, this year, I had a bicycle accident and wound up spending 3 days in the nearest (Walnut Creek, CA) trauma center. Am mostly recovered now but almost had a relapse when I saw the hospital charges - over $98,000, not counting the doctors. My Kaiser insurance paid some $8700 and the rest of the bill apparently somehow disappeared, except for my copay: $810 ($270/day). What would have happened if I did not have insurance? Would they have taken my house and tossed me into the street? heh heh
4. When I first came to Ecuador I lost a big filling the day before leaving and got a quick temp and was told I needed a $1200 crown. In Ecuador I was referred to a friend's Otavalo dentist who took care of it for $140. Next trip to the US my dentist said it looked very good and said he had seen a lot of good work coming from South America.
5. But be careful about surgeons eager to operate!

ChecMark/ wrote:

Even if I get my residency I will still have to wait the three months to apply for the national health care plan and I face the challenge of getting my meds, primarily my insulin, for that period.

Once a new EC resident obtains the cédula, he can sign up for IESS government health care at $73 per month, slightly more for a couple.

He will have to make three monthly payments into IESS before scheduling a routine medical appointment or qualifying for routine meds.

However, in the case of a true emergency, he can be treated at no charge at any hospital in Ecuador as an IESS participant upon presentation of the cédula and having made only the first payment.

Once his condition is stabilized, he may be transferred to an IESS hospital for additional healthcare if necessary.

The removal of the age limit and pre-existing condition rule, as mentioned above, occurred in early 2014.

cccmedia in Quito

Hi DonCarlos,

Are you and your wife living in Ecuador as resident? We're you able to find a job? In which city are you living? Is it safe?

We are doing a lot of research and want to know how people did it.

Thanks,

Rebecca

RebAlex wrote:

DonCarlos, Are you and your wife living in Ecuador as residents? We're you able to find a job? In which city are you living? Is it safe?

Welcome to the Ecuador forum, Rebecca.

As a new member posting for the first time, it's understandable that you are not aware of how the forum works.  You have posted 'off-topic' on a thread that was specifically created by the Founder of Expat.com to discuss healthcare in Ecuador.

Don Carlos and his family moved from New Mexico, USA, and he is a farmer-rancher on his farm near Baños, Ecuador.  If you wish to learn more about Don Carlos, you have several choices that do not involve this healthcare thread...

1. Click on his name at the avatar on one of his posts.  This will take you to a page from which many or all of his previous posts are accessible.

2.  Send him a personal message, also starting at his avatar area.

3.  Post at another existing thread more appropriate to your discussion.

4.  Create a new thread.

cccmedia in Quito

Oups, sorry about that. Thank you for the information cccmedia.

Hello Everyone,

I am now living in Ecuador.  I arrived in Cuenca on March 23 but two weeks later moved
to Vilcabamba....where it is warm and the sun shines. 

I came with a private insurance from the USA called Blue Cross & Blue Shield of New Mexico.
This insurance was administered thru New Mexico but it is a US government retirement health
insurance policy that is usable abroad.
Allegedly according to BC/BS my health insurance with them is valid in Ecuador.  I have not
needed to fall back on that yet.  In all the reading I have done regarding sickness and use of various
health insurances in Ecuador I have never read of any one posting about using their pension USA
health insurance here in country.  Has anyone ever done this?  Please tell me of your experience and
how you used your USA health insurance in Ecuador.  Thank you kindly.

CuencaHighLife.com just published an article that David Morrill wrote about this exact subject. Here is the link to the article if you would like to rad it on the site complete with graphics.

cuencahighlife.com/health-care-and-health-insurance-for-ecuador-expats-big-improvements-and-big-changes-change-the-landscape/

Or, here it is for your reading pleasure right here.

The health care insurance options for Ecuador expats changed dramatically at the beginning of 2014 when the government allowed legal residents to join the country's Social Security health care program for a monthly fee.
José Carrasco Hospital in Cuenca has upgraded its diagnostic capability since 2007.

José Carrasco Hospital in Cuenca has upgraded its diagnostic capability since 2007.

Before, choices for foreign residents were limited to private health insurance plans with in-country or international coverage. The good news, then and now, is that private health insurance costs a fraction of what it does in other parts of the world, including the U.S.

HEALTH CARE IN ECUADOR

Before looking at insurance options, both private and through the Social Security health care program, it's important to understand Ecuador's health care system.

Since 2007, when Rafael Correa became president, health care in Ecuador has improved impressively. Various surveys have shown that the country has moved from the middle of the pack of Latin American countries in health care quality, to being one of the top five. Annual funding has more than doubled for public health care from previous levels. A 2014 Bloomberg survey of overall health care efficiency, factoring both cost and quality, listed Ecuador 20th in the world. The U.S., by contrast, ranked 46th.

New public hospitals and clinics have been built while existing facilities have been upgraded. High tech diagnostic and treatment equipment, previously unavailable even in private hospitals, has been purchased, and a large number of doctors, including some specialists from Spain and Cuba, have been hired.

Ecuador offers two levels of public health care.

Social Security health care. The first, mentioned above, is administered by the Social Security, or IESS, system. It has seen the largest infusion of funds and the most dramatic improvement over the last eight years. It offers services through full-service hospitals in large towns and cities, and dozens of clinics in smaller communities (in Cuenca, the IESS hospital is José Carrasco Arteaga Hospital on the Azogues autopista). Services are available to those who have paid into the IESS system through payroll deduction and, in now, to “voluntary members,” including several thousand foreign residents who pay a monthly fee of $73.47 with a dependent or spouse paying an additional $12.62.
The Social Security hospital in Cuenca, José Carrasco.

The Social Security hospital in Cuenca, José Carrasco.

The plan covers all costs, including medicine (no deductibles or co-pays). There are no age or pre-existing conditions restrictions. Most expat members give the program good reviews.

A notable benefit of the IESS program that is particularly important to expats is that, in case of emergency, they can receive service at any emergency room in the country, including private ones, with IESS picking up the tab.

The downside to IESS is that it is part of a government bureaucracy and operates like one. Foreigners with limited knowledge of Spanish can have difficulty understanding and navigating the paperwork requirements. Other frustrations include occasional long waits to see a specialist or to line up a test, and some medicines are not available in the IESS pharmacy and have to paid for out of pocket.

Public health care. Although it shares some of the same resources and personnel with IESS, the public health care system is technically separate and receives less funding on a per patient basis. Its services are free to everyone, citizens, expats and visitors, fulfilling a constitutional mandate that no one in Ecuador can be refused medical care. As does the IESS system, it has hospitals in major cities as well as hundreds of walk-in clinics (the public health hospital in Cuenca is Vicente Corral Moscoso Hospital, the city's largest). There are restrictions: in some cases, the system reserves services and supplies, such as inoculations and vaccines, for high-risk patients.

Most foreign residents who have used the public system give it fairly good marks, almost always mentioning that you can't beat the price. Cuenca expats have used it for everything from respiratory illnesses to open heart surgery, with positive results.
Hospital Del Rio is one of the best private facilities in Cuenca.

Hospital Del Rio is one of the best private facilities in Cuenca.

Private health care. The quality of private health care in Ecuador ranges from very good to non-existent. The best private hospitals, clinics and professionals in the country are in Cuenca, Quito, and Guayaquil, with costs being the lowest in Cuenca. Quality varies in other areas and some rural communities have no private options as well. In Cuenca, there are 10 private hospitals and clinics that offer emergency services.

In general, private doctors are well-trained, many of them educated in the U.S. and Europe, as well as in Argentina, Chile and Cuba, known for having the best med schools in Latin America. Many doctors speak English.

Due to the rapid expansion of the IESS health program, it is not usual to find doctors who have joined the IESS system but who keep part-time private practices. For expats, it makes sense to use one of these doctors as a GP, since they can provide valuable assistance navigating IESS red tape.

HEALTH CARE COSTS

Health care is a bargain in Ecuador. Cost for services run from 10% to 30% of those in the U.S. A private hospital room in Cuenca, with full medical service and meals, averages $225 a day compared to $950 in the U.S. Most medicines cost much less and many are available without a prescription at local pharmacies (newer, name-brand medicines may cost more).

The removal of a subcutaneous benign lump with local anesthesia runs about $125. A colonoscopy, which costs $2,700 in the U.S., is $350 in Cuenca. A set of simple x-rays runs $45, while a full battery of blood tests costs about $75.

On average, general practice physicians charge from $25 to $35 for an office visit, while specialists charge $30 to $50. It should be noted that patients receive much more face-time with doctors in Ecuador (most do not have nurses), and many of them still make house calls.

The Bloomberg health study cited earlier, reports that Ecuador gets excellent results for its health care spending; $332 per capita for health care, compared to $8,608 for the U.S. A 2013 report by the World Health Organization, said that Ecuador spent 7.8% of its GDP on health care, compared to 18.2% for the U.S.

An important caveat: Some hospitals and doctors have a two-teir fee schedule and try to charge foreigners more than Ecuadorians. This is where an Ecuadorian doctor or friend comes in handy, and can make sure foreign patients are not paying the “gringo price.” The IESS system, by the way, has one fee schedule for all patients.

PRIVATE HEALTH INSURANCE OPTIONS

There are a number of good reasons to consider private health insurance. Most important is the fact that there is much less red tape in the private health sector and patients can work directly with their private physician. There are no long waits. Appointments with specialists can be made a few days, sometimes hours, in advance. The same is true with medical tests, even those requiring high tech equipment.

There are several options for private health insurance.

Ecuador-specific health insurance policies. Like those in many other countries, including the U.S., policies can be written with of variety of deductibles and specifications. A middle-of-the-road policy for a 64 year-old-man in reasonably good health, costs $175 a month from Salud, one of the largest companies in South America. A 64-year-old woman would pay $125 for the same policy. In addition to Salud, other companies writing insurance in Ecuador include Best Doctors and Pan American Health.

International private health insurance. These policies, sometimes called travel insurance, are written by a large number or companies, with Bupa and Health Care International being two of the most popular. They cover policy holders in any country in the world and cost considerably more than an Ecuador-specific policy, since international costs are averaged.

Hospital-specific policies. These policies offer a price beak if you use the hospital that writes the policy, either offering no, or very low deductibles. If you use another hospital in Ecuador, you will pay a higher deductible, typically 10% to 20%. Premiums for hospital-based programs tend to be slightly lower than those for large insurance companies.

This is a very brief overview of the health insurance market in Ecuador; many other factors affect costs. As in the U.S., costs rise with age and pre-existing conditions, and customers can be denied coverage altogether. The majority of private health insurance companies will not write a policy for those 65 and older. Those that do, will continue the policy beyond 65 but at higher rates, and often, with reduced services.

SELF INSURANCE AND ALTERNATIVE HEALTH CARE

Many foreign residents in Ecuador, possibly the majority, carry no health insurance at all. Because of the low cost of care, they will pay out-of-pocket for routine care and emergencies, or plan to go back to their home country for major medical procedures.

There are also a wide variety of choices of alternative health care in Ecuador, many more than you will find in the U.S. and Europe. Alternative practices, in fact, are frequently incorporated into the care provided by traditional physicians. The right to seek your choice of health care is protected by Ecuador's constitution.

Editor's note. Greg Medeiros is an expat and medical care consultant in Cuenca. He works with expats, providing advice on medical issues and assistance in planning and scheduling medical procedures. He can be contacted by e-mail at [email protected]. He is co-director of the Cuenca Holistic Health Network.

Thank you, Greg, for posting this excellent primer on healthcare in Ecuador.

It includes some information and advice I have not seen elsewhere.  For instance, the recommendation for IESS participants to work with a private doctor who is part of IESS and can assist Expat patients in navigating the daunting bureaucracy.  This tip can potentially save Expats from avoidable angst and enhance their healthcare experience at a vulnerable time.

Also, kudos to the author, David Morrill.  He is also the author and/or co-author of the Expats in Ecuador series of books about Cuenca and Spanish-language learning, available at amazon.com and elsewhere.

As a holistic health director in Cuenca, you are a valuable resource for this Ecuador forum, Greg.

Do you have a counterpart here in Quito whose contact information you might share with us? 

Do we have a holistic health center in the capital that you would recommend to Expat.com members?

cccmedia in Quito

I have just had June 1st a scary TIA in a bank foyer, got myself back to my apt in Cuenca and then in a taxi to the ER.  I pay IESS mo for insurance. However, I went to the nearest ER (Santa Ines in Cuenca) for obvious reasons.  The care was excellent, a neurologist came to see me and discuss my case within 10-15 minutes, I had a violent headache, sometimes associated with stroke, etc and they evaluated me , placed a drip w/pain meds in my arm, etc.  RNs and docs were very good.   Had a ct scan , couple of days later an MRI and carotid Doppler exam. Have been to talk again with the Neuro guy. 

Fast forward two weeks today -- after the fear subsided and I contacted my docs in California, I am feeling better overall now.  However IESS was a failure for me ( the doc/neuro I was supposed to be evaluated by after the initial ER visit NEVER SHOWED FOR THE APPT>) IESS is too far for me to get to in an emergency here.  I need help with where to go to talk with IESS about their options and service and after paying for 5 months  I do not think I want to use it.  Please respond if you have knowledge of IESS service delivery and who to talk with where in Cuenca.

Thanks

unless I missed something, no one addressed SELF insuring; having the money set aside to cover an emergency

what are your views please

we have been very pleased with Drs in Manta. All bloodwork and visit with an internist was under $200 for a physical

husband has spots removed every year from his skin. In the US, even with insurance, the bills would be about $2,00+ a year. He felt a Dr in Manta was superior to the US and did a very comprehensive exam

Portoviejo seems to have lots of Drs of all types and word has it that the hospital in Bahia is useless

We live on the north coast

thoughts on self insuring would be appreciated

Christie

Hi Christie: 
Go right ahead and self-insure....Many immigrants -- individuals, couples, families who can afford to do self-insure in Ecuador. Most locals here are happy to have insurance they can afford as their incomes begin to rise.  Self-insuring is common here all over the country amogst those of us immigrating here, esp for those with great health, low costs and in case of major $$ issues a plan to return to where they came from or enough to pay out of pocket here. In other words, money allocated just for  healthcare.
AS you have found, cost savings are great --MUCH lower than North America.
Europe, Australia, New Zealand, Asia,  I can't say.

Why not?

CWV123 wrote:

unless I missed something, no one addressed SELF insuring; having the money set aside to cover an emergency.
what are your views please?

El Supremo made sure the casinos here were closed four years ago.

So self-insuring is the last big gamble left in La República.

Sure, if you get hurt in a bad accident or have some other catastrophic medical situation, the medical bills will be way lower than in the US or Canada or some other lugares sofisticados.

But what about that grandfather from Michigan who had a stroke in Guayaquil last year and ran up 40K in medical bills!

If you can set aside money for self insurance, you can probably pay $73 a month to have IESS government insurance as your catastrophe backup.

cccmedia in Quito