As well as the great weather, thriving expat scene, and low-cost living, excellent, affordable healthcare is a big reason many folks retire to Ecuador. In Cuenca, the country’s main expat hub, a recent report on expats found that 75% cited quality healthcare services as their number-one reason for living here.
As someone who’s lived here for seven years—and experienced firsthand the top-quality care this country offers—it’s not hard to see why. Ecuador has invested heavily in healthcare over the past decade, and it now ranks among the top five countries in healthcare in all of Latin America. Many new facilities have been built and equipped with state-of-the-art diagnostic and treatment equipment.
As a result, Ecuador is a shining example of how taking excellent care of patients with minimal bureaucracy delivers a superior result. A 2014 Bloomberg study of healthcare efficiency, which factored in both cost and quality, listed Ecuador as 20th in the world. (How did the U.S. rank? A dismal 46th. And this is despite Ecuador’s spending only 7.8% of its GDP on healthcare, compared to the U.S.’s 18.2%.)
Expats often report a marked increase in their overall wellness after moving to Ecuador. Less stress, more exercise, and a better diet certainly play their part. But another key factor is easy access to the country’s high-quality, low-cost healthcare, which allows you to take better care of yourself without breaking the bank.
“I had an emergency appendectomy, and the total cost—laparoscopic surgery, doctors, nurses, hospital, equipment, and medications—was only $1,200,” says expat Linn Smith, who lives in the capital, Quito. “This same surgery can cost $40,000 to $60,000 in the U.S.”
Living in or near one of Ecuador’s three major cities (Guayaquil, Quito, and Cuenca) means you can access world-class medical service at a fraction of the North American cost. An office visit with a general practitioner will run $25 to $35; specialists charge $30 to $50. A private hospital room costs around $225 a day, compared to $1,000 or more in the U.S. A colonoscopy that averages almost $3,000 in the States is only $350 in Ecuador. Medications often cost much less, too, and many are available over the counter. Just ask IL Editor Suzan Haskins.
“A prescription I take costs $30 a month here in Ecuador and $80 in the U.S.,” she says.
Dental care is equally affordable. Cleanings and fillings on average cost around $30; a porcelain crown is only $300. For this reason, expats can often afford to take care of long-neglected dental problems when they come here. Some people even fly down here for this very reason.
“Based on the estimates I got in California, the dental work I needed would have cost me more than $20,000,” says John Marshall, who jetted down from the U.S. to have his dental needs seen to—at less than 11% of the U.S. price. “My total bill in Cuenca came to $2,100—and the service was excellent.”
Your first exposure to Ecuador’s healthcare may be a bit mind-boggling. There is no clipboard with multiple pages of personal history to fill out. No bloated staff to handle reams of paperwork. There’s no waiting room (you and the other patients wait your turn in the hallway outside the doctor’s office), and usually not even a nurse or assistant.
The doctor, who likely has studied abroad and speaks English, takes as much time as needed to diagnose and treat your problem. Follow-up care for the same condition is provided at no additional charge. Appointment times are more of a “suggestion” than a firm commitment, so I usually call my physician on his personal cellphone the same day I plan to visit him to make sure he’s in the office.
Call a doctor on his personal cellphone? For a same-day appointment? Both these ideas are so preposterous in the U.S. that you may think I have some special “insider access.” Not true. Doctors freely share their phone numbers as an expected part of the personal service they provide. And appointments aren’t even needed. Just show up, pay for your visit, and wait your turn.
Expats in Ecuador have five choices for their healthcare needs: pay as you go; the free public healthcare system; the IESS (social security) healthcare system; private coverage; and a hybrid of the above.
Pay as You Go
The cost of service and medications ranges from 10% to 30% of what you would pay for private care in the U.S. That means you’re saving at least 70% on what you’d pay at home. For this reason, most expats in reasonably good health choose to pay out of pocket for routine office visits and minor health issues. Should a catastrophic condition or illness arise, they often return to their home country for treatment.
“Recovery from my leg injury required daily physical therapy,” says expat Becca Vines, who lives in the mountain town of Cotacachi. “Charges for the therapy were only $2 per day, which I gladly paid out of pocket.”
Free Public Healthcare System
Ecuador offers a public system that is free to everyone, from citizens to visitors. While the facilities and services aren’t of the highest caliber, expats who have found themselves in emergency situations praise the care they’ve received. Bill Keyes, who lives in Cuenca, is one of them.
“I had a heart attack and was rushed to a private hospital, where I was told I needed a triple bypass,” he says. “While I had no insurance, the surgery was beyond the scope of the public facilities, so it was performed there [at the private hospital]. I stayed for nine days and received excellent care. Every penny was paid by the Ecuadorian public healthcare system. Three years later, I am in good health and am grateful for this country’s generosity.”
The public system is primarily geared toward the country’s poorest residents, who have no other access to care. I don’t recommend depending on this level of service when so many other affordable options are available.
IESS Healthcare System—Ecuador’s Social Security
In 2014, Ecuador’s government began allowing all residents (including expats who have a permanent residence visa or citizenship) to participate in its social security (IESS) medical plan, with no restrictions for age or pre-existing conditions. There are IESS hospitals in all of Ecuador’s cities and even in large towns throughout the country. IESS clinics are in many smaller communities.
Enrollment can be done online, with monthly premiums of only $65 (plus $12.62 for a spouse or dependent) that can be automatically deducted from your local checking or savings account. After paying into the system for three months, coverage is 100%, with no deductibles. As with the public system, if your condition requires care beyond the scope of IESS facilities, you will be referred to outside private providers.
My wife Cynthia and I have been members of IESS for years and have been extremely pleased with the level of care provided. Not only do we use the system for routine visits and minor illnesses, we both have had successful surgeries that required overnight stays.
But that doesn’t mean the system is perfect. Patients are assigned doctors based on staff availability, and it’s not guaranteed he or she will speak English. (In the major cities, bilingual assistants are usually available.)
Some specialties like ophthalmology (eyes) are underrepresented, so appointments must sometimes be scheduled weeks in the future. When I once had an urgent problem with one of my eyes, I got an immediate consultation with a recommended private physician. Keep in mind, though, that specialist availability is a fluid situation, because new doctors of all specialties are constantly entering the system as they start their careers with IESS.
Budget restraints and availability mean that sometimes a prescribed medication is not in stock. And should you be hospitalized, you’re going to share a room with two other patients. But these minor concessions are certainly worth overlooking to receive quality care for such a low monthly premium.
Private health insurance policies are available through large companies and individual hospitals. International health insurance is another option; however, because these plans provide global coverage, the premiums are very high.
Private company policies, much like in the U.S., can be written with a variety of deductibles, co-pays, and maximum coverages. Premiums are higher than IESS, but they’re still a fraction of what you’d pay for similar policies in the States.
Pre-existing conditions are almost always considered, and it is difficult to obtain coverage if you are over 65.
Expat Jan Hendon had a blood clot that required four days’ hospitalization, plus follow-up care. She says, “This was our first claim and we didn’t know what to expect. My condition was an emergency, and I was taken to an out-of-network hospital, so our policy with Confiamed (an Ecuadorian healthcare provider) therefore paid only 90%. Since the paperwork obviously couldn’t be filed in advance, reimbursement took a while, but overall we were pleased with the service.”
Other companies offering private health insurance in Ecuador include Salud (one of the largest companies in South America), BMI, Cruz Blanca, Ecuasanita, and Generali.
Individual hospital plans generally cost less than those through insurance companies, and you pay no deductibles if you use their facilities and physicians. You can go elsewhere for treatment, but you’ll be required to pay a deductible of 10% to 20%.
Many expats, including my wife and I, choose to be members of IESS, but we pay out of pocket for routine visits to private care specialists. I recommend this as a cost-effective strategy to maintain relationships with key physicians, while still providing a safety net for catastrophic coverage.
Editor’s Note: Along with excellent and affordable healthcare, Ecuador offers expats countless other benefits, including great weather, a diverse culture, and a low cost of living.
Join us in Quito for our annual Fast Track Ecuador: Lifestyle and Opportunity Conference this June, where you’ll hear all about the benefits of living in Ecuador, and where to start your search for the perfect place to call home there.