We’re rethinking health care in Panama. When we came to Panama we basically self-insured except for an “insurance” program with MS Chiriqui of Chiriqui Hospital, which was more like a hospital discount plan than actual insurance. Our experience with MS Chiriqui was OK, although we heard stories from others. But we had no complaints and for the most part got what we paid for. Then things started to change as more and more expats, lots of retirement age, moved to Chiriqui and took out MS Chiriqui’s insurance plan. Obviously the actuary, if they had one, miscalculated and eventually to survive the plan had to be bought out by . . . you guessed it, a US insurance company. I’ll talk more about insurance in a later post.

But when we came to Panama an emergency room visit was around $2.50 – today it’s $10.50 . . . and counting. You can still get an EKG for around $20 and a cerebral MRI for about $600. But the costs of hospital stays and doctor visits is soaring! Which in a way makes sense since we use the US dollar and as the US dollar has been consistently devalued by government printing presses running a muck to finance adventures in Iran and Afghanistan, as well as bailouts of anyone with really big bucks, a just plain stupid “War on Drugs” and all the attendant criminal/”justice” costs, and a “War on Terrorism” designed to get folks reelected, goose employment figures [all those TSA folks would otherwise be collecting welfare checks] and provide million-dollar contracts to folks either with high-level government connections or powerful lobbyists who can get Congressional ears with cash rewards [kind of an updated “Green Stamp” idea or frequent “flyer” rewards] or just threats to expose the pictures they’ve put on-line exposing themselves [big mistake . . . or more likely given the inverse relationship between power and size . . . little mistakes]. [Gee, I can’t believe I actually wrote that sentence!]

At any rate Panama, using the US dollar and, unlike the US, enjoying a booming economy is also experiencing inflation. So medical supplies cost more here as in the US. And there is the added cost of oil since most medical supplies and equipment has to be imported with, naturally, tax and duty being added. So costs HAVe gone up for hospitals just like everyone else.

It costs doctors more to feed their families like everyone else. There are a few doctors in Panama who may like the US doctors we love to stereotype be making big bucks.  [However, most docs I meet abandoning medicine in the US to retire early to Panama are not making the big bucks, nor are they free to practice medicine.]  A Panamanian doctor leads a tough life with long days usually working a full-time job for the Panama government health system and also having a full-time private practice.  The ones I see are doing well, but they don’t appear to be driving the fancy cars and getting filthy rich.

But even taking inflationary pressures into account there also seems in some cases to be what appears to be a greed factor, particularly in regard to expat Gringos.  One lady encountered a doctor’s receptionist honest enough to admit that there were Panamanian prices and Gringo prices for services.  Illegal, but . . . Take the “Pensionado” discount.  Ask and  you will be told it is “included” or “factored in” but if you don’t know what the regular fee is . . . A friend checking her husband into a local hospital was told she had to make a $200 upfront deposit against hospital charges.  When she pulled out her MS Chiriqui Insurance card the deposit amount suddenly went to $300.

When I was scheduled to leave for a cruise contract for 4 months, so had a quick, “regular” check up they wanted me to see a cardiologist.  With less than a week before I flew out I went to see my wife’s cardiologist.  He wanted a stress test and an electrocardiogram.  To get MS Chiriqui to pay or reimburse me it would have to get prior approval and since only one test was allowed a month, it would be either or.  Understanding my problem, my cardiologist said we could just forget the insurance and I could pay cash . . . the out-of-pocket difference to me was $50.  And he kept his staff on duty to do the procedures on Saturday afternoon since I was scheduled to leave on Tuesday!  Believe me . . . even if you value your time only a measly $5 an hour, I was ahead of the game given the time it would have taken me to jump through the insurance hoops and then get reimbursement.

My brother, for whom I care, needed an endoscopy and we had it done by a good doctor whom I’ve used and who I respect.  He had the procedure done and while he was off in a corner, behind a thin curtain, a Chinese Panamanian teenager was wheeled in for the identical same procedure.  When I went to pay my brother’s bill I asked if the Pensionado discount was included and I was assured that it was already included.  Laying right next to my brother’s bill, on the counter, was the bill for the Chinese Panamanian teen.  Everything the same . . . except the name.  When I asked how that could be if they’d already included the Pensionado discount, she didn’t want to discuss it and a supervisor insured me that it was already included and that what I saw I didn’t see.

Perhaps more disturbing is the thought that physicians may be using diagnosis to provide unnecessary services.  Now I don’t know if the following stories are true or not because they didn’t happen to me.  But I know and respect the people involved who have shared these stories.  Folks aren’t going to name names as I won’t because if you do you run the risk of libel whether the statement is true or not.  This is not the US and the law is different.

Talk to enough people and you will hear stories that will make your blood curl.  That’s why you always want to talk to lots of people and get lots of opinions before you jump, particularly  in regard to medical issues.

We have heard several accounts recently of people who have been told they needed surgery for one thing or another “immediately” and that their condition was “life-threatening” only to go to another doctor and discover that they didn’t need any surgery.

One guy was feeling poorly, lacking energy so he went a local doctor who ran a lot of tests including an MRI.  His diagnosis was that the guy had a tumor on his heart, that it was life-threatening and that he needed immediate risky surgery at an estimated cost of $105,000 just for the surgery.  After talking with his kids by phone he returned to the States for a second opinion at a major medical center.  There was no tumor: the local doctor had misread the MRI.  The person was fine: no surgery necessary.  Of course: stuff happens.  It happens here as well as in the US.  No one is perfect and that includes doctors who, like rest of us sometimes make mistakes, however mistakes of life or death.  But of course the truck driver driving that tanker full of gasoline down the Pan American Highway is in the same situation: mistakes there can mean life or death as well.

Another guy we know, in his 50’s, coming home from Costa Rica didn’t feel well and experienced chest pain and feared he was having a heart attack so stopped at a local hospital.  They ran an EKG and said he was fine and should take aspirin.  He went home and died of a massive heart attack.  Now that can happen anywhere!  Every time I’ve left a cardiologist’s office and been told I was fine the doctor has added, “But that doesn’t mean you won’t go out of here and die of a heart attack.”  Stuff happens.  Everywhere.

Another guy we know needed an angioplasty and probable stent.  He was told the cost of the stent was $1,500.  As they were wheeling him into surgery he was told the cost of the stent was now $2,500.  And when he got his bill the cost was $3,000.  The surgeon was on vacation and another doc popped in three times, “How are we feeling?  Any pain?”  Cost $200 per visit!  And – get this! – when he is ready to leave the hospital will not remove the IV drip line until the bill is paid!  I know that’s true because the same thing happened with my brother only I was too stupid to know what they were doing or why.

A local Gringo whom everyone knows has money was dying.  He’d put up a brilliant fight, but it was his time to go.  He was brain-dead but the hospital refused to allow the family to have the machines that were keeping him alive disconnected.  Finally his widow put up such a fight at the indignity  of not allowing her husband to die, that after a number of days the hospital allowed him to die.  You’ve got to wonder about stuff like this.

And you’ve got to wonder about the overall quality of care.  There are some excellent doctors in Panama and in Chiriqui.  How do you know who they are?  Ask around!  Talk to a lot of people.  Listen.  People will tell you one-on-one what they can’t in print or publicly.  Ask other doctors.  Sure, no doctor is going to bad mouth another, but . . . as with most things in Panama where everyone is related to everyone . . . watch the eyes!   If the eyes go up or roll, you’ll being given a message regardless of the words.

Is health care in Panama cheaper than in the US?  Yes, but increasingly in my humble opinion, it is not the great bargain it once was.

Is the quality of care equal to that in the US?  It depends.  Depends on what you are comparing it to.  Depends on the qualifications of your particular doctor . . . which, by  the way, is the same as in the US!  Depends on what  you can afford . . . again, same as in the US.

Unfortunately I think greed has infected some aspects of the medical system in Panama just as it has in the US.  Medical care in Panama is far from perfect just like it is far from perfect in the US.  I’ll talk more about insurance schemes next time, but my current take is that it’s a good idea not to put all of you eggs in one medical basket.  Miami is only 4 hours from Panama City.  Granted it’s a bit further to Seattle and Virginia Mason Medical Center which I wrote about the other day, but it’s still good to keep your options open.

Just before publishing this blog I received this comment from an expat about her husband’s experience in a local hospital.

I wanted to let you know about a couple of things that happened when my husband had his recent surgery. First, nobody came out to tell me what was going on during the surgery. A 1 to 3 hour surgery had not ended by 5 hours. I was frantic, and nobody would help me find out what was happening. I did not know if he was dead or alive. I went to the nursing station several times from 8:30 p.m. to 10:30 p.m, and often nobody was there, and the OR doors were still closed. They should not leave family out there unattended and uninformed.

The second problem was after the surgery. My husband was so weak he could not stand or move on his own. The nurses did not seem to be trained to lift a patient safely from the chair to the bed. I would ask them to help me, and they just looked uncertain about what to do. On the day before he checked out, they put him in a chair and gave him a bath with cold water, even though hot water was available in the room. Then they left him in the chair. I had to go get them to ask them to help me put him back in the bed. When they did that, they dropped him into the bed! He was so angry about that, because it hurt him.

The hospital does not seem to have any orderlies, strong men whose job it is to move and lift patients, from the bed to the gurney, from the bed to the chair, or wherever they need to be moved.

Other than that, the staff was pleasant and caring, and the hospital food was tasty.

Hopefully the surgery was as good as the food.