THE most frequent question I get on board ship about living in Panama is, “But what about medical care?”

Amongst USA folks there is an assumption that everything, EVERYTHING in the US is better than anywhere else in the world. The infrastructure. [Obviously these folks have never driven in Europe or Singapore, or flown into Bangkok on Delhi!] The freedom. [Probably they haven’t looked at “The Patriot Act”.] Security. [I grant you no country in the world performs this grand illusion, worthy of David Copperfield, better than the US!] And of course health care. If it is the most expensive, then it must be the best, the US government’s own figures of life expectancy and health care in other countries notwithstanding.

Talk to different folks who have experienced the health care here and you will get different stories. You will NEVER get the total story reading the Internet or any public forum. To get the real story you need to talk and talk and talk to a LOT of people and listen carefully to the Coconut Grapevine. Why? Simply put, Panama is not the US. Panama does not have free speech.

“If you can’t say something nice, don’t say anything at all.”

That’s what my mother used to say and, believe me, it applies in Panama. If you say something that isn’t nice, even if it is true, you can have all of your assets sequestered while you are sued in a law suit that drags on for years. “But I thought it was hard to sue people in Panama?” Yes, but . . . say the wrong thing about the wrong people and you can be ruined. So no one is going to give you the complete story about health care in Panama.

I can, and will, tell you our story, and it’s a good story. We have used the health care here, are satisfied, and have found it far superior to what we were getting in the States. Others have some far different, and frankly very disturbing stories. I get emails and comments from folks who have what I would consider horror stories . . . and I can’t risk publishing them. Of course pick ANY hospital or medical institution in the US and you will hear the SAME stories. Medicine, despite all the fancy machinery and “science”, is still an art. People are still people. Shit happens. People make mistakes and sometimes people die because of those mistakes. And sometimes people just die because it is their time, medical science or no medical science.

Are costs of medical care rising in Panama. Yes, like everything else because, remember, we use the US dollar. Also Panama is on an economic roll . . . some might say an economic boom . . . and that means costs and prices rise. But I have seen what I would consider some outrageous, even for the US, charges for hospital rooms, surgeons and anesthesiologists. Again, I don’t know all the background, but one certainly would not expect hospital stays in Panama to be more than in the US. Is their gouging of gringos? I don’t know. I DO know that, although technically it is not legal, there have always been “gringo prices” and “Panamanian prices” in Panama for everything. As an expat you are perceived to be fabulously wealthy and expected to be anxious to spread that wealth around.

So, provided you have the luxury, before you “jump” I would do a lot of asking around, put my ear to the ground, and find out the experiences of as many people as possible. I can only give you OUR experience.

For example: it’s time for me to get a checkup. I’m off on the ship for months at a time so it just makes sense to occasionally get a physical, have baseline EKG to take along with me and results of the usual battery of lab tests and have an MD tell me I’m still kicking. We have insurance with MS Chiriqui at Chriqui Hospital and we have had this since we came to Panama. Under the insurance plan they paid for half the costs of my tests, and I will pay $20 for my doctor visit. [It used to be $10, so that’s a 100% increase.] My EKG at the Emergency Room at Chiriqui Hospital cost $20. My lab tests here in Boquete costs $80, of which MS Chiriqui insurance paid $40. The doctor I use runs his office as a “clinic” so it is first-come-first-served which is OK by me since medical “appointments” in Panama don’t mean anything.

My wife saw her cardiologist a few weeks ago. It took two trips to David (40 minutes away) since the first time the doctor had an emergency and wasn’t available for her “appointment.” She had to wait a few hours for her “appointment’ but the doctor saw her, spent an hour (60 minutes!) with her and her cost, with the insurance picking up half, was $20.

We like the fact that the doctor is free to practice medicine. He/she doesn’t have to see 10 or 15 patients an hour. He can spend whatever time is necessary with you (unfortunately for you or the others who end up waiting). He doesn’t have to answer to a 20-something kid sitting at a HMO office with no medical training for his diagnosis or treatment. The doctor isn’t being hounded by malpractice attorneys nor does he/she have to carry enormous amounts of malpractice insurance, so he/she doesn’t have to order a battery of unnecessary tests just to cover his/her own butt. Your are not a number, or a “file”, but a person, which we find refreshing.

The hospitals have most of the bells and whistles. They may not look expensive and “clean” by US standards, and they may not even have hot water, but although my wife didn’t like the cold baths, she found the care adequate. This is Panama, and some things that are important in the US are not important in Panama. [Many Panamanians still think that taking hot baths will make you sick, and besides this is the tropics so tap water is rarely ice-cold.]

When my wife needed an angioplasty and stints she went to Panama City because our local hospital wasn’t performing those procedures. Our good friend Feliciano Ballesteros gave support and help in Panama City. Nikki went to Hospital Paitilla in Panama City which is affiliated with Her cardiologist in David had recommended the “best guy in Panama” for this procedure. Hospital Paitilla has relationships with a number of hospitals in the US and Spain including the Cleveland Clinic. With the exception of the cold sponge baths, Nikki found the care good and in a few days flew back to David. The total cost of the angioplasty and two stints was $15,000, of which MS Chiriqui paid 50%, so our out-of-pocket cost was $7,500.

So we have no complaints.

However, there are others who have different stories.

Life is all about risk. Are there risks, sure. More or less than in the US, or Canada, or Europe . . . depends.

Nikki worked 18 years for Ventura County Public Health. Every year the county shifted health care providers for its employees always looking for the cheapest option. Before we left Ventura, Nikki visited the HMO who provided the county employees with healthcare, to get a final check up, stock up with medicine, and pick up her records. Well, some of her records, since in all the switching of health care providers a lot of the records had just been dumped in dumpsters and carted off to landfills. The doctor breezed in and looking at her chart asked, “How are you doing with your diabetes medication?”

To which Nikki answered, “Diabetes. I don’t have diabetes. You must have the wrong chart.”

The doctor replied, “Oh yes you do! We diagnosed it a year ago. Didn’t anyone tell you?”

How’s that for quality medical care?