“What’s the medical care like?”

When I am on cruise ships the single question people ask most frequently about living in Pamana is, “What’s the medical care like?”

When we were considering countries we’d like to retire to, the question of medical care was obviously close to the top of our list as well. So here are some of our experiences with medical care in Panama, and some of our conclusions.

“Better than anyone else!”

There is amongst US Americans I think a universal assumption, well, at least until the past few years, that everything in the US must be the best in the world: after all, the thinking goes, “We are the brightest, most powerful, most knowledgeable, most generous, most blessed, most prosperous, most wealthy, most envied, most lucky, most free people in the world!”, aren’t we. To suggest anything else, was to risk being called “Anti-American!” That in itself reflects the common US assumption that, “We are the Americans, and everyone else [Latin Americans, South Americans, Canadians] are, well . . . chopped liver.”

But we, like everyone else, are a flawed and struggling people and a country facing challenges, and certainly that is true when it comes to health care.

So, before we talk about medical care in Panama, we need to think about medical care in the US.

Some quick comparisons, courtesy of the CIA [CIA Worldbook]:

Death Rate:
USA 8.38 deaths/1,000 population
PANAMA 4.66 deaths/1,000 population

Life Expectancy at Birth:
USA 78.11 years
PANAMA 77.25 years

Life Expectancy at Birth Country Comparison to The World:
USA 50
PANAMA 58

My wife worked for the County of Ventura. Every year the County, looking to save a few taxpayer dollars, would shift to a new HMO. One of their choices actually went under taking with them, and destroying, all of the medical records of the county employees. Before we moved to Panama, my wife paid one last visit to her HMO to collect her records, have a final check up, and get prescriptions renewed. Meeting with the doctor, the doctor asked, “So how are you doing with your diabetes?”

My wife said, “You must be looking at the wrong chart. I don’t have diabetes?”

Doctor, “Oh yes you do. We diagnosed you with diabetes a year ago. Didn’t anybody tell you?”

No, in fact they didn’t! How is that for “quality” health care?

According to the Council on Foreign Relations, talking about the impact of the cost of health care on US competitiveness in the world,
“Factoring in costs borne by the government, the private sector, and individuals, the United States spends over $1.9 trillion annually on health care expenses, more than any other industrialized country. Researchers at Johns Hopkins Medical School estimate the United States spends 44 percent more per capita than Switzerland, the country with the second highest expenditures, and 134 percent more than the median for member states of the Organization for Economic Cooperation and Development (OECD).”

Of course the Iraq War cost about $3 trillion (according to the WASHINGTON POST) . . .

We all know the US health care system is broken and may . . . or may not . . . be fixable. So let’s just drop the assumption that we have the “best” . . .

Three Systems

Panama has three health care systems:

  • National Heath Care – “Salud” – you see these white, yellow and green buildings in almost every Panamanian community. It is a basically “free” or “low cost” – 50 cents to see a doctor, $1 to see a specialist – system designed mainly to treat the enormous and poor Indigenous population and those without Social Security health care. It is underfunded, understaffed, and plagued by inefficiency and bureaucracy.
  • Social Security – Everyone who works in Panama must by law pay into the Panamanian Social Security system. Basically the employer pays half and the employee pays half. For our Indian worker I think we pay about $4 a week. Long lines, understaffed, and plagued by inefficiency and bureaucracy. Often doctors prescribe drugs that are supposed to be “free” but the Social Security system doesn’t have them, so users must buy them at pharmacies. Pharmacies sell drugs here by the pill. So if your doctor prescribes something, you buy only as many as you can afford, when you can afford them!
  • Private System – Is the system used by many middle and upper class Panamanians, by expats, and by the increasing number of people who are coming to Panama to have procedures done, a growing industry called “medical tourism.”

Likes and Dislikes

Based on our experience, here’s what we like . . . and dislike . . . about medical care in Panama.

Like . . .

  • It is personal – Your doctor has time for you. An appointment takes as long as necessary. The doctor isn’t part of an HMO and required to see 20 patients an hour to keep his or her job.
  • Doctors are allowed to practice medicine – Their diagnosis and treatment plan isn’t being second guessed by a 20-year-old kid with a high school diploma sitting at a computer terminal in the HMO office.
  • It is affordable – There are several reasons for this. First, Panama is not a litigious society, so the doctor doesn’t have to order dozens of unnecessary tests to cover his butt. And the doctor isn’t paying out half or more of his or her income for liability insurance. We have the bells and whistles, and the latest equipment, but every hospital isn’t competing on the basis of having the latest equipment, the fastest (and perhaps most dangerous) helicopter evacuation service, and the plushest offices and facilities.
  • It is accessible – And in this regard I’m talking mainly about the private health care facilities. At the national health and social security hospitals people endure and endless run around. But for those able to pay, and it is a little by US standards, you can quickly see a doctor and get a needed procedure.

Dislike . . .

  • Appointments mean nothing: prepare to wait for 30 minutes to 2 hours. Busy doctors? Not really. Flaky receptionists, yes . . . but what’s different about that? Pretty much it’s just a Panamanian “thing” with everyone, not just doctors. Your time is theirs, their time is theirs . . . it’s the land of “manana”, and it’s just the way things are.
  • No, you don’t need the most sleek and modern of everything . . . but often things “feel” grungy, which sometimes translates into feeling, dare I say, “dirty”. I know it’s not necessarily germ dirty, but . . . how much would a coat of paint cost?
  • You get nervous when in the middle of a pandemic the hospital bathrooms lack soap and hand towels, especially if you come off a ship with a Purell dispenser every five feet, and Viox wipes to open the bathroom door with . . .
  • Did I mention hospitals don’t necessarily have hot water? Now I grant you most Panamanians don’t have hot water: the national old wives tale is that taking a warm shower will make you sick. I know hot water isn’t necessary if you are scrubbing with anti-bacterial soap, but . . . as my wife discovered in Hospital Punta Pacifica, one of the best in Panama and affiliated with John’s Hopkins, when nurses give you a bed bath in cold water . . . well something is missing in the “bedside manner”, of which there was none.
  • We have very limited emergency services, like the equivalent of a US-style 911 system, or fully equipped ambulances with trained EMTs … you just have to take your chances.

Our Experiences

Riding Mr. Ed . . .

Picture 139When we first came to Panama we used to enjoy riding horses with our friends Brad and Jackie. We found a local guy who rented out his horses for $5 an hour. It was great fun! My kids were visiting so we all went horseback riding, all five of us. I guess the guy only had four horses of his own, so he borrowed one from a friend, which turned out to be a problem horse not used to amateur riders. My wife rode horses as a kid on her Grandpa’s ranch in Montana, and although that was a long time ago, she was comfortable on horses, but all this horse wanted to do was run. The equipment was, well Panamanian, meaning, at times improvised and cobbled together. As it happened the bit was cobbled together and came apart just as the horse was acting up. The horse took off, the bit was broken so my wife had no way to control the animal . . . she ended up being thrown off and landing on the pavement on her head.

Fortunately my daughter Rebecca is a “wilderness outdoor first responder” or something like that, somewhat equivalent to an EMT except she can’t deliver babies but can pronounce people dead if they are a certain distance from a hospital. Rebecca immediately went into EMT-mode. We were a long way from town, and my older daughter said, “Dad, you have to get a doctor since we don’t know where to go!”

So I rode off for town, not knowing at that point whether my wife was dead or alive.

I rode quite away until a car came along. The driver had seen the riderless horse so knew there must be a problem. We tied up my horse and he took me into town to the doctor’s office. We got in his brand new Toyota with gray seat covers and rode back to the scene of the accident. By this time my wife was somewhat responsive. My daughter gave the doctor a quick summary. With a head wound there was blood everywhere, but the doctor put my wife into his brand new car and we went back to his office. It took 3 hours and 70 stitches for him to sew Nikki’s head together, and he saw her three times a week for 10 weeks. The total cost was $850 . . . probably the cost of an ambulance ride in Southern California.

The really interesting thing was on one of the follow-up visits the doctor greeted us with, “Nikki! I’m so glad to see you! I had a dream last night that you didn’t come in, and then I couldn’t get back to sleep worrying if something was wrong.” How many HMO doctors in the States even know your name, if they aren’t looking at your chart, let alone wake up at night worrying about you?

And this guy made house calls!

I told that story on the ship and a guy sitting in the front row said, “I’m a doctor, and I still make house calls and wake up nights worrying about patients!” So there are still a few guys and gals out there . . . but, in general, it’s not the face of managed health care in the US.

So what happened? Nikki is fine! After spending a lifetime wasting 25 minutes every morning doing her hair, she discovered a new no-fuss, no-muss hair do that better suits our life in Panama. We ended up buying helmets in the States, which we haven’t gotten around to using. The guy is still renting horses, and still sometimes using the same horse, and sometimes we see obviously totally inexperienced riders on that same horse . . . If we found a reliable place to rent horses, we’d probably ride again. [One of the things about a non-litigious society like Panama is folks don’t worry about being sued.]

Every man’s favorite day at the doctor . . .

I went in for my “every five year” physical . . . new doctor, internist, $20 plus my insurance coupon, and another $40 for tests . . . and of course he told me “it’s time” for that guy-favorite, a day with Mr. Sigmoidoscopy. So I called to make an appointment, expecting to enjoy weeks of eager anticipation . . . only to discover I had an appointment in three days . . . only three days because I needed to “prepare.” I forget the exact cost, but most was covered by our local insurance (more on that tomorrow), but it was quick, easy and relatively “painless” . . . unless you enjoy that type of thing.

Roto Rooter . . .

My wife has heart disease and has had several angioplasties. This time last year she knew it was getting time to return to the hospital for another procedure. Her last angioplasty had been 12 years earlier, but the familiar symptoms were returning. We did not have a cardiologist in Panama so we began asking around and talking with gringo friends to find out who was the best cardiologist in Western Panama. There was universal agreement on one doctor. So we called and asked for an appointment . . . expecting to wait weeks . . . and he gave us an appointment the next evening. We sat down with him and he spent an hour with us, going over Nikki’s records, reviewing her medication, examining her, and explaining the situation. Although his English was somewhat limited, we received the most understandable explanation of Nikki’s condition we have received from any doctor. There was no rush. He took Nikki’s records and said he wanted “to take them home to study” and set up an appointment for stress tests. A week later we returned for a series of stress tests at his office, and began a two-month series of exams, tests, adjusting medication and diet, etc.

At the end of the two months, and shortly before I was scheduled to leave on Holland America for five months, it was decided that yes, indeed, Nikki did need an angioplasty and probably one or two stents. The doctor made an appointment with the best guy in Panama City who works out of Hospital Patilla which is affiliated with Johns Hopkins. We had the appointment right away, but it took about a week to shuffle papers between our insurance provider (more about this tomorrow) and the cardiologist to get approval for the procedure in Panama City.

So my wife flew to Panama for three days and had an angioplasty and two stents implanted, and then flew back to Chiriqui. The total cost for an angioplasty and two stents (including hospital and surgeon) was $14,000.We have a friend who had the same procedure performed in Boston, and his hospital bill alone was $60,000! Because we had a hospital insurance scheme with Hospital Chiriqui in David, and because they do not do invasive cardio procedures, our local insurance picked up half of the cost, so our out-of-pocket cost was $7,000.  That was then … ten years ago … certainly would not be that way today!

Hospitals . . .

Chiriqui Hospital David PanamaIn David, the third largest city in Panama, 45 minute drive from Boquete, there are four large hospitals. The Maternal & Child Hospital is a National Hospital focusing primarily on material and pediatric care. It is only two years old and was a gift from the people of Taiwan, with whom Panama has diplomatic relations. Almost next door is the Social Security Hospital which serves people who are working in Panama and paying into the Social Security system. Just down the Pan American Highway is Hospital Mae Lewis, a private hospital that is used by locals and gringos. And a few blocks off the Pan American Highway is Hospital Chiriqui, a private hospital that is generally preferred by expats because of their “insurance” program (more on that later). Hospital Chiriqui. Additionally, scattered around David, there are almost a half-dozen tiny private hospitals owned and run by a consortium of doctors. In some ways it isn’t very efficient, yet the hospital costs are low at least by comparison to the US.  However, compared to what hospital costs were when we came to Panama … they have skyrocketed!  Of course in a dynamic, growing economy the cost of almost everything has gone up. Of the private hospitals, Hospital Chiriqui has the most “bells and whistles” including a state-of-the-art MRI machine, one of two in Panama, and as an indication of how profitable health care has become in Panama’s second largest city [David], Hospital Chiriqui is constructing a big, new, 4 story hospital to keep up with demand.

Unlike in the US, in Chiriqui any doctor can practice in any hospital and you are not limited to only certain hospitals where your doctor happens to be on staff.

Emergency Care . . .

Here is where things can get a little dicey.

If you happen to be one of the very few people to get bitten by one of our famously poison snakes, like the fer de lance which is fairly common in Chiriqui . . . and let me quickly add that your chances of getting bitten by a poisonous snake are about the same as your chances of getting struck by lightning or winning the lottery! . . . if you are bitten by a snake anywhere in Panama you are generally about 45 minutes from a Social Security hospital which is where the anti-venom is kept. So you have plenty of time to get to the hospital where you will find that rather than immediately giving you anti-venom there is a long waiting/observation period while they test your blood and wait to figure out what kind of snake bit you and what type of anti-venom you need. Almost everyone, except for Indians living in very remote areas, recovers. So although the fer de lance and bushmaster can be “deadly”, your chances of dying if you get assistance are very slim.

OK, we got that out-of-the-way!

When we first came to Panama my wife asked our Boquete doctor, “So if I’m having a heart attack, what do I do?”

His response: “First you call me. I’ll come to your house and call an ambulance. We’ll stabilize you in David, and if necessary, once you are stabilized, we will fly you to the Panama City where the hospitals and doctors who specialize in invasive procedures are located.”  Nice, but that doctor moved to Panama City years ago.

Good enough . . . but when we say “ambulance” do NOT think of ambulance service in the US! There have been times in Boquete when we had four different ambulances . . . and none were working! And an ambulance here is primarily a means of transportation. Don’t think a team of trained “EMTs” on call . . . or an ambulance with any sort of equipment on board. Over the years we’ve been in Boquete the expat community has worked hard and raised money to improve ambulance service, but it still is nothing like what we were used to in the States.  We had a company that came in with a fully equipped emergency helicopter with an EMT on board.  It was a subscription service and the helicopter was WOW, but they had their wings clipped by the Panama air burauracrcy and never got off the ground. At least they refunded our money.

Where I live in Boquete we now have two doctors in town who have purchased and equipped their own state-of-the-art ambulance and provide emergency services.

Our experience . . .

Chiriqui HospitalOne afternoon my wife started having some kind of episode. She was dizzy, had no feeling in her arms, was weak, and couldn’t stand up. It looked like some kind of allergic reaction and I feared she was going into anaphylactic shock. [We have experience with this: I am highly allergic to shellfish of any kind in any amount, and my daughter is highly allergic to chocolate.] Without 911 or any similar kind of emergency help, I called our friend Brad, and together we carried Nikki to my car, and I went to the doctor’s office (the same guy who treated her when she was thrown off the horse . . . the story I told yesterday). It turned out the good doctor was on vacation and the gal who was filling in not only didn’t speak any English, but wasn’t that familiar with his office. Eventually she found the oxygen mask, started an intravenous drip, got Nikki stabilized and agreed we needed to get to the hospital in David. She called the ambulance . . . and the “fun” began.

The doctor called the ambulance, then said to me, “They don’t have any gas. They want to know if you can pay for the gas?” Yes!!!

So the ambulance and attendants arrived . . .

First problem: the doctor’s makeshift treatment room and the gurney that wouldn’t fit in.

Second problem: the ambulance crew hadn’t the slightest idea how to move a patient from a bed onto a gurney. Somehow we managed.

Third problem: Nikki was too big for the ambulance. Panamanians are shorter. So they couldn’t close the back doors of the ambulance all the way. She wouldn’t fit! So the creative solution was for the ambulance attendant riding in the back to wedge himself between the side of the ambulance and press his feet against the gurney to keep Nikki from sliding out the back doors, which were flapping in the wind.

Fourth problem: Nikki had an IV drip going and there was no place to hang the drip in the ambulance. The attendant in back was busy trying to keep the gurney from flying out the back, so Nikki had to hold her own IV bag.

OK, we stopped and got $20 worth of gas. Then we began racing down the mountain to David with lights and sirens going.,

Fifth problem: Nobody in Panama is going to move for an ambulance! Only the expats will pull over out of force of habit. So I’m in front, the driver is laying on the horn so people eventually will move out-of-the-way.

Sixth problem: We start to get one of our famous, afternoon “rainy season” cloud bursts when the water is coming down in torrents. In front the windshield wipers are barely working and in back the doors are flapping in the wind and the water is coming in soaking Nikki and the attendant who is bravely still holding the gurney in place with his feet.

The reality: Supposedly “laughter is the best medicine” and Nikki, although the center of the drama, couldn’t help but find the humor in the situation.

Fortunately we arrived at Chiriqui Hospital and into the tiny emergency ward. It took a while, but Nikki was stabilized and a team of internists eventually discovered that she had developed an allergy to aspirin. She spent two nights in the hospital, before coming home. The ambulance ride:(for those of you who remember the original Disneyland . . . definitely an “E-ticket” ride!) $20 for gas, and another $5 (in gratitude) for beer for the guys. Hospital: emergency room, two nights, and physicians $225.

Yet another story . . . my wife keeps things interesting!

Nikki was experiencing tingling in her arms, chest pain, yada yada . . . with her history . . . “Come on, Nikki, don’t be a hero! Let’s get it checked now. If it’s nothing, fine . . . if it’s not, “golden hour” and all that stuff.” So we go to Boquete to the new clinic for such emergencies that Hospital Mae Lewis has opened. The only problem is there’s only a receptionist staffing the clinic. No doctor . . . not even a nurse . . . receptionist and janitor. The receptionist informed us that the doctor was going to be coming in an hour and that we could sit and wait. OK, so this is to be an “Emergency Clinic” . . . right. And if it is a heart attack, we’re going to sit here and twiddle our thumbs for an hour and hope that the doctor actually does show up as scheduled . . . which, in itself, would be somewhat of a miracle anywhere, let alone in Panama. And I’m about to have a “Richard-goes-ballistic” attack . . .

I remembered that a friend I had met because he had read this blog, lived in an apartment upstairs. He is a retired neurosurgeon who still consults via video cam in complicated surgeries around the world. Although he wasn’t a cardiologist, I knew he had his own personal encounter with a massive heart attack and open heart surgery, so I went upstairs and asked him if he could just come down and take a look at Nikki. Gracious friend that he was he put on his slippers, found his stethoscope and came down and took a look. His verdict, “I can’t say what is going on, but I can say with 99.9% certainty that she is not having a heart attack.”

As a reader, “oldsalt1942”, once commented, “You get better or you die, and that’s the reality of health care in the vast majority of the world. You get better or you die. Period. And let’s face it, you can’t take life too seriously because none of us are getting out of here alive.”

Insurance . . .

Folks handle insurance in different ways. People who worked for the Canal or the US military in Panama have their own insurance. Some people worked for companies who still provide their retirees with the insurance they were promised when they retired. Some have their own policies from the States or some international insurance policy. Like most insurance when you are trying to get insurance after retirement you find that the insurance companies don’t cover preexisting conditions, which is exactly what you are worried about. And by the time most people reach retirement age they have preexisting conditions.

When you turn 65 of course and are collecting US Social Security you have Medicare. However, Medicare only covers treatment in the US. So unless you want to return to the US when you need medical care, which some folks elect to do, you are not covered. When I looked at the cost of Part B for me, and what all was not covered by Part B, I decided that for me it was cheaper to just pay the full amount for the procedure in Panama. So we,  were … are … basically, self-insured . . . with a couple of exceptions.

InsuranceSince we travel a lot, we purchase annual travel policies from a company in Scandinavia that cover us when we are away from Panama for emergency medical care except in the US. When you include the US the cost is prohibitive, and at least when we are in the US, I could use Medicare. It is important for us to have insurance that covers medical evacuation. I think anyone is crazy who takes a cruise without having travel insurance that includes coverage for evacuation. The cruise line wants you off the vessel and into a hospital as soon as possible, firstly for your own medical welfare, and secondly to avoid legal responsibility. A medical evacuation from a ship by helicopter can easily run $50,000 to $100,000! Get insurance!

Hospital Chiriqui did have an insurance scheme which we and many other gringos opted into at the time.  It wasn’t really insurance but more of a discount plan for their hospital and doctors who opted into the plan.  At that time when my wife required an angioplasty and stents several years ago, because the procedure is not available at that time at Hospital Chiriqui, we went to Hospital Patilla in Panama City and the MSChiriqui plan covered half of the cost.  HOWEVER, the folks who thought up the plan really didn’t do their actuary homework.  They sold the plan mostly to older expats and … guess what?  So the original plan has been taken over by MSPanama, the prices have gone up, and the benefits have been curtailed.

We would have done better in the long run had we purchased International Medical Insurance which is offered by a number of companies.  Younger expats can still get world wide medical insurance coverage at really rather good rates, but it depends on your age.  Many of these plans will not cover you after you reach age 70 and as you get older the cost becomes exhorbitant..

When my wife turned 65 she decided to take Medicare Part B & D and a Medicare Advantage insurance policy in the US.  Based on her experience I now have decided to also take Medicare Parts B & D, paying the penalty for not taking it out when I turned 65.  Now with grandkids, we spend more and more time at home in Seattle, and our plan is to use Medicare for foreseeable medical care and continue to use Panama insurance and doctors for emergencies.

30 thoughts on “More About Medical Care in Panama

  1. Richard,

    Are you able to able to share the name of the cardilogist(s) both in Chiriqui and P-city that were recommended to your wife

    Thanks

  2. mountainman // September 26, 2009 at 12:42 pm

    Richard,

    Are you able to able to share the name of the cardilogist(s) both in Chiriqui and P-city that were recommended to your wife

    Thanks,
    mountainman

  3. Richard, first of all thank you so much for an awesome informative website, I have learned much. My two brothers and I are headed down next month exploring/scouting for a possible move. Are your transit comments from Panama City to Boquete/David still up to date, i.e. better to fly than drive? Thanks again and God Bles you!!
    Chad

  4. Enjoyed reading parts of your extensive info. and experiences. Lots to think about. IN the meantime, I’ll be coming to Boquete for Spanish school in Nov. — can’t wait!

  5. Hi Richard,
    Thanks so much for your incredibly helpful and entertaining blogs. It seems from all I’ve read, I still can’t retire to Panama unless I’m very well off because of the lack of availability of medical insurance for those over 62. I’m not there yet but close…. and certainly could never afford ICU or other prolonged treatments out of my pocket with only SS and a small pension. So why is everyone promoting retirement to Panama? Seems like so many other places, it’s only for the wealthy… mind you I’m, not poor. Is there something I’m missing here? Thanks in advance for your response.

  6. Hello Richard,
    My wife and I are moving to Boquete this coming July. I am disabled due to major back problems. I suffer from a severe case of Osteoperosis, three compression fractures in my lumbar and thoracic regions and have to deal with severe chronic pain constantly. Currently, I see a pain management doctor who prescribes oxycontin, percoset, and zanaflex for pain relief. My only other option is a morphine pump inserted directly into my spinal canal. This option does not appeal to me at all so I stick with the oral medications. I also take several medications to help me with the osteoperosis, including two different types of calcium and vitamin D. Doctors here have given up on trying to correct the problem because the cures are worse than just having to deal with the problem with medication. My question to you is how doctors in Panama would deal with a patient in my condition? Are there doctors in David that deal with pain management? I am wanting to change medications if I can find something else that actually works. Would you happen to know what types of pain medications are available in Panama? I am open to suggestions and hoping that moving to Panama is a good idea for me. I love it there but my health and well being are more important than anything else. I hope you can help.
    Kindest regards,
    Glen Burke

    OK, I’m on the East Coast of Africa at the moment . . . how about some of my friends in Boquete coming to the rescue here!! Any ideas for Glen? Any of your own experiences you can share??? Thanks!! Richard

  7. It is obvious that you need sophisticated care because you have complicated conditions. I would say that full time life in Panama would be difficult for you. There just isn’t the level of sophisticated care available especially if you will be living outside of Panama City. True you can travel into the city for all these procedures but I think in the end you arn’t going to get the kind of care you can get in the U.S. What I would suggest is that you find a small condo or home in central Florida and use it as your home base. Go to Panama or wherever for two or three weeks at a time and then return to your U.S. home. Flights from Orlando to Panama are about 3 hours nonstop. Remember Panama isn’t the only place in Latin America that you can go and do this. There are lots of pretty nice apartmenthotels and short term apartment rentals. We like the aparthotel best because you have so much more flexibility and there is someone around who speaks some English 24/7. Your health is too important to station yourself in a remote area for all your retirement days.

  8. Hi, Dick! Enjoyed your blog….it’s good to know what’s happening in your life. As you travel, have you ever thought of returning to good old Pennsylvania?

    Your cousin, Jane

  9. Hello,
    I really enjoyed your Blog and your stories and information about medical situations and costs there in Panama and Chiriqui. Enjoyed your stories.

    We are planning on retiring to Panama as soon as we can get all our ducks in a row ,It is a process at this end and that but feel one step at a time and if we are frugal and don’t try to live like Donald Trump we will be just fine on our Social Security a small pension and a decent savings.

    We will be flying to Panama to start our paper work to apply for our Permanent Visa or which ever we need to be there full time. We were told it takes between 2 to 7 months to get paper work though. Can you tell me if it is in that time frame or???

    Sure will keep this blog so we can write down names of hospitals etc and doc information.

    Can you tell me how long the Permanent Visa’s are for before they have to be renewed ? and do we go to the Panamanian Consulate to renew Visas and to American to Embassy ?to renew our passports when it is time?

    Is there a particular web site that tells you how long the Permanent Visas are for before they need renewed.

    Judy Choquette

    Hi Judy! Since I’m at sea . . . quick reply. Welcome to Panama! 3 to 6 months sounds about right for Pensionado visa. Be sure and have all of your paperwork authenticated by the Panamanian consulate IN THE US before coming to Panama. It’s been almost 7 years since I did all this and things change, sometimes weekly, in Panama. Check with your attorney in Panama about current requirements. My Pensionado Visa is permanent which means it does not need to be renewed. You should be able to find current information on many of the Web sites of companies and attorneys in Panama who handle this kind of thing. The American Embassy in Panama City takes care of passport issues and renewals once you are here. Best wishes! Regards, Richard

  10. A great article on Medical Care in Panama. I look forward to receiving more or your great content.

  11. I am twenty seven years old. I have no health issues besides a spinal cord injury that requires pain medications like percocet/ oxycodone/ oxycontin, lyrica or neurontin, and motrin. I want to move to Panama but need these medications from my well-being and mobility. I am not in a wheel chair or anything. I have the money to move now. I also have monthly checks. I was hoping you could help me and let me know if pain medications would be available and affordable in Panama. I am considering Las Tablas but know that I would probably have to travel to Panama City for this type of treatment. Is pain management treatment available in Panama. Again, I am healthy besides the spinal cord injury. I had a discetomy but still have moderate to severe pain in my back and legs. Please let me know if I would be able to access my needed medications. Thank you for your time and consideration. –Thomas P.

  12. Hello,
    Do you think that there is a need for an Adult Day Care Facility? Me and my husband are thinking about relocating and we are intrested in opening one of these.

    Thanks

  13. I have read a lot of your blog. We are looking into coming to Pananma during the winter months
    Dec to march. Could you give some guidance of where to look for good apartments, rates per month, availability of domestic help, and acceptable medical facilities in the vicinity. We live in Canada(Toronto), and have some medical coverage outside on our private insurance program. However am interested in the insurance program you have from Europe.I too have heart problems.

  14. We have looked at Panama as a retirement place or a place to spend a few months. But like you have some medical issues related to the heart. There is a good hospital in Panama City with some kind of affiliation with Johns Hopkins Hospital in Baltimore. An affiliation does not mean it is Johns Hopkins, offers as comprehensive care however. We have never used it. Many North Americans like the Boquete area for spending extended time. The closest city to Boquete is David about 45 minutes away. There are two hospitals there but not sure what the cardiac services would be like. We are a member of a program called Medjet Assistance (google it) It covers emergency evacuations only and the coverage is 24/7/365 days a year. We have it but never have used it. If we developed complicagtions in Panama, we would get out of dodge quickly!! That program is the key. If you are seen in the ER and they determine you need to be admitted they make all the arrangements by private jet to any hospital you choose, even your own medical facility in Canada! You asked about places to stay. If you go on the web and google–Boquete complete list of accomodations–you will get a pretty comprehensive overview from reasonable costs to the very pricey all on one website with links to the homepage of the accomodations. Good luck on your search and stay in Panama!

  15. MY WIFE 84 IS OUT OF AN ANGIO STENT BY DR. ADAMES OF CHIRIQUI HOSPITAL LAST FRIDAY. AUGUST 9 1012 PERFECT RESULTS… TWO DAYS AND HOME IN DAVID…. NO AMBULANCES NEEDED…. COST 12120 USD …..DR.ADAMES CHARGED 375O. USA DLS …..GOOD RECOVERY ROOM SERVICES…SHE HAS ANGIO CHECK FOR THE NEXT 30 DAYS NO CHARGE…. IM AN OLD PANAMENIAN IOWA U CHEM. ENG.. GRAD. CALL US IF IN NEED. 66735214 OR 7743059 WE LIVE CLOSE TO THE DO IT CENTER……BEWARE OF WOODEN NICKELS

  16. Hello and thank you so much for taking the time to correspond and answer questions. It is truly appreciated . I will be visiting Panama during the month of Oct. along with my brother as he will be researching doing business there. I am presently on disability due to a roll over car accident in December 2010 , and am on opioid pain medication. I have been considering living in Panama for a number of reasons , yet am concerned about pain management as I have been unable to find information regarding such during my research via online. If there is any direction that you can point me towards , or any information that you can share with me it would be greatly appreciated. Thank you again, John

  17. I am 60 and my husband is 65. Have some pre-existing condtions. Want to retire to Panama and need to know what kind and cost of medical insurance we can get. We are Canadian and for us everything is free in Canada. But if we stay out of country longer then 6 months we no longer have medicare in Canada. So definitely we will need insurance in Panama. Do you have any contacts so we can get quotes. Thx, ps love your blog.

  18. I am so happy to find this blog. I have just retired with small pension and several friends have recommended David,Chiriqui as a place to retire affordably. Where can I find information on affordable housing. I am looking to rent not buy and I need to be very frugal so I am looking to live in neighborhoods where local working class Panamanian live. Not gated communities
    I am planning an extended visit in Feb 2013 to check out whether this is feasible so I need to rent something long term not a hotel. Apartment or house would suffice.

  19. Hi, which Scandanavia insurance company do you use for medical insurance. I have just turned 70 and cannot get coverage shou ld I have a heart problem or stroke.

  20. Hi,
    Wondering where I can find info regarding any medical conditions I may have that would disqualify me from moving to Panama from Canada? Wondering if someone with diabetes, copd etc would be allowed to become a resident of the country?
    Any info would be appreciated.

    Thank you

  21. Hi Richard, glad that I found your blog Thinking of visiting David area and retiring there. My question is… What do you do for long term nursing care? Can you hire in home care or are there health care centers? Thanks Carol
    p.s. Also I am LDS religion (Mormon) and wondering if anyone knows if there is an english speaking ward or branch in the David area

  22. Hi Richard, My wife and I are booked on the February, 2013 relocation tour and are looking foreword to meeting you. One question– Can I get medical insurance being 70 years old? Most plans I have read about seem to have a limit of 65. Thank You.

    Bob & Marilyn Anderson

  23. My husband and I are coming to Panama on Jan 21st fir 2 weeks. Staying at Playa Blanca, Sante Fe and Boquete. Want to find area and place to rent for a year to try out living there before buying. I am 61 and Bob is 66. Will we be able to get a medical plan. We are Canadian and used to having all medical paid for us. Is there anyone we can meet while we are there next week to discuss the options?..
    Thanks, I will have access to my email while in Panama. terrimueller@sympatico.ca
    Appreciate your response.
    Best Regards,
    Bob and Terri Mueller
    Barrie, Ontario Canada

  24. Richard, i am glad someone is paying attention of how the healthcare here in the US is ridiculous. I am Panamanian and i just recently went home to visit for the Christmas Holidays (Dec 2012). My father is in his late 80″s but his doctor does home visit. My dad does not have to leave home to go to the doctor unless he has to get something special done at the Johns Hopskins Hospital in Punta Paitilla. That has always been our family clinic (I am the baby (46 yrs old) of all the children) since i was a child because i was borned with a heart murmur and i continue with it. Our Dr. is Percy Nuñez (cardiologist) and he is wonderful, one of the best!!. Now he is older so i don’t think they allow him to see but half of his patients due to him being 70 or 71 years of age. You are right it is ridiculous how here in the US people think that everything is great and not realizing that even though you pay insurance you have co-pay, deductable and co-insurance that add up to be about $4000.00 a year out of pocket. Yes per year. I am responsible to pay that amount first if something really really bad happens then the insurance will pick-up 80 percent and i will have to pay 20 percent after the insurance pays their part for that year. I enjoy going home to Gamboa because it is a quiet and calm place!!!

  25. I require CLOSED MRI’S TO THE RIGHT MANDIBLE ON A REGULAR BASIS where in Panama city can ; provide this service

  26. Probably there are several places in Panama City and the city of David where they could provide you with an MRI. The question I would have would be who and with what experiece would interpret the MRI. Any place can have equipment but its what happens with the results of the diagnostic study. Lots of people will tell you the care is as good or better than in North America and a lots cheaper. But when you’re dealing with you health do you really want to fool around in third world countries? That is your decision. I know what my decision would be.

  27. Richard
    Love your articles and updates. Keep up the good work. I am wondering if veterans realize they can get care at vet centers in USA and forego costs of med insurance for the cost of an airline ticket. I have just returned from the US after getting a new hip joint for the cost of a ticket and a small copay. The VA farmed out the service to a private orthopedics clinic of my choice. Soon I am returning for a new pacemaker. Amazingly the hip joint would have cost about $6000.00 here but cost $49000.00 in US.

  28. Hello and thank you so much for taking the time to correspond and answer questions. It is truly appreciated . I will be moving Panama soon and am on opioid pain medication. I have had three back surgeries and require a moderate amount of medication monthly. I have been considering living in Panama for a number of years , yet am concerned about pain management as I have been unable to find information regarding such during my research via online or in person. If there is any direction that you can point me towards , or any information that you can share with me it would be greatly appreciated. Thank you again, Jeff

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