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 may not necessarily be 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 . . . At our local Chiriqui hospital, big, new building, with soaring prices for gringos, the bathroom used by clients and staff, used to collect urine and stool samples had no soap!
• 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. In fairness they do have a 911 number which rings in Panama City, 6 hours away, but the ambulance service will only respond if and when Panama City calls them, and only for traffic accidents, not other medical emergencies. In Boquete we do now have a couple of doctors, partners in life and business, who have bought and equipped their own ambulance and hired an EMT to work it.
• “Affiliated” Hospitals can mean anything. – Some folks like to assume that because a Panama City hospital advertises an affiliation with some well-known US hospital, that it represents an endorsement and indicates better care. Drill down and read the entire Web site and you’ll find that “affiliated” does not mean the hospital is run, endorsed, approved, or operated by the famous US hospital. It may mean nothing more that the Panama City hospital has physicians who come from the US “name” hospital a couple of times a year to give a lecture.