Our Experience With Health Care in Panama

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, and I’ll tell you a little more about him later.

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 the ambulances, but they all seem to end up in the junk yard or in operatable and in need of major repairs.

A few years ago a couple of doctors set up practice in Boquete, purchased and equipped an ambulance and hired an EMT.  So now at least we do have a private ambulance on call.

Our experience . . .

One 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 above mentioned 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. [These prices are before the hospitals started playing “pingo gringo” and getting greedy.]

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 was a retired neurosurgeon who still consulted 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.”

One reader of this blog, “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 you are not covered.  Initially I opted out of the additional parts of Medicare and a Medicare Advantage policy.  At that time it seemed to me to be cheaper to just pay the full amount for the procedure in Panama. So we were basically, self-insured . . . with a couple of exceptions.  [Important to note, especially if you are looking at old material on line.  Costs in Panama have soared!  Although technically illegal, “Gringo Bingo” is a way of life in medical care in Panama.  Now I know everyone has to make a living.  The US dollar has grossly devalued, so it buys less in Panama, just as in the US, and prices rise.  And Panama has a booming economy which forces prices up as well.  Many Panamanians assume all expats are coming to Panama because they are fabulously wealthy.  The reality is that most of us are coming to Panama beccause we can’t afford to stay in the US.

Since we travel a lot, we purchase annual travel policies from a company  that cover us when we are away  for emergency medical care except in the US, and with a whole lot of exceptions and caveats.  From way back in the day when we owned travel agencies, I think anyone is crazy who takes a cruise without having travel insurance that includes coverage for evacuation.  Cruise line policy is for your well-being, but primarily to protect the cruise line, if you have a problem they wants you off the vessel and into a hospital as soon as possible.  A medical evacuation from a ship by helicopter can easily run $100,000 to $200,000! 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 drastically curtailed and of course all the costs have gone up.

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 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.