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We had to see a doctor for my husband when we were in Panama, what a breath of fresh air. I'd go there for medical anytime. The US is awful!!! Best to you with a speedy recovery
Hi! Young working Panamanian here. I've a friend from abroad that sent me this vid. It was interesting to hear your perspective and I'm so glad that you were well enough to do part 2! I'll go watch it after dropping this comment to expand a little more on what you said, maybe you'll find this interesting despite the length! PART I (continues in reply below) Private Care in Bocas del Toro Actually, I've heard there's the one private practice in Changuinola, but I wouldn't know for sure, because I'm a Panama City denizen. Private Healthcare Costs I'm glad that private healthcare is accessible for you and that you were able to get done what you needed, but the costs are actually equivalent to US healthcare. How so? US median income is three-to-five-fold Panamanian median income. If you're finding healthcare is three to five times cheaper to what would be in the States, that's the reason why. The difference is that Panama has two public options (I will explain more down below) so, in theory, all Panamanians can access healthcare (more on that later) if there's no money for private-in theory, private is just a nice add-on that there's no need for. For example, $150 for a doctor's visit + ultrasound, depending on what the speciality is, actually sounds really onerous from my perspective. It's almost a fourth of my monthly upper-working-class salary! (I'm underpaid) I would have to save for some time to access that, so I mostly deal with the public systems. Although, as a local, I could probably find out where to get it done for like $120. Doctors Speaking English Indeed! My advice to foreign, English-speaking residents is that the younger the doctor, the better their spoken English is, so do try to book appointments with doctors on the younger side, whether public or private. Just a tip from a friendly Panamanian 😉 Doctors actually need English to survive Medicine school. How so? Panama has a relatively small population. This has implications for education and scientific and medical research: There's not a lot of the latter (we do a surprising amount despite lack of societal support, though!) so people in those professions have to read and rely on a lot of science from around the globe, and the market for all specialized books is really small so those books get real expensive really fast. Now, consider that English is the scientific language _du jour_ and that we need to import whatever books for specialised careers are cheapest, some of which are going to be in English (so you're taking a class and tests in Spanish and studying in English), therefore, those in scientific and medical careers will have decent-to-excellent English. The fresher out of Uni, the better, due to language trauma 😃 Doctor's Bedside Manner Yes, doctors do take the time to speak with you, whether in the public options (yes, I keep using plural) or in the private option. I can say, as a local, that I've been treated excellently by the vast majority of doctors, no matter the option. Perhaps there's a cultural explanation I'm too fully immersed in my own culture to grasp, but there are simpler economic and structural reasons: Unfortunately, despite everything Panama has achieved, we're not a wealthy country nor are we bereft of corruption. This means doctors working in the public options have to deal with lack of supplies and treat patients who reckon with no medications available or who have no money to buy medications, period, so doctors need to be patient-centered to be able to treat people. Wait! I can hear you already: But what has that to do with private healthcare doctors? Excellent question. It has to do with doctors and nurses' education. The government mandates that prospective doctors and nurses spend their residences exclusively in the public options. It does not matter whether they're graduating from a local private university, *they will do their residences in the public options*. For doctors specifically, it goes this way: You spend two years in a big hospital or in urban public healthcare clinics to learn the ropes, doing rotations in all departments, usually in Panama City. Then, you spend two years doing rotations in hospitals in provincial capitals, healthcare clinics in difficult-to-access areas, strapped hospitals, etc. So as to treat patients, a doctor needs to learn to listen to patients. How else will you treat a patient with type-2 diabetes who's four hours away on horse and can only buy insulin once a month because $10/vial is too expensive for them? Or a working single mother of three with mild asthma working at two jobs who cannot take histamines since she cannot afford to be sleepy lest she be fired from any of her jobs? Those are extreme examples, but budding doctors will face patients in difficult situations. Hence why doctors center quality of life. Your Panamanian doctors probably asked a lot more questions about your lifestyle than you expected. This is why. Seeing a Specialist or Getting Surgeries In the private option in Panama, you can just book an appointment with an specialist. The worst I've heard is three-month waiting list, but that's for an extremely scarce speciality. Surgeries are readily accessible. They'd wheel patients into the OR right after getting doc's approval and referral if they could! In the public options, the problem is not getting a referral. As long as your GP believes you need a referral (it can be even from a GP working in private healthcare for one of the public options), you will get one. The problem is the waiting lists, as the ratio of patients to specialists is so lopsided because most people use the public options. You get triaged by need even just to see a specialist! I'm glad the people who need it the most are able to see one quicker and far more frequently but this stretches out the waiting times. My relatively healthy elderly relatives see their gerentologist once a year. Same for surgeries. If you're young, not dying, and able to carry out your daily activities despite cumbersome illness, forget about having a procedure in less than a year if you're booked at an extremely busy public hospital. You can get around this using the system but you need to be creative. Speaking from experience here.
PART II (and final) *Quality of Public Healthcare* If you can access it, it's really good. However, if you can't, then… it's not so hot. Bunch of statistics that I hope I recalled correctly: About 40% of Panama's population lives in rural areas, over half of whom (25% of Panama's population) lives in difficult-to-access areas, yet good public healthcare can only be accessed at urban centers. I'd go as far as saying that good public healthcare can only be accessed at Panama City, David, Chitré, and Santiago, in that order, although other Panamanians may disagree with me. And many procedures and specialists can only be done or gotten to in Panama City (or abroad!). In sum, 4 out of 10 Panamanians struggle to access healthcare. About 60% of Panamanians make minimum wage or less, of whom 32% percent live in deep poverty. Also, despite having two- to three-fold the average minimum wage of other Central American countries bar Costa Rica, medicines-even some common ones-can be up to six times more expensive. Therefore, pharmacies are an onerous expense for a lot of Panamanians, of whom 8 out 25 can only afford medications through public options, either free if they're insured or acquiring subsidized medication from the few, under-supplied Ministry of Health pharmacies. I've used private healthcare too, and the doctor quality not only is equivalent, but many doctors work in public and private options, like my dentist (whom I see through the public option but has their own independent practice). Waiting lists are a big problem, like I mentioned before. This gets exacerbated by lack of supplies because major procedures will have to be rescheduled if there's not enough to have it done safely. That said, once you get into the OR, care is excellent. Speaking from experience. Although I do not recommend public healthcare to non-Spanish speakers, unless they go with a trustworthy Spanish-speaking person. If going through the public, you WILL have to deal with bureaucracy at some point, the members of which, unlike doctors and nurses, are almost all monolingual Spanish speakers. Public Healthcare Options I've mentioned their existence in passing, but I'll try to be brief: Panama doesn't have universal healthcare. Public healthcare is not free at the point of healthcare for everyone. Most Panamanians are covered by the Caja de Seguro Social (CSS). It works similar to my understanding of how employer health insurance works in the States. From your salary, a monthly tax gets deduced and your employer matches that tax to your name; it all goes to CSS. CSS also takes in a tax for pensions, but that's a little bit more complicated and we're not talking about that. (As am aside, it's mandated by law that domestic workers should be enrolled into CSS by their employers if they work for a family three days per week or more.) This tax, like a prime, gives you government insurance. Doctors visits are free at point of healthcare because it's already been covered by taxes. Same for medicines through CSS hospital pharmacies, they are free for ‘insured people’. Most major public hospitals are CSS, we call them _policlínicas de la Caja._ When Panamanians talk about _asegurados,_ they're talking about people enrolled with CSS. Most Panamanians don't know this, but you can self-enroll with CSS, paying your taxes yourself. Your local _hojaldre_ seller is probably not self-enrolled. Instead, they'd access health care through local public healthcare clinics _(centros de salud)_ managed by the Ministry of Health (Minsa). Same with people in rural areas. Minsa also runs a bunch of hospitals in major areas and big centers with lots of specialists _(policentros de salud)._ This is subsidized healthcare; doctor's visits and medicine are low-cost to the patient. A GP, dentist, or paed visit costs $1; seeing any specialist (dietitians, ob/gyn, dermatologists, etc.) costs $2; other services may be down to a fifth cheaper than private. All people living in Panama, even if undocumented, have a right to access healthcare this way. People enrolled with CSS can go through this system mostly for free, but would have to pay for their medicines. You should know that mandatory vaccines and seasonal vaccines (flu, covid) are free because they're bought by the government. You can walk into a _centro de salud,_ get a vaccine card for $1 that you keep for other vaccines, and get vaccinated for free (easier if you know Spanish). The government distributes mandatory and seasonal vaccines even to private hospitals and healthcare networks, so private options should never charge you for vaccines. They can charge you for your doctor's visit, use of facilities, even the cotton ball (although that would be gauche), but they cannot charge you for the vaccine. *Are you a doctor?* Nope! I sure wish I had their income, though! Their salaries in the public sector are over 4 times what I earn. But I'm related to several doctors. This is a small country. I've also had health issues of concern in the past that I've had to deal with while CSS-enrolled and unenrolled through both public options, so I know pretty well how navigate the public options, unlike most of my fellow Panamanians. I go public for my healthcare because my GP (excellent doc!) works exclusively at a public hospital, is better for my pocket, and no health-related concern has been unmanageable this way. I do see some private specialists that I save up for, mostly because their work schedules and waiting times are more convenient. I do my routine blood work via private labs because public-option queues are ridiculous. You need to arrive at 3 a. m. for a good spot. Also, I've been told I'm a good, funny patient. So docs and nurses open up to me. I actually know quite a lot about the inner-workings on the medicine side of things regarding Panamanian healthcare. *Have you ever been to the States?* Gods, no! Between the visa and having to rent a car, that's out of reach, so I don't even want to go. Plus, knowing what I know of the US healthcare system… I rather like mine. (Remember, $150 is just under a quarter of my monthly salary.) I have been to Europe and some places in Latin America, though!
This is such detailed and FANTASTIC information!! Thank you so much for sharing your knowledge and perspective, it is much appreciated and will help many readers (including me!) understand the system better.
@@IGoPanama Sure, as long as you censor my username. But!!! Feel free to drop me any questions your users have. If you don't know how stuff works in our healthcare system, it can be hard to navigate-even for locals!!!!
OMG, I hope you are all recovered by now. Not sure how I missed this video. I am so happy you have spoken about the medicine process and the doctors in Panama vs the USA. As a Panamanian who has lived in the USA for over 20 yrs the care system in Panama is 100 times much better. Here in the USA we're only a transaction to the doctors and all they do is prescribe meds over and over and over!
Good God, Hon - it's amazing you've been able to do as much as you have, while going through SO much! BEST of luck to ya, and can't wait to see your sparklin' eyes again... ASAP!
Best wishes for a speedy recovery. FYI, overall my wife and I have had only good encounters with Panama medical care. We joined a local medical group to attend to the small stuff. I have consulted successfully in PTY with a cardiologist and a urologist, also with reasonable pricing. (BTW, note that if you obtain a jubilado visa one does get a 15 to 20% discount on all medical services and pharmaceuticals.) Our biggest surprise is that some drugs in Panama cost more than in the USA. Our biggest concern is if one has a dire emergency one must depend on a local ambulance service to get quickly to a local public hospital or more slowly to PTY almost two hours away from where we live. So, regardless of age, one should include medical care on the priorities list and have a plan. Hope this helps!
Hope you have a speedy and uncomplicated recovery! I hear you on the iron. If you’re seriously low on either that or B-12. It’s like your life force has been completely drained. Kudos to you, even more so now! Managing your Panama PB and producing content. These past few months, while feeling like garbage. I’m happy to hear you received a correct diagnosis, finally. Our healthcare system here is a joke/nightmare. The hospital here in So Cal. Just sent my bf’s 80 year old mom home after she showed up for her hip replacement surgery. Where she was supposed to stay overnight. Because they needed they beds for “Covid.” It’s so great to hear more positive affirmation, regarding our decision to relocate to Panama. Thank you for sharing!
Thank you for sharing this with us, Mary, and for being so generous with yourself and the videos while feeling miserable for so long! At 70, I've been lucky to avoid being sucked into the US medical system so far, but am getting an idea of what a mess it is since becoming a Medicare recipient and having to deal with all the insurance BS. Now I'm thinking maybe Panama for a necessary hip replacement. Sending love and prayers that all works out well for you and you are back in full health soon!
Thank you so much for sharing your very personal experience with us..I know you did this for our benefit..You'll be fine because you have part 2 to do on this story.. I wish you a speedy recovery. Much Love
Your story mirrors my wife's experience. She is Panamanian and had always contrasted the British medical system when we lived there from what she knew of Panama. I, of course, thought she was being too critical of the British system (and where we lived we enjoyed a standard much above the national standard, and it was all free, of course) and too rosy a view of the Panamanian one. However, it seems I was wrong. Even in my occasional, and quite trivial, encounters with the medical services here - both public and private - have been as good as, if not better, than anything back home. Also, as you mentioned, the thing is the doctors (who, even in the public system, do all speak English - apparently because they have to for their training) actually take time (or have the time) to talk to you - and this was true even when I visited a doctor in the busy, local public clinic. My wife has, like you, had to consult doctors and a specialist, and received a diagnosis, having never had her problem properly dealt with in Britain. And as you also mentioned, even when consulting the specialist, or having tests done at the private, well-equipped clinics in Panama City or Costa del Este costs were extremely reasonable. Anyway, I hope everything goes well and hope to see you fit and well next week!
Good luck with everything, you’re in good hands. After twenty years as a nurse in US one of my main reasons for moving is the broken healthcare system God forbid anyone like anyone I’ve worked with gets there hands on me. Our system is broken, heartless and dangerous. Thanks for the video. Looking forward to the next. Rest and recover in your new country
As a Panamian physician, I need to say that a lot of people here don´t even know the real cost of the medical things in general compared to other countries because of the public system. I am an young physician here but also a patient . When I was in the college, the social security of my mom cover me and I need medical services. I go to seven different specialists, an EKG, an ecocardiogram,a lot of X-rays, a CT scan and physical therapy two days in the week for my condition. In the private settings, this could cost me like 2000 dollars or more but I don´t have to pay anything. Also as student, we learn from the U.S. guidelines and sometimes from Europe guidelines and also the Faculty of Medicine of University of Panama prepare us to aspire to go to United States because we know since the first semester, the tests(the steps) to enter to medical residency. This year, 5 Panamanian enter to U.S. medical residency and also a lot of Panamenian physicians that are trained in U.S. come to teach us sometimes and in congress.
My first visit to a doc here in Boquete, 2 years ago to establish a doc. She talked for 30 minutes and I thought "This is going to cost me" it was 30 bucks. Hope your surgery went well
Surgery scheduled for 5 pm? That's quite rare. Usually scheduled surgery is earlier in the day. Also, I'm surprised you waited so long, given those symptoms.
I had to wait. I couldn't have surgery during a period when Brian was out of the country for 6 weeks. Plus, I run a business so I had to have everything prepared in advance. Plus, the anemia situation had to be fixed as well.
Can you get good bio-identical hormone replacement in Panama? Not pellets. Estradiol patch, oral micronized progesterone, and injectable testosterone? Armour Thyroid?
Hi there I have a question.. I live in the Bahamas ..our hospitals are bad. Do u suggest me flying down there to see a doctor.. cause they can't seem to figure out what's wrong
