Health care is always an important topic for those considering the expat life. In Ecuador you have several options, and which one works best for you is something you should think about very carefully. You can’t have too much information making this decision, so here is a real-life example from our second experience with surgery in Ecuador, this time in January 2017, when my wife needed to get her gall bladder removed.

First, let’s do a quick review of the options available. Ecuador has a public health care system that expats can participate in after paying into the system for only three months. The cost is about $80/month for a couple, and entitles you to use any of the doctors, clinics and hospitals that are part of the IESS (Instituto Ecuadoriano de Securidad Social) system. This is the least expensive option (except for just showing up at an Emergency Room for free treatment), but it has its drawbacks.

Under IESS, you do not have much choice in your doctor or your hospital. You also may have to wait a long time for an appointment, and the hospital may assign you to a room with anywhere from one other to five other patients. Some IESS facilities require you to send someone out to get you meals or even medication; they do not all provide them as part of your stay. Lastly, the IESS facilities tend to be older, with less up to date equipment and procedures available.

You could also choose to purchase health insurance from a private carrier, and there are several to choose from. Prices range anywhere from $200/month per person on up, with the difference being in things like amount of coverage, deductible, and so on. If you are over 65 when you go to sign up, you may have limited options or need to pay higher premiums.

Under these plans, you can choose from a wider range of doctors and facilities, including private hospitals. However, you still pay up front for the medical care, then submit the bills along with supporting paperwork and wait for reimbursement of whatever portion your particular plan covers.

Lastly, you could do as Rita and I have decided to do, and just pay as needed for any health care needs. We are in reasonably good health (and getting better thanks to local food and climate), the costs even at the best hospitals and clinics are a fraction of what they are in the States, and this gives us complete freedom in our choices of doctors.

We were able to put this decision to the test, when Rita began having pains that were eventually diagnosed as gallstones. The doctor we chose was recommended to us by Ecuadorian friends. He is bilingual, and attached to the Kennedy Clinica Hospitals, a very good hospital group with three facilities in Guayaquil, about a two hour drive from our home in Salinas.

His standard fee for office visits for consultations and diagnoses is $80. As part of the procedure, he also did an ultrasound, for which we were charged $60. When the gallstones were identified, he ordered an MRI for a more detailed look, which we were able to schedule at our convenience in the Imaging Center, also part of the hospital. This procedure cost $370.60, after a discount was applied since Rita is over 65.

After we discussed the options with the doctor, and agreed to laparoscopic surgery to remove the gall bladder, things proceeded very quickly. This is common in Ecuador with the private care system, none of the delays in the US where it seems every appointment and procedure can’t be scheduled for two or three weeks. We checked into the hospital at 7am on a Monday morning, with surgery scheduled for 10:30am the same day.

Let me stress again here, even if your doctor speaks English, it is good to be prepared with some Spanish-speaking ability of your own. The administrator who checked us in, the cashier, and most of the nurses on the floor did not speak English, so we had to be able to communicate on at least a basic level.

A good way to prepare for this is to study in advance the types of phrases and words you may need – things like body parts, how to describe pain, and so on. Also, since I knew what kind of information they would require when we arrived, I printed out a “cheat sheet”. I listed Rita’s full name, age, birthday, address, cell number, cedula number, and doctor’s name. I also wrote a brief description of what we were there for, and what type of room we wanted, which I ran through a translator program and included. Producing this sheet, along with her cedula (and a credit card) helped things go smoothly.

We requested a private room, which was very nice. It had a bathroom and shower, a small refrigerator, and most importantly a small couch that folded out into a single bed, so that I could spend the night in the room as well. The nurses provided fresh sheets for both nights of our stay. The private room cost us only $332/day. According to the TrustedChoice web site that tracks hospital charges, the average cost in the US for a private room is $2,000/day.

The prep team arrived just after 10am, and by 10:15 I was accompanying Rita to the OR. We met her doctor at the door, where he took over and assured me he would call the room when the procedure was completed.

Only an hour later, I got the call, and met with him once more at the door to the OR. This time he was dangling the removed gall bladder over a specimen cup, while he described the procedure as completely routine, and informed me it would be sent for a lab test. By 2pm, Rita was awake again and back in the hospital bed.

Much like my experience at the Kennedy branch in Alborada when I had arthroscopy, we were treated very well at the hospital. The staff was friendly, helpful and caring. On the occasions that we buzzed them using the call button, they responded immediately, even in the middle of the night. One of the things we like most, is that in Ecuador we have always felt like we were treated as people, not as names on a hospital chart.

The only problem we had in the two nights we were there, was that Rita was extremely sensitive to one of the medications provided for pain control. The nurses were slow to stop providing it completely, waiting for approval from the doctor in the morning, and as a result, Rita had some problems with nausea. However, the first evening after the surgery, she was able to get out of bed to make it to the baño. Within 24 hours, she was able to sit up by herself.

The procedure itself was performed beautifully. She had only three small incisions for the equipment, none of them large enough to even require stitches. Each was closed with a small piece of tape, and protected by three 2″ oval clear band-aids.

Like any hospital, it was difficult for either of us to sleep, with constant interruptions all night for blood pressure tests, checking the IV drips, and so on. On Wednesday morning, we were definitely ready to leave.

This is another interesting difference between the US and Ecuador. You don’t need your doctor’s approval to leave the hospital. After his morning exam, he told us “If you want to leave, that’s up to you, or you can stay another day if you like”. You do however need the approval of the cashier. Before we could check out, I had to go downstairs and pay the bill. Once that was completed, it was the cashier who gave me a statement to show at the exit, authorizing us to leave the hospital.

We did not come directly home to Salinas, however. Instead we stayed at the nearby Courtyard Marriott, to relax for a full day and to get one good night’s sleep before Rita had to face the two hour ride back home.

It has now been ten days since the operation, and Rita is doing fine. The band-aids are off, she is able to eat real food again (just no fats), and she has started to get outside and walk a little over the past few days.

Our total cost for this venture was a little more than we had expected, given my experience was not quite $6,000. However, her operation was a a little more complicated, as it involved the removal of an organ. The OR fee was higher for her, and the equipment used was more expensive. Her doctor is also the most senior specialist, so his fee was higher than average (but well worth it). All together, including visits for diagnosis and all of the prep work like ultrasound, MRI, pre-op cardio check, the bill came to almost exactly $10,000.

To keep that in perspective, Health Care Blue Book says the average cost for this procedure (without diagnosis costs) in the US is $16,500. And since in the US this is usually done either on an out-patient basis, or with one night’s stay in a hospital room, that brings the average US cost up to the $18,500-20,500 range, plus ultrasound, plus MRI, etc, etc.

In closing, I know we could have gone cheaper using IESS, or by using the Santa Elena hospital. But we feel if you are going to splurge on anything, it should be health care – especially when cutting you open and poking around inside is involved. We still feel good about our decision to use pay as you go. Running the numbers, if we had been paying into the Salud plan we looked at for the past 37 months, and had been reimbursed the 80% of our expenses during that period after deductibles that the plan allowed, we would have paid out almost exactly the same cash to date.

As long as neither one of us needs to cough up another body part any time soon …

Bottom line is think carefully about what your medical needs are before coming to Ecuador (or any other country – heck, you should be thinking about it pretty hard right now if you are staying in the US too), but we have been able to find great medical care at affordable prices here.