This article was written by my good friend, Don Murray. The original article may be read here, at In the article that follows, “I” is Don Murray. I thoroughly recommend reading Don’s articles at his site. Lots of good information there.

Before I get into the meat of what I have learned about Ecuador’s Healthcare system, I need to offer a few disclaimers as follows:

I cannot verify that all that was told to me by Mr. Intriago is completely accurate or will remain as truth for any particular period of time. As a developing nation, Ecuador’s systems are in a constant state of change/improvement. What is true today may change tomorrow…or an hour from now. The information provided here should not be considered comprehensive of all possible related factors, and does not address a complete accounting of the availability or quality of treatments or procedures in all areas of the country, which can vary greatly!

Additionally, implementation of policies is likely to be inconsistent. The rules may say one thing but implementation may or may not be consistent with rules and regulations. What is policy in one office in one city may not be the case in another city. Such is life in Ecuador!

Finally, while I have done my very best to research and present accurate information, I cannot be held responsible for any information that may not be accurate or factual. It is the responsibility of each individual to make their own choices related to healthcare (and everything else) using all possible resources to assist.

As expats living in Ecuador, we have learned quite a bit about how to integrate ourselves into an entirely new culture. Creating a brand new life on the shores of a foreign nation has been a grand adventure but there have been a few minor challenges. It is like being in some kind of an advanced class every day and you have to learn as you go.

Among our challenges has been understanding our healthcare options. I wanted to learn the real scoop about Ecuador’s healthcare system. I have personally experienced only the tip of the tip of the system. I buy my prescriptions over the counter as others do; no prescriptions required (excepting narcotics) and I have been paying cash. The prices are significantly lower than those in the states. I had a small “thing” removed from the top of my ear, an office procedure that was handled efficiently and was inexpensive. Again, I paid cash. I was present to observe two occasions of emergency room treatment for friends, and have heard firsthand accounts of others’ experiences, all with varying results.

Upon the recommendation of a good expat friend, we actually purchased a private insurance plan for Diane shortly after we arrived. I was denied coverage due to pre-existing conditions, much like would have been the case in the States with private insurance companies prior to the Affordable Care Act (Obama Care).

I have also read numerous bits and pieces of information on various websites, blogs, forum postings, etc. and after all that, I still could not form any concrete understanding of how the National Healthcare “system” or “systems” worked. It seemed a mysterious blend of public and private clinics and hospitals. I wanted answers!

I was discussing this with my good friend, ‘Tripp’ Martin here in Bahia de Caraquez. Tripp is a long-time expat and business owner, married to a Latina. He offered to help by introducing me to the Director of the local Social Security office. (Tripp Knows Everyone) He also suggested I write a follow up piece so that others would be able to access this information as well.

Jairo IntriagoOkay…here we go!
Medical care in Ecuador falls into two general categories; Public and Private. The Public Care system is attached to the Social Security Administration, or IESS.

The private care system is completely separate and requires payment at time of service. Hospitals and clinics must secure your ability to pay before admission, and without private Ecuadorian insurance or proof of IESS referral, often won’t provide treatment unless payment is guaranteed in the form of a credit card or a chunk of cash up front! As we were discussing all this in our meeting, Tripp related the story of a friend of his whose brother bled to death in a private hospital waiting for his proof of payment to be accepted.

Stateside plans such as Blue Cross/Blue Shield, while stating that they offer international coverage, often involve paying out-of-pocket and waiting for reimbursement. That’s not bad for a few hundred or even a few thousand dollars, but can create a real financial hardship if costly procedures are necessary. If you must front the cost of chemotherapy, for example, which can run about $8000 per round, you might find yourself faced with some pretty tough choices. While still cheaper than stateside prices, extensive care could easily be out of reach for many if not most folks if paying cash were your only option.

All employers and employees in Ecuador are required participate in the IESS system. If you are not an employer or employee, legal residents who hold a Cedula may voluntarily participate. Participation is not automatic. One must physically go to the social security office and register. As of this moment, one may voluntarily join the IESS system up until turning 65 years of age. There is no lower age limit. After 65 years of age, one cannot join. Between the age of 60 and 65, a physical exam is required, as is disclosure of all pre-existing medical conditions.

Once affiliated, and provided you continue to pay your monthly fee, you will remain affiliated until you die. The monthly fee is based upon 21.5% of the current average wage. Today’s calculation worked out to be $56.65 per month. Now, I’m not clear if that figure is adjusted for each region. It may fluctuate up or down by a few dollars based upon regional adjustments…if that is the case.

In our area, the fee must be paid monthly at Banco Guayaquil. In other areas, the IESS may designate a different bank or payment procedure.

I have recently seen published reports that the government has proposed changes in the enrollment criteria that are expected to go into effect sometime early in 2014. These changes would remove the upper age limit for enrollment and would also specifically permit inclusion of pre-existing conditions, something that was apparently not universally accepted before.

When asked about the proposed changes, Mr. Intriago could not confirm that the changes would go into effect. He stated that his office had not received any such notification as yet. He also said that communication on these sorts of things is not always timely.

IESS participants must make telephone appointments for routine clinical care. Emergency needs are served at local hospitals. Presenting one’s Cedula is all that is required at the time of service so that one’s participation status can be verified by computer.

All care in the IESS system, including medication and routine dental, is provided at absolutely no charge to participants. In the event that the public hospital or clinic is unable to provide for your needs, they may refer you to a private hospital that has the capacity to provide the services required; Again, at no charge to the participant.

In the case of an emergency, such as an automobile accident or other trauma, the closest hospital, public or private, will provide emergency services.

I can speak a bit about the private insurance process as Diane is a participant. We purchased a plan from a company called Salud. They offered a number of levels of coverage, from level 1 to level 7. Level 1 is the most basic coverage and provides minimal care with higher deductibles for a very low monthly charge.

Level 7 is the premium coverage with zero deductible and access to the “best” private clinics and hospitals with private rooms. If I remember correctly, the lowest level plan was around $40 per month. Diane’s level 7 coverage runs a bit over $200 per month based on her age and health status, with an included cancer rider and life insurance policy. We purchased a plan for Diane that fit our budget and provided the level of care we sought. We would have considered a plan for me, as well, if I had not been denied coverage. Salud has a network of private clinics and hospitals around the country and the facilities are also rated level 1 thru level 7. In typical fashion, one calls a number for an appointment. There are other insurance carriers besides Salud but I cannot speak to their plans.

Tripp Martin Jairo Intriago & DonMurrayLeft to Right: Tripp Martin, Jairo Intriago, & Don Murray
When asked about elective procedures that are not essential, Mr. Intriago simply shook his head “no”. When asked about such things as joint replacements such as hips and knees, he said those things were considered prosthetic devices which were not covered under the public plan at this point.

Quality of care fluctuates wildly across the country. Residents living in larger cities such as Quito, Guayaquil or Cuenca have access to large, modern hospitals and clinics and most report great care in those areas. Much of the country does not enjoy such modern facilities. Routine care and minor traumas may be dealt with adequately in smaller towns. Access to lifesaving emergency care such as that needed for heart attacks or serious head injuries is not readily available throughout the country. True critical care only exists in major population centers. Blood supplies are not well stocked or available and simple supplies like crutches are also difficult to find in some places.

Ecuador remains a developing nation which means systems and infrastructure are improving. Mr. Intriago spoke of the President’s desire to improve medical care throughout Ecuador and cited examples of hiring more physicians for the public system. Hiring more physicians is a great start! Hopefully, more and better equipped hospitals will soon follow.

If you have a serious or chronic medical condition and are considering a move to Ecuador, you may want to consider more than the reduced cost of living, the improved standard of living and a great mountain view or the sound of the surf in your back yard. You may need to consider proximity to the necessary medical services you require. Good quality care does exist in Ecuador and for a reasonable price…just not everywhere in Ecuador.

Tripp is certified TRC (Transnational Referal Certified) by ICREA  and is a member of NAR (The National Association of Realtors) and as such has access to more than 3 million international real estate agents all over the world and their International MLS services. Learn more about Trip Martin here.