The health care system in Ecuador is consistently ranked among the best in South America. In fact, Bloomberg recently ranked Ecuador as having the 20th most efficient health care system in a study of advanced economies, second only to Chile in Latin America. The United States, on the other hand, ranked a dismal 46th, near the bottom of the list. In the same study, Bloomberg found that the U.S. spends the most of all advanced economies on health care on a relative cost basis ($8,608 per capita) with the worst outcome, while Ecuador spends among the lowest in the world ($332 per capita).
The latest World Health Organization’s survey of health care costs by country shows an equal disparity. As of early 2013, the per capita expenditure on health care in the U.S. was $8,635 compared to $750 in Ecuador. Spending on health care in the U.S. represents 18.2% of the national GDP, the highest in the world, while it represents 8.8% in Ecuador. Although the recent expansion of Ecuador’s Social Security health care system (see below) will increase costs, a private actuarial analysis suggests they will not exceed $900 per year per capita and 10.5% of GDP.
For the record, the per capita cost in Canada is $4,500, 11.5% of GDP; $3,750 and 9.9% in the U.K.; $1,425 and 9.9% in Argentina; $1,135 and 8.4% in Panama; and $725 and 7.7% in Colombia.
One of the great perks for foreign residents living here is easy access to this high-quality, low-cost system. In Ecuador, you receive personal attention from health care professionals not seen in the U.S. since the 1970s.
Private clinics throughout Ecuador make hygiene a priority. These clinics rival their North American counterparts in cleanliness, safe practices and the use of modern technologies. Private clinics also employ some of the most highly skilled physicians in the country.
In the bigger cities such as Quito and Cuenca, you’ll find hospitals with state-of-the-art equipment, as well as talented medical specialists in all fields.
A visit to a general practitioner costs $25 to $35 while a visit to a specialist runs $30 to $40. Simple outpatient procedures are equally inexpensive. For example, the removal of a benign lump (under local anesthesia), including biopsy, costs about $100.
Procedures that require surgery are also top-notch. Many specialists in Ecuador have trained in the U.S. or Europe and their skills are impeccable. Just as importantly, the costs for advanced surgeries are a fraction of what they would cost in the U.S. For example, a shoulder repair for a torn tendon is a two-hour procedure done under general anesthetic. In Ecuador, the total bill for the operation, anesthesia, pre- and post-operative care, an overnight stay in the hospital, and all supplies and medications costs just $2,130—about a third of what the same procedure costs in the U.S. And follow-up physical therapy with an experienced therapist costs a mere $10 per visit.
Private & Pubic Health Insurance
Health insurance is a bargain in Ecuador. A recent review of comparable insurance policies for a 60-year-old man in the U.S. and Ecuador reveals vast differences in premium costs. In the U.S., the man would pay a monthly premium of $1,200; in Ecuador he would pay only $70. Policies for women and children are equally inexpensive. For example, a woman, age 50 to 60, would pay $72 for the same policy in Ecuador while coverage for a dependent child, between 2 and 17 years-of-age, costs just $15.69 a month.
The policies cited are offered by Salud, S.A., Latin America’s largest health insurance company. These policies pay 80% of doctor’s visits, 60% of medications costs, and 100% of hospitalization. It also offers additional coverage for walk-in procedures and accidents. Check the company’s website for more information.
One little known benefit for expat retirees living in Ecuador is that, in many cases, they qualify for the public health care system, where for just $60/month on average, all your medical needs are covered — prescriptions, doctor’s visits, hospitalization, you name it — even optical and dental.
Ecuador’s Social Security System (IESS) and What It Means for Expats
The recent expansion of Ecuador’s Social Security (IESS) health care system is great news for expats. The Social Security health care system recently eliminated age and pre-existing medical condition restrictions on voluntary membership in the program. All legal residents are eligible to join.
- No age limit to join
- ** No limit pre-existing conditions (see below)
- Individual cost to join is equal to 22% of Ecuador’s minimum wage, so approximately $70 per person; dependents will increase the cost by 4%
- Coverage includes: medical, dental, eye care, surgeries, and prescriptions
- A Ecuadorian cedula is required
- There is a three-month wait for benefits to start … however, there is no wait for emergencies
** The “no limit for pre-existing conditions” is set to be changed soon. There will also be limits placed on catastrophic health care as well. Details will be forthcoming.
But this is great news for expats. Many who had private insurance are now canceling their coverage. However, expats should confirm this information with their Ecuadorian attorney before dropping their private health insurance.
A new IESS hospital will also be built in Otavalo near the bus station and next door to the newly constructed IESS office.
A Note About The Affordable Care Act or “ObamaCare”
If you’re living outside the U.S., you don’t have to purchase health insurance by the end of March, 2014, through what will be the newly established health insurance marketplaces in each state. And unlike other citizens residing in the US, you won’t be penalized through a fine for not buying the mandatory insurance. In other words, if you’re an American living abroad throughout 2014, you will be exempt from buying heath insurance and exempt from the penalty for not buying it.
In fact, in order to buy the insurance as an individual, you must be living in the U.S.
Here are three things that every expat should know with regards to the Affordable Care Act (ACA):
- U.S. citizens who are bona fide residents of a foreign country are notrequired to have health insurance as mandated by the ACA.
In general, U.S. citizens living outside of the United States for at least 330 days in a given year and who meet the IRS requirements to be a bona fide resident of another country are exempt from the ACA. (You’ll find the full list of requirements for bona fide residence in Form 2555 on the IRS website.)
U.S. citizens living outside of the United States but who are not bona fide residents of a foreign country are required to have health insurance or face fines.
a) have told your country of residence that you are not a resident of that country
b) are not required to pay income tax in your country of residence,
then you are not a bona fide resident of that country.
If you don’t meet these stipulations—or any of the other listed IRS requirements—and you do not purchase health insurance, then you could face fines in 2014 of $285 per family (US$95 for individuals)—or 1% of your income, whichever is the greater amount… That amount will rise to a whopping $2,085 per family (US$695 for individuals) or 2.5% of your income by 2016.
To avoid these fines, it’s in your best interest to purchase at least minimum essential coverage.
Good news if you are entitled to Medicare, however: Medicare qualifies as minimum essential coverage. If you’re eligible for Medicare, you won’t be at risk of fines.
- It could make sense for you to have minimum essential coverage under the ACA even if you are a bona fide resident of another country.
Many expats are fortunate to live in an area with high-quality, affordable, and easily accessible health care. Those who are bona fide residents don’t have to pay for health coverage in the U.S. But even if you are a bona fide resident of a foreign country, having extra cover in the U.S. could help you to secure your own peace of mind.
If, for any reason, you think that you or your family might have health issues that will require treatment in the United States, it’s worth thinking about purchasing a low-premium/high-deductible U.S. plan that’s coupled with a medical evacuation policy. There are several medical evacuation companies that will provide evacuation from almost any location in the world to the U.S. hospital of your choice for a reasonable membership fee.