Health Care Survey: The Best Havens for Quality Care Overseas

There is something amazing about the medical system here, and something not quite right with ours,” says Shane Simons, who moved to the tropical island of Penang, Malaysia, eight months ago from Los Angeles. “My doctor in L.A. told me I needed a mole removed from my neck. I was in his waiting room for 45 minutes and his consulting room for 45 seconds. That cost me $2,000. He recommended I get it removed at a cost of $5,000.

I saw a specialist in Penang and it cost me $30 and it turned out the mole was fine.” When Mike Sherrer moved to Panama, he says he thought he would return to the U.S. for any major medical procedures. “Now I think that, if I were in the U.S., I’d come to Panama for any medical treatment. The health care is great.”

Mike paid just $700 for a surgery that he says could have cost him 400% more back in Florida. And that $700 included the operating room, doctors’ fees, everything. What impressed Mike most, though, was the personal touch: “The thing about the doctors here is they give you time…” Does a new life overseas mean you have to compromise on health care? The answer is a definitive “no.”

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Health Care Survey: The Best Havens for Quality Care Overseas

Like Shane and Mike, you’ll find excellent, affordable care in many locations overseas. But where? For our 2013 Health Care Survey, we asked our experts to reveal what’s on offer in seven of the world’s best havens today. These are the most popular countries with expats: places that score high on quality of life in general. Where you’ll find affordable real estate or a lower cost of living… where the dream you nurture can be a reality.

But what about the health care? When you’re considering health care overseas, you want three basic questions answered: First, what’s available? For instance, are the hospitals modern and well-equipped? Do they have affiliations with well-respected international hospitals? Is there a good network of clinics? Can you find the drugs you need?

Second, just how good is the care? Is the staff well-trained? Do the doctors stay on top of the latest treatments? Will you find the right specialists? How long will you have to wait for appointments? Does the country have national standards for accepted practice?

And finally, how much does it cost?

When it comes to our health, we’ll pay what it takes to get the outcome we want. But in these seven destinations, that amount needn’t break the bank. In fact, costs are so low in some places that expats simply pay out of pocket—without compromising on quality. In others, expats mix and match public and private systems to get the best bang for their buck.

The solution that’s right for you depends a lot on your needs and wants. But here are some on-the-ground insights and recommendations to get you started.

1. Costa Rica—Convenience, Comfort, and Care

By Jason Holland

Health Care Survey: The Best Havens for Quality Care OverseasBack in California Laurel and Charles Carpenter paid $1,200 a month for health insurance. Now, living in the Central Valley town of Atenas, Costa Rica, they pay just $88 a month to be in the Caja—the country’s universal health-care system. Charles has multiple sclerosis and the Caja covers all his treatments and medications. With the money they don’t spend on insurance, they can afford to have a private, full-time nurse, which would cost $9,000 or more per month in the States. Charles’ and Laurel’s story is similar to that of other expats in Costa Rica. Expats must join the Caja (La Caja Costarricense de Seguro Social) to get a residence visa.

But with health care in Costa Rica—in both the public and private systems—among the best in Central America, that requirement is hardly a negative. And the Caja’s cost is low. It’s determined by your income but generally only runs $30 to $90 per person per month. And that monthly fee covers everything, from prescriptions to doctor visits to testing to surgeries.

The public health system has a large network of clinics and hospitals throughout the country. But while emergencies are treated right away, wait times for routine procedures can be up to several months. As a result, many expats use a combination of the public and private health-care systems. In the private system, wait times are practically nil and doctors are very accessible.

I have the cell-phone numbers and email addresses of all my family’s doctors. And they answer. The costs are also low—as little as half the U.S. rate for most procedures. A visit to a general practitioner can run $50 to $60, for instance, and $80 to $100 to visit a specialist. Doctors tack on an extra $20 to $30 to make house calls.

At these rates, it’s possible to pay out of pocket. And some expats do. But you can get low-cost private insurance through the government-affiliated Instituto Nacional de Seguros (INS). Like most private insurers, INS excludes pre-existing conditions and does not take new policy-holders aged 75 and older. Annual premiums for INS are in the low $2,000s for those aged 55 to 65, up to the $5,000 range for those aged 76 to 80. Many U.S. and European insurance plans are also accepted in Costa Rica. Costa Rica has three JCI-accredited hospitals, all in the capital, San José. Most of the specialist doctors and services are concentrated here.

CIMA is affiliated with Baylor University Hospital in Texas, and Clinica Biblica is affiliated with Jackson Memorial Hospital in Miami and Evergreen Healthcare in Washington. Many Costa Rican doctors trained in North America or studied English, so they speak some English. Many are fluent. Every doctor I’ve spoken with attends conferences in his specialty abroad.

Expat Luc Charette, 66, originally from Montreal, puts it well: “I’ve always dealt with the medical system here with great confidence. I’ve never had a doubt about being treated in Costa Rica. For example, I know the surgeon scheduled to perform my valve replacement went to the States to study, so his qualifications are top-notch.”

2. Malaysia—Low Cost and World Class

By Keith Hockton

Health Care Survey: The Best Havens for Quality Care Overseas“Malaysia is the best country in the world to get ill or get injured,” says Chicago native Justin Strong, who has lived on tropical Penang Island for the last 12 years. “We go to the doctor here and we don’t need to worry about how to pay him. In the U.S., medical bills were sending us broke.” Hospital care in Malaysia is a bargain. In fact, it’s so low-cost that I know a number of expats who simply pay out of pocket—no insurance at all.

A check-up at the doctor’s office costs $16, the same price as a house call. Visiting a specialist can cost as little as $4—usually it’s $16. A hip replacement that costs $80,000 in the U.S costs $20,000 in Malaysia. A facelift that is $20,000 back home costs $4,000 here. And a serious operation like heart surgery, which can set you back up to $180,000 in the States, is around $14,000 here.

It’s no surprise, then, that Malaysia is one of the world’s busiest medical-tourism hot-spots. And the quality of care is equal to or better than that in most Western countries. There are seven JCI-accredited hospitals in Malaysia and doctors usually speak English. Sometimes it’s even their native language, as you’ll find Australian and British doctors working here.

There are six government hospitals and nine private hospitals where I live in Penang. No appointments are necessary. Just turn up and ask to see a doctor. On average you may have to wait 30 minutes to an hour, depending on the hospital. Malaysia has a public health-care system but it’s not open to foreign legal residents. But with low costs and a good mix of local insurance options, that’s not a problem.

No one insurance company is preferred— expats tend to shop around and look for the cheapest offer. For national health-insurance plans, you can pay premiums of about $400 to $1,000 a year per person. I’m an active individual who likes mountain-biking and trail-running, and I have found myself in a few Penang hospitals over the years. They are the best that I have experienced anywhere. I don’t think it’s a pleasure to go to any hospital, but I actually enjoy going to the ones here.

3. Panama—First World and Affordable

By Jessica Ramesch

Health Care Survey: The Best Havens for Quality Care OverseasExpats in Panama definitely appreciate its health care. Former San Diegan Mitzy Martain says, “We know so many people who have had wonderful health-care experiences here. Everyone in the medical community in Panama is marvelous, in my opinion.” She adds, “I had to have a very serious surgery involving my spine and never even gave a thought to going back to the States.”

In Panama you’ll find many specialists who speak English, are affiliated with international medical associations, and keep abreast of developments in their field. Panama City’s “big four” major hospitals are all affiliated with U.S. hospitals.

Punta Pacífica, the newest of the four and affiliated with Johns Hopkins, is Latin America’s most advanced facility. And new hospitals and hospital expansions are going up all over the country. A new Children’s Hospital is being fundraised right now, and new public hospitals are in the works for the city of David and Panama City, as well as provincial centers.

New specialists are also being trained to meet these new hospitals’ growing demand. Today, most areas expats choose to live in are never more than 45 minutes away from a hospital. Pretty much every medication you can find in the States exists in Panama. In the U.S. I used to pay over $50 for my Ventolin® inhaler. I also had to get a prescription, which meant paying more to wait for and see a doctor.

In Panama I get it for $7—and seeing as it’s not a narcotic or particularly dangerous, it doesn’t require a prescription. Smart.

Once you receive your Pensionado or other legal residence visa in Panama, and you are retiree age, you can start taking advantage of all Panama’s retiree benefits. Health benefits of the Pensionado include 15% off hospital and private-clinic services (when insurance does not apply), 10% off prescription medications, 20% off medical consultations, 15% off dental visits, and 15% off optometry services.

Panama has a public-health system but generally I don’t recommend it. Most expats are happy to pay for inexpensive local insurance that gets them cheap access to the city’s first-rate hospitals. A number of companies offer Panama-wide coverage. If you’re retired U.S. military, note that Hospital Nacional accepts Tricare.

You can also get hospital-membership plans that offer members substantial discounts at the hospital on everything from consultations to surgeries. Cost for these memberships varies but is generally low—under $150 a month for a couple. I use my private insurance, and my copay at the nicest hospitals (such as Hospital Paitilla in Panama City) is about $10 for a general practitioner and $17 for a specialist. And you don’t need to see the GP first and get a referral. You can go straight to the specialist.

4. France—Health the European Way

By Barbara Diggs

Health Care Survey: The Best Havens for Quality Care OverseasKim Petyt, an American wedding planner based in Paris, was visiting the U.S. when her daughter developed an ear infection. “I couldn’t get an appointment because she didn’t have U.S. insurance. Finally, I took her to an ER pediatrician, which cost $300 just for a quick checkup and prescription for medication. In France the same thing would have cost $90 at most (with no emergency-room visit necessary).”

U.S. expat Michelle Botha says her MRI cost about $10,000 in the U.S. and less than $265 in France. I can add that, when I lost my asthma medication (albuterol) in Washington, D.C. last summer, I had to pay $65 for a new one…really upsetting since I never pay more than €13—about $17—for the same medication in Paris.

Kim, Michelle, and I belong to the sécurité sociale, France’s universal healthcare system. French health care in both the public and private systems is excellent— and, by U.S. standards, very affordable. The public health-care system pays around 70% of most medical costs, including doctor’s visits, hospital stays, lab tests, and more.

Most French then buy insurance through a private insurer, called a mutuelle, to cover all or part of the remaining cost. Expats must show proof of health insurance to get a residence visa for France. If you’re a retiree and not from the European Union, that means private insurance at first. (And not a cheapie plan—it needs to provide coverage as comprehensive as the sécurité sociale.) You can later apply to join the sécurité sociale, if you choose. You’ll pay a monthly fee (determined by a complex formula).

Mutuelle coverage, if you choose to get it, normally costs €50 to €100 a month per person. (That’s about $65 to $130.) If you prefer to stick with private health care, many insurers offer private health insurance. One low-cost option is to sign up with an organization and join its group plan.

The Association of Americans Resident Overseas is popular with expats in France. The annual premiums for its group plan are slightly under $5,000 a year for those in their 50s, and the coverage is comprehensive. Your French doctors are likely to have done part of their training overseas and attend international conferences in their field. But even if they haven’t, they probably received their excellent training and continuing education in France.

In the public system, expect to pay about $45 to see a doctor and about $78 to see a specialist. A private hospital will cost you about $156. You usually don’t have to wait more than a week or two to get into a doctor or specialist in France, though it does depend on the hospital and on the procedure you need.

Most French hospitals have very modern equipment, particularly in large cities. Outside the main cities, most small towns have a doctor or good clinic fairly close.

5. Uruguay—South America’s “Switzerland”

By David Hammond

Health Care Survey: The Best Havens for Quality Care OverseasIf you fall in love with Uruguay, as I did, one thing you’ll appreciate is the high-quality, affordable health care. In Uruguay, medical equipment is modern and doctors highly trained. There are two medical schools in Montevideo, but many senior doctors in Uruguay were trained in the United States, Germany, and Brazil.

Many Uruguayan doctors also attend continuing-education conferences abroad. For cost, consider this: I had knee surgery just over a year ago. I paid $200 for a CT scan, a $7 co-pay for each doctor visit, and a $7 co-pay for each physical therapy session afterwards. Everything else was covered by my regular $185-a-month health-care plan.

Lisa Marie Mercer has had a similar experience. She and her husband moved from Colorado to Atlántida, Uruguay, just over a year ago. “My monthly insurance in the U.S. was $650, with a $2,500 deductible,” she says. “My medications started at about $200 a month.”

Today, as members of the mutualista at the Asociación Española hospital, “we each pay the equivalent of $80 a month. My prescriptions come to about $60 a month.” Uruguay has a public health-care system, and expats who have applied for residence can use the system in an emergency. But my advice is not to rely on it. Instead, the most common medical-care choice in Uruguay is a hospital plan called a mutualista.

The Mercers belong to one, and so do I. With a mutualista, you become a member of a hospital and go there for all your scheduled health-care needs. You make monthly payments to the mutualista and also pay a small co-pay when you see a doctor or have a medical test. A mutualista is different from health insurance. There is no deductible, no lifetime cap, and no complicated terms to decipher.

Each private hospital sets its own guidelines for accepting non-employed members (such as retiree expats). Some hospitals will not take new members over a certain age or with certain pre-existing conditions. The Mercers belong to the mutualista at the Asociación Española. I’m a member of the British Hospital Scheme.

The British Hospital is not a true mutualista, but it has a similar hospital plan. The membership fee is higher, but the waiting times are usually less. As a man in his 50s, I pay about $185 a month, which includes a travel insurance rider. I know an expat in his mid-60s who pays $270 a month. Co-payments are about $7 for a doctor’s visit and $15 for an emergency-room visit.

For expats with pre-existing conditions or who are above the cut-off age (60 or 64) of some mutualistas, Asociación Española is said to have the best balance of quality facilities with leniency in accepting new members—it has accepted new members in their early 70s. The next choice is Médica Uruguaya.

Most of the staff and many doctors in Uruguayan hospitals speak only Spanish, so consider coming with someone to interpret for you if you don’t speak Spanish. It’s easy to find good medications, both generics and brand-name drugs. Do note that brands may not have the same names as in the U.S. Cost can depend on your hospital plan. Many offer a 50% discount.

At the British Hospital, you can also pay $15.50 a month and get all your prescriptions at a set $14.20 each. If you prefer to buy health insurance instead of joining a mutualista, health plans are available with a variety of coverage options. Most are priced in a range from $250 to $500 a month.

6. Mexico—Excellent Hospitals

By Glynna Prentice

Health Care Survey: The Best Havens for Quality Care OverseasWhen Tim and Donna Leffels’ daughter developed eczema in Mexico, they paid 600 pesos—about $47—for a consultation with the city’s best dermatologist. “I thought 600 pesos was expensive, but it was worth it,” notes Donna. “The doctor spent quite a bit of time with us and answered all my questions and concerns.”

That $47 fee is on the high end for Mexico, which tells you how affordable most care is. Many specialists, particularly in smaller cities, still charge $35 or less for an office visit (including my local gynecologist). But the thorough care and long consultation that the Leffels enjoyed is standard procedure.

Mexico has both a universal health-care system and private health care. The public system, known as IMSS (Instituto Mexicano del Seguro Social), has clinics, hospitals, and pharmacies all over the country. Expats with a valid residence visa can sign up for it—and many do. IMSS does have some drawbacks. It excludes many pre-existing conditions, for instance. The quality of facilities can vary, and wait times can be long. But with a top rate of only $300 a year or so, it’s a great low-cost option if you’re on a budget.

With IMSS, all treatment is free—including prescriptions. (Though do note that they are often older drugs or generics.) Doctors in the public system are also less likely to speak English well, if this matters to you. In the private system—especially in the larger clinics and hospitals—many doctors speak fluent English. Many actually studied in the U.S., Canada, or Europe… and stay up-to-date in their field. In addition to IMSS hospitals, you’ll generally find at least one private hospital in mid-sized cities.

In large cities, such as Guadalajara, Mérida, and Puerto Vallarta, you’ll often find several. Many are affiliated with hospitals abroad; in fact, at least two U.S. hospital groups actually own hospital chains in Mexico. There are also several excellent Mexican hospital chains, most notably Star Médica, with seven hospitals, and the Los Ángeles group, which has more than 20 throughout the country.

These hospitals are modern, well-equipped…and much less expensive than their U.S. counterparts. For instance, on a recent check-up at Mérida’s Star Médica hospital, I paid about $60 out of pocket for a mammogram and $80 for a bone-density scan. In addition to international health insurance carriers, numerous national insurers also offer coverage. A healthy individual of 60 or so should expect an annual premium of about $2,500 to $4,000, depending on deductibles and other factors.

Do note that many policies in Mexico are major-medical only. And medications are generally no problem. You’ll find familiar brand names as well as generics at affordable prices. For instance, Lipitor (atorvastatin), which has gone off patent, is available in both generic and branded form. Branded Lipitor costs about $34 a month, while generic atorvastatin runs about $25. And for most drugs you won’t even need a prescription.

7. Ecuador—The World’s Best Retirement Haven

By Edd Staton

Health Care Survey: The Best Havens for Quality Care OverseasPatty and Mike Grimm have been in Ecuador for nearly three years. During that time, “we have pretty much covered the gamut of medical care, including dentistry, eye exams and glasses, emergency rooms, colonoscopy, mammogram, gallbladder removal, treatment for ulcers (endoscopes), and serious back treatments,” says Mike. “In each and every case, our care has been first class, with very caring and skilled medical practitioners. And it’s been a fraction of the cost of the U.S.”

Over and over, expats praise Ecuadorean doctors who “put the patient first” and take time with their patients—up to 45 minutes for an office visit, if needed. In Ecuador’s major cities—Quito, Cuenca, and Guayaquil—English-speaking doctors are fairly common, since many have gone to medical school in the U.S.

These three cities are also where you’ll find Ecuador’s most modern hospitals and most of the medical specialists. Costs are low—about 10% to 25% of what you’d pay in the U.S. For major surgeries, the cost is often less than 10%.

Expat Linn Smith, who lives in Cuenca, can attest to the low cost. She had an emergency appendectomy whose total cost—laparoscopic surgery, doctors, nurses, hospital, equipment, and medications—was only $1,200. “This same surgery can cost $40,000 to $60,000 in the U.S.,” she says.

It’s no wonder, then, that a recent survey in GringoTree, the Cuenca equivalent of Craigslist, revealed that 67% of expats are “self-insured”—pay as you go. But insurance is available. In addition to international plans, you can choose an Ecuadorean health-insurance plan, which costs around $70 a month. (Salud, S.A. is Ecuador’s largest insurer.)

Or you can choose a health plan offered by a private hospital. Ecuador also has a public health-care system. In 2010 and 2011 the country spent millions of dollars to upgrade this system, and it now allows expats to join it. To qualify, expats must hold a residence visa and be between the ages of 18 and 60. The cost is $60 to $70 a month, and you must pay for three months before you can access regular care (one month for emergency care).

Under the public system, you have no choice of doctors and you must sometimes wait weeks for appointments. But coverage is comprehensive, with no deductible. You’ll be referred to a specialist if needed and transferred to a private hospital if you require special facilities—at no additional charge. Most drugs are available without prescription, although they often have different brand names.

The doctor or pharmacy can cross-reference the names. “Services here are expanding, spurred in part by progress, U.S./European-trained doctors and the influx of expat arrivals,” says expat Linda Walker. “All of our physicians regularly attend Latin American, Stateside and worldwide seminars/conventions to keep abreast of the latest in their fields. You’ll now find dental state-of-the-art offices that rival any in the U.S.”

How Does the U.S. Compare?

By Glynna Prentice

When we talk to U.S. expats about their health-care experiences abroad, we hear repeatedly of three things that impress them: the personal, caring attention; how quickly they are able to see a doctor; and, inevitably, how affordable the care is, especially given the high quality. Make no mistake: Excellent health care is available in the U.S. But a visit to a specialist that can cost $200 or $300 out of pocket in the U.S. costs just $25 to $45 in Latin America, and around $16 in Asia.

In the U.S. you may have to call multiple doctors just to book that visit. And once you get to the doctor’s office, you’ll likely spend longer in the waiting room than in the examination room. With these downsides, many expats feel they can get more bang for their health-care buck outside the U.S. And they’re right. Today, in the countries we cover here, you can find doctors trained as well as the best in the U.S.

You can find the same high-tech equipment in the hospitals, and the same knowledge of cutting-edge treatments. (In some cases you can even find treatments not yet allowed in the U.S.) And it’s combined with the kind of old-fashioned, personal care that’s almost impossible to find in the U.S. anymore.

See here for a slideshow of photos of the seven countries mentioned above.

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