S.O.L. In Paradise Discussion – Continued

The original S.O.L. In Paradise post I wrote provoked Lee Zeltzer to start a discussion on Boquete Ning called “Putting A Healthcare Rumor To Rest”.

I think healthcare is a necessary item to be discussed by foreigners living in Panama and those thinking about or in the process of retiring here. The discussion going on in Boquete Ning is very lively and I think it is worth your following the thread.

I do take issue with the way Lee framed his discussion.

What I take issue with is his saying,

“Don wrote about it, perhaps prematurely and then contacted the US Embassy to obtain verification.”

(“it” referring to Regional Hospital healthcare). That implies, that as an afterthought, I wrote the Embassy, which is not true. I wrote the Embassy prior to writing the post.

I felt that the information I had been given was of significant importance to be presented. I qualified that it might only be related to the fact that heart surgery would not be available in Hospital Regional after July 1.

Lee said that I should have talked to a second doctor before making the post. I have been in Panama since 2002 and know that you can get any number of answers from doctors. I would not trust the answer to this question being told by one, two or more doctors. The only way to get the real answer would be to ask the legal council of the hospital, and the Embassy is the best source to ask the question.

Another thing, I am concerned with. is Lee’s title “Putting A Healthcare Rumor To Rest“, because that could allow people think that healthcare is nothing to worry about, and Hospital Regional will always take care of you if you have a problem.

It is not as cut and dry as that. There is more to the story than, as Lee says,

“Bottom line yes you do need to pay for medical care at Regional but unlike a private hospital they will admit you, treat you and work a=out a payment plan with you.”

Let me preface by saying I have been in most areas of Hospital Regional, all floors, emergency room, blood donation area, social worker offices, psych ward, the hospital administrator’s office several times and the morgue.

It would be worth your while to take a couple hours sometime and go sit in the emergency waiting room and get a feel for where you will be brought in the event of a serious car accident. The Regional Hospital is the hospital where all trauma cases are brought because they are considered better equipped to handle them.

If you are lucky, you will never get to see the emergency area that is holding current cases. I have seen it too many times.

I just reviewed the list of cases from the Embassy that I have worked on at the Regional Hospital. At least six of the cases ended up in the morgue. A couple other cases, that were attempted murders, walked out. Of the six that died there, the majority were transferred there from other hospitals. Most because the patient ran out of money in a private hospital and one because the other public hospital did not have the capability to care for the patient.

I visited one individual because of a phone call from the Social Worker saying I needed to have the patient removed because the hospital needed his bed. When I saw him, I thought he was too weak to be discharged. A discussion took place between U.S. Embassy personnel and the social worker.

To make a long story short, the hospital still released him around 1PM. I got a call from his land lady around 6PM asking if I could come to his apartment.

Lilliam and I went to his apartment and found him having difficulty breathing and called 911. He died about an hour after 911 arrived. He should never been released from the hospital, but was released because the hospital wanted his bed.

After July 1, there will be no doctor in David that is qualified to do coronary related surgery.

David does not have a qualified neurological surgeon. I knew the previous one and he was very good. Currently, this need is being handled by bringing a surgeon from Panama City.

Not all doctors in David practice in the Regional Hospital.

If you are admitted, you may have no say about the doctor caring for you. The doctor may or may not speak English. It is extremely rare to find one of the nurses that speak English.

While I am on the subject of Doctors, I saw Dr. Adames name mentioned both in comments on my post and in the discussion on Boquete Ning. They tended toward a negative tone because his practice will only be provided in Hospital Chiriqui. Further many felt his prices were high.

I know Dr. Adames and consider him to be the most highly trained coronary physician in David and yes, his fee is higher than the average GP. Let’s face it, a mechanic capable of working on a Rolls Royce jet engine gets paid more than many other mechanics.

I have been to Dr. Adames office in Hospital Chiriqui many times and it is always full. I think he has more practice than he can take care of. If you need the service he provides, you need to plan on going to Hospital Chiriqui or go to Panama City. If you have no insurance then you are going to be limited to Hospital Santo Tomas in Panama City and being in a long waiting queue.

As I said before, there are many doctors in David that strictly practice in the private hospitals and do not attend patients in the public hospital.

Yes, I think this discussion is important and under no circumstance should its importance be lessened. Maybe I care about this subject, more than most people, because of my experiences here in Panama.

Many hear that you can come to Panama and get cheap healthcare and cheap insurance. Hospital Chiriqui has a plan that many get because of its cost. I know people that have had good experiences with only the HC insurance. I have had people tell me of horrible experiences.

Let’s face it, healthcare world wide needs to be a priority consideration as we get older. Señora Noris has made many valuable comments on my blog related to healthcare. I have grown to really appreciate her comments because she is a Panamanian and she shoots straight. It is good to get our perspectives modified by a Panamanian’s viewpoint.

One thing she points out is that people coming to Panama, without insurance, and planing on using the public hospitals create an additional load on a system that cannot meet all of the needs of the population they are here to support.

So with this, I will close this post. I still maintain that if you move to Panama without a plan to handle your healthcare needs, you may find yourself S.O.L in Paradise.

14 thoughts on “S.O.L. In Paradise Discussion – Continued

  1. My wife is Panamanian and she will never allow me to go to Regional least of all the ER. We go to CSS (Caja Seguro Social) for most needs. If we need it the doctor will recommend a specialist. Then we go from there. If I had to choose a hospital it would be May Lewis. If I have time and the trip is cheaper I’ll go see the VA in the states. I went to the cardiologist you mentioned above to have my pacemaker checked. He told me the battery only had three months to go. Because the VA will change pacemakers ONLY when it’s down to three months we flew up to Missouri. When the VA cardiologist checked he said I had about six months left. It was a wasted trip.

  2. Thank you for your post and yes we are here with no Panama Health Care Plan because the cost of health care insurance is out of reach for us, being that it was greater than 60 percent of our monthly income. I do have VA in the U.S. and when my wife reaches Medicare Age, we will most likely get Part B and trade it in for an HMO plan that takes the Part B Premium as full payment. Then if we need extensive healthcare we will return to the U.S. We have that option, because we rent and always will in Panama and we brought minimal possession with us. No 20 or 40 foot shipping container. That is how we are planning for our healthcare, no different than if we were in the U.S. but we eat significantly healthier in Panama and have much less stress than trying to living on the income we would have in the U.S. So, yes we may be S.O.L. as far as healthcare is concerned in Panama, but we accept the risk. Something that we understood from day one as SS refugees in Panama.

  3. Mr Ray – Thank you for your reality check. Too bad, many are going to balk. The VA system is overpowered in its sheer numbers; Medicare doctors, if one can find one willing to take you, are too far and few in number. They too feel their reimbursements are way too low. Those ‘Dorothy’s’ down your way need to double click their heels. IT ain’t Kansas no mo! Sorry. Modern reality ain’t what one thought it would be – in today’s world versus ‘back when.’.

  4. I have read the thread on Ning and I am suprised at the number of people who have a “cant happen to me” attitude. As we age, it can, and it will. It would seem the U.S. folks are relying on whatever (not being American I don’t know) is available in the U.S., but how is that of help if you have a heart attack or a stroke where speed of treatment is essential?

    In my opinion, expats here relying on Panamanian public health care are cheating regular Panamanians. I’ll leave that discussion at that.

    We chose to buy “somewhat” expensive private insurance and I can understand that not all can afford it but one needs to be pro-active. Plan such costs into your budget, they are more important than a lot of other things available here.

  5. I was visiting with a fella the other day. He said the new hospital in Volcan is now open yet they did not have the staff to staff it. I don’t know. All I know is what he told me.

  6. All the health care insurance in the world isn’t necessarily going to help someone who is injured as a result of an accident, or has some other type of medical emergency while in a part of the country where there are no private facilities. People residing or traveling in the country need to know they have access to the Panamanian health care system and regional health centres if the need arises.

  7. Thank you don for your comments about myself. I participate in your blog because these are very important topics. My husband is an american and worries too because he doesnt have insurance at all.
    I am very busy but will take the time to explain how the health system here works. Its not easy to understand because it is unique.

    I believe that what was mentioned as c s s is the clinica. They have drs offices urgent care pharmacy lab x ray and ultrasound. Mri and special testscare done in regional.

    Psnama the country hss 2 health systems. C s s and ministerio de salud. Css has hospitales and policlinic all over. Min salud also has hospitAls and centros salud everywhere. In some areas the dont have 2 hospitaks. There is one subsidized by both agencies.. case of regional. Thats why they take everybody. Centros de salud are cheaper for minor things. They dont have urgent care. Css policlinica in downtown has urgent care. There is slso
    cooperstivo This is a different systemsystem.
    it is good to have some type of private insurance. Will explain why later.

  8. Pedasi punditt, you have a good point. We eat healthier here than in USA. When I arrived in the US my weight was 124 pounds size 4. No matter what I did I, went up to 200 lbs. my health was realy bad. We came back to Panama I lost weight my health has improved tremendously. Mark´s HBP is under controlt w with hald the dose he used to take. So we decided to have a healthy life style.

    As far as insurance, we both are 60 and I just got an insurance quote from IS (Iternacional de seguros) for $280 a month and covers both of us. We cant afford it right now, but are working hard to get it This is a very good deal for anybody our age. I can ask the broker how much it would be for people over 60, etc.

    I just was thinking last night that this health care issue is also related to the living will to a certain degree. As mark said to me, I dont want life support. But he worries about not being taken to the hospital in case of a heart attack. Its kind of what many of you are going through. Most dont want life support, but dont want to die. This made me remember when my in laws passed away. In my mother in law´s case, she was taken to he hospital 2 to 3 times a week because the caregiver hid her living will. This went on for 2 year. Finally, I got to the hospital and showed them her living will. Their reaction was like we were wasting a bed needed for someone who really had a chance to live and she was sent to hospice where she died naturally in her bed a week later.

    In Panama, we dont have hospice. Hospice is the comfort of our home and family. Doctors know when a patient is dying and many tmes send them home. We are used to it and we prefer it. That was my grandmothers case. Dr. told my mom she is dying, take her home. she peacefully died surrounded by her family.

    Here is a good example on how to handle elders who do not want life support. My uncles case. Her daughter my cousin is an emergency doctor very reputable- She knew he was terminal. She spoke with family and made the decision not to take him to the hospital. They told his doctor their wishes. He signed the papers where he was responsible for his care at home and they paid him to visit him at home the same way he would in the hospital. He prescribed medications. CSS sent the oxygen tank. No one had to ask for permission from work to go see him at the hospital. 0 stress, good care from his children wife and grandchildren. Less expenses, and a bed was available for a person who really had a chance to live and who would die because a person with no chance was using the bed.
    Many times we only think in ourselves and we even are contradictory.

    Regarding Dr. Adame, I really dont think he is the best. He simply is the only one that performs surgery. Not all of us need a cardioligyst surgeon to take care of our condition. Most conditions can be monitored by regular cardiologists who are very good at keeping your hear working and not needing surgery. If the time comes that you need surgery, then you should go see him. or another one in Panama. It is a waste of money and time.

    The more I think about it the more I realize that pretty soon he wont be as good, because is concentrated on making money. he is office is overcrowded and he is human and humans have limitations. What will happen is that you wont get an appointment soon, he will be busy all the time he his quaiity will decrease for lack of time. Just wait and see.

    I can say that from experience, it has happened in the US. I worked with Parkview hospital in california and I worked with the Visiting Nurse Assoc of the Inland Empire.

    Also, Mark and I needed to see a cardiologyst I asked my orthopaedic and my internal MD in a private office which one would they recommend this is what they both said; If you want to spend thousands of $$$ in unnecessary tests just to hear you are ok or not go to DR. ADAMES. But, if you want to hear the same paying less and by a good cardioligist with many years of experience you can see and he gave me a list. Which I did and worked.
    Mark saw a way better dr. dan Adame, Dr. Temistocles Diaz from Panama. He comes twice a month to hospital cattan. Dr. Dias is a panamamian who got his degree in USA and worked at MT SINAI I think in california. Has way more experience than adame and is also a surgeon. There are many in Panama city. Mark was very pleased and relieved. Mark said the best by far. He took time to listen, did the test, explained very well and told mark he only needed to take his medicines and follow ups. Not necessary to waist money to see a surgeon if he followed instructions and followed up not even every month.

  9. Forgot to mention in my uncles case, the doctor signed the death certificate and no autopsy was made. Once the patient is taken to the hospital thinngs can turn very different and stressful. I am talking about terminal elders and care being provided by a certified doctor at home. dont miss interpret, please. Verything has to be done legally

  10. Don, I agree. I do not think in any wise that you were premature to write on this topic when a doctor, and the only one of this specialty and standing evidently, calls you personally to give you a “heads-up” for whatever reason or motivation.

    I also think that the U.S. Embassy was very proactive at your request, and tried several times to contact the legal staff at Hospital Chiriqui, which they finally succeeded through their persistence. Apparently, the Embassy thought your concern was valid and timely, and they left few stones uncovered to find out what was going on. In doing so, the information provided you by the doctor was denied and the status-quo confirmed, …for the time being…

    However, the concern that is left is where did this doctor get his information, and is there an underlying dialogue going on in decision making circles, that precipitated this doctor to call?

    Other than that, I think that any hoopla, opinion, or added personal agenda emphasis by others are redundant and self-serving if they function to be critical of your service to the community.

    The fact is, and perhaps the real basis of this discussion, is that since I have been in Panama, healthcare costs have risen a good bit. Much faster, indeed, than the income growth of those who solicit such services. What used to be somewhat “out-of-pocket” expenses, are now becoming exponential. North Americans are being quoted two to three times the cost of medical services on a private basis, of what is normally asked of the local population. This will not improve as local doctors, and perhaps medical corporate hierarchy, feel that their services need to be remunerated at a higher growth than previously and discreetly acceptable.
    Human nature, when it sees an advantage for added gain, particularly at the cost of other peoples, seldom retreats over any new altruism or moral ideals.

    What appears to be happening to healthcare in Panama, is the same dynamic that has been in real estate, where there are two, or more, price tiers. One for the Panamanians, another for Expatriates. The same has happened to food costs. North Americans pay a premium for the food brands that they trust.

    However, this variable in healthcare costs is particularly onerous as many of those that need such care, are in an aging category who, for the most part, have fixed incomes based on their retirement means. In addition, insurance premiums are based on rather fixed actuarial estimates, and if healthcare costs show little signs of slower growth, insurance firms are sure to catch up in increased preemptive cost retrievals, or what is known as “sticker-shock.” Folks on fixed incomes, who are retired or unable to work, can then be priced out of insurance, adding to and exacerbating the problem.

    This situation of current healthcare cost containment can figure to be detrimental to the plans of future North Americans thinking to relocate to Panama. These evolving circumstances can also change the mind of the Ex-pats currently here, to believe that going back to North America is more palatable than previously entertained.

  11. @Don Ray: Thank you for the heads up info you have been providing to the ex-Pat community far longer than any other ex-Pat’s in Panama. Your contributions and time and effort to assist ex-Pat’s are unrivaled.
    @Joe S: Very thoughtful and intelligent post, you have hit the nail on the head. I’ve been here sinced the 90’s and I’ve noticed the changes stated.
    @Ex-Pat’s who can’t or won’ pay their own way, I suggest booking the ferry (when operational) to Cuba. I hear that they have a very good, cheap, medical system and the cost of living is way low. Good luck with that..

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