Rude Awakening

I received the following email this morning. Maybe it is time to put out another advisory, that retirement in Panama is not for everyone.

Hi Don Ray,
I visited with Peter yesterday. He said he had found John on the floor at the Occidental apartment. Peter said it was a hard fall but nothing was broken. It looked like someone had taken a bat to John. Peter had him transported to Regional. When they checked in at ER no one asked who would be responsible for the bill.

Regional kept him for 4 nights. Peter purchased a wheelchair. He went out there to pick him up. They unhooked the tubes, put John in the chair and off they go. The hospital did not present Peter with a bill. or ask for payment.

Peter is trying to get John checked into El Hogar de los Ancianos. John is #4 on the waiting list. Peter said they were going to charge $700/month. Peter said there is a place in Dolega but that is too far for him to go.

Peter was very impressed that you had made the trip to the Occidental and that a lady from the embassy called.

I just thought I’d update you. Some Americans are in for a rude awakening when they learn they can’t find a care home.


Last month I visited another U.S. Citizen in Algorrobos that is also on the waiting list. He had recently had a stroke and his neighbor’s are taking care of him until a vacancy is open.

I had visited with the individual in Algarrobos and his neighbors for over 2 1/2 hours after the Embassy had contacted me. The large part of that time was explaining to the neighbors why the U.S. Embassy could not airlift the individual out of Panama and back to the U.S.

I had to explain that the Embassy doesn’t have a budget covering all citizens that decide to move to Panama. I told them that his social security payment was the benefit that the U.S. Provides and it is his responsibility how to best spend it.

They said, “but we are spending more per month on his care than he receives”. I responded that the Embassy has no authority over individual decisions.

These cases are sad to see and unfortunately they are growing. Too many people believe the misinformation published by International Living and other for profit sites that are selling real estate or preying on the naive. The sites talk about the availability of cheap healthcare and insurance. They talk about cheap living expenses. They amplify the positives and avoid talking about the negatives.

I talked to a Panamanian not long ago that was in need of a gallbladder operation. They had no insurance and went to the Regional Hospital. They were given an appointment several weeks in the future. The individual searched and finally found a doctor that would do it in Puerto Armuelles.

You may not be turned away from the emergency room, but when it is considered an elective surgery, you may not get scheduled prior to an emergency need.

If you don’t have good insurance and the ability to go to a private hospital, you may find yourself at death’s door. Even then, you may not be admitted. Recently I had a comment on a post that a person was taken to a private hospital with a heart problem and would only be admitted after putting $4,000 on their credit card. Without the $4,000 the person would have been sent to the Regional Hospital.

Even the latest case with Marion. She had directed those taking her to the hospital to go to Hospital Mae Lewis. The hospital wanted to send her to Regional Hospital because they had no blood. Luckily, the individual taking her had the right blood type and her surgeon said he would do the surgery in Mae Lewis.

Of all things that people need to consider when considering Panama as a retirement location, the first should be healthcare and health insurance. Don’t come here with a preexisting condition thinking things will be fine. Don’t assume Medicare will cover you in Panama – it won’t.

The Panama health system is being stretched to its limits. While construction is underway to increase capability to serve, where are the qualified doctors going to come from?

Extended care and elderly care is another discussion factor. As mentioned above, the one home, Hogar Santa Catalina, is full. There are two U.S. Citizens on the waiting list. The first opening may be in December.

If you do get in, you may find yourself in a solitary environment you won’t like. No English spoken by clients or staff. Visiting doctors will most likely not speak English. Cheap compared to nursing homes in the U.S. but at a cost of social loneliness.

I have written these types of cautions before. This is one of the reasons I say you should rent in Panama for a minimum of 6 to 10 months minimum before deciding to make a full move. Panama can be fine for some and a disaster for others.

29 thoughts on “Rude Awakening

  1. Smart words Don. We lived here for 9 months before buying our home. We are one of the lucky ones that everything fell into place. When I had the stroke, we had no insurance. It was $600 right up front in the ER. I had the ultimate care in Chiriqui Hospital with round the clock nurses. The total was $3200 for one week. Sounds cheap but you better have that money stashed and set aside before coming here. It’s so difficult to make people understand that this is NOT the US, Canada, England…..this is Panama where the laws change daily. We have been here over 8 years now and love being here. But, we have learned so much being here through mistakes, Panamanian friends, culture, etc. International Living has to STOP making things look like it’s paradise. It’s only paradise when you make it your own and abide by the way things are here.

  2. Excellent information, Don. International Living published yet another ”enticement” to move to Boquete, filled with sugar coating as well as outright lies about living here. Not to mention what WASN’T said… related to health care, water quality, and the tremendous increase in violent crime targeting expats.

    Undoubtedly, several people will pack up and move here, many without EVER having set foot here previously, expecting everything International Living promised and more. Some will come with sufficient resources to get back to Kansas when they realize that life here was misrepresented to them. Others will find themselves in serious financial trouble and unable to afford to return. It happens a LOT!

  3. It is truly imperative that people who are considering moving here and read the numerous internet sites about Boquete, or Chiriqui, or Panama’, MUST REALIZE that each particular site, or comment, is not necessarily factual. The majority of sites lean towards their own particular motive to entice people to move here.

    When someone makes a broad stroke comment, you must consider the source. It could be true, it could not be.

    Most times, when a site and its posters make only glorious, “positive” claims about how paradisaical it is here, they have a motive. They are going to be benefited financially by the numbers of people moving here. The expats who have something to gain will rarely tell it like it is. That defeats the purpose.

    Expats who try to earn their living here, many who are NOT legally qualified to engage in business, do so by selling real estate, services, advise, or renting their personal properties. Of course they want more people to live here. The greater the expat community, the better chance they have to gather more “customers”.

    I have always told people about what it’s like moving and existing here; the good, the bad, the ugly, and the truth. It takes a certain, free spirit type of person to truly enjoy living here. Panama’ is certainly not for everyone. All one needs to do is to research the rate of those who pack up and move back home… making an incredibly costly choice for a life experience…

  4. I think what has to happen is some sort of information session for those arriving here. Let me be clear though, it is not just U.S. citizens who need this info. One of my neighbours didn’t get medical insurance because they “wern’t ill”. They are headed back to their home country to get an operation and are likely to lose a lot of money on their investments here. This is a great place, but you need to spend money on things like insurance and personal protection. A Polyanna attitude of “it won’t happen to me” just does not work – especially as we all get older.

  5. Well. It is said that we’re all headed to paradise. It’s the journey there that gets a bit tricky, no?

  6. I have a preexisting, so no insurance…I paid some $3000.00 to deal with pneumonia…not fun, but it was effective.

  7. I think the healthcare situation in Panamá is oversold by those who profit from expat migration primarily by the touting the great care found in the capital without properly informing their readership of the severe drop-off in quality of care in the interior of the country. I don’t believe that is by accident, either.

  8. Hi all– I came to Panama sight unseen more than four years ago. I wasn’t looking for ‘Paradise’, just a place to live that wasn’t as bad as the US. I came with cancer and found a brilliant doctor who has been treating me. I had fallen before coming and was so incorrectly diagnosed by both ER doctors and Orthopods in Oregon, where I previously lived. This doctor had me ‘up and running’ in no time. He is a ‘full fledged’ MD and a holistic doctor, an Accupuncturist and a Chiropractor. I don’t know or know of a person who has lived with this type of blood cancer for the 6 1/2 years that I have, At one point, I was frightened into trying mainstream meds and wound up in the hospital for a week in serious condition. I was left with a heart problem, a hearing and vision loss. Never again! My personal physician in Oregon told me that if I had completed the protocol, I wouldn’t be alive today. Thankfully the Atrial Fibrilation reversed itself and my heart went back into sinus rhythm. In addition, since I applied for the Pensionado on arrival and now have the Cedula, I have been seen at the National hospital in Concepcion several times, once for pneumonia which cost $4.80 plus a prescription that I had to get outside the hospital. The most recent was to get a heart check. After checking in, I made an appointment in the morning and was seen in the afternoon. I waited about 20 minutes from the time the appointment was scheduled. It cost $.75 to see the doctor. He ordered an EKG, which cost $10.00. I need to have an ‘ECHO’ and some lab work, but I’ve been busy and haven’t scheduled them. All is not negative in the National Hospital.I have wonderful Panamanian neighbors and have never had a problem here. I have one young man who is my taxi driver, my neighbor and my best friend here. I would wish everyone who comes the blessings I have received since coming to Panama. I was an in-home caregiver in the US for over 15 years and with need immediate care after leaving the hospital, until they are able top the present info, I’m seriously thinking of opening an Emergency Care home for those who leave the hospital and are not able to go back to their homes.

  9. The last few sentences of my post was kind of garbled. I meant that– with the obvious need for those leaving the hospital and not well enough to go back to their homes, I am seriously considering an emergency home, until they can find permanent, if necessary accomodations

  10. Many expats who come to Panama fail to consider the effect they have on a very fragile system. Citizens of Panama are desperate to have a health care system that works. They pay seguro monthly to provide a modicum of care for their families. Outsiders thoughtlessly arrive without considering well-being of the existing populace, and then, when they have their inevitable health crisis, expect the struggling hospital system to care for them, without having contributed to support it. If you aren’t well insured, don’t come, or go home if you are already here.

  11. I’m good with everything Lynnie said…except for the last line.
    For one, it seems unnecessarily gruff and, therefore, not likely to persuade anyone. And, two, if someone comes down here and sets aside a reserve of money to strategically “self-insure” by paying out-of-pocket for their medical expenses, I don’t have problem with that. (See Bella’s earlier comment.)
    But like Lynnie, I don’t like when expats put a strain on the Panamanian systems anymore than U.S. citizens like it when immigrants put a strain on their country’s system.

  12. There’s also the opposite of saying only great things… Being honest about the bad things. But when anyone starts to get a little honest about living in Panama, other expats tend to get nasty and say things like “if you don’t like it, why are you here?”

    So if you’re a “complainer” for being honest about the downside or a charlatan for saying only good things, what is one to do?

    Just a thought. 😉

  13. Don Ray, you ask where are all the doctors going to come from. The answer should be Bogota, Colombia. Castro sent a lot of Cuban doctors to Venezuela when Chavez was president. Many of these doctors have become very unhappy with the situation in Venezuela. They are making their way to Colombia hoping it is their first step to go to the US. Panama could invite some of them here.

    Then again this might upset Castro because it shows a failure on his and Venezuela’s part. Some businessmen in the Colon Free Zone might not be paid for the debt owed by Cuba.

    Also, it might upset the present doctors here because the Cuban doctors could be viewed as competition.

  14. How are expats putting a strain on the national health care system? I’ve never been in a national hospital, but I’ll bet that I would have to spend a long time searching to find a gringo there.
    I know from CC that there are some indigent gringos who use the services, but is it really significant enough to come to a conclusion that medical care of Panamanians is adversely affected?

  15. I will have to disagree with your characterization of indigent gringos. Many of the Embassy cases I have dealt with in the Regional Hospital were admitted after paying upwards of $40,000 at the private hospitals and then running out of money.

    One was forced to leave by the hospital because they wanted his bed only to die 8 hours later in his apartment.

    He could have gone to a private hospital, but was taken to the Regional Hospital because he was struck by a car and that is where most accident cases go.

    However, you are correct in that there are many people coming to Panama without healthcare insurance and when they need help they will not be admitted to any hospital except the Regional hospital. That number is growing.

    It may not be a high percentage, but it has been high enough that at least one doctor in Polyclinic continually badmouths all gringos and wonders why Panama is allowing them to enter.

    The fact is that the Panama system is already under strain. Any addition patients adversely affects it, since it is intended to take care of Panamanians.

    I will also say that if you have not had to visit patients in the Emergency room of the Regional Hospital, you are lacking some perspective. I have been there visiting patients too many times.

  16. No matter what, from experience I know panama is cheaper than the USA. where in the USA you pay what you pay here for health services. nowhere in the USa. Also, being an american one should know that we have to have some money to provide for that kind of expenses. When we lived in the US, we spent most of our income in health insurance and insurance for everything and I remember my first experience the first week living in USa, I had a discomfort and called on the phone to a large number of doctors and every single one said if you dont have insurance we cant see you. I said I have cash and they said NO. YOU NEED TO HAVE INSURANCE. Also, the gynecologist fee was $300. Here a gynecologist cost less than $50. So, I didn´t get to be seen by a dr I had to call mine here and told me what to do and what to buy. fortunately, it was over the counter prescription.

    Regarding appointments with doctors, eventhough you have to wait, it is not as long as in the USA., at least in california. Dont forget that you are using the public health system which is already crowded serving panamanians and their families and they pay into it every month.

    I remember we had blue cross blue shield and mark need to see a specialist. They gave him an appointment in 2 two months and we were paying private cadillac insurance.

    also remember i had an appointment with a specialist and was seen by a gastro nurse. so you pay for a real doctor and you get a nurse instead.

    So please, there is no awakening here. I wonder if you lived in costa rica, honduras, el salvador, argentina, or anywhere else if you would get health care for free.

    I find it very disturbing to read about this type of comments, but yes, Panama is not for everybody. No country is for everybody.

    Mark stopped being worried about health care here. I told him the other day were close to getting our social security retirement and medicare and he should not worry because he could travel to the usa for care and he laughed and said; ja jaja, you think medicare will pay for health care needs? dont be naive, what they cover is minimum, you get more here in Panama. for example, I retired here in Panama and my retirement covers everything in the seguro social. when I was younger my seguro covered my kids and my non working parents also for the same price. Woud you get that in the USA?

  17. Noris. You are a Panamanian and all the benefits you have do not apply to non Panamanians. Outsiders coming here without insurance will not have the same experiences you have. Yes, individual costs, such as doctor’s appointments, are cheaper.

    I scheduled a doctors appointment today and had a hard time getting it for me because the doctor did not speak English and really didn’t want gringo patients. Luckily, my Spanish is good enough. Many moving to Boquete don’t speak Spanish and don’t want to learn.

    I probably have more experience with the problems gringos have faced with the healthcare system in Panama than you have because of the Embassy cases I have had to deal with.

    The majority of problems are not going to come from general doctor visit needs, It is going to come from detached retina problems like my friend Henry had. He lost his eye because of improper care in Panama. He returned to the US for his second eye’s needs because he couldn’t take a chance on losing the last eye.

    I maintain, that Panama does not need more foreigners coming that are not covered by insurance.

    Cut finger, broken arm, etc. no problem.

    If the cost for medical is more than you have, it will be a problem and many are moving here with just enough money to pay rent, utilities, and food. These are the ones that need to wake up.

  18. what I thank you for Don is for discouraging more people from coming here. That i do appreciate. Please dont come here. stay where you are and get the perfect health care with your little money. And dont talk about water, because when i lived in CA i had to buy water too, Ive been drinking water from the faucet here in Algarrobos and havent had any problems not even parasites. I had my labs done last week. everything normal.

    Encourage people to go to Costa Rica, Honduras, Belize, South America, Brazil, wherever but here and bon voyage.

  19. Noris. I do not discourage people from coming here. Do not try to put words into my mouth. What I tell people to do is understand the country, understand the culture, understand the rainy and dry seasons and not come with the rose colored glasses that International Living wants people to have.

    Panama is fine for those that have expiation in line with reality. Furthermore, I would never recommend people to go to Costa Rica, Honduras, or Belize. I would not recommend them to go any place that is culturally different than their home land without testing the waters first.

    By the way, people in Boquete are complaining about the purity of water in their area. Water all over Panama is not the same as the water you are experiencing.

  20. Noris what exactly is your agenda to be so facetious to Don Ray? Do you personally benefit financially with gringos moving to Panama’? Sell real estate, perhaps?

  21. Just another thought, Noris, you speak English rather well, I have a feeling that you want more gringos moving here so you can charge them service fees to translate for them. Am I close?

  22. On the subject of the purity of water, raised by Noris, I am attaching a notice from one of the residents in Boquete.

    Dear Boquete friends,

    I am also concerned with the contaminated water situation.

    My background is in microbiology and immunology. I worked in the area of researching infectious diseases as well as managing the laboratories that I worked in for over 15 years. I also taught microbiology at the universities where I worked. I have hands on experience using and selling Reverse Osmosis systems for water purification and using Ultra-violet systems for disinfection.

    Unfortunately with the coliform load currently in the water, a reverse osmosis system will be overwhelmed and may allow microbes through or fragments of the microbes, which can also make an individual sick.
    Ultra-violet systems offer no protection against parasites, especially their eggs. With the current coliform load in the water, again, UV systems may be overwhelmed.

    We know that the local government is not known for moving quickly to solve problems. And I think this situation with the water will be another example of this.

    So in the interim, the best protection for an individual is to take your filtered or UV irradiated water and add an extra step:

    Boil your water on the stove in a pot (with the lid on) for a minimum of 20 minutes. The 20 minute countdown starts when the water starts to boil.

    For 1 gallon (or about 4 liters) of water – minimum boiling time is 20 minutes.

    If your pot is holds more than 1 gallon (or 4 liters) of water, for every extra 1 liter of water, add another 10 minutes to the boiling time.

    Allow this water to cool and use this water for drinking, food preparation, cleaning your teeth – basically use this boiled water for anything that goes into your mouth. I would even go to the extent of using this water to wash your hands.

    The amount time for boiling is extremely important. The boiling step will kill parasites and their eggs and it will also destroy the proteins in the microbe fragments that make you sick.


    If you are already having stomach upsets (but do not have diarrhea), you may want to consider doing something about this……

    – see your doctor and have him prescribe something for you – make sure you explain to the doctor where you live and that there is a contamination problem; or

    – I personally use colloidal silver as an alternative to an anti-biotic, anti-viral or anti-fungal pharmaceutical. If this indicates to you, take the colloidal silver on an empty stomach – do not have it with food as stomach acid changes the structure of the silver and makes it less effective.


    I hope this information is helpful.

    Carmel George

  23. Youvall are wrong abiut me. I font benefit from any gringo. Not even my gringo husband. And by the way i am an american citizen too. I have severalbincone sources from panama not from gringos. Thank god i am self sufficient. Have my own businesses. Have my panamanian rrtirenent income also. In the future if gid oermits will then receive usa retirement benefit.

    Most important i as well as you all have the right to express ny opinion. You prive me rigjt when you cant stand a different opinion. More and more it looks that this only for a group that agrees with everyting. I don have anything agsinst fon ray oerdonally or any agenda. I do not know him personally and nevet attacked him pesonally. But writing to only hear praise andcagreement i consider it not right. Also a bunch of you have been disresoectful to me by inventing all this about me because i disagree with dons comment. And yes many comments are like the ugly gringos commebts you also mention sometimes. Remember i speak as both oanamanian and american. Lived in both countries and know better. Worked in both countries and Many things commented here are not 100 oercent correct. Are perception of a person. I currently have income from many sources in panama not gringos. So respond to my comments and not my person. Demonstrate that you all can debate with the right tools and weapons which are knowkedge, education and good manners. Demonstrate you are wekl educated people. And i still belive many of you are complainers who live in a bubble.

  24. Mark is gringo with no insurance. Was taken to urgent care. Had ekg plus non routine exams. Paid 49 total. As i said many times most of you dont understand the system and dont bother to try.

    Where in the us you pay 49 dollars fir urgent care labs and medication? See ny point? If mark had complained for paying i would have hit him in the head and have him back in the urgent care room.

  25. Noris, as I have said many times, you can get the simple tests and doctor’s visits with little problem and little cost.

    The problem will come when the tests indicate that a stint is required or some other serious situation resulting in surgery.

    At that point, the hospital will be looking for real money. At that time, you better have the money or the insurance.

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