Tag Archives: Healthcare

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. Continue reading Rude Awakening

Another HealthCare Observation

I have another healthcare case, which is providing more experience, that I feel I should share.

This individual came to Panama with no insurance, only social security income, and has developed significant healthcare issues. He was taken to one of the public healthcare facilities and was seen by the resident doctor.

The doctor was very vocal in stating that he did not understand why elder American citizens, with medical problems, are allowed in Panama and why the U.S. Embassy does not provide assistance to them. He ended the conversation saying that he would limit his service, for this patient, to just writing a report on his condition and no more.

He explained that there are no beds in the public hospitals and that a Panamanian needs to wait almost seven days for a bed.

I know this doctor, as he is the doctor that Hogar Santa Catalina took Robert (the stroke victim) for a checkup. In that meeting, he accused all U.S. Citizens of being insolvent and if he needed treatment that he would have to be taken to his private practice in Hospital Chiriqui where he would bet paid his specialist fee.

Needless to say, this doctor was removed from my list of doctors receiving a recommendation by me. His attitude is a discredit to the medical profession and he is a poor representation of Panamanian physicians. He was extremely rude to me when I was was with Robert in his office.

That being said, it should be noted that his sentiments are shared by others. Luckily, they are the minority. I will admit, that while this doctor’s deportment is deplorable, he has some valid points behind his statements.

If this individual goes to the Regional Hospital and has the proscribed CAT scans, x-rays and other tests, he may not have the ability to pay. If that happens, it will put more more burden on the already overburdened Panama system.

Most private hospitals will not admit patients without proof of payment. The public hospitals are crowed and understaffed. Walk-ins to the public hospital will most likely be placed on the same 7 day waiting list mentioned by the doctor.

I had another case where the Regional Hospital asked a U.S. citizen to leave because they said he was in good enough condition and they hospital needed the bed. I received a call from his landlady about 6 hours after his release telling me that he was not doing well. He died about 2 hours after the 911 services arrived. It was obvious that it was an error by the hospital to release the patient.

Bottom line is that if you are moving to Panama, with a problematic medical history or the probability that medical care will be needed, be prepared to pay. I took a physical prior to moving to Panama and found that I needed surgery and didn’t know it. The rumors of cheap health care in Panama is always relative.

I can visit a clinic for a cold or infection or minor office visit. The cost will be $6 for the visit and I have always been treated with respect. However, if I need to see a specialist, the office visit will be from $35 to $80 or so after the jubilado discount. In all of my specialist doctor visits, I have always been treated with resect.

I always advise any person making an exploratory trip, for viewing Panama as a retirement location, to visit the hospitals. You should also visit the Regional Hospital (public) even though you think you would only use a private hospital, because the public hospital is most likely where you will be taken, if you are in a serious accident.

If you do move here, you should immediately determine what doctors you want to use as your primary care physicians. Finding one in an emergency may put you with one doesn’t like foreigners.

Worthwhile Read

Another prominent blogger, in Chiriquí, is Richard Dietrich, His current blog is probably a worthwhile read. I usually don’t direct people to his blog because I view it an a “for Profit” blog as evidenced by the $1,144,000 property he is selling, other ads and promotion of his books.

The fact that he spends more time on cruise ships lecturing than living in Panama makes his Panama experiences different than the majority of people moving from the U.S., thinking they are moving here for a slower paced and cheaper way of life.

Depending on one’s age, it may be neither of those.

In his current post, he touches on items such as the “Pensionado Discounts”, “Gringo Bingo”, “Healthcare” and a new chapter to his latest book called “Exit Strategy”.

It is the Exit Strategy, I would like to spend a little more time on. No book, magazine article, or blog should be sufficient for making the decision of a permanent move to Panama, or any other foreign country for that matter.

At best, they may provide a reason for a closer look. The closer look needs to be intensive. You have to live like a resident for a minimum of 6-10 months in both the rainy and dry seasons. The longer the better.

You need to experience waiting in lines to pay bills, waiting in lines to get over charges removed from bills, language and cultural differences, water outages from hours to weeks, electricity outages from hours to days, continuous electricity fluctuation (which may damage connected devices), non English TV, gringo pricing, Internet outages (assuming you can get Internet), healthcare, healthcare insurance, and on and on.

With those 6-10 months, you may not need an exit strategy. You will either realize that Panama is a mistake for you or you will know a few of the things you have to cope with. I have lived here going on 13 years and continue to have new experiences.

And yes, I do believe you shouldn’t move here without an Exit Strategy. I know people who are here, who want to move back and can’t do it.

It may be because they put all their life savings into moving and can’t pull together enough money to make the move back. It may be because they came here and a health problem hit and they had no option to return because their health wouldn’t permit it. Many have had health bills in Panama that totally depleted all their savings. Of course, that happens in the U.S. too, except no one ever told you that the U.S. had cheap healthcare.

As a disclaimer, when I moved here, my long term plan was to live here for a maximum of 20 years, sell my property for a $1,000,000 and return to the U.S. I moved with an exit strategy in mind. In that regard, I was no different than my fellow blogger Richard.

However, an error in judgement in a second marriage removed that as a possibility. No I didn’t marry after moving to Panama, but was married in the U.S. exactly 10 years prior to my move to Chiriquí. The good news is that I would never have met Lilliam and her family if I hadn’t moved to Panama.

This reminds me, don’t move here, because you think the move will be good for your marriage. If your marriage is on shaky ground before the move, this move will end the marriage.

Bottom line, buy all the books you can and take advantage of all the media on the Internet to better understand living in Panama. The cost and time will be insignificant compared to a permanent move.

Just remember this old saying my dad used to tell me “ I know you think you understand what you thought I said, but I am not sure you realize that what you heard is not what I meant.”

No article, book or blog will compare with your individual Panama experience. HERE is Richard’s book, if you want to assist him with part of his exit strategy.

TriCare Meeting at Hotel Ciudad de David

I stopped in to the meeting today. It was a packed room. I expect there were close to 90 people there including the TriCare representatives.

Since most of the attendees at the meeting are retired and some over 65, two websites of interest are TriCare Standard and TriCare For Life.

I was happy to see that the meeting began with a statement of appreciation for those that had given service to their country.

Another early point that was covered is worth repeating. The speaker said he had talked to several people in the room that were new to Panama and not familiar with healthcare availability here.

He mentioned that many things that might be provided in the U.S. might not be available here and that if one had preexisting conditions, it was important to understand Panama’s capability prior to coming here.

For example some drugs in the U.S. may not be available here.

Medical coverage in Panama is different than CONUS. All medical care must be paid up front.

He advised that it was the individuals responsibility to manage his own health program, such as making treatment appointments.

He mentioned that to have coverage over 65, you had to be registered for Medicare part B and that you had to keep DEERS updated.

I thought the meeting was well managed and felt that everyone had an opportunity to get their questions answered.

I will most likely try to make the first part of tomorrow’s Embassy Outreach meeting.

Dr. Bullen’s Next Office Date – June 13

I received an email from Dr. Bullen asking me to let those in Chiriquí know that he will be in his David Office on June 13.

When Lilliam’s search for a skin cancer specialist resulted in finding Dr. Bullen in Panama City, she would tell him of the real need in David for a doctor with his capability. She was going to him every six months and on each follow up, she ask when he would open a David office.

You can than Lilliam for him being here.

The original post and the previous post have more information of his dermatology practice. I saw what the treatment by a doctor without Dr. Bullen’s experience can do and I have seen how he has taken care of Lilliam.

That is why I don’t mind helping him become known in Chiriquí.

Another Great Day

This morning we went to take supplies to Robert in Hogar Santa Catalina. He was in great spirits and the happiest I have seen him. He had had phone calls from both of his sisters. One had called him on Memorial Day to thank him for his service to his country.

I wrote his sister after we left to let her know how happy he was to hear from his second sister. His first sister calls him pretty frequently. I stay in contact with her and send her photos such as the ones I took on his birthday.

I think Lilliam gets as much enjoyment as Robert on our visits. She talks to many of the residents and asks how they are and tries to make them know that they are not alone. Lilliam is a rare person.

One of the ladies there has early Alzheimer’s disease and usually tells Lilliam that her home isn’t far off and someone is on their way to take her home. They aren’t and it is always a similar story. Still she is always happy to see Lilliam.

This morning we had stopped by McDonalds and picked up Robert a pancake and sausage breakfast. He said he would save it for tomorrow.

Seeing Robert in such a good mood really brightened my day.

S.O.L. In Paradise – Beating A Dead Horse

As I mentioned in the previous S.O.L. post, it will be worth following the thread in Boquete Ning.

Today, Bonnie Williams wrote a comment that I don’t want to get lost in the midst all the other comments on the ongoing thread. While she limited it to ExPats in Boquete, I would expand it to all of Chiriquí.

Here is her comment.

I think we’ve beaten this subject to death. To summarize, I see expats in Boquete having essentially four options for healthcare:

1) Have no insurance in Panama. Go to Hospital Regional for medical emergencies, but be aware that it may be difficult to receive timely attention. And you will be billed upon departure. Non-emergency surgery will be delayed, perhaps forever. Plan to return to the U.S. for any needed medical non-emergency services.

2) Enroll in the Hospital Chiriqui co-pay plan. This will pay for many routine, preventive procedures, but it will pay only part of the cost of hospitalization and/or surgery, and there is a relatively low cap on how much it will pay annually. It pays for no bodily appliances such as stents and pacemakers. This can result in the patient owing a significant amount of money.

3) Buy comprehensive national or international insurance. It is expensive. But it has a high payout limit and, after the chosen deductible, pays most or all medical expenses. There generally is no required deductible for emergency or pre-approved hospitalization or procedures.

4) Self insure and hope that you have enough put aside to cover a catastrophic medical event such as heart surgery, serious automobile accident, etc.
As routine medical care in Panama is relatively inexpensive, most expats can meet those expenses without incurring significant financial difficulty. When considering health insurance needs, it is my opinion that particular attention should be given to catastrophic medical events which, without good insurance, could subject one to no care, poor care, and/or financial ruin.

Dr. Bullen’s Office is Open

Like the butcher that backed into his blade, I have been getting a little behind in my work.

As I said I would in my previous post, I went by Dr. Bullen’s office on May 16 and took photos. Unfortunately I took them with my real camera and not my iPhone and forgot about the project and didn’t post them.

His office is easy to locate in Hospital Chiriquí. Take the hallway directly across from the Pharmacy and the first office on the right is his Office. The sign on the office follows:

Click to enlarge

I talked to Dr. Bullen and asked if he could do everything as if he were in Panama City. He said he will be able to after he gets the pathology lab trained. He said some of the lab work is done differently than they are trained to do it, but that will change.

He said his charges are the same in Panama City as in David. $75 for the consultation. That is $60 for jubilados.

Dr. Bullen has two areas to serve patients. I am including two photos.

Click to enlarge
Click to enlarge









I picked up a card in his office that takes about services he provides.

bullen x


I wish he had been in David when Lilliam first had her problem diagnosed. However, He was a god send when she was advised to see him in Panama City. See Previous post for office hours.