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Affordable health care has always been an attractive feature of Costa Rica. Today an article was published in Tico Times, which sounds kind of worrisome:
Does anybody have any details about what is going on?
What “details” exactly are you searching for that are not featured in the fairly informative article you are linking to ….?
The article is quite descriptive about what’s going on, no?
Scott
[quote=”sapronov”] Does anybody have any details about what is going on?[/quote]
I think the details, quite frankly, deal with inflation if you have not felt it.Yes, medical care in Costa Rica has been affordable. Vastly more affordable than care in the U.S. particularly if you had Medicare.
The prescription “doughnut hole” in Medicare would cost my wife and I many times what we are paying for medical care in Caja. Under Medicare part D we would be paying ten times annually what Caja costs us for two years of care.
Each of us has been hospitalized three time for a total of 37 days. I’d call that very affordable.
I would not be surprised to see an increase in our monthy payment to Caja but our experience has been that the medical care is equal to any you can find elsewhere. The private system is still covered out of pocket or by health insurance providers who gouge their customers with outrageous costs and limitations.
Scott, you are right – the article is pretty descriptive and gives quite a few details. I should have formulated my question differently, asking for opinions of those, who are more familiar with the situation in Costa Rica. This question would be: is there any chance that the way Caja works, will change more or less significantly? The only thing I can think of is that monthly payments could be increased, as waggoner41 (thank you for the input) pointed out. Are there any other options on the table? Thank you in advance.
The CAJA is part of the governmental/social infrastructure in Costa Rica much like the schools, the police, and other public services. With a network of established local clinics, laboratories and hospitals, I would be very surprised to hear any talk of ” . . . chang[ing] the way Caja(sic) works . . .”. Surely the government is not going to convert it to a fee-for-service system or the like. What it is is what it’s likely to remain.
Understand, too, that, limitations and all, it’s very popular with most of the citizenry.
What I think is likely to change is the cost of enrollment. As costs rise, and as demands for a broader range of services escalate, there has to be found a way to finance the system. Either the government can devote more general revenue money to it or they can raise taxes on enrollees and their employers. My guess is that it will be a blend of the two.
Now, you asked about options. Well, there’s private insurance from INS (with its many limitations) and soon from other insurance companies, and there’s always the option to obtain care in the private sector and pay cash. And there are some international insurance companies that will cover care rendered here on a reimbursement basis.
[quote=”DavidCMurray”]What I think is likely to change is the cost of enrollment. As costs rise, and as demands for a broader range of services escalate, there has to be found a way to finance the system. Either the government can devote more general revenue money to it or they can raise taxes on enrollees and their employers. My guess is that it will be a blend of the two.quote]
I rather doubt that the government has the funds to spare from the general fund so expect to see costs rise for all. For us expats though, it is unlikely that costs will rise so high that Medicare would look like a viable option. My wife and I could tolerate as much as a 50% increase and pay it willingly.
ARCR members are paying even less than we are and the majority of them are much better off financially. Remember that all of us, as expat residents, are required to pay into the Caja system whether we use it or not.
Hearing complaints that Caja killed a family member or a friend are, so far, nothing more than opinion. I have yet to hear that anyone has grounds for their beliefs. I question whether they would have the same views if it happened in the States under Medicare.
Our preventive care is as good as it is in the States with regular visits every three months. Emergency care is immediate but non-emergency hospitalization waits until there is an bed available. Last month I scheduled surgery for a hernia and the appointment is set for late November.
Our care for breast cancer, heart attacks and a blown appendix was immediate and thorough.
Hospital stays, except for the heart unit are in dormitories and we both enjoyed the companionship of the other patients. If you find it necessary to have a private room then the private medical system is available at their exhorbitant costs.
I want to thank everybody for sharing your thought on the topic. When I saw the article, its title sounded pretty alarming. My wife and I are getting ready to move to CR, so we are trying to follow major news about important issues. It’s always good to hear other people’s opinion.
as costa rica is plagued by lifestyle illnesses that could be prevented, the CAJA system will continue to be burdened to the breaking point. there is a lot of disinformation about health issues here — the propaganda is that it’s better to eat margarine than butter and the diabetes risk from a sugar-laden/simple carb diet has yet to be addressed. obesity is epidemic here, just as in the US, but little is being done to educate the population about the dangers of being overweight. the prolific use of omega-6 oils contributes to inflammatory diseases — heart disease, cancer, stroke, etc. the sad part is that the ticos have all the tools to be healthy — the abundance of cheap fruits and vegetables, yet they clamor to imitate the american diet — and we see how well THAT worked for everyone!!! and then you have the influx of gringos who are still clinging to their bad eating habits and relying on the caja to give them drugs, etc. to counteract the damage all those imported packaged foods and bad lifestyle choices are causing.
You should be alarmed!
In regarding [b]waggoners[/b] post [i]”Hearing complaints that Caja killed a family member or a friend are, so far, nothing more than opinion. I have yet to hear that anyone has grounds for their beliefs. I question whether they would have the same views if it happened in the States under Medicare”.[/i]
I [i]really[/i] disagree with that statement.
Many of us have heard from friends or relatives that patients are often at the mercy of a relation staying with them 24/7, to provide the help needed. In fact, I think [b]waggoner[/b] himself, expressed this elsewhere on the forum. In the USA is one required to bring their own pillow, towels, soap and toilet paper?
An elderly ex-pat died earlier this year, when as his wife put it [i]’he was put in a storage room because he was upsetting other patients’ due to a reaction of being given the wrong medication[/i]. He was then ‘forgotten’ and was severely dehydrated and then died. This was confirmed by an autopsy and charges were recommended.
CAJA for emergency care is good and if you are lucky to live in an area where the doctors/ebais are good, you are indeed ‘blessed’ but this does not seem to be ‘the norm’.when you consider that nearly 250,000 people die each year in the US from medical mistakes in the hospitals, bad drug reactions, drug interactions, surgical mistakes, neglect, and incompetence, misdiagnosis, etc. it puts a whole other spin on it.
[quote=”costaricafinca”]In fact, I think [b]waggoner[/b] himself, expressed this elsewhere on the forum. In the USA is one required to bring their own pillow, towels, soap and toilet paper?.[/quote]
The things you bring to the hospital to provide for your own comfort are part of the ways that Caja has cut costs in order to make it a viable and affordable health care system. I have yet to find the need to supply my own toilet paper or pillow. My biggest issue was with the bland hospital meals and my wife supplemented that with the necessary spices. Being woken hourly at night by the lights for medications to be dispensed wasn’t a great issue as it was done quietly. I slept during the day without problems.If you feel it is outrageous to supply these things I would suggest the private health care system. They will provide you with all of the comforts of home and a private room at a cost.
Tell me one way that Caja has cut costs that affect medical care So far I have seen none and the fact that the patients assist one another in their trips to the bathroom is one of a willingness to help others in the same plight as thay are themselves not out of necessity.
[quote=”costaricafinca”]An elderly ex-pat died earlier this year, when as his wife put it [i]’he was put in a storage room because he was upsetting other patients’ due to a reaction of being given the wrong medication[/i]. He was then ‘forgotten’ and was severely dehydrated and then died. This was confirmed by an autopsy and charges were recommended..[/quote]
The same type of occurrences have happened in the States and appropriate action should be taken against those who were responsible as they would be in the States.
There was one individual who was very fearful of being out of his home and in the hospital environment and was quite noisy about it. Rather than complain about him the others in the dormitory talked to him and comforted him. There was never a thought of shutting him away somewhere. I appreciated the compassion that the patients showed toward one another.[quote=”costaricafinca”]CAJA for emergency care is good and if you are lucky to live in an area where the doctors/ebais are good, you are indeed ‘blessed’ but this does not seem to be ‘the norm’.[/quote]
‘The norm’ as I see it is what I have seen and experienced during my stays in the hospitals here. My local clinic is in Cuidad Colon and I receive the same care here as I received in the States. The idea of early release for patients is something that I appreciate. Having been hospitalized under an insurace program in the States with Kaiser-Permanents I felt that I was kept in the hospital twice as long as necessary.
No matter where you are you hear about individuals who do not perform their jobs as they should even in the States. Although medical care is more crucial than other industries it applies to every walk of life.
Let’s hear about your personal experiences utilizing the Caja. Picking apart the Caja system utilizing one instance is, I believe, unfair and I would be interested in seeing a citation for this situation on the internet. If you check out medical complaints in the U.S. you will find there is no lack of information.
One mans opinion.
I appreciate Wes’ input and joy de vive here in Costa Rica. Really do. Anyone that moves here and takes in kids and looks at the bright side is good people in my book. I, from many years of experience here have seen some terrible messes and injustices that of course may happen in the US but based on the number of people, per capita speaking, I don’t see CR easily surpassing the US in incompetence on almost every level. Now I am not trying to compare CR to the US. However when people do they need to remember that CR has a minute population. The instances of professional mal practice here is very high speaking per capita. I have never been injured in many years going to doctors in the states and cleanliness levels were always very high. I went to what some say is the best private hospital in Costa Rica for an emergency operation and I was injured by the anesthesiologist.
I tried the caja because fairly recently I had to start paying for it. Well I went for an appointment and had to wait in a line at 5 am. So if you are a US citizen, it seems very wierd to wait in a line to get your appointment (outside mind you) and then return for the appointment. Be that as it may, I was not impressed with the general practitioner I saw. I made an appointment for a blood test. I received the results which were way high across the board. The GP was quick to start admonishing me about my diet and prescribing me medications. I said to her that in the US when test come back so abnormal they are usually ran again. So she acquiesced to my idea and guess what – all is normal. Now, is this a big deal. Well, kind of. I think the biggest revelation is the cultural norm here for going the route of least resistance rather than being thorough. I see this in the legal and medical and semi professional services here plus in construction. Excellence does not have the same importance as it does in the US. Thoroughness seems unheard of.
Just get it done (which it really isn’t, but because you stopped you can call done even when its not done right) and then “next” is the attitude here. And that may be for a number of different reasons. Regardless I want excellence when it comes to my health. I understand that many who come here cannot afford high end medical insurance. So, I kind of feel bad that they cannot, but many people that come here can. So they should not in my opinion use the caja because the next story sums up my experience with the Caja emergency care.
Took a sip of juice and felt a scratch in my throat. Looked at the glass and the rim was chipped, The chunk was swallowed. How many times have I told the crap for brains maid to do it my way, but no it’s the hurry up and get it done incorrectly way she is used to. She was fired because I have told her many times not to put glasses rim down on the tile. So now the know it all gringo has to suffer because “we know best” now jobless Tica is stubborn.
Emergency time. Go to clinic. Wait. Sent to new Heredia hospital. Beautiful building, new facility, walk in and there was disorganization as if they were being inundated from a disaster.
People walking around not knowing where to go, other people sitting behind desks smug and bored. No empathy for patients. You don’t know what is going on?, ah, so what just get out of my line and go over there and someone will figure it out eventually. I wanted to start helping people myself. I was appalled. If it was my business I would have fired everyone on the spot. Compassionless. I finally figured out where I was to be. Then the doctors walked out. Yes, they all left at the same time. Jovial, as if there was no suffering or urgency around them. They were in another world. They did not look tired or over worked or frazelled as an American doctor would have considering the circumstances and patient load. Amazing. It was as if they were working at McDonalds and their doctoring was as significant as filling a burger order. I walked into the new state of the art bathrooms and the trash cans that Ticos use for their toilet paper had not been emptied and there was another trash can full worth of used toilet paper piled next to and around the trash can and many cotton balls with blood on them and a stink to boot.
After more than two hours there, I informed that there was no eye ear and nose doctor there (it took two hours to figure out who is the staff?) and I was taken by ambulance to Hospital Mexico. Mind you this whole odyssey started at 6 pm and now its 10 pm. A nurse road with me. Now with all that was going on why the hell would anyone leave to accompany me to the hospital, she was needed there desperately. The driver invited her and she went, and they happily conversed the entire way. I got to Hospital Mexico to find a broken down dirty facility with a child doctor making jokes and having a great time while people were hurting all around me. 11 pm passed. Nothing. 12pm passed. Nothing.
I went to the little prima donna in training and said I was leaving (I had had it and was on my way to private care totally exhausted). He said wait you have to sign a paper saying that I was refusing the non-existent care. So be it, I guess that rattled some feathers as I was told the eye ear and nose doctor would see me now, its 12:30 am. She sprayed some numbing stuff down my throat and put her finger there and felt a piece of glass lodged in my lower tongue / throat area. She got a long pair of prongs to grab it. She could not. Again, she put her finger down my throat to feel it and dislodged it and down it went. I don’t know if she was trying to get rid of me or what. I was disgusted. They drove me back. I insisted on taking a taxi back as they had to call the driver so I had to wait. They said they would get in trouble if they returned without me, so I waited, The nurse who accompanied us sat on her but the whole time. It was the merry crew all the way back to Heredia Hospital where I got in my car and drove home. Almost 2 am.
That was my experience with emergency Caja care. Yes I am still alive but I was thoroughly convinced that nobody was taking any of this seriously except the patients.
Maybe your experience differs, but that was mine. Any how who I will never use the caja for anything unless I have no other choice. And by the way, there were no other foreigners there and all the Ticos were looking at me like “what the hell are you doing here?” Not the worst night of my life but in the top 50.
i waited 9 hours in a NYC hospital ER for treatment of blood poisoning, while all the gunshot and stabbing victims got priority. the worst part was having to sit next to the woman who fell through a glass sliding door and was bleeding all over the place. your story could’ve happened anywhere — and does.
First let me say that 2BNCR and I were acquainted before I moved to Costa Rica and it was he who gave me guidance in resolving a legal issue that saved me more cash than most of us bring to Costa Rica. 😀
[quote=”2bncr”]I appreciate Wes’ input and joy de vive here in Costa Rica. Really do. Anyone that moves here and takes in kids and looks at the bright side is good people in my book.[/quote]
Good people or no, the family that lives with us is a business proposition.
At the age of 70, I am facing what I never wanted to see in failing strength. It is not my health that is an issue but the ravages of living life at headlong effort in the U.S. have taken their toll.
The first year here cost me 25% of my bodyweight (from 185 pounds to 132) from the stress of trying to deal with a culture that is the opposite of what we Americans deal with all our lives.
I believe it was here on welovecostarica [b](Scott help me here)[/b] that I read an article that explained the differences between a results oriented culture (the U.S.) and a process oriented culture (Costa Rica). From then on I realized that the problem was not Costa Rica, it was me.
[b]The deal with the family[/b] is that we will provide for all the costs of education for their seven kids and in return they provide us with:
1 ~ A Tico face in Costa Rica preventing others from gouging us with the exorbitant prices most expats pay for everything from labor to unpriced goods and services.
2 ~ The muscle need to deal with the heavy work that needs to be done around the property that I can no longer do.
3 ~ Their (the parents) intimate knowledge of where the best prices are for what we need. Marcos also has a passing knowledge of the entire country.
So it is not a one way deal by a “nice guy” like me.[quote=”2bncr”]I don’t see CR easily surpassing the US in incompetence on almost every level. The instances of professional mal practice here is very high speaking per capita. I went to what some say is the best private hospital in Costa Rica for an emergency operation and I was injured by the anesthesiologist.[/quote]
I’m sure 2BNCR intended to say competence rather than incompetence and will respond accordingly with this:
My experience with incompetence had to do with the legal profession rather than medical as I opened with. By the time I was able to get into the Caja system I had come to understand the differences in culture and was better able to deal with it.[quote=”2bncr”]I tried the caja because fairly recently I had to start paying for it. Well I went for an appointment and had to wait in a line at 5 am. So if you are a US citizen, it seems very wierd to wait in a line to get your appointment (outside mind you) and then return for the appointment. Be that as it may, I was not impressed with the general practitioner I saw. Excellence does not have the same importance as it does in the US. Thoroughness seems unheard of.[/quote]
No one is going to get my behind out of bed at 5AM to get a clinic appointment. If it is a clinic issue it is a non-emergency situation and I wait until late morning or early afternoon and request an appointment. The appointment is always within two days and I do not have to stand in line to get it.
[quote=”2bncr”]Just get it done (which it really isn’t, but because you stopped you can call done even when its not done right) and then “next” is the attitude here. And that may be for a number of different reasons.[/quote]
I have experienced the same thing here but in different ways. Overpayment for labor is the most common.
Just an example:
Before the family moved in I was paying 100,000 colons to have the property cared for. Within a month Marcos sent the gardener on his way and another was hired to do the same job for 30,000 colons.[quote=”2bncr”]Regardless I want excellence when it comes to my health. I understand that many who come here cannot afford high end medical insurance.[/quote]
We all want excellence when it comes to medical care. We are retirees living on Social Security and eligible for Medicare with its 20% co-pay and donut hole pharmaceuticals.
We have foregone the expense of Medicare and joined Caja which, to date, costs us under $100 per month for both of us.
Between us we have faced breast cancer, heart blockages requiring four stents and a ruptured appendix, peritonitis, hernis and septic infections. I can only imagine what it would have cost us either in insureance for private care or on Medicare with its 20% co-pay and attendant pharmacy donut hole costs. 😯[quote=”2bncr”]Emergency time. Go to clinic. Wait. Sent to new Heredia hospital. Beautiful building, new facility, walk in and there was disorganization as if they were being inundated from a disaster. [quote=”2bncr”]I was appalled. the trash cans that Ticos use for their toilet paper had not been emptied and there was another trash can full worth of used toilet paper piled next to and around the trash can.
That was my experience with emergency Caja care. Yes I am still alive but I was thoroughly convinced that nobody was taking any of this seriously except the patients.[/quote]
If it is an emergency situation I deal with it in an entirely different manner.
At 3:15 on Saturday afternoon I experienced what felt like a gunshot through my body from lower right above the hip to near my upper left shoulder. It took about 15 minutes to realize it was probably my appendix. The clinics are closed on the weekends so Marcos drove me to the nearest farmacia (4PM) where the doctor advised me to go to the nearest private clinic to get an order to get into the hospital for an exam (4:30). With order in hand Marcos drove me to San Juan de Dios where I was admitted within 15 minutes (5:15). I was assigned an exam room and examined and sent to the surgical area (6PM), waited 1/2 hour to get space in surgery (6:30). I awoke in recovery shortly after midnight. It was 8 1/2 hours from rupture to recovery that I consider as good as the States.
I spent considerable time in the after surgery dormitory due to other issues related but none the fault of the hospital or the medical care.
The dormitory was neat and clean, the cleaning crews were constantly busy emptying trash, sweeping & mopping floors, carrying out laundry and all the other chores necessary to a sanitary environment. I had a completely different experience from that of 2BNCR to be sure.[quote=”2bncr”]Maybe your experience differs, but that was mine. Any how who I will never use the caja for anything unless I have no other choice. And by the way, there were no other foreigners there and all the Ticos were looking at me like “what the hell are you doing here?” Not the worst night of my life but in the top 50.[/quote]
Neither my wife nor I saw any other expats during any of our experiences with Caja. Possibly in the future they will learn to deal with the differences in culture. It is a matter of being flexible enough to make the changes that need to be made fit in. For a type “A” Leo personality like myself I have found that it is possible.Life is what you make of it. 😀
I am glad to hear that your experiences were good. Yes life is what you make of it. It is also how you handle what happens to you. I handled it fine. Completely accepted my experience and have made what I cansider to be needed adjustments in my personal health strategy. I am just leary about hospital in CR after my experience. yes I know that it could happen anywhere, but the overall disinterest worries me. yes you can say its a cultural thing, but I want to feel as if peiole in charge of my health services care. I have never experienced that nonchalant attitude in the US. My first time in a private hospital 10 years ago in CR was completely differnt. BTW regarding the new giant Heredia hospital I would much rather go to older clean facility well staffed facility than modern big building understaffed and poorly managed.
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