Extracted from www.nicaragua-guide.com
Nicaragua Health Care
Describing health care in Nicaragua is like describing the weather in the United States. It depends where you are talking about. Nicaragua is a third world country with the wealth concentrated in a few cities and it takes wealth to have modern medical facilities. Also, consider the fact that most residents of the USA believe they have the best medical care in the world yet the USA is ranked 38th in the world by life expectancy behind almost every other modern country including Cuba. For you non-believers, go to http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy and check it out.
Nicaragua has greatly improved its health care in the past few years and boasts the most modern hospital in Central America. Indeed, friends of ours chose to relocate to Nicaragua due to its reputation of good health care. They are both diabetics and have other medical complications.
One suggestion is what my wife and I did when we left the USA for Nicaragua. We went to our various doctors and dentists and requested copies of all our medical records. After all, they are your records. I believe they charged an administrative charge of $10 for each of us.
Food and water
Most everyone we know drinks the tap water in the larger towns and cities. It is not unusual for someone to become ill in any new country because the food and water is not necessarily bad but different. Personally, we have a five gallon water cooler in our home but that is because we like cold, refreshing water and we did the same while living in the states. Five gallons lasts about a week and costs 25 córdobas ($1.25). If you are only here for a few weeks we recommend drinking bottled water because you are not here long enough to adjust to the change. Many of the guide books recommend not buying from the street vendors but those special native dishes are part of the experience here. Just use common sense as you should in any country. If the chicken is not cooked all the way through, you should discard it or ask for a another serving whether it is from a street vendor or a 5-star restaurant. Fruit and vegetables should preferably be peeled or cooked. We’re not sure every street vendor or restaurant worker in Nicaragua keeps their hands clean while preparing or serving the food but we’re not that confident it was always true in the states or any other country either.
If you are on prescription drugs you should bring sufficient supplies with you. Keep medication in its original container and bring along a letter from your physician stating your medical conditions and the medications you are taking. This is in case you have a serious medical emergency while here to ensure the doctors can treat you quickly and with full knowledge of your present medical state. While most, if not more medications, are available here you should ensure you have enough until finding the local pharmacy stocking your type of medication.
Pharmacies and medical laboratories are quite numerous and can usually be found in any town with more than a few hundred people. Due to the poverty of the majority of the people here, many can not afford seeing a doctor unless it is a truly serious illness. For that reason many natives depend on the pharmacies and labs to take care of most of their medical problems. For most of the common ailments we also frequently just go to a pharmacy and ask for their recommendation. You quickly learn which pharmacies are more knowledgeable and carry more types of medicine and prescription drugs.
My wife requires special prescriptions for a thyroid condition and high blood pressure, both medicines of which are readily available here and at prices less than just the co-payment amount back in the states. Prescriptions are usually not necessary except for the most controlled drugs. Some drugs which are approved and manufactured in Europe are available here even if not yet available in the states. The brand-name medicines you use in North America or Europe will go by their generic or scientific name here but most medicines and antibiotics are widely available and usually cost much less. While it is true that you may simply walk into a pharmacy and purchase most drugs without a prescription, please use common sense and consult with a doctor periodically to see if you are using the correct medicine, in the correct dosage and to ensure there are no interactions among the medicines you are taking.
Since we do not yet have the armies of lawyers looking for malpractice suits or chasing ambulances, there is little litigation against pharmacists, doctors and hospitals. This results in these medical personnel being more open with you in giving their medical opinion and pharmaceutical companies are not pressuring these same people to sell their medicines. Nicaragua, being a small country, does not yet warrant their attention.
Condoms and birth control pills are readily available in most of the pharmacies. Other forms of birth control are not commonly used in Nicaragua such as IUDs and diaphragms. All forms of abortions were recently banned in Nicaragua due to an agreement between the Catholic church and the present government.
Many doctors in Nicaragua received their medical degrees from the United States while others have been trained in Mexico, Europe, Cuba or in the Caribbean area before taking positions here. Your location in Nicaragua will determine the diversity and quality of the medical care available. If you live in a small fishing village on the Atlantic side you will not have a modern medical facility. Also, if your idea of comfortable living is being within 30 minutes of a state-of-the-art hospital then Nicaragua is probably not going to be the country of choice anyway. If you live in or near Managua, Granada or León you will have excellent local medical practitioners and be within a short drive to the some of the best hospitals in Central America. We like to call the medical care here “practical health care”.
We live in Granada which has many clinics, doctors, pharmacies, several small hospitals and it is only 30 minutes to a great hospital. Our local doctor is a Nicaraguan who speaks good English, has a office in Granada but is also a surgeon at the best hospital in Managua. We have his office number as well as his personal cell phone number for emergencies. How many doctors do you have that will give you their direct home number? Presently, an office visit costs us 230 córdobas (less than $12) and they only take cash.
Outside of these major cities, physicians, their staff and other medical personnel frequently do not speak English, and medical reports are written in Spanish. It is always recommended that people moving to a new country learn at least some of the local language and an ability to speak some Spanish will help you or a loved one to receive the best care available. If unable or unwilling to learn the language, take along a Nicaraguan friend or associate to assist you. Our Nica neighbors are more than willing to help us in any way as we would them. That is one of the reasons we chose to live here. We have many foreign friends with small children that are entirely comfortable with the doctor care they receive here.
We have no experience with it but we have heard of a new company called Nicas that provides relocation services which includes providing expatriates with a list of recommended doctors and specialists. Questions can be sent to email@example.com. Consult your country’s embassy which often will provide a list of recommended doctors, dentists and specialists.
Each department (equivalent to a state) in Nicaragua normally has its own public hospital. Public hospitals will usually not charge you for emergency services but you will still have to pay for medication and supplies. Again, if you are in a smaller town or village you may not be pleased with the available medical facilities assuming they exist there. Granada and León have many clinics and adequate hospitals while Managua has several modern hospital facilities. Especially in Managua you will find personalized care as well as highly-trained, English-speaking doctors and state-of-the-art facilities. Many people are surprised at the diversity and level of quality care you can find if you know where to look. Ask other expatriates for their recommendations. If just traveling to Nicaragua it is a very good idea to check your health insurance to ensure it will cover medical care here though costs are low enough you may not need to refer to your health insurance.
Medical care is very reasonably priced with a wide range of coverage options for foreigners that can cover everything from maternity costs to serious ailments. Be sure to read the section on health plans and insurance coverage. The low cost of health care available here is due to several reasons. Casual malpractice suits are not common here removing a huge insurance cost to being a medical practitioner. Doctors and their staff do not have to fill out endless amounts of paperwork and insurance forms. Labor and cost of living are much less here for all, so medical personnel do not have to make a lot of money to exist. Due to insurance costs and oversight, doctors in the states usually order only the most essential lab tests, MRIs or x-rays. But here, the costs are low enough that it is not only reasonable but good preventative care to order more comprehensive tests. One of our most pleasant surprises was finding out that the test results are often available almost immediately meaning we may be able to discuss the results with our doctor the same day.
Costs vary in different locations and we can not guarantee them but here are some typical costs as advised by a medical professional:
Doctor visit <$15
Specialist consultation $30-40
Hospitals in Managua include:
• Bautista Hospital
• Berta Calderón (De la Mujer) Hospital
• Salud Integral
• Carlos Roberto Hospital
• Alejandro Davila Bolaños Hospital (Military)
• Japanese-Nicaraguan Hospital
• Manolo Morales Hospital
• Metropolitano Vivian Pellas Private Hospital
• Fernando Vélez Paíz, Pediatric Hospital
One private hospital in Managua is considered one of the finest hospitals in Central America. Vivian Pellas Metropolitan opened in 2004 and is the only hospital in Nicaragua being considered for accreditation by the U.S.-based Joint Commission International Accreditation organization for recognition having top standards for quality and service within the medical industry. The hospital is open 24 hours a day and employs more than 300 of Nicaragua’s best medical personnel in gynecology, cardiology, orthopedics, pediatric, internal medicine, neurology, urology, and ophthalmology. Many of these people speak some or good English. Besides the usual expectations of a modern hospital, Pellas has a pain clinic, pharmacy, maternity ward and a laboratory that can run tests for a very reasonable cost.
Pellas is also home to a children’s burn facility that provides many young victims with free services. Vivian Pellas is the wife of a successful Nicaraguan businessman and she created the hospital and burn unit due to a terrible accident she experienced years earlier. It is an interesting, dramatic story that is worth researching on the Internet.
When you enter the Pellas hospital, you are reminded of the unhurried hospital pace of the 1950s in the states. Unfortunately it is due to the fact that most Nicaraguans can not afford even the low costs of hospital care in Nicaragua so the typical patient is the expatriate or rich Nicaraguan. The Pellas hospital also offers complete medical checkups for some very reasonable costs. The cost may be low enough to make it practical to fly down here for a vacation and then get a complete medical examination for less money than the medical examination in the states.
The Salud Integral, Bautista hospital and the military hospital are also good hospitals. The Salud Integral has 24 hour emergency services, operating rooms, intensive care and a clinical laboratory. Private consultations are available and they have four types of rooms to choose from, ranging from $40 upwards. Bautista hospital is a private hospital that was once considered the best hospital in Nicaragua until the newer clinics opened but Bautista should still be considered and at a lower cost than other Nicaraguan hospitals. There are rumors of two new modern hospitals being built in Managua but rumors in Nicaragua often remain rumors. We are still waiting for the coastal road first proposed in 1928.
Some resident expatriates do warn, however, that some of the high-tech equipment you'd expect to find in U.S. hospitals isn't available in Nicaragua. These same residents advise you to purchase MedEvac insurance to ensure that in case of an emergency you'll be airlifted by jet to Houston or Miami from Nicaragua. This is a decision you have to make since we are not medical experts. Our personal observations make us believe that everything within reasonable health care seems to be here in Nicaragua. My wife and I can no longer reasonably afford the medical care of the states. Emergency ambulance services are becoming more available but not as readily as in the states. In an emergency, individuals are taken to the nearest hospital that will accept the patient. This is usually a public hospital unless you or someone acting on your behalf indicates that you can and wish to pay for a private hospital. Payment for medical services is usually on a cash basis, although the private hospitals will accept major credit cards for payment. Check your health insurance to ensure it will cover medical care in Nicaragua.
Finally, don’t be surprised if you find some procedures or techniques are more advanced than those you had in the states. Medical technology is expensive and Nicaragua had the advantage of starting late, meaning that in some fields they began with the latest equipment and did not have to update existing technology.
Health Plans, Insurance
The Social Security Medicare Program of the United States does not provide coverage for hospital or medical costs outside the United States of America. Many health insurance plans do not provide coverage overseas and those that provide customary and reasonable hospital costs abroad may not pay for your medical evacuation back to the United States which can be expensive depending on your location and medical condition.
Items one international insurance company suggests considering if you plan to keep your existing health plan from your country of origin or purchasing special international medical insurance:
• Does my insurance policy cover emergency expenses abroad such as returning me to my country of origin for treatment if I am seriously ill?
• Will the doctor, clinic or hospital in Nicaragua accept payment from your insurance company? Remember their costs are low because they normally do not have to put up with the bureaucracy, resistance and slow payment of insurance companies.
• Does this insurance cover high-risk activities such as parasailing, mountain climbing, scuba diving and off-roading?
• Does this policy cover pre-existing conditions?
• Does the insurance company require pre-authorizations or second opinions before emergency treatment can begin?
• Does the insurance company guarantee medical payments abroad?
• Will the insurance company pay foreign hospitals and foreign doctors directly?
• USA senior citizens may wish to contact the American Association of Retired Persons (AARP) for information about foreign medical care coverage with Medicare supplement plans.
In checking with our expatriate friends we find there are many options for the international traveler or the expatriate moving here. One friend recommends the Danish company, IHI (International Health Insurance) as a comprehensive plan. It allows the option of flying back to your home country (travel for the spouse and hotel are included in coverage) if surgery is needed. For more information, go to www.ihi.com. Other expatriates recommend Global Insurance which is linked to this web site but go to www.globalinsurancenet.com for the whole scoop. For information on International Medical Group go to www.expathealthcenter.com. They also have life insurance available.
Options keep changing so use the good old Internet search engine and see what is available. The best advice is to talk to someone who has the policy and has used it for emergency health service. If you pay enough you can get any level of health insurance coverage but if the price seems too reasonable then there is probably a reason. Some people opt only for the evacuation insurance to get back to their country of origin where their normal insurance or Medicare coverage will kick in.
Many of us that have moved to Nicaragua simply do not have medical insurance or rely on local coverage options. With the much, much lower medical costs here we are simply betting it is cheaper than paying high insurance premiums assuming you can get the medical insurance. At this point, some of you are probably gasping for breath hearing that you could exist without health insurance. Please remember that the USA is one of the last countries not to offer national health insurance and a large proportion of the USA residents does not have any health insurance.
One popular Nicaraguan health plan is the health plan offered by the Pellas hospital in Managua. There are two levels of the plan which are available for Nicas or expatriates with little or no paperwork prerequisites. While not exactly a comprehensive health plan it does offer the subscriber substantial discounts that increase over a period of time. It is very reasonable.
The two programs are the Gold Plan and the Silver Plan. Under the Gold Plan a person over 40 would pay less than $700 a year for coverage and would receive up to 100% off in emergency room care, substantial discounts for most procedures and many other services. Under the Silver Plan, a person over 40 would pay less than $200 a year for coverage entitling them to discounts up to 70% off hospital charges, 20% off doctor consultations and 30% off childbirth, among other services. Again, the discounts start at a lower level then increase to the above amounts over a period of time. Rates for younger people and children are much lower and there are also family discounts. Even people over 65 or those with pre-existing conditions can enter the plan. Friends in the plan state that they did not even need a medical examination before being accepted.
There are excellent dentists available in the major cities of Nicaragua and many speak English. They can perform almost all of the services that you would expect at much lower costs. Many people plan a vacation to Nicaragua, have major dental work performed and use the savings to pay for the family vacation.
Our English-speaking dentist in Granada recently quoted the following prices to us:
Root canal, post installed and crown installed $400
And if we agreed to all of the above work he would give us a discounted total price and replace our old fillings for free.
At our first dental visit in Nicaragua, the dentist requested an updated x-ray of our teeth and gums. We drove across town to an x-ray lab where they quickly, without an appointment, performed the x-ray and in a few minutes we had the x-rays in our hands returning to the dentist. And, it was a state-of-the-art x-ray showing a 360 degree view of our teeth. Our dentist in the states had to take several x-rays to cover all of the teeth. Total cost - $20 each.
The dentists here perform all forms of dentistry including cosmetic dentistry to correct dental problems and to simply improve your appearance when you smile. It is the low cost that will really make you smile.
Glasses and Misc. Services
There are many optometrists available in even the smaller towns and many of them have the accompanying stores selling lenses and frames. For some reason we’re not familiar with, the discounts are not as substantial as other medical services.
I recently had an eye examination and purchased a pair of bi-focal (no-line) glasses which cost around $90 which is less than the typical chain stores in the states but more than purchasing them over the Internet. Still, be assured that the optometrists and the eyeglass services in Nicaragua will meet your expectations in service and quality.
Cosmetic Surgery and Other Specialized Services
A surprising but pleasant discovery for me was to find out how many of our friends were now getting cosmetic surgery performed here in Nicaragua. The main reason, of course, is the much lower cost but also because the technology now exists here. All types of facial surgery are performed to bring back that youthful appearance. One of our friends also had surgery to remove their eye cataracts.
There are several clinics in Managua offering the latest laser technology to fix your eyes to negate the need for glasses and we are now seeing advertisements of laser clinics for dermatology. Other applications available in Nicaragua are laser treatment of permanent hair reduction, skin tightening, skin rejuvenation, vascular and pigmented lesions, tattoo removal, scars, warts, leg veins, acne and acne scars. Another reason to vacation in Nicaragua and let your treatment savings pay for the vacation.
Care for the Elderly
While usually not considered as a reason for moving to Nicaragua, retirement developments and assisted care centers are starting to appear. The main reason is that the labor cost is so low. You can hire a cook, maid, gardener and/or caretaker for less than $100 per month. A person with medical experience can be hired for a very reasonable cost. Compared to the cost of assisted living in the states, you can be well taken care of in Nicaragua for a fraction of the cost. And you would still have the experience of living in another country.
Can the U.S. government assist me if I become disabled overseas?
• If an American becomes ill or is seriously injured abroad, a U.S. consular officer can assist in locating appropriate medical services and informing family or friends.
• If necessary a consular officer can also assist in the transfer of funds from the United States.
• Payment of hospital and other expenses is the responsibility of the traveler.