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Medical Care and Options in Costa Rica

March 27th, 2016

I was  diagnosed with cancer last year.

While I thought I had a pretty deep knowledge of medical care both private and public (my wife has been with Calderon Guardia hospital, the second largest CAJA hospital in CR, for 34 years), it turns out I was wrong.  In this post I will share some information on health care in this country and the stuff I have learned.

Medical care in Costa Rica is of interest to not only ex-pats living here or wannabe ex-pats with plans to live here…  but to the many thousands of tourists who visit Costa Rica every year for what is known as medical tourism. Medical tourism we can define as people who visit Costa Rica with the express intent of having various medical procedures done here with the expectation that those procedures may be far less expensive than those same services performed in their home country.  In general, those are realistic expectations, but things are changing.  Over the past several years, medical institutions here have learned the medical tourism is big business and they have responded as expected. There are basically two options here for receiving medical care.  Private (aka for profit) and public (aka the CAJA or socialized medicine). If this topic is of interest, please read on…

As I began treatment, I found myself having to interact with both the private and CAJA systems. It was an experience!

The CAJA

The formal name is Caja Costarricense de Seguro Social and provides health care and retirement services to its members.  If a Tico (Costa Rican) is employed, his employer is required to provide the CAJA to all employees.  This is not always true.  Employees can also purchase their own CAJA “policy” and thus avail themselves of the services.

Any person seeking legal residency in Costa Rica must join the CAJA.  No exceptions. It used to be that membership in the CAJA was quite inexpensive.  Not any more. Now, depending on what kind or residency you have and what is your income, monthly payment to the CAJA can actually be a bit brutal. My sister who moved here about 8 years ago only pays about $70.00 per month and for the amount she uses the services and the costs of all the free meds, dentistry and ophthalmology… it is just a helluva good deal for her.

In any case, the CAJA is in very bad financial condition, and even though you may pay for those services, they may not always exist or if they do exist, it may be months or years before you receive them. While they offer a wide variety of medical services, the equipment they use may not be state-of-the-art.  For example, my wife required spinal surgery last year but chose to use a private hospital because they used a special piece of equipment that made locating the nerves within her spinal column MUCH easier to see during the surgery. Her hospital, while having excellent surgeons, did not have access to this critical piece of medical equipment.

Private Health Care

There are a fairly large number of private hospitals here with the best known probably being Clínica Biblica, Clínica Católica, Hospital Metropolitano, and CIMA.

These hospitals are in considerably better financial condition with  far more modern facilities and perhaps the latest in diagnostic and treatment equipment. In fact my wife chose one of those hospitals with 100% successful results. In a couple of the above hospitals, there maybe more English speaking physicians. Oddly, it is probably best that ability to speak your language should not be the primary mover when selecting a good doctor!

My Story

As it turns out, the very first thing that must be done after discovering that one has cancer, in my case, a very aggressive form of cancer, is to begin the testing. Among others, these included some x-rays, a biopsy, a bone scan and a CT scan.  An aggressive cancer diagnosis was confirmed, and that meant no time to waste. These tests are pretty critical because the doctors have to know immediately if the cancer has spread (metastasized) to the lymph areas, other soft tissues areas or to the bones. Treatment, surgery etc., is determined from those results.

I figured that I would have all these tests done by the CAJA at no cost to me…  probably at my wife’s hospital because she knew a ton of doctors and techs. Well… that was not the case as I soon learned.  First, my doctor wanted the biopsy done at Biblica (not sure why) which suited me just fine because for a few bucks more, they would put me under.  As I may be the world’s biggest sissy, I had no issues with paying for that service.  CAJA would not accommodate the anesthetic, and it was not very expensive. Then things got far more complex.

The CAJA did schedule the bone scan. I had to wait about 10 days which did not please my doctor.  While the time passed, I made inquiries about x-ray therapy (radioterapia) through the CAJA as my doctor really wanted to avoid surgery if possible.  Turns out I leaned two nasty little facts.

  1. You can’t just immediately get x-ray therapy at the CAJA.  Seems approval it is done by a committee and can take months or even years to get on the schedule.  That seemed quite unbelievable until I learned also that
  2. There is only ONE X-ray therapy facility in Costa Rica!! That is not a typo. Only one, located in Hospital Mexico. Ugh!

I promise you that the words “aggressive cancer” and “can take months or even years” are not what you want to hear.

It gets better! There must be several options for radio therapy besides the CAJA. Right?.  At the time, it seemed not. While one hospital offered some form of radiotherapy (breast cancer, melanomas, etc as I recall) none had what I needed.

I was referred to a location in Uruca, near San Jose.

I made an appointment with one of the oncologists. He began by asking for the bone scan and CT scan.  I told him I would have the bone scan in a week. As for the CT scan?  Seems the hospital has equipment issues and it would be  “a few weeks” to get me in.

I met with the x-ray techs (the folks who run the linear accelerator thingy). Helpful folks indeed! They explained the entire process and stated nothing starts until the CT scan results. I mentioned the delay with the CAJA and they then proceeded to take me to school on the topic of everything from surgery to medical testing in CR.  I had already called one hospital who wanted 430,000 colones for the scan.  That’s about $813.00 at today’s exchange rate. Waiting for the CAJA was not an alternative.

These folks then, without being asked, disappeared into a back office reappearing in about 10 minutes handing me a list of excellent facilities that could take me the same day.  AND… the prices!

Clinica Biblica – 627,000 colones

Clinica Catolica – 594,000 colones

CIMA hospital – 430,000 colones

Hospital Metropolitano – 263,000 colones

and finally

Murano Clinica Medica – 177,000 colones  <<<<<

Now let me point out a couple of things…

  1. The difference between the highest and lowest cost CT scan was a huge 520,000 colones or  $982.00  US!!   Quite a savings!
  2. Who the heck was Murano???

I always KNEW that prices could and did vary enormously for certain things in CR, but I did not realize that medical care and testing fell into that group nor did I realize how much difference there was.  It turns out that Murano was an excellent, state of the art private clinic right next to the CAJA hospital in Heredia. They had me in and out in one day. Spotless and efficient and nobody has ever heard of them… except my team in Uruca.  Many thanks again guys!

The good news was that both scans were clear.

The bad news is that I carry no private insurance and thus had to pay for the x-ray therapy. 8 weeks, every day for about 20 minutes and at a cost of $20,000 US.  It was that or wait months to begin treatment at the CAJA.  Not much of a choice really.

At the end of the x-ray treatment, I began the chemo stuff. Nasty with some unpleasant side effects. Thankfully the CAJA did pick that up because at $800.00 US per treatment, things could have gotten ugly real quick.

I made the decision about 16 years ago when I arrived here that I would use the CAJA and forego private insurance.  I figured I would “self-insure” for any services I wanted outside of the CAJA.  As I have “saved” maybe 16 years times an average of $1,800 per year (about $29,000) I am not terribly upset about have to pay for these treatments at this point, but I may re-evaluate my future insurance plans.

However, I have added something to help control our costs until I get the private insurance .

Except for the issues in this Blog article, CAJA has worked well for me.  I have used private hospitals and doctors a few times for special cases where I preferred a specialist with better training. I paid out of pocket, and I have learned that if the hospital or doctor is involved with medical tourism… and that often translates to him speaking English… my costs will skyrocket.  Big time!

Last year I discovered MediSmart. Basically, for $17.00 per month my wife and I are provided heavily discounted medical services at Hospital Metropolitano. My wife’s gynecological appointment was $18.00.  $50.00 to $60.00 is the norm here. My appointments with a general medicine person run $14.00.

As most medical issues are really minor, we use this service a LOT.  Then, should the doctor find anything important where we might want a second opinion, we have no issues switching to another hospital/doctor if we feel it is our best interests.  This has not yet happened. On our last visit, the doctor nailed the diagnoses in ten minutes and prescribe the right meds exactly. Yup, I could have gone to my CAJA doctors but just getting an appointment can take some time.

Hope some of you will find value in the posting! Good luck to all.

TG

 

 

 

 

 

 


5 Responses to “Medical Care and Options in Costa Rica”

  1. Devon Price on March 27, 2016 6:54 pm

    Hello Tim,

    I hope your medical treatment is successful and you are cured in short order.

    Best of luck to you!

    Devon

  2. Tim on March 28, 2016 11:21 am

    Thank you!

  3. Ken on June 26, 2016 4:45 pm

    Gosh, sorry to hear about your cancer, and with Devon I hope you’re OK.

    To your tale, it sounds like the x-rays were the big financial sticking point. Most of us assume we can goose the Caja along by paying for a private test or two, but having to cough up $20K is a bit more than a goose. Some of us would have no choice except to wait (or die waiting). I wonder how long the Caja really would have made you wait for the x-rays?

  4. Elizabeth Hacker on August 16, 2016 6:14 pm

    Thanks for this information. Does CAJA work in conjunction with private health insurance? $1800/year seems reasonable if the coverage is good. The word CANCER is so scary. I hope you are much better and are in remission. Best wishes for a speedy recovery.

  5. Tim on August 17, 2016 6:49 am

    “Does CAJA work in conjunction with private health insurance? ”

    No. They are not connected in any way. Also, thank you for your kind thoughts.

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