How does healthcare work in Ecuador, and what travel insurance, health insurance or expat insurance do you need?

How does the health care system work in Ecuador?

Affordable and good healthcare is one of the reasons why expats (e.g., from the U.S.) move to Ecuador.
In Ecuador, you have both public and private healthcare facilities to choose from.
Many doctors are trained abroad and know what they are talking about.
In larger cities like Quito, Guayaquil and Cuenca, you'll find affordable and accessible care. Outside the big cities, care is generally of lower quality.
The country has invested heavily in healthcare in recent years, improving the level of care.
Pharmacies are easy to find, especially in the big cities. Pharmacists also provide medical advice and medications can be purchased for which you need a prescription in other countries. However, be aware of the side effects and possible addictiveness of such over-the-counter medications.
Call 911 for emergency medical assistance (ambulance).

Public health care is provided by the Instituto Ecuatoriano de Seguridad Social (IESS) - a system that provides services to workers through a contribution from salary.
Expats with residency visas can also become members of the IESS.
As an IESS member, you pay a monthly fee and get access to a wide range of medical services.
If you are not insured through the IESS, you can access public hospitals at low cost. You can also get good medical care here, but the choice is more limited.
The quality of public care varies. In urban areas, facilities are reasonable, but rural areas may lack resources. Waiting times in public hospitals can also be long.

Despite IESS being a good safety net for emigrants, most choose to supplement/replace it with private insurance that fills in the gaps and offers more options.
Private institutions, as in most countries, offer faster access to care and better service. Also, private care is generally of very good quality.
Private care is more expensive though (although prices are a lot better than in countries like the U.S. and in Europe). You can avoid these extra costs by getting international health insurance.
In private healthcare, you will more often encounter staff trained abroad. This also means that there are generally more English-speaking staff.

There are general practitioners in Ecuador. These are generally found in hospitals or private clinics.
You can also just make an appointment directly with a specialist.
Check with your insurance company which practices you can visit.

Also in dental care you will find many doctors who speak English.
Dentists in Ecuador do a five-year degree, similar to a bachelor's degree, and sometimes supplement it with some kind of master's degree in Ecuador or abroad.
These degrees are registered online in the SENESCYT system, which patients can check with the doctor's full name.
Dental treatment is affordable, but it is helpful to have private insurance to cover these costs.

In Ecuador, you can get good pregnancy care in both public hospitals and private facilities.
Most people give birth in the hospital, some at home or in birthing centers.
Through the public system, you can get free prenatal and delivery care.
In private care, on the other hand, you get more personal attention and have more luxurious options. So many expats choose this.
To get the most out of your pregnancy classes, it may be wise to learn Spanish.
Abortion is illegal in Ecuador, with some exceptions.

Crime is common in Ecuador. This does not necessarily make the country unsafe for expatriates, but it does mean that it is good to be aware of the risks.
The most common safety concerns for expats are theft and robberies. Be extra careful in crowded places and at ATMs and be aware of distraction tricks.
Cabs are not always safe in Ecuador. So it is better to use registered cabs.
There are several areas where crime is more intense. For example, be careful in border areas with Colombia (Carchi, Esmeraldas, Sucumbios) because of drug-related crime, and be careful in Zamora-Chinchipe on the border with Peru because of unexploded mines.
Avoid traveling after dark in remote areas, keep your passport and other documents safe, do not carry large amounts of cash with you, and always cooperate if you are robbed.
There are frequent demonstrations, which can get out of hand. It is best to avoid such gatherings; as a foreigner, you are also prohibited from engaging in political activity in Ecuador.
As a woman alone, it is also important to be careful.

Diseases transmitted by insects (especially mosquitoes) are one of the greater risks in Ecuador. Malaria and dengue are the most common.
There are also several vaccinations recommended for staying in Ecuador. Check this in advance with your vaccination doctor.
Another risk in Ecuador is altitude sickness. Quito is one of the highest capital cities in the world and some people experience symptoms of altitude sickness as soon as they are in the city. So keep a close eye if you feel nauseous, have a headache and can't sleep, for example. This can be treated, but if it gets worse you should consult a doctor immediately.
Tap water is not safe to drink.

Driving in Ecuador can be quite stressful. The streets are narrow, not always very good (outside the cities) and landslides occur in winter, especially in the mountains.
Drivers in Ecuador do not care much about traffic rules and can drive hard and carelessly. Driving under the influence is also common. Make sure you drive carefully, that your tank is always full and your doors are locked. Do not leave valuables in the car.
Ecuador has a bus system. It is a good alternative to driving yourself, although not all drivers drive as carefully and you do have to watch out for theft.

Is the trip to Ecuador and your return sufficiently covered? Are you sufficiently covered before, during and after your activities? Which insurance best suits your trip and your activity? Read more about insurances for abroad on JoHoinsurances.org.

Due to pressure on the public health care system, it is now mandatory to have private health insurance to enter Ecuador.
Read more about insurances for abroad on Expatinsurances.org.

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