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

How does the healthcare system work in Guatemala?

What is the quality of healthcare in Guatemala?

• Guatemala has a turbulent history of civil wars; that period ended in the 1980s/1990s. That has certainly had an impact on the Guatemalan health care system.
• Even though the constitution states that every resident of Guatemala has the right to good basic health care, the practice is unfortunately different.
• The government in Guatemala still invests relatively little in public health care; the investments are even one of the lowest in Central America.
• There are more and more 'programs', partly from the government and partly from NGOs, that focus on specific target groups such as women, newborns or Mayas and on themes such as 'healthy food', 'emergency aid' and 'diabetes'.

How does the public healthcare system work in Guatemala?

• About 88% of the population is covered by public health care.
• Hospitals and clinics, the so-called 'Hospitales Generales', which provide this free public care, have a major shortage of financial resources, which results in a major shortage of medication and equipment. Guatemalans often have to buy their own medication in a pharmacy outside the hospital. If they pay in cash, this often results in an additional discount.
• The care in hospitals and clinics in Guatemala City is of a reasonable standard. In other cities and certainly outside urban areas, the standard is low; in many villages there is no doctor or nurse available and people are dependent on limited health care provided by (international) NGOs.
• Most public hospitals are open 7 days a week and receive everyone, whether or not you have a referral letter.
• For foreigners who live and work in Guatemala for a longer period of time, public health care is not always accessible... and you may not want it to be (long waiting times, lack of equipment, low quality). In many places, there is no English-speaking doctor or nurse available. Many foreigners living in Guatemala choose to go to another country in Central America to get more specialized care.

How does the private healthcare system work in Guatemala?

• Many expats, emigrants and digital nomads in Guatemala choose private healthcare, as do about 12% of (wealthier) Guatemalans. Facilities in private hospitals and clinics are generally better and the chance that you will encounter an English-speaking employee is much greater.
• Please note that payments for care provided are often requested in advance; via cash or credit card. Of course, there are international health insurances that can take this off your hands, and can also shorten waiting times.
• The costs of private healthcare in Guatemala are lower than costs in, for example, the USA, but of course considerably higher than the costs of comparable interventions under public healthcare. As an indication (depending on the clinic/hospital): root canal treatment approx. USD 420, colonoscopy approx. USD 800, cataract treatment approx. USD 3,200, hip replacement approx. USD 11,200, radiation for cancer approx. USD 12,000, coronary heart disease (bypass) approx. USD 24,000.
• Depending on your international health insurance, and always after consultation with your insurer, you can also choose to go to a hospital in another country in Central America for more specialist procedures.
• Also note that 'medical evacuation' is part of your policy, so that you can be transported overland to the nearest specialist clinic in Guatemala, for example, or even by helicopter to Mexico. This is especially important if you live, work or travel for a long time through non-urban areas in Guatemala; the chance that you will not find good healthcare within a reasonable travel distance is then considerably greater.

How is the general practitioner arranged in Guatemala?

• In Guatemala, it is common to go directly to a specialist if something is wrong with your health. The specialists also have walk-in consultations and often have an office in the hospital.
• High-quality healthcare is mainly available in Guatemala City, plus a few larger cities in Guatemala.
• Always check in advance with your expat insurance (except for emergency care) with which private hospitals agreements have been made, so that you can be sure that the care provided by a specialist/hospital will also be reimbursed.

How is the dentist arranged in Guatemala?

• In general, there are good dentists ('dentistas') in the larger cities in Guatemala, who follow international standards, and for a very reasonable price.
• In consultation with your (international) dental insurance, do some research on which practice you choose: some dentists are more specialized in orthodontic or preventive care for children and adults, while others focus on special dental care for older patients. If you are unsure about a particular procedure, ask for a second opinion or a price indication from another provider.
• Private dentists often have their practice in or near a larger shopping center in the better neighborhoods of the city, certainly in Guatemala City.
• There are certainly several reasonably to good English-speaking dentists in the larger Guatemalan cities.

How is pregnancy care arranged in Guatemala?

• Guatemala has an alarmingly high percentage of infant mortality. Infections at birth are the main cause of this, especially in the more rural areas.
• The relatively high maternal mortality figures are also largely caused by inequality in access to health care.
• Special NGO programs are providing the first university courses in Guatemala for midwives. You also see more and more initiatives where doctors, traditional midwives (comadronas) and obstetricians work together.
• Please note, regarding breastfeeding, that immediate and frequent breastfeeding in private hospitals is not a given. Babies often stay in a separate room that night(s) and are given sugar water and powdered milk to drink, so that the mother can rest.
• The influence of the US is now great here, and has clearly had an impact on breastfeeding in public in recent years. This is certainly true for women who belong to the 'middle class' and 'the elite' in the big cities. Among the indigenous Mayan population, who mainly live in the countryside, public feeding is usually still considered very normal.
• Lactation consultants are still relatively rare in Guatemala. Women are told to switch to artificial feeding at the slightest problem; this results in a lot of malnutrition. The NGO La Leche League Guatemala is fighting for more knowledge and practical support around breastfeeding in Guatemala.
• In Guatemala (and Mexico) the rebozo is very well known; an elongated wrap made of woven cotton that you can use as a belly band or baby carrier. The massage techniques with the rebozo can help with pelvic complaints, back pain and hard bellies. The muscles are gently loosened by shaking and rocking with the cloth.

What are the hospitals like in Guatemala?

• The government-funded hospitals in Guatemala are often understaffed, underfunded, poorly equipped and can be unhygienic and unsafe.
• The best hospitals are in Guatemala City and Antigua.
• Outside Guatemala City you will find a hospital or a private clinic in larger towns, where an English-speaking doctor is often present. In villages there is usually a puesto de salud, a health center. If you need to stock up on your travel medicine while traveling, many types of medicines are available at pharmacies (farmacias) in Guatemala.

How safe or unsafe is a trip or stay in Guatemala?

What should you pay attention to in terms of safety in Guatemala?

• Crime numbers in Guatemala are high.
• Crime in Guatemala ranges from relatively harmless (such as pickpockets) to violent robberies and sometimes even rape and murder.
• It is not wise to go to busy tourist places, such as Antigua, Lago de Atitlán, Quetzaltenango, Chichicastenango, etc. with large amounts of money or adorned with jewelry. Pickpockets are active in busy places.
• Certain neighborhoods (zonas) of Guatemala City are definitely not to be visited as a tourist. Get good information on the spot, take online sources and warnings seriously and always check city bus routes: make sure you stay out of the 'unsafe' neighborhoods with these types of bus routes: there is an increased risk of robberies and violence here. Armed robberies also occur regularly in the entertainment and business districts and the more luxurious residential areas. Robberies and violence also occur frequently in the neighboring municipalities of Mixco and Villa Nueva.
• Where possible, avoid the Alta Verapaz region. There is a lot of drug violence here. If you are travelling to the Petén region (including the highlight Tikal and Mayan excavations), always travel with a transport company recognised by the tourist organisation INGUAT.
• Although fortunately incidents are rare, a 'tourist' bus is occasionally robbed. Always hand over your belongings and do not heroically resist. Serious violence is not avoided if you resist!
• It can be restless before, during and after an election period. Avoid gatherings and stay well away from political demonstrations.

What should you look out for in terms of diseases in Guatemala?

• Tropical diseases are present in parts of the country. Checking vaccinations before you leave is highly recommended.
• Always drink bottled water in Guatemala, which is cheap and available everywhere.
• There is a risk of diseases transmitted by mosquitoes, such as dengue fever and the zika and chikungunya viruses. Check well before departure which medicines you need a declaration for in order to be allowed to take them to Guatemala. Always take the original packaging with you when travelling.

What should you pay attention to when it comes to traffic in Guatemala?

• A large part of the roads in Guatemala are difficult to pass. Especially in the western region there are many bad roads.
• Car robberies occur regularly. Especially on the road from Guatemala City to the Atlantic coast. There are also robberies on the main roads between Escuintla-Guatemala and Escuintla-Antigua and on the roads to and from Guatemala City and the border with El Salvador.
• Stay on the main roads as much as possible. Do not travel before sunrise or after sunset. Be on your guard during the day as well: robberies occur then.
• If you are travelling by car, be extra alert at intersections. Stationary traffic can be the target of armed robbers.

What work and travel insurance policies are suitable for short and long stays in Guatemala?

• Is the trip to Guatemala 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.

What emigration and expat insurance can you take out for Guatemala if you are going to live there for a while?

• It is not a legal requirement for expats to have health insurance, but it is highly recommended. In some circumstances, such as the Investment For Residency Visa (with a minimum investment of US$60,000), you will be required to provide proof of health insurance.
• Some areas are considered dangerous, and depending on current events, these areas may not be covered by your insurance company. Make sure you are up to date with information regarding the coverage areas of your specific health insurance.
• Make sure your insurance covers medical evacuation as well as coverage in neighboring countries. Read more about insurances for abroad on Expatinsurances.org.