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

How does the healthcare system work in Panama?

What is the quality of healthcare in Panama?

• The health care system in Panama is financed by taxes and managed by Caja de Seguro Social (CSS), the Social Security Fund (which, in addition to health care, also regulates pensions) and Ministerio de Salud (MINSA), the Ministry of Health (which determines health care policy, coordinates administration and provides care).
• MINSA manages public clinics ('polyclinica') and low-cost regional hospitals.
• CSS manages a number of public hospitals, aimed at people who fall into the government's social security fund through their payroll (employer and employee contributions). In Panama, this is about 80% of the population.
• Many doctors in Panama have studied in the USA, Mexico, Cuba or Europe and often speak reasonable to good English.
• Doctors who work in private hospitals and clinics are required by law in Panama to also work a minimum number of hours in public hospitals.
• As everywhere in Central America, you will find the better hospitals and clinics in or near cities such as Panama City, San Miguelito, Arraiján, Chitré, Colón, David, Changuinola. Smaller health centers can also be found outside the larger cities. In Boquete, Coronado and Chiriqui, among others, good care is also provided, but despite a large expat population, there is often limited capacity.
• Panama City and David in particular are good destinations for medical tourism, especially for cosmetic and orthopedic care.
• Even though you can just as easily pay with US dollars in Panama, health care - public or private - is often relatively (much) cheaper than in the USA or Europe.

How does the public healthcare system work in Panama?

• Self-employed entrepreneurs, but also expats, emigrants and digital nomads, who want to use public health care can go to MINSA clinics and hospitals.
• Keep in mind that most health care institutions managed by MINSA have very minimal facilities, with little privacy and comfort. This care often relies heavily on support from family members and is provided from older buildings. There are a limited number of beds and the equipment is often outdated. It is known and indicated that the waiting times are long and that, for example, there is not always sufficient or clean bedding available.
• Only residents with a permanent residence permit can go to CSS institutions, provided that they pay taxes in Panama.
• MINSA and CSS care generally does not include: eye care, dentist, mental health care, physiotherapy, additional care and many medicines.
• It is often not possible to schedule an appointment in advance at a MINSA or CSS hospital; just go there and prepare yourself for a long waiting time: many patients, few doctors.

How does the private healthcare system work in Panama?

• Reasons to choose private healthcare in Panama, as in many other countries worldwide, include the shorter waiting lists and the better facilities in private clinics.
• Private hospitals with Joint Commission International (JCI) accreditation are certainly of good quality. They often maintain close ties with American institutions.
• Private healthcare is much more expensive than public facilities, but it is still considerably cheaper than in the US and Europe. Keep in mind that you pay in advance (estimated healthcare costs).
• If you have international health insurance, ask for a pre-authorization if you want to receive care in a private hospital.
• To make an appointment at a private hospital or clinic, you can usually schedule an appointment yourself via the institution's website, or call in advance. Sometimes you have to fill out a form in advance.

How is the general practitioner arranged in Panama?

• Healthcare in Panama takes place in hospitals, clinics and - outside the larger cities - health care centers.
• If you are looking for care, plan a visit to a hospital or clinic - with or without consultation with your international health insurer.
• At most private clinics and healthcare centers you can just walk in, or schedule an appointment online or by phone. Sometimes it is also possible to obtain some information in advance via WhatsApp, or you can send a photo, for example. The doctor will often ask you to come by.
• Some clinics also offer home services, where it is possible for the doctor to visit you at home. Of course, you pay extra for this. The doctor can perform basic tests and prescribe medication.
• Always check in advance with your insurance company - emergency aid excluded - 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 Panama?

• In Panama, basic dental care is not part of the 'public health care' (MINSA/CSS).
• In general, the better dentists ('dentistas') in the larger and medium-sized cities in Panama are affiliated with the larger hospitals. They follow international standards, for a very reasonable price.
• Do your research before choosing a practice. The Panama Dental Association maintains databases where you can search by name, specialty, location and language spoken. If you are unsure about a particular procedure, ask for a second opinion or a price indication from another provider.
• Because Panama has a lot of "medical tourism", especially around dental care, you will find dentists in quite a few locations who speak reasonable to good English and work with international materials and standards.
• Compared to the USA and Europe, treatments with a dentist in Panama are really much cheaper.

How is pregnancy care arranged in Panama?

• The birth of a baby in Panama normally takes place in a public or private hospital. Home births are possible, but not common.
• The regular check-ups in the early months of your pregnancy take place in a regular clinic close to where you live.
• To give birth, you choose a hospital/clinic and pediatrician who will support you during labor. You can also use a midwife ('partera').
• It is not unusual to visit several clinics in advance and ask questions about the maternity care that is provided, so that you can make a conscious choice. For example, also ask about the policy regarding caesarean sections or breastfeeding; some clinics sometimes want to (too much) steer towards the commercially more attractive procedures.
• Pregnancy courses are available in the big cities and expat locations, but less or not at all outside of that. In the more remote areas, people rely even more heavily on traditional methods of pregnancy and birth, with the help of a midwife.
• If you want maternity care after the birth, you hire a nurse yourself.
• After the birth, you will be scheduled for monthly check-ups in your clinic or hospital; from the first year onwards, this will be done every three months.
• Everyone born in Panama is automatically a Panamanian citizen.
• The birth must be registered with the civil registry in Panama. The hospital will often do this automatically, provided they have the IDs (passport, residence card) of both parents. Two witnesses are also required, other than the parents. You will receive the birth certificate at the hospital.
• If there is a home birth, you must register the birth yourself. You do this yourself, or a familymember/grandparent/lawyer.

How is the pharmacy arranged in Panama?

• If you want to replenish your travel pharmacy while on the road, a reasonable number of types of medicines are available at pharmacies (farmacias) in Panama.
• A number of medicines are available without a prescription in Panama.

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

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

• Panama is in principle a relatively safe, politically stable country in Central America. Certainly compared to some neighbouring countries in the region.
• However, drug gangs are also active in Panama and robberies and muggings take place.
• Crime in Panama ranges from relatively harmless (such as pickpockets) to violent robberies and sometimes even rape and murder.
• In particular, (drug-related) gang crime takes place in some neighbourhoods of Panama City and Colón. The Panama ruins of Panama Viejo are safe to visit, but the neighbourhoods around the ruins are not.
• If you visit the popular San Blas Islands by boat, pay attention to the condition of the boat and the presence of life jackets.
• If you live in Panama for a longer period of time and travel with your own car, be alert when you get a flat tire. Criminals disguise themselves as 'helpful passers-by', in order to then rob you.
• For example, if you visit a restaurant or supermarket, do not leave any belongings in your car. A burglary can easily happen. In Panama, there are greater security risks in the east and south of the Darién province, especially in the border area with Colombia. Criminal organizations and armed drug gangs from Colombia are active in the difficult to access (border) jungle area.
• As everywhere, it is also not wise in Panama to go to busy tourist places with large amounts of money or adorned with jewelry. Not even on the beach and/or on the islands. Pickpockets are active in busy places.
• Drugs are offered in Casco Viejo (Panama City) and on the island of Bocas del Toro. The penalties for possession of and trafficking in hard and soft drugs are severe.
• In Panama, the chance of being affected by tropical storms is relatively small. The country is just outside the hurricane belt. However, there is a lot of rain from April to December, sometimes a lot of rain.
• Earthquakes occasionally occur in Panama. Be prepared and inquire which authorities you should contact for up-to-date English information if something like this happens.
• If you live in Panama for a longer period of time, you will sooner or later have to deal with demonstrations, as a result of political or economic issues. A strike can have consequences for transport, fuel supply and other government services. And be careful: even peaceful demonstrations can end in violence.
• Dangerous sea currents can occur in the Pacific Ocean and in the province of Bocas del Toro. Always check with the people who live there where you can and cannot swim.
• If you live or travel in Panama with children under the age of 17, check the rules regarding the curfew. In some cases, young people are not allowed to go out on the street at certain times without an adult (which is of course sensible in a country like Panama). A measure to combat crime and vandalism.
• LGBTIQ+ people are generally not yet accepted in Panama; although that does depend somewhat on where you are.

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

• Expats, emigrants and digital nomads generally experience Panama as a country with a high quality of life: climate, beaches, nature, friendly people, relatively low cost of living.
• However: tropical diseases are present in parts of the country. Checking vaccinations before you leave is highly recommended.
• Always drink bottled water in Panama, which is cheap and widely available.
• Panama City is easily accessible from almost anywhere in the country if you are looking for good quality healthcare. However, given the sometimes unexpectedly longer travel times, it is wise to find out where the nearest private and/or regional hospitals are located before a possible emergency occurs.
• Keep in mind that the people who staff emergency services often only speak Spanish. It is wise to be able to say your home address in Spanish, as well as a few other 'emergency' words and phrases. It can save your life if you need an ambulance quickly.
• Hospitals and doctors often want you to pay cash in advance for a consultation or treatment. Private hospitals also usually ask for an advance payment or proof that you are well insured.
• Check well before departure for which medicines you need a declaration to be allowed to take a first dose to Panama. Always take the original packaging with you and think about arranging a medication declaration in time. Write down the international name of the active substance for each medicine you use and try to find out before departure whether your medicine is also available in Panama: where, how and at what cost.

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

• Traffic rules in Panama are at best a 'guideline' for how to move in traffic. Many people do not adhere to them and sometimes behave quite chaotically. Therefore, drive 'defensively' and do not get involved in discussions. Be aware of potholes in the road.
• In Panama, especially if you live outside the big cities, keep in mind that a drive to the nearest clinic can sometimes take 30-45 minutes.
• Weather conditions, heavy traffic and frequent accidents can significantly increase the estimated driving time in Panama.
• Do not travel by road after sunset, especially in remote areas. Avoid car and bus journeys in the evening and at night.
• Also be on your guard during the day: this is when robberies occur.
• Stay on the main roads as much as possible.
• In the rainy season, you should expect roadblocks due to landslides and mudslides.

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

• Is the trip to Panama 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 Panama if you are going to live there for a while?

• In some circumstances you are eligible for the local 'CSS/MINSA' health care system. Even then it is advisable to insure yourself with an international health insurance, because many things are not or only partially covered by the local 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.