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Ecuador - Health Service

In 2018, it became a legal requirement that everyone arriving in Ecuador has valid medical insurance and remain covered for the entire duration of their stay.

If you are a visitor to Ecuador, travel insurance with a decent level of healthcare cover will be sufficient. Do check the exclusions carefully, though. If you are planning to go paragliding for example, ensure you are covered for sporting activities.

However, if you are moving to Ecuador for the short or long term, your healthcare cover will need a little more planning. The cheapest option may not cover all your needs at a time when your health (and by association your cashflow) is in difficulty.

Expats Can Join The State Healthcare Programme In Ecuador

Up until 2014, expats living in Ecuador had to purchase private healthcare insurance. There were no other options available.

However, the government has changed the rules. Expats can continue to arrange their own insurance if they choose, but they can now access the state healthcare programme as well.

Ecuador’s healthcare system has undergone significant change over the past decade, and government funding has been increased. Around eight percent of the country’s Gross Domestic Product (GDP) is spent on healthcare. New hospitals and clinics have been built, and major improvements have been made to existing facilities. The country now boasts one of the best healthcare systems in South America.

In addition, the cost of healthcare – and as a result healthcare insurance – is much lower than in the United States.


The state healthcare system offers two levels of care. The one which tends to be most attractive to expats is the IESS programme. This is administered by the Social Security department.

The majority of people who are members of a state healthcare programme belong to the IESS. Each month, a percentage of a worker’s pay is deducted by the employer and paid across to IESS.

Other members join on a voluntary basis and pay a set monthly fee. A family of two adults and two children can be covered for about $100 a month.

There are no restrictions to who can join the IESS programme. You will be accepted regardless of age or pre-existing conditions.

The programme provides cover for primary and emergency care, including prescriptions. There are no deductibles, although if you want treatment or medicines not covered by IESS, you will have to pay for them separately.

Be aware that the paperwork is in Spanish, so you may struggle if you don’t speak the language.

The Public Health Care System

This is the second tier of the government healthcare system. It is a free system which is available to everyone. Many of the facilities and staff providing the public service are the same as those providing IESS services. It covers primary care and major essential operations.

However, it is a separate scheme and the amount of funding per patient is lower. As a result, some aspects of healthcare are rationed under this programme.

Private Healthcare

Most expats live in or near Cuenca, Quito and Guayaquil. These are the areas with access to the best private facilities and medical staff in the country. You will often have a choice of several locations for where to receive your treatment.

If you are using healthcare services in one of these cities, you will often also have a choice about who treats you. You will find it easier to locate English speaking staff here, including those trained in the United States. Your local consulate may be able to suggest suitable English-speaking GPs.

Alternatively, you can join our ExpatFocus Facebook group for expats in Ecuador, where other members will be able to answer your queries about recommendations.

Along with short waiting times for tests and appointments, and a more personal service, private healthcare provision means you won’t have to grapple with the IESS paperwork.

Some private practices have a two-tier charging system, meaning expats pay more than local people. The public systems do not do this.

If you live in a remote area: “access to good levels of healthcare can also be an issue” explains Canadian expat Leigh Anderson.

The amount you will be charged to access private treatment depends on your age, pre-existing medical conditions and any other relevant factors. You may find it more affordable to take out a policy with an insurer based in Ecuador. This is because the medical services, treatment and medicines are cheaper in Ecuador than elsewhere.

You can even take out a policy for a specific hospital, which will offer lower premiums and deductibles. However, if you use a different hospital for treatment, the deductible rate will be higher.

Infectious Diseases In Ecuador

There are a number of communicable diseases which are present in Ecuador including Tuberculosis, measles and malaria. Hepatitis A can also be contracted through unclean water in the country, caused by the unreliable and insecure water supply systems.

Ensure you have received a full course of vaccinations before you arrive in Ecuador and are alert to the health risks, so you can minimise your exposure to them.

You can read more about this important preparation in our article Which Vaccinations Might You Need When Moving To Ecuador?

Risks When Visiting Areas Of Wildlife In Ecuador

With its varied terrain and unique landscapes, Ecuador has many exciting outdoor activities on offer. Unfortunately, some of these can lead to injury and death if you do not fully recognise and respond to risks.

If you are heading for an outdoor adventure, always tell other people where you are going and when you should be expected back, and then stick to the plan. Heading off alone can be dangerous, so always go out with others.

There are several risks to bear in mind when out in Ecuador’s nature.

● While jumping down a beautiful waterfall can be enjoyed as part of a group activity following a safety demonstration which teaches you to do so correctly, attempting this without training is extremely dangerous.

● Flash floods come out of nowhere and are lethal to anyone swimming or kayaking in the areas affected.

● Ecuador is home to a number of species of venomous snake, including the Ecuadorian Coral Snake and Fer-de-Lance.

● Road accidents happen everywhere in the world, and Ecuador has many roads at high altitude.

Women are particularly vulnerable to attack in Ecuador even if travelling in pairs. Avoid going into the home of a stranger or any other private space where you can’t quickly get help.

Ecuador's position on a ring of volcanoes leads to earthquakes. In 2016, almost 300 people were killed and 2,500 injured by a 7.8-magnitude earthquake which caused buildings to collapse. If a building starts shaking, get under the nearest table and stay there until you are sure nothing will topple over and fall on you.

Keep well away from the border between Ecuador and Colombia. The area is rife with Farc rebels who work with drug-trafficking criminals to attack military targets and anyone else who strays into their path. In 2018, for example, two journalists and their driver were abducted and murdered in the area.

These risks can make you worry about the safety of Ecuador, but if you plan accordingly, you can relax and enjoy the adventure. As Maureen Stimola, who moved from Vermont to Tena in the Ecuadorian Amazon for a year, asks: “Where else could you find a giant snake hissing outside your bedroom window, eat grubs, cross rushing rivers on bamboo bridges, have a near fatal canoe accident and hike through the jungle wearing the Achuar Nation President’s square-toed dress shoes?”

Most people who come to Ecuador as a visitor or expat will have a safe and enjoyable experience. And there really is a lot to enjoy about the country.

Smoking In Ecuador

The regulations about where you can smoke in Ecuador are in a slow process of change. By 2021, smoking indoors in a public place is expected to be illegal.

Smoking is currently banned from the public transport systems as well as from educational establishments including schools and universities. National Parks also prohibit smoking anywhere within their boundaries as discarded butts are a danger to wildlife and could cause fires.

It is unusual for restaurants to allow customers to smoke indoors, but they often have an outside area where you can eat, drink and smoke at your table.

Shopping centres are slowly becoming smoke free, but the rules are being implemented at a different timescale according to the decisions of each mall owner.

As a result, you cannot be certain whether any location you visit will or will not allow smoking. Normally the presence of ashtrays will tip you off, plus you will probably see someone smoking if it is permitted. You can also always ask staff what the rules of their establishment are.

The Ecuadorian government is trying to reduce the number of smokers in the country and the diseases that smoking causes. As a result, cigarette packages will display large and unmistakable warnings about the harm smoking does.

Read more about this country

Expat Health Insurance Partners


Cigna has worked in international health insurance for more than 30 years. Today, Cigna has over 71 million customer relationships around the world. Looking after them is an international workforce of 31,000 people, plus a network of over 1 million hospitals, physicians, clinics and health and wellness specialists worldwide, meaning you have easy access to treatment.

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