The Ministry of Public Health (Ministerio de Salud Publica del Ecuador) regulates public healthcare in Ecuador, which is divided into two forms:

• public healthcare which is free to everyone, including expats
• the Instituto Ecuatoriano de Seguridad Social (IESS), which is available to everyone making contributions into the system

The public health care system is separate from the IESS but shares some resources and personnel. It is also less well funded, but it fulfills a constitutional mandate that no one in the country should be refused medical care. Like the IESS system, it has hospitals in major cities, as well as many walk-in clinics. However, the system is basic and may reserve services and supplies (for example vaccines and inoculations) for high-risk patients.

Ecuador’s national healthcare is extensive, and free at the point of delivery to everyone resident in the country. Doctors and nurses are obliged to do a one-year ‘rural internship’ after graduation, to serve the more remote regions and to gain their medical license.

Healthcare itself is generally considered to be of a good standard, particularly in the cities, but may still not be up to the quality that expats are accustomed to in their home nations, with shortages of personnel and equipment, and lengthy waiting times. However, public healthcare has been improving with an increased level of state investment.

National health insurance, the IESS, is financed out of payroll and if you are working in Ecuador, you will be making compulsory payments into the system. You will then have access to a range of hospitals and clinics which are provided on top of the free healthcare that is available to everyone. You will also be covered by the IESS for emergency treatment in a private hospital. The IESS plan should cover most of your costs, including medication, with no deductibles or co-pays: if you are asked for a co-payment, there is a fixed schedule within the IESS. There are no restrictions on age or pre-existing conditions. However, be careful that you are not overcharged as a foreigner: taking a Spanish-speaking friend with you to medical appointments may be a good idea.

Everyone, whatever their income levels, is covered under Ecuador’s universal healthcare system. As an expat, it is likely that you will be making contributions into the national scheme and will therefore also be covered under the slightly more sophisticated IESS, which was opened up to expats in 2014. The José Carrasco Arteaga Hospital in Cuenca, for instance, is an IESS institution.

However, it is now a legal requirement that you have health insurance if you are a foreigner in Ecuador, either as a tourist or as a resident. This applies to all residents, with no exception, whether you are a new resident or became a resident before the new law came into effect.

However, the law is flexible regarding whether your insurance is public or private: you can therefore register with the IESS or contact a private provider in order to fulfill your legal requirements. You will need to provide proof of your policy to the Ministry of Foreign Affairs.

You will be automatically covered by the national scheme and will be registered by your employer. If you are self employed, you can register yourself and pay voluntary contributions.

The Ministry of Health’s approach nationally focuses on community and preventative medicine. The national scheme covers:

• primary and community medical care
• clinical medicine
• paediatric medicine
• gynaecology
• surgery

and within these categories hospital provision includes:

• oncological hospitals (SOLCA)
• children’s hospitals
• psychiatric hospitals
• gynaecological and maternity hospitals
• geriatric hospitals
• ophthalmological hospitals
• gastroenterological hospitals

Larger, more specialized, hospitals are found in the cities, whereas rural areas have provision from smaller hospitals and clinics. If you are in an urban area, you will have a local community health care centre (Centros de Salud), which functions as a ‘day hospital’ for minor procedures.

You may find that your local IESS GP also has a private practice.

You will find that costs are around 10% to 30% of those in the US. A private hospital room, with medical service and meals, can average US$225 a day as opposed to $950 in the US. Medication is reasonably priced and a lot of drugs are available without a prescription at local pharmacies, although you may pay more for name-brand medication. A visit to your GP will be between US$25-$35 and a visit to a specialist between US$30 to $50.

You will be covered by the national healthcare scheme. Expat retirees often opt for private medical insurance as well, however, due to the limitations of the public system. Registration with the IESS will get you a number of benefits, in addition to healthcare, if you are over the age of 65.

As an international student, it is advisable to take out private cover during your time in Ecuador, although the state system will cover you in an emergency. Contact your educational institution to see if they have in-house insurance or can recommend an affiliated insurer.

Your dependents will be covered by your national insurance but your spouse may need to contribute to the premium by paying a smaller amount.

Dentistry graduates also have to do the one-year rural internship along with doctors and nurses, so there is some dental provision in public sector care. National healthcare provision focuses on the poorest sections of society and dental care for children is free. As an expat, you may prefer to take advantage of the private dental care available.

17.6% of your income will be deducted from payroll.

The upfront cost of private healthcare is considerably lower than in the US, and for minor procedure such as blood tests or x-rays, you may choose to pay out of pocket, but costs can easily escalate if you have a more serious condition, especially if you require medical evacuation. Many expats thus choose a comprehensive private policy, and you may also wish to use this insurance to comply with your legal entry requirements.

The public scheme is comprehensive, but it is also overstretched and suffers from prolonged waiting times. It functions mainly in Spanish, whereas many medical personnel in the private sector are English-speaking, and it also suffers from a high degree of bureaucratic red tape. Ecuador’s private clinics are of a high standard, particularly in the cities, such as Quito, Cuenca and Guayaquil.

Ecuador is developing as a medical tourism destination and expats report comparatively low costs and good results, for treatments as diverse as teeth cleaning and spinal surgery. Dental treatment in some of the country’s excellent clinics is a popular choice. Private health cover will entitle you to a full range of primary to tertiary care and elective treatments.

With a local provider (listed below), you could be looking at a monthly premium of $125 – 175 depending on age and gender.

Many international providers offer private cover, but there are also a number of local insurers.

• AETNA
• Allianz
• AXA
• Cigna
• Foyer Global Health
• Pacific Prime
• Worldwide Medical Group

Local providers include:

• BMI
• Confiamed
• Cruz Blanca
• Ecuasanita
• Generali

Some hospitals also offer their own in-house policies with no or low deductibles.

Centros de Salud - community health care centre

Instituto Ecuatoriano de Seguridad Social - National health insurance

Ministerio de Salud Publica del Ecuador - Ministry of Public Health