My Experince With Ecuador’s National Health Coverage: A Cautionary Tale

When we first arrived in Cuenca in 2012 we were advised by Gringos that the prudent thing to do was to get health insurance. We were always covered in the USA. Being new we took their recommendation and opted for coverage. The cost for both of us was $187 monthly and since our monthly income was $1293, it really put a burden on our budget. After attempting to use our insurance I had serious doubts about its viability. Nothing was ever paid or reimbursed. There was always some mitigating factor that made us ineligible or we were told we would be reimbursed “manana”. We would go to their insurance office every other day and after two months of “mananas” I indicated to them into what orifice they could place their insurance. So, we went the self-insured route for three years.

Was there an alternative?  Yes, there was IESS, the national health coverage. The price was very attractive.

I spoke with people who used their IESS insurance and have read accounts of folks who have used the system. I have heard and read the pros and the cons. Since I am getting to “that age” it seemed like the logical move was to join IESS, the national health system. Needless to say, the cost for both of us was excellent. The decision was made – we enrolled.

I have had degenerative discs since 1980 – 36 years. To relieve inflammation, I take Meloxicam. It was prescribed by my doctor in the USA. Until now I could go to the pharmacy 80 feet from my apartment and buy it over the counter. But now the government here in their great wisdom has made it necessary to have a prescription. Since I joined the IESS system and never used it, I thought I may as well make an appointment with a doctor so I could get a Meloxicam prescription and be entered “in the system”.

My  IESS  Journey

[color-box color=”gray”]Monday – Day 1

  • I left the apartment at 9:00AM for a 9:45AM doctor appointment on the southwest side of town – a 25 to 30-minute bus ride.
  • All I wanted / needed was a prescription for Meloxicam. With me I had X-rays of my spine that were taken seven months ago, with all the paperwork to prove that I indeed have a disc problem.
  • I arrived at the IESS doctor, explained the problem, showed the x-rays and received the prescription. The doctor also gave me paperwork, scheduled physical therapy in two months, (which I did not request or want), told me to go to the El Centro IESS pharmacy for the prescription and then go the main IESS office to schedule an appointment with an orthopedist, (which I did not request or want). I was not examined at all.
  • We went to the El Centro IESS pharmacy and there I was told that they did not have Meloxicam and I must go to the pharmacy at the IESS hospital. Since I was already in El Centro, I went to the IESS main office to schedule an appointment with an orthopedist. After an hour of sitting around sick people coughing and sneezing, an appointment was made. Now we had to go to a clinic on the northeast side of town. This is an area of the city that we don’t know so we had to take a cab.
  • We get to the clinic, wait in line and get to the window. We are told the paperwork we were given has to be in triplicate so off we go to find a nearby store to have copies made – then go back in line at the clinic. It is now 1:10PM. We are given an appointment for the same day at this clinic, (Hallelujah!). The doctor is not in but will be back at 2:00PM and we are given an appointment time of 2:00PM – and we are the only patients waiting. At 1:50PM the doctor returns. Three patients come in after us and are seen before us. Finally, at 3:00PM we get to see the doctor!
  • NOW, he wants to see an MRI, so-it’s back to IESS El Centro to schedule the MRI appointment. Back at the IESS main office I am given paperwork to go to Santa Ines Hospital so an MRI can be scheduled. We go to Santa Ines and an MRI is scheduled for Saturday morning. After that an appointment has to be scheduled to have the MRI read back at the clinic in the northeast area of the city. After seven hours of running around today I still do not have what I initially sought – the Meloxicam – maybe tomorrow.


The Saga Continues…

Tuesday – Day 2

After spending / wasting another 4.5 hours going to four more IESS offices, doctors, clinics and hospitals today, including the main IESS pharmacy, I STILL do not have the Meloxicam I was prescribed. There is none available at the main IESS hospital and they don’t know when they will have it. Now I will have to go to a regular pharmacy and buy the prescription. So, that is 11 different IESS locations, two days and 11.5 hours of running around and have nothing to show for it. OH – still not finished. On Saturday I have to go for the MRI, and then make an appointment for a doctor to read it.

“And The Beat Goes On” (My apologies to Sonny & Cher)

Wednesday – Day 3

One thing I forgot to tell you: On my Monday foray into the IESS mine field, no physical was performed. I had to ask to have my blood pressure taken. WOW! 130/100, the highest it has ever been in my life. The doctor told me to stop using salt and come back every day for 10 days to have my BP checked daily and then scheduled a follow-up appointment for two weeks later. I went back the next day and-WOW! 100/60, the lowest it has ever been in my life – in less than 24 hours. How can this be? So today I took the bus across town, 25 minutes one way to have my blood pressure taken again at the doctor’s office as instructed.  WOW! No doctor and the office is locked. We wait outside for 40 minutes and no doctor. Apparently IESS doctors can come and go as they please.

P.S. In order to comply with the doctor’s instructions, on the way home I stopped by the Military Hospital to have my blood pressure taken today at no charge and what do you think?  My BP was still on the low side.

Thursday – Day 4

Rather than take a 25-minute bus ride each way across the city only to find that the doctor is not there, I go to a local clinic and have my BP taken for $1.00.

Saturday – Day 5

I had the MRI taken.

Monday – Day 6

I had to go back across town again to have the MRI read. The doctor studied the MRI. His diagnosis – he told me to be careful when I walk, gave me a prescription for Flexaril and guess what else???… Meloxicam!!!!

With IESS you can get the prescriptions you need at no cost since you are a dues paying member of the system.  Right? Guess again.

To get the medicine I was prescribed, twice, by IESS doctors and going to two IESS pharmacies, which did not have the medication, six days, and a total of 16 hours running the IESS gauntlet, I had to pay for the medication myself.

Is this a great system or what???

The heck of it is, I could have walked 15 minutes down the hill from our apartment, gone to my family doctor, gotten the prescription I needed and gone to the local pharmacy.

Total time: about 50 minutes and I would have spent the same for a doctor call, (if he would have charged me to write a prescription), as I have the past six days on taxis and bus fares.

Two Weeks Later…

As instructed I go to my scheduled follow-up appointment at 8:00AM. I got there at 7:55AM – no doctor. The doctor finally arrived at 8:20AM. I was ushered into the office and the doctor asked me why I was there. I said that I am returning because you instructed me to do so. Remember the blood pressure issue? I showed the doctor the list I kept of the days my blood pressure was taken and the results. The doctor looked at the results and said that it looks fine – but never took the BP while I was in the office and sent me on my way.

I am REALLY looking forward to my next IESS encounter.

More: Now my wife is experiencing the same type of running hither and yon with her IESS doctors. Two appointments with not as much as her blood pressure checked…and now the procedure she needs to have done has been finally scheduled – in three months! Her latest appointment was scheduled for 10:25AM and she was not seen until two hours later. Patients that got there after her were seen before her. Not knowing that she understands some Spanish she heard the one nurse say, “The Gringa can wait”.

Now we are back to self-insuring but we are keeping the IESS insurance…just in case. I might need another tour of the city!

17 Responses

  1. “Self Insurance” withva $1,300/mo. income eqals no insurance.
    An extremely riskhy gamble.
    We are all just one slip in the bathroom or one big blue bus away from a debilitating accident.
    We won’t even talk about the unexpected long-term illness.
    I see Bankruptcy in your future.
    You’re skating on extremely thin ice.
    The older we get the mire likely we are to require heath care.
    No matter thst you ate oatmeal and mango and your BP was normal this morning.

    1. IESS is a joke. I am an expat passed the waiting period for IESS and cannot get an appointment even for a referral to an orthopedic surgeon-a specialty not even available at IESS. I required emergency knee surgery and they could do absolutely nothing. I pay my monthly Premium for NOTHING- fraud in the US, folks.

      I ended paying $23,000 out of pocket at a highly-respected private hospital in Quito and still another surgery to go. Why in the hell am I paying $66.00 for IESS to receive no treatment and no benefits. And why am I damaged to this level financially?

      Waste of money and no straight talk from anywhere here – as usual.

  2. You can get the prescription you need in the US and have it shipped to Cuenca with no import duty. Sign up with and the shipping from Miami will be about $10 for a one lb package. Make sure there is a copy of the prescription in the package. Another option is to take another NSAID, like Naprosyn which is available over the counter in Cuenca.

  3. I have IESS and Bellgenica and use IESS only for most of my ongoing BP meds and otherwise consider it critical care coverage. My Bellgenica plan has a cap of $15K per disiease/incident per year.

  4. My experience with IESS has been without any of the obstacles that were incurred by this author. I had shoulder surgery with many doctors visits, follow ups and therapy post surgery with no problem. Sorry to hear about the problems Ed had to deal with.

  5. I am disappointed that Gringo Tree published this “story”. My experience with IESS health services have been excellent. Then again I am a laid back gringo and follow instructions as directed by the care giver. I have never waited more than 30 minutes on most appointment. I did have one of about 1 1/2 hour. The caregiver was in an emergency surgery . Glad she could help someone in need of urgent care. I can wait. OBTW they don’t care about you going in and telling them whats wrong with you..they have their own procedure to diagnose and confirm a treatment regimen.

  6. For the $65.04 a month in IESS insurance premium, I find this person’s experieces quite bearable. I recently had shoulder and neck pain so went through numerous tests and appointments and yes, sometimes the doctors are late, or have others scheduled (this person never considered this) ahead of you so you wait, etc. Still all is covered 100% and with all the appointments I had to see the GP, and two specialists plus technicians, it cost me about $180 for German Morocho’s time as my translator and taxi driver but it would have costs thousands in the US in costs (without insurance). I see a private GP and dentist and optometrist here and pay out of pocket keeping my IESS for emergencies or potential critical issues. Have no problem with this IESS system. In the US would see a GP and be sent to various specialists, etc. too.

  7. I also had a good experience with IESS. I had a Cardiac Catherization with a stent. Was done quickly and efficiently. Stayed overnight in the hospital. I did have some problems with medications. Some I was given and some I had to buy. I don’t think the experience was any worse than In the US. The cost was $0 except for the meds and the monthly payment of $77.00 for both of us. Co-pay in the US would have been $10,000.00. I can deal with a few inconveniences for that. Spanish is a must, and if you don’t know your way around the IESS system, a medical translator / assistant is a plus.

  8. For those who complain about the story and say their experience with IESS has been good — this is the very essence of IESS. Some people have good experience, while others are bad.

    My own experience mirrors this story very closely. I went in for a physical to “get a baseline in the system.” No BP was ever taken. No blood work was done. Prescriptions were given — based on my list of what I took in the States, but with ZERO independent validation. Only to discover that the drugs did not exist in IESS pharmacy, and I had to buy them myself outside the system anyway.

    After many trips across town here and there, and appointments in which no doctor ever showed up (one time I was told after 2 hours that the doctor was no longer part of IESS, and I would need to set up another appointment — another 2 months in the future!), I finally gave up.

    Like Ed, I still pay into the IESS system — for that possible slip or bus that Ken March mentions (Ken — Ed DID say he is still paying into IESS for that exact reason), but I now pay $30 to a private doctor to get REAL care and examination, on the same day I ask for an appointment. IESS is nothing but a desperate last-possible-option for care, as far as I am concerned.

    I think Ed gave an accurate description of his experience, and by only changing the dates, I could have almost written the same article. 🙁

  9. Me and my wife, have had IESS for 2 years and the treatment has been very good. Yes at times they don’t have meds I need so I buy them. We have ongoing appointments with the Doctors we need to see. You have to know how to work the system, which we do. Our out of pocket costs are minimal for medication. It is a system you have to use all the time, why to get to know the system. If you use it sometimes, this is not good, because there is no flow..once into the system there is a flow and the treatment is very good.

  10. I have missed reactions with IESS so I use them mainly for physicals and my wife is preparing for her second foot operation paid for by IESS but performed in the private sector since there is no Doctor in the IESS system that does that type of operation. But I would like to address your concern about your blood pressure.

    Remember I am not a Doctor but am passing on information from my Doctor. When I got into the VA several years ago, Reno VA is very good and has not been caught up in the current scandal. My first visit to the VA my blood pressure was about 130. My Doctor said I should take the measurement before breakfast and my first coffee.

    So he gave me a blood measurement machine and I started using it and found my blood pressure was normally 100 to 110 in the morning. I used to measure it every day now about once a week.

    Paying a dollar to get your blood pressure measured is ridiculous, I will let you borrow mine for 3 months so you can get a baseline. Before you take what I was told check with your Doctor

  11. Ed is a great guy. I was his neighbour for a while. i gave up on iess 2 years ago due to too much fannying about. A lot of the time when I went to pay the system was down. I will be getting private insurance. Recommendations welcome. Thank you.

  12. I actually find this article informative, I’m eyeing up Ecuador as a potential. I can see how cautionary tales such as this would be useful to people who do not expect this type of service. However, as a Nova Scotian, the interactions seem pretty normal, and the wait times are gold standard.

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