Last week Gene and I were getting the deck set up for the summer. This involved some electrical work (moving outlets), setting up the string lights and furniture, and putting up the ceiling fan. When Gene stepped down a rung of the ladder from installing the ceiling fan, his knee popped, and he was unable to put weight on his left leg. It was so bad that I ended up making a late-night run to Walgreens for crutches (aside – did you know crutches are not covered by an HSA?) so he could get to the bathroom without my help.
Verdict is a torn meniscus. Doc says it may heal on its own, but if it doesn’t, he’ll need surgery to repair it. So…yeah.
The injury has been frustrating, but it also got us thinking, what if this had happened after we had started our travels? Would I be able to make a late-night run for crutches? Could we even get ibuprofen easily?
We decided to break down our healthcare options in three different places, two of which are on our list of places we will definitely spend time (Puerto Rico and Belize) and a third country chosen at random (Costa Rica).
Belize
We did get to experience Belizean healthcare first-hand on our first visit to Hopkins. Our oldest daughter cut her foot on some glass pretty badly. It happened at night and there was nothing we could do about it until the morning. We just wrapped it and bandaged it as best we could until the clinic opened the next morning. But when we got her to the clinic, it was clean, and the wait was pretty short.
After the doctor stitched her up, he wrote down the name of an antibiotic and told us to go to the drugstore to get it. It wasn’t a prescription. He just wrote the name of the antibiotic down so we wouldn’t forget it. At the drugstore in Hopkins (there is only one) we asked for the antibiotic, and the guy asked us how much of it we wanted. No prescription, no rules. Just ask for amoxicillin and pay for it. Super simple. The cost wasn’t bad either. I think it was $10 US for a week’s supply.
That small injury, and the injury to Gene’s knee last week, both could be handled pretty capably in Belize, but don’t let that fool you into thinking the country has any real medical infrastructure. The country is poor and that is reflected in the amount and sophistication of their health facilities. But, as we found on our visit, the doctors are caring and knowledgeable.
For more serious injuries requiring a hospital, most people go to Belize City, where there are a few decent hospitals. There are also larger clinics in San Ignacio, Corozal, Dangriga, and Punta Gorda. Had our daughter’s injury not been able to wait overnight, Dangriga, a 30-minute drive away, would have been our only choice, but we would have been driving on streets that have no streetlights and copious potholes, so the drive may have been more dangerous than the injury!
There is health insurance in Belize but many expats self-insure. The Belizian heathcare system covers Belizean citizens for free, and everyone else typically pays cash, as the costs are low. An international insurance plan will cover evacuation for major injuries requiring specialized care.
Puerto Rico
It is easy to think that, since you can travel to Puerto Rico without a passport, that your U.S. health insurance will carry over as well, but that is not the case. There are some Puerto Rican insurance companies that will honor U.S. insurance policies for emergency care only. For more general care, expats will need to self-insure, purchase Puerto Rican insurance or an international insurance plan.
Puerto Rican insurance is generally more affordable than in the United States and there are typically no deductibles to meet before insurance coverage kicks in.
As you would expect, facilities and care vary widely around the island. You’ll have more options in San Juan than you will in Vieques. There is public healthcare in Puerto Rico, but health care is not free. It is, in fact, underfunded, which has led to a shortage of doctors on the island.
Because of this, many expats choose private healthcare. To make use of private healthcare, individuals will need medical insurance as well as cash.
Costa Rica
Most sources praise Costa Rican healthcare for its accessibility, quality, and cost. The country has both private healthcare and a public system, Caja Costarricense de Seguro Social, known as Caja. Expats can use either system, depending on their medical needs and budget. Wait times are longer and access to specialists is limited, but the costs are low, and the coverage is comprehensive.
Many expats choose private practice, either using international insurance or paying cash. Doctors in private practice in Costa Rica are generally trained in Europe or North America and often speak English.
Costs are generally a fraction of what they cost in the United States. You can see a specialist for about $100 and surgeries are less than half of the U.S. cost. Like in Belize, many of the drugs we need a prescription for in the U.S. are available over the country in Costa Rica.
In summary
We’ve only highlighted three countries, but we feel confident that, with a good international health care plan, Gene’s injury would have been handled at least as well in each of these three countries as it has been here in the United States (although we might have been carving crutches out of driftwood in Belize!). We will be fully researching healthcare options and regulations in each of the countries we visit before we go. We can’t predict the future, but we can be prepared for it.
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