Health Insurance in Ecuador

Today I went to our pharmacy, Farmacia Desarollo Social y Ninez para la Familia (owned and operated by the Ecuadorian government, by the way) and thought since it's close to the start of April, might as well check with our health insurance provider, Instituto Ecuadoriano de Seguridad Social, or IESS for short and find out how we start using their system for health services.  So I took off to El Centro (downtown) for these things.  

After taking the Cuenca Transito bus to the Mercado 10 de Agosto stop, I hoofed it as usual five blocks north to Farmacia Desarollo Social.  Takes ten minutes and is good walking exercise for me.  Carlos, the pharmacist on duty virtually every time I go there, filled our expensive but short list of prescriptions - just two of them this time - and I wished him a Feliz Pascua (Happy Easter).  Nice to not have to go to another surcusal (branch) of the Farmacia to get the rest that might be lacking at this main location.  That usually entails a walk along Calle Simon Bolivar several blocks to the San Blas location, which is also the name of one of Cuenca's older Roman Catholic churches as well as its namesake park.  Fifteen minutes with a gentle downslope to it.  

So I have some time to ask some questions of the folks at IESS.  I head there on foot for several blocks, about a ten minute walk.  On the way I encounter some tourists from as it turns out Norway.  They speak English, but it's not their home language.  First day these young gals have been in Cuenca, and is their first time in Ecuador.  Veterans at exploring Argentina a few years ago, though.  I ask them if they have a map and know their way around.  They do.  We smile and continue our separate ways.

Gran Colombia, one of the main east/west streets in Cuenca, is closed off to vehicular traffic due to construction on the Tranvia, or light rail system that was supposed to be finished at the end of 2015.  Now we hear that it will be done by the end of 2016, according to the mayor's office (la oficina de la alcalde).  There's 24 hour a day nonstop construction to help get the work done and allow the businesses affected to retain their customers to the extent possible.  I saw quite a number of storefronts closed shut and locked. . . not a good sign.  Some said they had relocated, one to the El Arenal sector (where Feria Libre is located, the largest mercado in all of Cuenca).  The larger businesses and those with more than one location in town (or in the country) tended to be the ones that stayed open.  The little guy with a family owned and operated tienda truly has suffered during the Tranvia construction.  

I reflected as I was walking along Gran Colombia how we had first entered Cuenca along this very street on the intercity bus.  It took us from the west along Ordonez Lasso, through the El Centro/downtown where it changes name to Gran Colombia, and out to the Terminal Terrestre bus station by the airport on the eastside.  Now it was all torn up, some areas in dirt, some with orange plastic piping holding electrical cable of some kind - an educated guess - and some already done in concrete and ready for the rails to be laid.

At the end of walking several blocks, I came to the IESS building at Gran Colombia and Mariano Cueva.  This is where my wife and I came when we enrolled for IESS health insurance.  This time I was by myself.  
I knew I needed to go to a different floor to get information about medication coverage and the like.  Was it the third floor?  I looked at the directory in Spanish, and decided that perhaps the third floor was a good place to try.  I encountered a few employees doing this, and eventually ended up in the presence of young Andrea, on the sixth floor.  She spoke conversational English, having spent time living in New York.  This happens more than one realizes. . . quite a few Ecuadorians travel abroad to practice their English and to work for more money while they are young, as well for further educational opportunities at the university level.  

Back to the Tranvia before I forget.  One of the employees there at the third floor asked me about what I thought about the Tranvia.  I told him I thought it was going to help Cuenca and Azuay Province quite a bit, but in the short term there was a high price to pay with shuttered stores, people's livelihoods at risk due to the construction dislocations, and the ever inflating cost of the total construction expense.  That last one hit home with him.  He clearly thought it was too expensive for the people to afford.  (Yes, this conversation was in English.)  

Looking over the document on medications I had prepared, Andrea on the sixth floor searched on her desktop computer to find out if they were provided free of charge to insured IESS members or not.  A good number of them were.  Those that were not were typically name brand drugs, or expensive medications that were not made in Ecuador and had to be imported.  The end result after going through all of these medications line by line was that IESS will from all accounts likely pay for around $70 of our (currently) ~$300 monthly prescription bill.  These lower cost prescriptions IESS will be happy to provide to us at their dispensary.  This is less than what I hoped they would provide, but any help at this point is welcome.  One way to look at it is that we pay the IESS health insurance premiums of around $85 each month, and the free prescriptions we get are around the same cost of the premiums.  So we do get to enjoy a cost reduction from this point on, just not as much as we might have hoped.  

Up next for IESS health coverage and care: calling the call center for getting an appointment to see an IESS doctor.  They likely will ask questions, and determine if you need to stay on the medications you are currently using.  They may authorize providing for free some medications that Andrea at the IESS central office didn't say would be provided for free, but that's just an educated guess on my part.  

My coverage starts April 1, and Carolyn Anne's starts May 1, being listed as my dependent on the IESS application.  As you can see, if you know our story from the many posts here at this very weblog, due to the length of time it took to get our pensionado retirement visa from Ecuador due in large part to the fingerprint requirements set out by Ministario, we are way behind the curve on getting IESS insurance benefits compared to other extranjeros that arrived in Ecuador the same month and year we did.  But that's life.  Never fair, but we have to roll with the punches.  And we have been, paying for doctors and medications out of pocket since we have arrived. . . without complaint, I may add.  

I asked Andrea if IESS has a specialist for arthritis pain such a rheumatologist in the United States.  "!Oh, a reumatologo!" she exclaimed.  "Sure!  We have one that we refer patients to that is at Hospital Monte Sinai.  He's available to her if she needs one.  Remember to see the IESS doctor for the referral first, though."  I smiled and thanked Andrea for the patient, and thoroughgoing information afforded me this afternoon.  Hospital Monte Sinai is where Carolyn Anne had her last fall, if you remember, and went to their emergency room (cost: $68 as it's a private hospital).  It also has the one farmacia in Cuenca that carries medications no one else seems to carry.  A quality hospital in our estimation.    

Upon coming home today, Carolyn Anne remarked - again - that she needed to go immediately to bed for rest due to arthritis pain.  An 8 out of 10 today, she said.  I don't enjoy hearing that and frankly I'm at my wit's end on what to do. . . but pray.  That's the beginning and the end of what I can do.  I can't make the pain go away.  I can see what can be done about it, and I am delighted to hear that a pain specialist such as a rheumatologist is available through our new IESS health insurance.  Hopefully there will be some new treatment or medication regimen that will help my dear wife.  

In the interim of late, Carolyn Anne has been seeing a doctor at Clinica Hogar in El Centro where she has spent a good amount of time volunteering to see what if anything can be done to help with the arthritic joint pain all over her body.  Her advice to her is to change the diet to some degree by eliminating items such as cheese, red meat, tomatoes (tomatoes!), oils including salad dressings, and breadings on meats.  I'm sure the doctor means well, but after looking at information on the 'Net from the Arthritis Foundation, I can see that the jury is still out on some of these statements.  One person's solution may not work for another.  Every person is an individual, and there is likely not one uniform method or diet that works for all sufferers.  

This lady doctor did put her on a couple of new (expensive) medications.  I told Carolyn Anne we can try these things - medications, diet - for a month give or take and evaluate how she is responding from there.  I think that makes some sense given the level of pain she is suffering and has suffered.  I can tell you one thing, though: here in Ecuador, with the care and easygoing thoroughness the doctors provide in caring for their patients, Carolyn Anne would likely never had gotten that level of individual attention and care if we had stayed in California.  That you may be assured of!