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Aug 06 2015

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Healthcare in Costa Rica: From the Public System to the Private-Our Story, by Bob & Linda Beavis

Beavis1by Bob & Linda Beavis

April 26, 2015

It’s isn’t a bruise like we thought…….

Linda fell on a section of very rocky road near our house on Friday and hurt her right shoulder. We thought just soft tissue damage but planned to go to our local Caja hospital clinic today for an X-ray just to be sure.

Well, we ended up in San Juan de Dios Hospital in San Jose. Long story short, she’s broken the arm just below the shoulder joint and has been admitted to hospital. It’s somewhat “elective” surgery so she may have to wait a day or two to get into the operating room to have pin(s) inserted to the break. It’s apparently a clean but total break.

The Emergency Room Entrance at San Juan de Dios Hospital in San Jose

The Emergency Room Entrance at San Juan de Dios Hospital in San Jose

I just got home to retrieve some stuff for her and have to drive back right away to take the things to her. I may be a tad late getting back tonight. Hospital rules are that family can only visit one hour per day (6-7pm). Some of the staff speak a bit of English.

April 30, 2015

Day 5 Update: Went to see Linda today after her messaging this morning that they moved her to a room on a ward. Turned out I was caught in the standard visitation protocol that I could only get in for an hour at 4pm. Stood in line with about 200 other visitors to get in but actually that worked smoothly, other than the guard confiscating the Gringo food I had in my bag for her.

Linda is in a room with 6 other women (1 bed is empty so otherwise it would have been 8 in the the room). All nice ladies and all full Spanish, which is interesting. Linda has gotten to know them all a bit; I introduced myself to them all and had a bit of Spanish chat with them.

Found out I could get a “permisso especial” to visit anytime I want based on Linda’s need for interpretive service plus assistance since she only has one functional arm.

All in all she is doing very well.

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Nurse with Linda at San Juan de Dios Hospital in San Jose

May 1, 2015

Visited Linda today with my “permiso especial” for about 4 hours. Got her through the shower routine (minus shampoo/soap – not provided by the hospital & I forgot to take them) and helped her eat lunch.

She continues to manage the situation well and is having some conversations with her Tica roommates. Crossing our fingers for surgery to happen next week. I’ll be heading back down tomorrow to visit.

No system is perfect. Social systems usually make you wait & private systems make you pay. CR does have both systems to give a choice. We’re using the social rather than spending $6000-$8000 to get it done privately.

May 2, 2015

The big news of the day – The doctor told Linda she WILL have her surgery this coming week. Which day, who knows…..

May 5, 2015

Linda got word this morning that her surgery will be “very soon”. We’re suspecting it will happen tomorrow.

May 7, 2015 – Changing hospitals: from Public to Private

Quick update on Linda: She had full shoulder replacement surgery Wednesday night at 10:30pm. Long story short, we concluded we were getting a runaround at the public hospital, moved her 2 blocks to a good private hospital with orthopedic specialty staff.

At Hospital Metropolitano, Linda was received, assessed and in a bed in a private room in less than 3 hours. Just EXCELLENT service! We dealt primarily with the surgeon – very respected young guy – he gave us face to face updates 4 times within the first 90 minutes and a couple more until the last one at 2am after the surgery was finished.

Hospital-Metropolitano

The surprise to us was that the break was NOT below the shoulder, but was actually the right shoulder “ball” itself, broken into about 4 pieces. Hence the full replacement option was taken. Healing should be a bit quicker, but therapy will be involved. Thankfully, we have a great PT close to our home.

The worst of the ordeal is over – finally! Linda should come home Friday.

May 7, 2015

My Gal’s home after a harrowing 14 days. Fantastic hospital service and treatment but it had a significant cost that, hopefully, our U.S. insurance will cover. New shoulder should fully fix the problem. The hospital gave us the pictures.

Beavis2Beavis3

The shoulder ball was in about 4 pieces, too tough to repair. An artificial implant was put in instead. Surgery at 10:30pm last night, checked out of hospital at 5:30pm tonight.

Word of caution: This type of (“elective”) injury was VERY badly handled by the CAJA hospital. In essence they told Linda (after 12 days), “You’re a Gringo. You should go to a private hospital or you may be waiting 2 months here for this surgery.” We were appalled and immediately moved to get her into a private hospital yesterday.

The fault totally lies with the CAJA doctors who are apparently very arrogant and could care less about Gringo patients. The other hospital staff at the CAJA hospital were generally good service, but a patient is expected to tend to themselves far more than the North American standard.

Much as we are very much not the “Rich Gringos” the doctor implied, we immediately took my wife to Hospital Metropolitano where we received immediate & excellent treatment. My wife had shoulder replacement surgery that night (not ‘a repair’ as she’d been told would be done at San Juan de Dios). We really felt, as Gringos participating in the CAJA, typically at higher premiums than Ticos, we are entitled to equal treatment in the CAJA and were being told we would not.

May 8, 2015

The CAJA system here is not perfect. Some things they do really well. In Linda’s case, the initial triage was excellent. The problem was she was in a long line-up for surgery. In such cases, being able to access private hospitals is an alternative not found in Canada and is hard to do in the U.S.

However, here’s another good example of the public system here, dealing with the sliver I got in my foot 3 months ago while at the beach. I left it for 2 months thinking it would work its way out on its own and it was an annoyance, not really bothering me too much.

I finally went to our local hospital clinic emergency department where they tried to extract the sliver under some mild local anesthetic. The attempt was not successful but I was out of the emergency dept in less than an hour. So they gave me an appointment to come back for minor surgery this week. I went for the appointment, was put into a small surgery room where heavier local anesthetic was administered (ouch!) The ball of my foot was sufficiently frozen that I never felt another thing while the surgeon dug out what was a 3/8 inch, fairly thick sliver of wood.

Total time in hospital: 40 minutes. Total cost: $0.00

Postscript

Beavis4While we had moments of anxiousness in the public hospital, I came to realize that we simply were in a lineup within an overtaxed surgery slate for “elective” stuff.  As I tried to clarify later, the outer ends of the spectrum have been very good (emergency or scheduled services).

The other point I want to make is the saving graces of holding onto Medical A & B, and signing up for a Medicare Advantage plan for those retaining a home in the U.S. (See below.) The one we found included $50,000 of emergency coverage when out of the U.S. Our final tab at Hospital Metropolitano was $18,000. The reimbursement payment from the insurance came through at about the two month point, paying the claim in full, with no deductibles or co-pays.

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