Costa Rica is more than ever for medial tourism and all of the celebrities know about it. On my world-famous, monthly relocation retirement tours I talk about the quality of health care in Costa Rica. I take my clients to visit the country’s two premier private hospitals and we go into depth about the country’s health care system at our highly-informative two-day seminar. Below is an excerpt which talks about the quality of the country’s health care. People who relocate here should not have to worry about their health concerns here. I have had many clients on my tours who have come here specifically to take advantage of the country’s low-cost medical care.

San José, Costa Rica – Conservative talk-show host Rush Limbaugh said this week he’d go to Costa Rica for medical treatment if Congress passes proposed reforms to the US healthcare system. That might sound like an unusual choice, since this is a country with one of the longest standing socialized healthcare systems on the planet. Everyone here (including resident foreigner), are required to pay into the government-run health system, whether they use it or not.

But Limbaugh’s choice may also serve to advertise what many Americans traveling here for medical treatment already know: Costa Rica is a fabulous place for medical tourism.

Life expectancy in this little Central American country surpasses that of the United States and at one point, back in the early 2000s when the World Health Organization rated countries’ general health, Costa Rica ranked higher (No. 36) than its northern neighbor (No. 37), despite spending 87 percent less on health care per capita. Some who’ve studied Costa Rican health care consider it better overall, and attribute that to the fact that free coverage extends to 86.8 percent of the population.

But the Cadillac-style private hospitals at Chevy Aveo prices are what really draw 25,000 Americans to Costa Rica every year.

“People travel to Costa Rica (and) receive the same quality of medical services for a fraction of the cost,” said Jorge Cortés, president of the Council for International Promotion of Costa Rica Medicine and medical director of Hospital Biblica, one of three internationally-accredited private hospitals in Costa Rica. “When people see they can get the same surgery for three or four times less, they decide to get medical care abroad.”

Lower labor costs and fewer malpractice suits keep the prices down here. In Costa Rica’s private system, a teeth-cleaning might run $40 and a general check-up costs $50.

Medical bargains

More extensive surgeries? A facelift averages $2,800 to $3,200 in Costa Rica, compared to $7,000 to $9,000 in the United States. A knee replacement may cost $11,000 in Costa Rica, but can be as much as $45,000 in the United States.
But there’s another arm of the country’s medical system – the public system – which is relied upon by a majority of the population. While celebrated by Costa Ricans for “universal access,” it’s often criticized for long wait times and delays in treatment.

“There’s a difference between the healthcare system that serves people living in Costa Rica verses that which is known to foreigners,” said Robert Book, a healthcare economist for the conservative think tank, the Heritage Foundation. “It’s the private option for foreigners that Mr. Limbaugh was referring to when he said he would go to Costa Rica.”

On Tuesday, Mr. Limbaugh clarified his comment about leaving the United States, after “the liberal media” celebrated his vow of self-imposed exile, viewing healthcare reform as a way to rid themselves of the conservative talk show host.
“If I have to get thrown into this massive government health care insurance business and end up going to the driver’s license office every day when I need to go to the doctor, yeah, I’ll go to Costa Rica for treatment, not move there,” he told listeners Tuesday, according to a transcript on his website.

Mr. Cortés said Limbaugh would not be alone in traveling abroad for medical care. He’s expecting medical tourism to increase by 5-7 percent over the next year, regardless of what happens with the US healthcare reform bills.
Booming business and that increase is building upon a growth Costa Rica has already seen. Since the recession forced many Americans out of jobs, Costa Rica has seen a surge in the number of their northern neighbors coming here for health services. In fact, there’s an entire industry catering to the medical tourist, including post-surgery spa services, sightseeing packages, hotels, and transportation.

But, if Limbaugh did move to Costa Rica and chose to initiate the process of residency, he’d be required to pay into the government-run social security system – which runs the health care system too. Under law, all people employed in Costa Rica must contribute 5.5 percent of their salary to the state-run social security system and employers are required to match their payment with 9.25 percent. Even those here for retirement are obligated to contribute under new immigration laws, regardless of whether they hold private insurance.

“The strengths of our health system (is) that it is universal, that it’s based on the idea of solidarity and that it’s fair,” says Dr. Ana Morice, vice health minister in Costa Rica. “What we need to improve is access to health services. Many times someone requests an appointment and doesn’t receive it until a year later. In that area, we have much to improve.” Of course, if Limbaugh decided to move to or buy real estate in Costa Rica, he wouldn’t be the first celebrity. His neighbors might include actor Mel Gibson, model Gisele Bundchen, AOL executive Steve Case, or Vice President Joe Biden’s brother, Frank.

Costa Ricans sure are a happy bunch. Don’t worry be Costa Rican. This article reports on the findings of the New Economics Foundation The “ticos” (colloquial for Costa Ricans), just topped a new list of the happiest people on the planet compiled by an independent research group in Britain.

The country scores 76.1 out of 100 on the New Economics Foundation’s Happy Planet Index (HPI), which measures life expectancy, satisfaction and a country’s environmental footprint. The index was released Saturday.

This is the second index the group has done. In the original HPI, published in 2006, Vanuatu, an archipelago in the South Pacific, was graded the happiest, Colombia came second and Costa Rica third. Now, apparently, Costa Ricans are getting some satisfaction. “As well as reporting the highest life satisfaction in the world, Costa Ricans also have the second-highest average life expectancy of the New World (second only to Canada). All this with a footprint of 2.3 global hectares,” reads the HPI.

Also, this index seems to just love Latinos. According to this year’s ranking, the world’s 10 happiest countries are all — except one — in Latin America and the Caribbean. Following Costa Rica, they are the Dominican Republic, Jamaica, Guatemala, Vietnam, Colombia, Cuba, El Salvador, Brazil and Honduras. Nicaragua came in 11th.

The index punishes bigger, wealthier nations, turning on its head the idea that a nation’s GDP brings the brightest smiles. Of the 143 countries surveyed, the United States ranked 114th, sandwiched between Madagascar and Nigeria. The researchers placed their native United Kingdom 74th, just after Slovakia and before Japan and Spain.

The research group argues on the index’s Web site, “governments have been concentrating on the wrong indicators for too long. If you have the wrong map, you are unlikely to reach your destination.”

So why, you might ask, despite decades of social, political and economic hardship, are Latin Americans racking up the happy points?

The report explains, “Survey data reveals two key features of Latin American culture. One is the presence of relatively unmaterialistic (sic) aspirations and values, compared to countries with similar economic conditions. Latin Americans report being much less concerned with material issues than, for example, they are with their friends and family. Secondly, social capital is particularly strong in the region. Civil society is very active, from religious groups to workers’ groups to environmental groups.” African countries such as Zimbabwe ranked among the least happy in the world.

In the past a trip from the Domincal area to Quepos took a couple of hours on the old unpaved road. Last week we left from Uvita which is one-half hour south of Dominical and traveled to Esterillos Oeste just south of Jacó beach. The trip lasted only an hour and forty minutes. It used to take at least three or more hours to cover the same distance.

On my retirement tour we also visited the mountain town of Atenas in the Central Valley and got a bird’s eye view of the other new highway which goes from San José to the coast. At the rate things are going this new road should be completed shortly, marking another great leap in the country’s constantly improving infrastructure and improving the quality of life here.

Hospiotal Cima SAn Jose

Prostate cancer is the abnormal growth of cells in a man’s prostate gland. The prostate sits just below the bladder. It makes part of the fluid for semen. In young men, the prostate is about the size of a walnut.

Prostate cancer is common in men older than 65 but can affect men in their 40s and 50sThe younger you are the more aggressive and dangerous the prostate cancer. In older men it usually grows slowly and can take years to grow large enough to cause any problems. Most cases are treatable, because they are found with screening tests before the cancer has spread to other parts of the body. Although most men may die with prostate cancer, most men do not die from it. Experts don’t know what causes prostate cancer, but they believe that your age, family history (genetics), and race affect your chances of getting it. What you eat, such as foods high in fats, may also play a part.

Some men also suffer from an enlarge prostate as they get older. Middle and older age men who retire in Costa Rica can be assured that Costa Rica’s urologists have the knowledge to handle all of your prostate concerns.

The PSA test is the exam which is used to detect abnormalities in the prostate gland. This test is widely available in Costa Rica. All men over forty should take it yearly especially those who have a history of prostate cancer in their family. This disease is CURABLE if caught in time. Believe it or not I know American men who live here and have never taken the exam. They are basically playing with fire. My friend C who lives in Heredia is 65-years old and a chain smoker and fairly heavy drinker. He once told me he never goes to the doctor or has taken the PSA test.

I have a another friend who lives in Escazú who constantly monitored his high PSA levels for a couple of years. He had a biopsy which was positive and was operated on successfully at Cima hospital. He is very pleased with the results and the quality of care he received. Today he is 100% healthy.

I had other friends that were not so lucky. They both ended up dying of the disease. One fought a brave battle for ten years but eventually succumbed to the disease. Another friend never went to see a doctor until it was way too late. Since the disease is asymptomatic in it’s early stages, the yearly exam is the key and can make the difference between life and death. Both of these people would probably be alive today if they had taken a yearly PSA test.

I am a prostate cancer survivor and still take the PSA every year just to make sure there is no reoccurrence of the disease. I have an excellent Urologist who works at Cima hospital. His name is Arieh Grunhaus and his English is perfect. If you have any concerns please fell free to contact him at 011-506-22081716.

Chris Howard retirement tours is the only one that has a Declartoria Turística license issued by the Costa Rican government’s tourism institute (ICT #DL-231-2004)

Since Costa Rica is a nature lover paradise there are hundreds of tours from which to choose: white water rafting, surfing tours, wedding vacations, canopy tours, bird watching tours and a whole lot more.  Unfortunately, a large number of these nature tours and including retirement tours are not licensed and regulated by the government.

In theory all tour operators in Costa Rica should have what is called a Declaratoria Turística issued by the Costa Rican Institute of Tourism or ICT to ensure the quality and safety of the people who go on their tours.

In order to obtain the approval of said entity of the government, all applicants have to have an unblemished criminal record, the nature of their particular business has to be investigated and studied and the tourism department’s legal team has to approve the company. The whole process can take over a year in order to ensure the applicant and his services are REPUTABLE and to PROTECT the people who take the tours.

Unfortunately, enforcement of this law is lax and many companies do not offer this protection. Several tourists have died on canopy tours and on rafting trips because they signed up for tours offered from less than professional companies. Others have been cheated out of money or offered shoddy services by unregistered companies.

As for retirement tours there are now many including the original tour I founded around 20 years ago. Each company has  an angle and makes a lot lot of claims. I have never taken any of the other tours so I am nobody to evaluate them. The only thing I can state unequivocally is that none of the other retirement tours except for mine (#DL-231-2004) has a Declartoria Turística license issued by the Costa Rican government’s tourism institute (ICT).

2. Rentista income increased to $2,500 per month and applies to BOTH a single applicant and to a family unit (applicant plus spouse and/or other dependants under the age of 18). So, it does not make any difference if the applicant is single or is married and has a spouse and five kids, the applicant will have to prove exactly the same amount of unearned income: $2,500 per month.

3. No increased income requirement when renewing carnet. The second sentence of Articulo 263 – Transitorio II, which would have applied the new increased income requirements to all non-permanent residents at the time of the next renewal of the residency carnet, was deleted from the final text. So, if your residency was approved based on a pension of $600+, or $1,000 rentista income, you will have no changes in your income requirements when you renew your carnet after the new law goes into effect.

This key change in the text of the law came about as a direct result of our e-mails, which let the Asamblea know someone really cared about this issue.

4. Mandatory membership in CCSS. Residents will have to join “La Caja” and will need to present proof of membership when renewing the carnets. La Caja Costarricense del Seguro Social (La Caja) is the National Health Insurance System of Costa Rica. Membership in la Caja is mandatory for all Costa Rican employees, workers, managers, etc., but membership is currently voluntary for foreign residents. Membership fees (health insurance premiums) are very low compared to health insurance rates in the U.S. and other industrialized nations.

5. Law goes into effect six (6) months after the approved law is published in La Gazeta, the official Costa Rican government newspaper. Therefore, any residency applications filed prior to the effective date of the law would be treated as filed under the “old” income requirements of $600 for pensionado and $1,000 for rentista.

6. Many changes address human rights issues. This is not the right forum to address those changes but I want to mention that the new law creates an Immigration Commission and a system to appeal the rulings of Migracion y Extranjeria.

Apparently Mexico has become the epicenter of this epidemic. The source of the disease was traced to a hog farm in the eastern state of Vera Cruz. At present there are over two thousand people with the disease and almost 200 deaths have been reported. Perhaps the death toll and spread of the disease can be imputed to the the country’s poor sanitary conditions. For example, there is virtually no place in the country you can drink tap water.  This causes many vulnerable tourists to come down with the famous “Montezuma’s Revenge” which is a form of diarrhea. A wife of a friend of mine came down with Shigella which is closely related to Salmonella  while traveling in Mexico. She almost died.

Mexico City is one of the most polluted cities in the world.  Ten thousand (10,000) tons of contaminants fall over the city daily. Tourists have been know to become ill by just breathing the air.

Recommendations to prevent being infected by swine infection by the virus consist of the standard personal precautions against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public. People should avoid touching their mouth, nose or eyes with their hands unless they’ve washed their hands. If people do cough, they should either cough into a tissue and throw it in the garbage immediately, cough into their elbow, or, if they cough in their hand, they should wash their hands immediately. Vaccines that are effective against the current strain are being developed. Al of this may be hard because of Mexico’s poor sanitary conditions.

Fortunately, no cases of this disease have been reported in Costa Rica. The country is much cleaner than Mexico and its tap water is not contaminated. Cases of food poisoning and dysentery are very rare among retired people and tourists here. This is one more reason to chose Costa Rica over Mexico for retirement.

In the April 30th edition of Costa Rica’s La Nación newspaper there is a good article about the current state of affairs in Panama. For some time many publications, realtors and expatriates have been hyping Panama as “the” place to retire. Some go so far as to say that it is the world’s best retirement haven. Unfortunately nothing could be farther from the truth.

According to the most recent polls forty-seven percent of all Panamanians view crime as the most pressing problem. The number of homicides has increased the last couple of years: 444 in 2007, 593 in 2008 and at the rate things are going this year the latter number will be topped. Forty-two percent of the murders have to do with drugs and fighting among local gangs.

Poverty is another issue in Panama. The country has one of the worst distributions of wealth in Latin American which helps explain why nearly 30 percent of the population is living in poverty.

Kidnapping has become a popular business in Mexico, not just in the north of the country but especially around Mexico City.

Having lived and studied in Mexico over thirty years ago I developed a real love for the country and thought I would eventually live there. However, I discovered Costa Rica and my plans changed immediately.  It was love at first site. Given what is happening in Mexico at this time I made the correct decision.

The media has been saturated with stories about the drug cartels and  their battle with rival gangs and the Mexican government’s efforts to eradicate this growing menace. In fact, this week President Obama met with Mexico’s president Calderón in an effort to seek a solution to this problem.

Unfortunately, there has been another offshoot of this dangerous situation. Kidnapping has become a popular business in Mexico, not just in the north of the country but especially around Mexico City. Up till now the target has mostly been Mexican citizens but is only a matter of time before American retirees become the victims of this growing trade.

According to a CBS report about 70 people are kidnapped per month and this number is growing. The victims are not just the very rich but anyone with cash is now in danger. There is general climate of fear with is permeating  the society. This burgeoning problem has given birth to several business. Cars are being converted into armored  vehicles at a cost of between $30 to $60,000 dollars. Businessmen feel this is a small price to pay to protect themselves and their families. There are even stores which sell all styles of bullet-proof clothing with some garments costing as much as $5,000. In addition, almost everyone who can afford it has private body guards. In the CBS report the lawyer who was interviewed had four armed guards with their pistols drawn at all times.

Indeed the situation in Mexico has deteriorated to the point that the country is considered to be as dangerous a Pakistan by the U.S. State Department. It surprises me that one international retirement publication continues to hype the country as the best place to live in Latin America. I think the facts speak for themselves.

This one-time retirement haven for people from the U.S., Canada and other countries is just too risky. What a shame!

Fortunately, Costa Rica still awaits those who to retire south of the border. You seldom hear anything bad about Costa Rica in the foreign media. If the country is mentioned it is usually in connection with its natural wonders and destination as a tourism and retirement haven.

Corruption is also another big issue in Panama.

(1) Stability: A tumultuous political history starting with the succession from Colombia and ending with Operation Just Cause when the country was invaded. Costa Rica is the most enduring democracy in Latin America and the MOST stable.

(2) Weather: Living in Panama City is like living in Florida. Oppressive heat and high air conditioning bills. Not exactly what cost-conscious retirees have in mind.

(3) When the U.S. Pulled out in 2000 Panama had no other choice but to push tourism and retirement. Prior to that the country wasn’t a place  many people went to retire.

(4) Infrastructure: is not good outside of Panama City.

World-class infrastructure. Are they talking about Zurich . . . ?
Panamanian authorities are actually addressing the evils arising from an outdated infrastructure, failing to keep pace with the furious development that is taking place.  The housing lobby is stiffly pressing the government to improve, among others, the overstressed waste management, sewage and drinking water systems.

Daily receiving 300,000 cubic meters of raw wastewater, Panama Bay is the biggest toilet in the city.  The authorities have already approved the construction of one $350 million modern sewage system that will lead the way to clean up the awfully smelly and badly polluted bay.  Completion is planned within three years, but considering that most public projects run here in slow motion, it could take more time in order to deliver.

(5) The only cool climates are altos de María and Boquete. Both places are boring. Boquete has a terrible problems with wind at during certain times of the year.

(6) More choices of places to live and climates in Costa Rica than Panama.

(7) Here is one what one person said who has spent time in both places. ‘Cops of various kinds everywhere, constantly stopping people randomly to check your credentials etc. We had a scary run in with an immigration cop who threatened us and extracted a bribe for us (Long story but we basically just made an innocent mistake and the guy took advantage of that to give us a hard time.) The nature (parks, forests) there is more “tucked away” in parks as opposed to being visible everywhere like in Costa Rica. People didn’t seem as friendly, overall, as in Costa Rica.”

(8) Medical Care: Costa Rica has better medical care (Cima and Bíblica are the best in Central America) and hospitals and more years dealing with expatriates.

(9) Crime: is bad in Panama and they don’t publish their statistics for obvious reasons. Here is what one resident thinks of the place:

“One of the reasons is that my wife is afraid to leave the house because of the rapidly rising crime rates, especially the murders and killings that saturate the television stations every night.  It has been said that the largest number of assassinations never make it to the news room because the government is covering up in order to protect the image of Panama as a retirement paradise.  Another is the incredible deterioration in the quality of life in the capital city in the last five years.  I have neighbors who are extremely inconsiderate of their co-owners and insist on making life difficult for others in their pursuit of self satisfaction, “the world be damned, I want mine” attitude.  You can call it “juega vivo” to the extreme. It gets tiring after a while to have to be fighting the service providers such as the banks, cable companies, phone companies to keep them from abusing their customers with incompetent service.  It is almost as if it were a national obligation to stick it to the other guy lest you be considered…..what is the term?  A pendejo (coward) because you are not fighting tooth and nail to exercise one upsmanship on all with whom you come in contact throughout the day to day dealings that are required. This is especially true when you see the maniacs driving on the roadways of the capital. They could care less who gets hurt because of their negligence.”

The country beginning with the government from the highest to lowest level is totally corrupt.  The business sector probably less so. That isn’t to say that there are no honest people, there are but they have no power to make changes.  It isn’t hard to imagine that if improvements are not made in reducing corruption, the consequences of political upheaval will make living here more unbearable.

I hope this satisfies some of the curiosity as to why I would want to leave. I sincerely hope for the sake of the future Panamanians, that this can be turned around.

Also:

A) According to Panama America, one local newspaper, the statistics reported by the Technical Judicial Police (PTJ) show high levels of crime, reflecting a 32% increase during the first two quarters of 2007. The General Treasury of the Republic reported 411 violent deaths (Murders, Suicides, Deaths from legal intervention and/or from undetermined intent and Unintentional Firearm Fatalities) within the 21 Corregimientos (Villages) of the metropolitan area. http://www.pa-digital.com.pa//archive/08132007/ciudad02.shtml

B) Counting with thousands of members, 209 gangs nationwide (130 in the capital) are now bigger and deadlier.  One hundred forty-three juveniles were killed in 2006.  The rising murder rate can be directly linked to the soaring drug abuse.  Panamanian juveniles have the highest narcotics consumption rate in Central America.  The average age in which children are introduced to drugs is 12 to 14 years old, but some risk groups are exposed earlier in life.

C) The World Bank ranks Panama as Latin America’s second-worst country in wealth distribution.  The earnings of the upper economic sector, the so-called “Rabiblancos” (popular nickname for the wealthier families), account for 60% of the national income; while those at the lower end of the pyramid, 20% Panamanians, account for just 2%!  Poverty is evident at both urban and rural areas. T the Third National Report of Human Development of the Program of the United Nations (PNUD) stated that 1.4 million Panamanians, 40% of the population, live in poverty and that 16% live on less than $1.00 per day.

D) This issue could very well explain why crime is hiking higher, fueled by 8% rate of unemployment (10% in urban areas and Central America’s highest unemployment rate among  juveniles and young adults 16 to 25 years old); plus 24% rate of informal employment (30% in 2005) and the highest shadow economy rate in the region (60% of the national GDP.)  Panama’s economic progress should not be coldly measured by GDP growth.

(10) Affordability: here is another expats take on the cost of living.

“ In Panama City I think it reasonable to expect to live on $2,800/month including rent or mortgage payment for an above average life style; $2,000/month pretty bare bones with some socializing; $4,000 high end life style. Someone else may have figures on living in a small town like Chitre, Las Tablas or Volcan.  My impression of living in Boquete, El Valle, Altos del Maria is that they would be at least on a par with PC as real estate is high there, and particularly in El Valle and Altos del Maria auto expenses would be high as you would need to travel to PC for most shopping or entertainment.

Probably more than I should share about or life here, but I get weary of the claims I read of what a great life you can live in PC for peanuts. People who come here with that attitude are doomed for disappointment and are among those who cut and run after a year or two. Those who are contented here are those who are here because they love it – warts and all. “

High-end real estate property at bargain prices? They should be kidding!
Three years ago, the average ocean front-side condo at Balboa Avenue was priced at $450 per square meter.  Nowadays, prices have skyrocketed up to $3,500 and even higher in certain building complexes, up to $5000M2!

In a recent report analyzing Panama’s housing boom, The Financial Times warned about the fact that the median sales price of Panama City new condos is actually getting higher than the median sales price of existing single-family homes in America!  According to the London’s newspaper, the “baby boomers” could start to lose interest in buying a second home or a two-bedroom apartment in Panama City for $224,500 or more, which not long ago could be bought for $60,000 or $80,000. http://www.pa-digital.com.pa/archive/08272007/finance01.shtml The National Association of Realtors reported that US median national home price was $224,500 in August and prices are going down still further. http://online.wsj.com/article/SB119072589181638646.html?mod=hpp_us_whats_news

(11) Corruption:
Corruption is also another big issue here.  We are not just talking about bribe-prone traffic officers, perhaps the main complain of driving resident and visiting foreigners.  One recent survey about this subject, done by Dichter & Neira Latin Research Network, reported that 81.2% Panamanians consider the actual government as mostly lacking and/or inefficiently combating corruption.  71% consider the National Assembly as the most corrupt political body, while 65.4% perceive the Supreme Court as corrupt.  Corruption has long time surpassed baseball as the national pastime.