Industry: Private healthcare gaining ground in Central America
Upper and middle class North Americans and Europeans are traveling to Central America in search of medical, dental and surgical care. Significant savings, and equal to or greater care than in their own countries is fueling the ever growing parade

By Robert Goodier
Guatemala City

An American citizen holding his jaw while leaving a dental office in Antigua, Guatemala, is likely grimacing in anticipation of the pain he might feel when the anesthetic wears off—not from the bill he just paid. Antigua’s Clínicas de la Cruz has state-of-the-art equipment and low rates compared to the cost of dental care in the United States, an example of the growing number of high-quality healthcare clinics and hospitals in Central America catering to nationals and foreigners alike with an international standard of service. Their client lists are ever growing, fueled by an abundance of health insurance options, an increased number of foreigners living and traveling abroad, visiting nationals living abroad, increased regional stability, and new international trade pacts.

Dr. Hugo Villegas, medical director of Costa Rica’s private hospital CIMA in San José, said that a third of the hospital’s clients are American, followed by Canadians and Europeans. Asked about the income levels of his clients, he said they tended to be in the upper-middle or upper class, “although with the proliferation of medical insurance companies we are seeing more from the middle class. We accept foreign medical insurance and as of late Latin American medical insurance companies are referring clients to us,” he said.

The clear advantage of private care

An empanada vendor selling fried snacks near the hospital’s main entrance may lend a Latin American twist to public health care, but the more telling sights are of overcrowded waiting and emergency rooms and lines winding half a block or more from side doors, all signs of overburdened health care systems throughout the isthmus. Public hospitals throughout Central America tend to serve as training grounds for medical students and residents who often later go on to work in the private sector. Doctors may work two jobs, one in a public hospital and the other in a private clinic. “They can’t make ends meet” on a public doctor’s salary, said Dr. Estuardo Ligorria, acting CEO of Guatemala’s prestigious private hospital, Centro Médico. “There is an abyss in quality and treatment” in Guatemalan public hospitals, said Christian Guillermo, administrator of the private hospital Herrera Llerandi. The system is too poorly equipped to deal with the sheer number of people who need it, he said, unlike in his private hospital, where the staff is internationally accredited and the facilities are top-notch.

One state official in Honduras admitted that citizens who pay for private care can expect better customer service than from its public counterpart. In fact, doctors and representatives of major private hospitals throughout Central America that were consulted for this article unanimously point to higherquality training, better equipment, and faster service as some of the advantages their facilities have over public hospitals.

Yet it may be disingenuous to speak of public health care in Central America as one entity, since the quality varies wildly in each country. Costa Rica’s overall healthcare system is world-class, reaching the 36th spot on the World Health Organization’s international healthcare system ranking in 2000, one slot higher than the United States. In comparison, Honduras and El Salvador ranked 131st and 115th, respectively. The quality in private care, however, seems to ignore borders, with the biggest private facilities boasting top-of-the-line equipment and training regardless of what country they are located in. Many of these private hospitals established links with U.S. hospitals and universities and are internationally accredited. It is telling that in Costa Rica and Honduras, both of which offer free health care to its citizens, 25 percent and 20 percent of the population, respectively, regularly pay for private care.

The grimacing U.S. citizen leaving the Guatemalan dental clinic represents a growing category of private-clinic clients: expatriates and so-called medical tourists. Not only do many expatriates use private facilities, but others are combining a vacation in the tropics, or a visit to see family, with medical services significantly cheaper than what they would pay in the United States or elsewhere. The phenomenon has grown so quickly that Costa Rica’s CIMA, for example, added a floor entirely for medical tourists. Guatemala’s Centro Médico cut the ribbon on a new facility on June 7 and is focusing on the growing medical tourism market as well. Dr. Ligorria said it is a fast-growing business, offering services at prices that are “very attractive and affordable to a U.S. citizen who does not have insurance or is underinsured – the HMOs, you know. Over the years I’ve seen people come here because they are tired of things not getting done well in their countries.”

Salvadoran doctors joined together in attracting medical tourism by creating the Health Services Exportation Chamber (Cámara de Exportación de Servicios de Salud – EXPORTSALUD). According to Dr. Carlos Ramos Hinds, president of the chamber, in 2007 nearly 2,800 Salvadorans living abroad and 1,000 foreigners visited El Salvador to undergo medical procedures, a number the chamber aims to increase. “Growth expectations in the health tourism sector are enormous, not only here in El Salvador but worldwide,” he said. “It’s a trend growing exponentially, influenced by many factors. With the creation of the chamber, we are trying to organize and increase this movement of foreign patients or nationals living abroad seeking first-class medical attention at the lowest cost.” As is the case among promoters of medical tourism in Costa Rica and elsewhere in Central America, EXPORTSALUD touts El Salvador’s ideal location – a twohour flight from Miami or four hours from Los Angeles – and its draw for beach loungers and adventure seekers alike with beaches, volcanoes and tropical forests.

Guatemala

The country is not commonly associated with healthcare, but a look at the services offered at Centro Médico de Guatemala in Guatemala City makes a convincing case that it should be. Founded in 1948, the hospital is the oldest private care facility in the country, with 200 specialists and world-class facilities, including a newly inaugurated tower with 24 deluxe rooms and suites and a helipad. The facility is rightfully called the best in the country, and caters to foreign dignitaries, medical tourists, and Guatemalan nationals, among others.

Anahi Godínez, client services and marketing manager for the hospital, said people choose the hospital because they trust its doctors, the tradition of medical ethics, the attention paid to hygiene and epidemiological control, and its “kind and human treatment”. The hospital has an educational agreement with the Memorial Regional Hospital in Hollywood, Florida. According to Dr. Ligorria, “for the last seven years, we have had the mission of offering the best medical care in the country and all of Central America. Therefore, we are always trying to improve our facilities, we have the best equipment, we keep up with our staff, and we are not just talking about it, but we really try to be the best in town.”

Not to be outdone, the Herrera Llerandi hospital, also in Guatemala City, provides care for an equally distinguished clientele and offers high-end facilities and services. It is constantly investing in new equipment, and recently purchased a digitalized imaging system for improved diagnoses. The hospital has links with the Methodist Hospital in Houston, Texas and Baptist and Kendal hospitals in Miami, Florida. Guillermo said “the hospital offers the highest technology and the vanguard of medical attention, the highest quality services for both outpatients and overnight patients.”

El Salvador

According to Exportsalud, El Salvador’s two biggest private hospitals are Hospital de Diagnóstico in San Salvador and Hospital de la Paz, in San Miguel, closely followed by Hospital de la Mujer in San Salvador. Dr. Hinds suggests that growth in the private health sector has been due to increased awareness among patients. “People are increasingly well informed and there has been a change in the mentality of patients and their family members,” he said. “Today, patients want more and more precision in what is their diagnosis, what is their management plan and prognosis. In the old days, patients were content with taking a pill, without even knowing what it was treating or what they could expect for recovery. Today, people question their doctors, want to be involved in the treatment decisions and ask for second opinions, and only private healthcare holds as its primary focus that relationship of equality and trust between the doctor and the patient.”

Honduras

CEMESA and Hospital del Valle in San Pedro Sula and Honduras Medical Center in Tegucigalpa are among the top hospitals in Honduras. The most in-demand services are check-ups as well as general and aesthetic surgery. Marcela Peña, marketing manager of CEMESA said they have plans to build an entirely new facility and turn the present one over to low-income patients. The hospital has links with the Texas Hospital and Texas Children’s Hospital in Houston, where Honduran doctors are sent for training or U.S. doctors are sent to work in the San Pedro Sula hospital. Patients are sometimes sent to the American hospitals as well. According to Dr. Rudy Cruz, medical director of CEMESA, demand for private health services in Honduras has grown 300 percent in the last five years, and CEMESA alone has jumped from a 35 to a 75 percent occupancy over the same time period. Cruz said that the spike in the demand was fueled by an online service developed by the hospital five years earlier to attract Honduran immigrants living in the U.S. Potential patients can send an email with their questions and include test results from U.S. hospitals to doctors in CEMESA, who then provide them a diagnosis as well as the costs of the treatment or surgery. Treatments are also available for relatives of immigrants residing in Honduras, whose treatment is paid for by relatives working in the U.S. “Remittances [from Hondurans living in the U.S.] have spurred the growth of our services and of the Honduran economy in general” says Cruz.

The Honduras Medical Center –HMC- is another example of this explosive growth. Opened in June 2003, in a period of five years it has captured 50 percent of the market share in Tegucigalpa. Dr. Ricardo Aguilar, medical director at HMC, said that although the hospital has not been keeping an official tally, many of the hospital’s bills are paid by international transfers from Hondurans living in the U.S. “Without these relatives working in the U.S., their access to our medical services would be limited” said Aguilar about Hondurans with low wages. As with other hospitals in the country, HMC is linked with a hospital in the U.S., the Methodist Hospital in Houston.

Costa Rica

Clínicas Bíblicas and CIMA are two of the country’s biggest and most reputable clinics, where English is often spoken well. Clínicas Bíblicas offers state-of-the-art facilities, with recent purchases of equipment such as a magnetic resonance imaging (MRI) machine and an endoscopic surgery suite for minimally invasive surgeries. It is the only hospital in Central America accredited by the Joint Commissions International, a division of the non-profit Joint Commission, the largest accrediting organization of healthcare facilities in the United States.

Hospital CIMA is operated by the International Hospital Corporation, headquartered in Dallas, Texas, and is nationally accredited in Costa Rica. This year it doubled its operating room capacity to eight rooms for major surgery, four of which are “intelligent” rooms outfitted with the latest in imaging hardware.

Physicians and nurses take advantage of an education exchange agreement with U.S. hospitals Johns Hopkins, Mayo Clinic, MD Anderson Cancer Center, the University of California at Los Angeles, and the University of Texas Southwestern. Dr. Villegas attributes the popularity of CIMA and other private hospitals to the enactment of the Central American Free Trade Agreement and the growth of medical tourism, “with the recognition of high quality medical care in Costa Rica is leading us to invest and grow accordingly,” he said.

 

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