Wednesday, October 7, 2009

Vamos al médico! Let's go to the doctor! Health care in Chile

One of the questions that gets alot of play over on a board or two that I post on is health care in Chile. About which I can say, it is generally good. There are two systems of health insurance, public and private, FONASA and ISAPRE, respectively which I believe anyone can opt into, though the prices as an individual are higher than as part of a collective contract. I continued my health insurance from my previous employer when I went indie, and if you want to know how much that costs, email me, you know where. Talking about the cashflow factor online is sure to get you some freakshows, and I attract enough already as it is.

Basically how it works is thusly: You get sick! oh noes! what to do? You call or make an appointment online. But where? MegaSalud and IntegraMedica are two kind of catch-all medical centers, though those of you who live further uptown or have posher tastes in clinics may prefer Clinica Santa Maria, conveniently located on one bus route, across the river from the Salvador Metro station, or the Clinicas Alemana, Vitacura, or Arauco Salud (at the mall!) or even MEDS, if your problem is sports-related. Downtown, less spiffy options include the Posta Central (really only for people who have FONASA, or public insurance), and very good care can also be had at Clínica Davila, Hospital de Profesores, and a number of others (pimp your favorite, if you like).

So. You haven't quite coughed up a lung, yet. Please arrive at the doctor somewhere between ten and fifteen minutes early. More than fifteen or so minutes, and they won't sell you your bono (copay coupon), so don't think about going in the morning to buy the bono for your afternoon visit. Bono purchasing is usually done by putting your right index finger on the digital scanner, confirming your identity (no ID needed!), and they forking over the copay money, which, depending on your previsión (coverage, sorta) and the care you require will probably cost between about 3 and 10 thousand pesos ($5-$18, usually more like $7-$10, in my experience). You then wait in the waiting area until you are called to your box, or consult room, usually by the doctor himself.

You then have fifteen minutes to defend yourself from accusations of being overweight (a popular topic for all but the preternaturally thin), explain how long you've been in Chile, and why you came, do a quick assessment of your doctor's English skills and oh, get the medical attention you came for.

Among the gringas that I know, we cast about good doctors' names like hard-won treasure. It's not that the other docs are bad, it's just that we have expectations, formed in our home countries, of how doctors should treat us, the language they should use. I have to admit that I often choose doctors (if I don't have any recommendations) on the basis of them having foreign-sounding names. When I was hoarse for two weeks, and was beginning to wonder if I would ever get my voice back, I went to see a doctor whose middle name was Azucena, a name I can almost guarantee does not (and did not) belong to Chilean. She was Ecuadorean, and used actual medical terminology, talking about vocal chords, trachea, and inflammation, pathologies and recovery time, and didn't once say "gargantita" (widdle iddy bitty throat). I don't think it's just me, but I don't want infantile language coming out of my medical professional's mouth. I have a friend (who shall go nameless, even though some of you already know this story) whose gynecologist referred to her having relations with her husband as "playing mommy and daddy."

Really? He's a medical professional, and that's the best he can do? I'd like to see him delivering a baby. Oh look! here comes the doll, little girl! Now you can play house!

Baby talk aside, the whole experience isn't really so awful, though it's best to ask for an English-speaking doc if you need one. Everyone will have an academic knowlege of English, but they may touch your back and say, "you are humid!" and you may then wonder about the precision of their words (this, too, happened to a friend). There is a long story I have to tell about the bizarre thing that happened to me one time when I went to leave blood and pipi (I mean urine) samples, which will make you laugh, or at least thank your lucky stars for those wipes they give you in the states.

For now, I leave you with healthy thoughts, assurances to my mother that I have not required medical attention any time recently, and with the reminder (those of you in Chile) that we change the clocks this Saturday. Spring forward. East Coast US-people, that will be one hour time difference. When you guys fall back there will be two. So simple, yet so confusing!


Fly Girl said...

Hmmm, almost any health care is more accessible then what we have now in the U.S. I'd put up with baby talk if they they had sort of a clue about what they were doing. And what's with the weight preoccupation? Are many Chileans considered overweight?

Eileen said...

I don't have any complaints about the accessibility of health care at the moment in Chile. I'm sure that poor people have less access to health care, and that entering a hospital as "indigente" gets you worse care than if you go to a private hospital, but in general things seem pretty okay on the health-care front, though I have gotten some doozy médicos with harebrained advice/opinions.

Re: weight. Chile has a very high obesity index, comparable to that of the United States. However, that's people who are medically obese (judged by BMI), not people you might think of as obese just by looking at them. People tend to be chunky, but you seldom see people who would have trouble buying clothes at a regular store, and the sizes go up to about a 16, I think. (not really sure).

Chileans in general have stomach problems (IBS, ulcers) and high blood pressure. They also tend to be apple-shaped, carrying a lot of weight around the middle, which has been proven to be bad for the heart.

However, hassling European stock gringas for not fitting the Chilean beauty (and to some extent) health standard, is just plain stupid. Also, I don't know how they missed the memo, but yelling at people about their weight does not get people back to the doc any time soon. I've had few problems on this front, but a fairly svelte friend of mine was recently told that she was just on the border of overweight. She's healthy, and fine. And now, justifiably, irked.

and hey, thanks for commenting!

lydia said...

hey, that was my goal for this week: figure out healthcare! how convenient.

you know, i've never thought of looking for a perfect-english speaking doctor... i always thought the ideal would be to get a doctor with 0 english, and that way avoid the annoying conversation and awkward vocabulary i always get. sometimes when i think people are trying to learn or practice english they let the original goal of the visit slip past them and i almost not gotten the medical care i wanted because my doctors spending so much time talking about gringas and halloween.

i think i would start breathing fire if my doctor didnt use medical terms. (now that'd be a sudden symptom they'd struggle to diagnose!) i dont' remember specifically in the past but i also haven't gone in much.

thanks for the info.

Eileen said...

@lydia, if you have health insurance, you might need a credencial the first time you darken their door, not sure. There's sometimes some kind of activation process you have to go through. Otherwise you can go to the posta and get care (though I was turned away in Iquique because I have ISAPRE and there were alot of people waiting.) Hope you find good docs in Valpo, there are good ones everywhere. Watch it on the firebreathing though, who knows what they might diagnose you with!

Abby said...

Hmm...svelte...I like it :)

Annje said...

I only had a few experiences with medical professionals in Chile, and don't remember many details, but I have had several conversations about how differently doctors treat you and talk to you,going by what Chilean friends and family have told me about maternity and pedatric care in Chile vs. the U.S.: i.e. what kinds of instructions they give, what kind of choices you would typically make. It seems healthcare in Chile is a little more "paternalistic" perhaps.

The baby-talk would definitely bug me--call it what it is and tell me what I have--I can take it--trust me.

I have thought about the task of finding a doctor for myself and kids in Chile and I too have thought if maybe foreign might be the way to go.

Taryn said...

Oh, this one makes me laugh for so many reasons! Such a "fun" topic and so many good stories out there!
Like the doctor who gave me the link: as a reference for the medical advice he gave me??!!? All with a straight face!

Lydia, I agree. Best to avoid those who think they speak English.
Oh how I wish doctors and waiters would all subscribe to my "respond in the language in which you were addressed" policy.

Annje, I don't know how old your children are, but I have a fabulous pediatrician "dato" if you're interested.

Eileen said...

Taryn, and it doesn't get any better, I was with a friend who's been in Chile for nearly two decades and speaks flawlessly, and she still got the f'd up English response. Until he got to the word bebida (this was in a resto), and realized he didn't know how to say it in English. Argh! I'm so happy for Elisa that she'll fit in in Chile, just fine!

Sharon said...

BTW, Arauco Salud has been bought by Megasalud, so it will change names soon. The whole thing is a mess right now and the people working there might have been lobotomized recently, judging form the way the handle things. It was an ode to ineptitude.
Thankfully, the only doctor we have over there is a family friend, so it made the whole visit a lot less uncomfortable.

Margaret said...

Great topic. I really haven't had many try to practice their English on me, but I did have an ortorrino (ENT) hum churchy hymns as she shined her little light up my nose... Needless to say, I didn't rush back there in any big hurry...
And let me guess, did your urine sample story involve the assistant who wanted to hold the cup? (yeah, like that went over real well!)

Matt said...

I've had pretty good experiences with doctors here- No budding English students, professional care and a couple of good contacts out of them; my last doctor's brother is head of SII in Santa Cruz, always helpful :) I do only go to the most expensive clinicas I can find though, I'm a bit cuico like that.

I also think doctors treat girls differently here. And rightly so. Everyone knows it's a big, bad world out there and girls are poor, defenceless little lambcitas who must be protected from real language.

I have no idea whatsoever how my insurance actually works. I come from a first world country and first world countries have universal health care. All I know is that I pay 30 luca a month and get pretty much fuck all to show for it, apart from a card from Banmedica with my name spelled incorrectly.

Eileen said...

Matt says: "All I know is that I pay 30 luca a month and get pretty much fuck all to show for it, apart from a card from Banmedica with my name spelled incorrectly."

Women, beware. You will not find health insurance anywhere near this cheap (most people I know who go private pay between 150% and 200% of this) because of a little something I like to call "the uterus tax." When I pointed out how ridiculous it is to tax me for something I'm not planning on using, an employee said, but women go to the doctor all the time! And I said, yes, and men don't go until they're on the verge of death. And she said, yeah, and then they die. That's cheaper for us!

You heard it here first!

And Margaret, my story is worse than cup holding. I don't even know if I can tell it! But in the end, all was fine and my pipi is limpiecito, which I know everyone was worried about.

Anonymous said...

Um, I want to hear the story, although I may regret it later ;)

Emily said...

First, to Matt: "I come from a first world country and first world countries have universal health care. All I know is that I pay 30 luca a month and get pretty much fuck all to show for it."

Ha. Hahahahahaha. I only laugh because while your first world country does in fact have universal health care, the US does not. I would far rather be uninsured and poor in Chile than in the US. And like Eileen said, I pay twice what you do simply because I'm a girl, and I have not yet hit 25, at which age I apparently will become a baby making machine and have to pay accordingly.

Back to the post: yes, this overweight thing is weird. I've only had it at the gym last year, when the guy told me my BMI which was on the low end of the healthy range and then said "so you shouldn't lose weight, you should just get rid of some of this fat and make more muscle." Granted I hadn't been working out regularly, but following this guy's advice would have put me in serious athlete BMI territory. Seems like maybe they should work on encouraging proper nutrition and exercise on a societal level before focusing on telling the gringas to lose weight? I'm sorry, I'm 5'9", if you ask me to weigh what a 5'2" Chilean woman weighs I will actually die.

Anonymous said...

interesante post, en realidad todo lo que tiene que ver con salud en un buen tema en cualquier parte del mundo, nunca sabes si lo vas a ocupar, como chilena nunca he tenido malas experiencias en cuanto a salud talves sera porque consulto poco, y de los dos sistemas que funcionan en chile he usado ambos, y hay diferencias en cuanto a coberturas se trata, ahora en cuanto a atención son muy similares.
En cuanto a los hospitales, postas o consultorios publicos te atienden con cualquier tipo de prevision que tengas, ya sea privada o publica, por lo general si tienes isapre pagas una consulta particular luego tu isapre te reembolsa, en muchos casos si eres extranjero y te ocurrio un imprevisto que necesita una urgencia y no cuentas con prevision te atiende gratuitamente.
ah otra cosa si alguna vez tienen una urgencia y asisten a una clinica, hospital ya sea publica o privada y les exigen un cheque en garantia para su atención esto es ilegal.

Andrea said...

"Uterus tax" is a very accurate name. Can I 'steal' it?

FWIW, I'm 30 & a woman, & pay 130000/month for private health insurance. My boyfriend, who's 32, pays 55000 (yes, less than half what I pay) for exactly the same health plan, just because he's a guy.%$#@€€&/@~!!!