www.CostaRicaTicas.com

Can I get a couple of suggestions as to one or 2 of the better hospitals in San Jose to be used in the event of a medical emergency. Also--are there any hospitals that provide comprehensive medical care in the Quepos/Manuel Antonio area and if so how well rated are they? Thx.

In San Jose, there are only 2 that I would consider:
1. Clinica Biblica which is located about 8 blocks south and 4 blocks west of the gultch.
2. CIMA which is located in Escazu near the Multiplaza.
LVSteve

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Just an old horney, fat gambler.

Would add to LVSteve's recommendation Clinica Catolica in Guadalupe. Not as well know in the gringo community as Biblica or Cima but an excellent private hospital

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Pura Vida
Only Irish coffee provides in a single glass all four
essential food groups:
alcohol, caffeine, sugar and fat.
Alex Levine

Piroca,

Bring your own smoke detector if you stay overnight.

Just a thought...

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Eu gosto de brasileiras...

Not a bad idea if you in a public hospital such as San Juan de Dios which is over 100 years old and made from wood. The public hospital in Alajuela, which has been open less than 1 year, has much better safety equipment.

However, the private Hospitals (Clinica Biblica, Cima & Clinica Catolica) all have adequate safety features. For example Clinica Biblica has internal fire hoses, emergency lighting, alarms, heat detectors, well marked emergency exits, emergency evacuation maps as well as fire extinguishers. In addition they have on site their own full time fire fighters.

_________________
Pura Vida
Only Irish coffee provides in a single glass all four
essential food groups:
alcohol, caffeine, sugar and fat.
Alex Levine

I was taken to Clinica Biblica after a crashing and burning at the DR about 1am couple years ago . Thought I was having the Big One .Was seen immediately by an internist given Ivs , X rays, blood test and a EKG. A short time later a cardiologist arrived . To make a long story short I’m still kicking . The staff and doctors seemed very component and the hospital was cleaner and better organized the many I have been to in the states. Total cost $324.00US

I've heard rumor that MD's in CR are pretty good with many recieving training in US, Canada, or Europe.

Is this case? In other words if one, hypothetically, was to have a serious accident or was in need of surgery (for say appendix) would these guys match US docs?

In general the care you will receive from Costa Rican physicians will be equal to the care you get in the US with one major difference. Your Doctor in CR will spend time with you asking questions, examining you and answering your questions. You will never feel rushed or feel you are just another few dollars in his pocket.

The private hospital are clean, well staffed and well equipped. The public hospitals are old, overcrowded and lack the latest equipment.

The cost for a private hospital is high for Ticos but ridiculously cheap when compared to US prices, for example:

Mulletguter wrote:



What would his bill been in the United States?

My own experience is similar. For reasons not important to this this discussion I need to have a yearly colonoscopy. Cost in Miami for the Dr. and the hospital...anywhere from 3 to 4K. My cost at CIMA for DR., Anesthesiologist and hospital $424.00

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Pura Vida
Only Irish coffee provides in a single glass all four
essential food groups:
alcohol, caffeine, sugar and fat.
Alex Levine

One thing I might add. I was staying at the DR and wasn’t going anywhere else , so I just had a few bucks in my pocket . ID and CC’s in the room safe. My ATF Chica went to the Hospital with me . There was a little problem at the check in because of no ID and no way to pay . She went back to the DR to find my buddies who had no clue what had happened. They came and gave them a CC. I had already been admitted.

Now I always carry one CC and copy of passport when I leave the room.

This is Great information. However, is there a hospital in or near the Quepos area that's essentially a full service hospital in the event of an emergency?

My personal experience is with CIMA and Clinica CAtholica.

Both had excellent service. CIMA is beautiful, and looks like an embassy with very rich decorum, and the front desk and reception all wearing professional suits and business attire.

Catholica looks more like a typical cinder block hospital. But as with CIMA, I was admitted within 20-30 minutes, and the doctors were not rushed and the nurses were all very helpful. Very pleasant environment-- much different than the HMO's back in the States.

However, I've heard that once you stray from SJ, the quality of medical practice suffers, greatly.

http://www.nacion.com/ln_ee/2005/julio/24/pais1.html

Mayoría de hospitales operan en condiciones críticas:
Construcciones son obsoletas y falta personal en enfermería
Directores reconocen fallas, pero solicitan más apoyo de la CCSS
El 78% de los hospitales públicos opera en condiciones críticas.

Según un estudio realizado por el Ministerio de Salud, 21 de los 27 centros incumplen con el 30% o más de los requisitos de personal, mobiliario e infraestructura que exige la norma de habilitación aprobada en el 2002.
Durante dos años, los funcionarios evaluaron planta física, trabajadores, equipo y documentación de todas las unidades de servicio de los hospitales.
Si bien el grado de cumplimiento no es el adecuado, hasta el momento no se ha ordenado el cierre de algún centro.
Francisco Gólcher, jefe de la Unidad de Habilitación del Ministerio de Salud, explicó que las recomendaciones sugeridas en el informe son de acatamiento obligatorio, pero agregó que, por ahora, se solicitó a cada hospital un plan para remediar la situación, con su respectivo cronograma, el cual debe ser aprobado por ellos.

En el México y otros hospitales nacionales están revisando los extintores y equipo contra incendios para prevenir accidentes.
Eddy Rojas
"Estamos claros de que algunas decisiones dependen de niveles superiores como la inversión o contratación de personal, por eso, evaluaremos las solicitudes que los directores hagan ante las autoridades de la CCSS", dijo.
Los directores de los centros hospitalarios aceptaron que deben hacer mejoras en sus establecimientos, pero solicitaron más ayuda por parte de las autoridades de la CCSS. Aclararon que siempre han estado realizando cambios.
Al mismo tiempo, dijeron que es lógico que la mayoría no cumpla el 100% de la normativa, pues muchos hospitales fueron creados hace más de 80 años, y la reglamentación se aprobó hace tres.
La norma de habilitación especifica las condiciones que deben cumplir los centros hospitalarios públicos y privados.
El Ministerio de Salud también evaluó cuatro centros particulares, y la mayoría de ellos están totalmente a derecho.
Algunos puntos. Entre las conclusiones de infraestructura, el estudio determinó que el 63% de los hospitales tiene construcciones obsoletas. Además, la mitad de ellos ya cumplió con su vida útil, pues tienen más de 30 años.

En la Unidad de Oncología del San Juan hay problemas de personal. Andrea Ledezma es enfermera, pero labora como auxiliar.
Eddy Rojas
También se evidenció un alto deterioro en los pisos, paredes y cielo rasos de las estructuras y apuntó que "el mantenimiento preventivo y correctivo está rezagado".
En cuanto al recurso humano, el análisis sostuvo que la mayor deficiencia está en los hospitales regionales y periféricos.
Existe un recargo de funciones y algunos no cuentan con especialistas, sino que son atendidos por personal técnico, como Internamiento o Farmacia.
Una de las principales preocupaciones de los directores es la carencia de plazas para enfermeras y anestesiólgos.
Por ejemplo, el hospital de Liberia estrenará en febrero seis salas de cirugía, pero solo tiene dos anestesiólogos, para las tres que ya tienen y para las nuevas.
Algunos detalles de la Norma
En regla
Preocupación
Directores están preocupados por el faltante de enfermeros y anestesiólogos
La norma se publicó el 23 de setiembre del 2002 en La Gaceta.Clasifica según los servicios que se dan en obstetricia, atención al recién nacido, cirugía, medicina interna, ginecología, pediatría, emergencias, anestesiología, farmacia, enfermería, diagnóstico por imágenes, laboratorio clínico, esterilización, nutrición, trabajo social, infecciones intrahospitalarias, dirección, administración, registros médicos y estadística, seguridad e higiene laboral, lavandería, documentación.La norma toma en cuenta el recurso humano, la planta física, el recurso material, documentación, gestión, educación, manejo de la información y la calidad en cada uno de los servicios.
Buena nota
Privados. El Ministerio de Salud evaluó cuatro hospitales privados de la capital: el Cima San José y las clínicas Bíblica, Católica y Santa Rita.
Buena nota. Según el estudio, la Santa Rita, Cima San José y Bíblica cumplen con el 100% de la norma de habilitación. La Católica obtuvo el 67%.
Argumento. El director de la clínica Católica, el médico Juan Carlos Quesada, explicó que las autoridades de Salud hicieron la evaluación en el 2002 y desde entonces no han regresado. "Nosotros les hemos entregado informes con los trabajos y correcciones que se han hecho, eso no está reportado en el informe. La mayoría de las observaciones fue de asuntos logísticos, había que arreglar algunos protocolos y asuntos de recursos humanos".
Cambio. Quesada agregó que hace tres años la clínica Católica estaba administrada por las hermanas de la Purísima Concepción, ahora está a cargo del Grupo Sama.
Habilitada. Sostuvo que la habilitación que les dio Salud vence en julio del 2006. Fue del criterio de que los privados deberían tener una norma diferente a los públicos, porque ellos no poseen salones con pacientes, sino habitaciones individuales, por lo que muchos puntos que incluye la norma no los involucra a ellos.

Hospital de Quepos con plan correctivo para que extintores no caduquen, hay unos vencidos.
Francisco Rodríguez
Con recursos propios
Otros centros intentan mejorar

Hace 10 años el hospital Enrique Baltodano, en Liberia, Guanacaste, fue declarado inhabitable por el Ministerio de Salud.
Hoy es el hospital del Estado con el porcentaje más alto de cumplimiento de la norma de habilitación, con un 77%, a solo tres puntos de salir del rango "bajo" para subir al "bueno".
El médico Mario Angulo, director interino, explicó que el esfuerzo ha sido paulatino, pero constante. "Los detalles que nos faltan por resolver son sencillos, como protocolos de atención", dijo.
Entre las modificaciones, el edificio de hospitalización es totalmente nuevo, y en febrero se abrirán seis salas de operaciones, además de las tres que ya están.
La otra cara.En 1993 las autoridades del San Juan de Dios, en San José, desalojaron la sección de Medicina porque no soportaba un sismo, pero en octubre de este año se inaugurará la nueva estructura, con un costo de ¢2.500 millones.
Manrique Soto, director del San Juan, dijo que muchos de los arreglos en estos centros se ejecutan con recursos propios del hospital. Sostuvo que si bien se envían cartas a la junta directiva de la CCSS, en las que exponen los problemas, no siempre reciben respuestas.
Dinorah Garro, administradora del hospital México, explicó que ellos siempre proyectan las prioridades de cada año, pero lamentó que los recursos son tan limitados.
"Las obras menores se deben incluir en los presupuestos de cada hospital, pero para las más grandes necesitamos apoyo de la CCSS, el problema es que para nosotros algo que parece muy grande puede ser pequeño según las prioridades de las oficinas centrales", dijo.
Alberto Sáenz, presidente ejecutivo de la CCSS, indicó que la responsabilidad de los edificios y pacientes es de los directores.

En pocas palabras
Alberto
Sáenz
Presidente ejecutivode la CCSS
"Directores deben priorizar"

El informe del Ministerio de Salud revela que el nivel de cumplimiento de la norma de habilitación hospitalaria es crítico.
El diagnóstico es muy útil, que se tendrá que atender de forma paulatina, pero las sugerencias y correcciones que se piden en los hospitales no se pueden resolver de la noche a la mañana.
Algunos sostienen que la norma tiene estándares muy estrictos y difíciles de cumplir.
Nosotros no queremos estándares bajos, siempre debemos aspirar por los estándares más altos, estamos de acuerdo con ellos, los podemos alcanzar, pero de manera paulatina.
Los directores de hospitales están de acuerdo en cumplir con la norma y hacer las correcciones del caso, pero sostienen que necesitan más apoyo económico por parte de los directivos de la CCSS.
Los directores deben priorizar sus presupuestos, y al igual que ellos harán su esfuerzo, nosotros también haremos el nuestro por fortalecer los recursos para mantenimiento y mejoramiento de los edificios y personal. El director el es responsable del edificio y de los pacientes de cada hospital. Primero se debe administrar lo esencial, sin dejar de hacer cosas.

CRFan,
Thanks for that article though it might help those of us whose spanish is not quite so fluent if you could either have translated or AT LEAST just provided the jist of what it was saying in ENGLISH (While providing the full article for those with the time or ability to translate it). Basically, it was a story about how most hospitals in CR beig critically short of established standards. The question in my mind is how those standards measur eup to other latin countries or even the US. I've seen similar complaints from time to time about US hospitals. They had a case here in Tampa not long ago at one of our hospitals of a surgeon removing the wrong foot of one patient. One can always find horror stories in the media (thats what they like to report).

I've heard stories like this too. In fact, the last time I was in CR I went to a dentist (who trained at Tufts University in Boston-#1 dental school in the US) and the cost came out to about 1/3 of what it would have been in the US. We've all heard of sex tourists and eco-tourists. Well, there's also a medical tourist category. Often these are rich Los Angelenos going to CR for some cosmetic surgery and a week or two of healing time for less total cost than if they had the procedure done back home.

If one needs a procedure, like a colonoscopy, that costs $3-4K in the US and that one can get in CR for $424, one can obviously save a lot of money and get a nice vacation to boot by having the procedure done in CR rather than back home. Here's my question. That all assumes that all the costs would be coming out of your own pocket. Usually the $3-4K procedure back home will be mostly covered by your health insurance. What is story about having your insurance cover the costs of having the procedure done in CR? Will they normally cover only the $424 or also your air and hotel costs (obviously chica costs will always be out of pocket) or are you completely on your own? Even if they don't cover anything, one might still come out ahead if the cost of the procedure is less than your deductible. Obviously one needs to check with the health insurance carrier, but I was just curious to know if anyone has any experience in this area?

YO Prolijo:

Damn good retort. Although I can read some of his text it is difficult to really understand it enough. BTW, this is an english language site.

My problem with hospitals in CR and one of the reasons I decided not to move there for more economical medical care is that I am not convinced about the care. Yes, there are good physicians and perhaps OR facilities but there are many other services needed. For a number of lads on this site who are younger without health problems this is not a problem. Seniors like myself have a problem with this. I do not want to be laying on a gurney in a hallway and not being able to communicate with a nurse when my expanol is diminished due to sickness. And that is even if I live near SJ with better facilities .....which would not be my desired residence.

This has always been a concern and I think that older ex-pats must examine it very closely.

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Damn if I'm going to repeat this shit again. I need a drink.
I've been drinking vodka every day for 45 years and I have certainly never found it to be habit forming.

Sorry I didn't have time to expand on the article last night.



Thanks for that little insight, Circus, ole boy. I went back and looked over the rules of the board and was unable to find that...guess I just didn't search well enough. Oh well. My father came to visit me when I lived in Italy and he just couldn't believe how stupid (his word) everybody was because they couldn't speak English.

Anyhow the jist of the article, as I interpret it, is as follows:

I don't find a lot of discussion of the capability medical staff or of the quality of treatment...or how many left legs get cut off instead of right ones. It is more an evaluation of structural condition of construction, availability of support staff/nurses/appropriate specialists, adequacy and availability of furniture and of emergency safety items such as fire extinguishers.

There is particular concern expressed about shortages in nursing staff and in adequate numbers of anethesiologists.

As would be anticipated, the private hospitals received better scores than the public ones. Of the 4 private hospitals in San Jose (Cima, Bíblica, Católica and Santa Rita), Catolica was the only one that did not receive a perfect score. However, the new administration of Catolica says that corrections have been made there since 3 years ago when the evaluations were actually performed.

Of note, the hospital in Liberia did quite well after having failed miserably a few years ago.

That's the best I can do on the article.

Another note just for the fun of it. UCR is very difficult to get into and recently several private med schools have popped up. They are much more expensive, but acceptance requirements are far lower than UCR. Many med students do a portion of their training in the US by doing rotations in US hospitals, etc. But you gotta be careful.

An older gringa friend of mine had eye surgery from an ophthalmologist who claims to have his degree from one of the premier universities in California. He botched the surgery dramatically and she had to search for help in one of the private hospitals. The head of the department tells her that this guy actually just did a rotation in the California school...and he was only there for 2 weeks before he got thrown out for being caught stealing small equipment from the school's lab. (verified on video)

Also, my attorney was plaintiff's attorney on a case against a plastic surgeon. He had a meeting with the Colegio of Medicos (basically what we would refer to as the State licensing board). When he told them who he was there to talk about, they just pointed to a file cabinet and said they had hoards of complaints on that particular doc for botched plastic surgery...it was made clear that no kind of discipline had been given and that none was anticipated.

That said, there are a great number of very capable and well-trained physicians here. Just don't think that you can believe the first one you talk to. Checking background and getting referrals from satisfied patients is very important.

CR Fan