I had appendicitis, which was treated in a public hospital in Brazil, and here is the story. “But, Sirsandals, that’s all fine and good however I’m not here to read about your medical issues… Show me the MONEY”.
Don’t worry. If you stick around to the end, there will be a neat tie in with finances.
The same week I had appendicitis, earlier in the week I had a sore throat. I went to the UPA; on that point, let me explain a bit about health care in Brazil.
Brazil has free national health care. It also has private health care, for those who prefer the private facilities. In the private facilities, you’ll have nicer rooms, potentially lower wait times (depending on location) and potentially more sophisticated equipment. I have used both. Last time Mrs. Sirsandals and I were both in Brazil before moving here, she had a little issue for which we went to a private facility. Everything worked out fine, and the total bill wasn’t that bad. We paid about $400 BRL, which was about $80 USD at the time; for a bunch of labs and a diagnosis. The public healthcare system is made up of UPAs, which are like urgent care facilities, and hospitals, which are not only hospitals but also where you can get checkups, medicine and so forth. At least that is my current understanding; don’t hate me if this information is incomplete or off a bit. Free info on the internet comes without guarantees or warranties.
So, I went to the UPA, got diagnosed with strep throat, and got a choice between penicillin and an antibiotic shot. I went with the shot.
That was Tuesday of the week. By Friday morning I had begun to experience mild stomach pain. By about noon, I stopped working and just laid down. That evening I was debating going to the hospital. I decided to tough it out, but by the next morning Mrs. Sirsandals pushed me to go. I didn’t want to be overly dramatic so we didn’t get an ambulance (also free) so we drove there. I chose to go to the public hospital because I thought it wasn’t anything serious and the recent UPA experience was pretty good.
I went to the emergency room. Step 1 in the emergency room, or UPA for that matter, is someone will see you briefly and assign you a severity level. The more severe they determine your condition to be, the faster you’re seen by a doctor. I got yellow, which is somewhere in the middle of the 5-level system. The levels look like this.
About 45 minutes later I was seen by the doctor, who examined me, said he suspected appendicitis, and ordered some lab tests and a CT scan.
I went to a waiting room to wait for the lab tests. A lady came by a while later and drew blood and so forth.
A while after that I went for a CT scan. They tried without contrast first, then did a second one with contrast to confirm suspicions. They took me for surgery after the diagnosis.
I entered the hospital at 9:30am and was in surgery by 4pm.
The surgery went just fine. They kept me overnight. Because it’s a public hospital I didn’t have a private room. There was an older guy in the room with me, but it was a relatively nice room and quite large. No TV or amenities except free Wifi.
Mrs. Sirsandals spent the night. The food was actually very good. Here’s a picture of one of the delicious meals I received. Mashed squash, potatoes, rice, beans, and beef. It was properly salted and quite filling… no complaints!
Everyone was super nice (people in Brazil seem to generally like Americans and American culture, so that may have helped).
They decided to keep me another night. I was finally released the following Monday. Two weeks later I was scheduled to have my stiches out.
So anyhow, everything went great, and I was quite impressed with the public health system. From what I understand the public health system here is very much a case of YMMV (Your Mileage May Vary). The overall sentiment I gather from speaking to Brazilians is the quality varies drastically by city. It’s likely the same could be said about healthcare in the US, or almost anywhere.
“So, Sirsandals, great story and all but what does the subject at hand have to do with FI?”. Well, quite a lot and I’m sure you’ve already guessed the not-so-cleaver-segue to the topic of retirement healthcare costs.
For the US readers, we all know other countries are scary, and the doctors can’t possibly be trained to the level of US trained healthcare practitioner, right?
I firmly believe you can find “facts” (quoting was intentional) and statistics that support any position you want to affirm. For instance, here’s a ranking of healthcare systems for 2021 from Ceoworld Magazine.
You see, United States doesn’t even show in the top 10. In fact, countries which rank higher include Mexico, India and Argentina. If I were arguing the quality of these stats, I might point out something such as “what the hell does ‘Government Readiness’ mean, and how does that weight on the more relevant criterion such as ‘Professionals’ quality.” Anyhow, I digress.
The point is a very important component of a geoarbitrage strategy is reducing your healthcare cost. For US readers, it may be a good strategy to consider if you plan to retire before you qualify for Medicare.
What am I doing for health care?
At the time, I still worked, and as such, I had health insurance in the United States, which covers me there, but not overseas. I kept it because my daughter was covered under the plan, and to satisfy my FUD (fear, uncertainty and doubt). I now have private health insurance in Brazil. You’ll recall, Brazil has a public and a private system. Health insurance here is for the latter system. With health insurance, there are a couple of options.
Travel insurance and equivalents. This provides reimbursement of costs, but you initially pay out of pocket. Issues: cashflow issues with paying providers out of pocket then waiting for reimbursement. Premiums are paid in dollars and subject to exchange rate fluctuation.
Local plans. This provides a card you show the hospital or providers that are in network. They bill the insurance provider. Benefits: paid in BRL and less subject to exchange rate variability. Provider bills insurance directly, less cash flow issues. This is what I use now.
We checked around the time of this incident (early 2022) and the Monthly plans for my wife and I would be about $1,450 BRL/month or ~$290 USD/month for the two of us. My current cost is about R$1,800. My reference point on direct-payment costs related back to my recent surgery. I asked and found from two sources the cost of laparoscopic appendicectomy in a private facility in Brazil would have set me back 10-15K BRL, or about 2-3k USD.
Since getting on the private plan, I have sliced open my thumb on a mandolin food slicer making fries (ouch) and fractured my wrist (via Jiu Jitsu). So for better or worse, I have gotten to use it.
The experience in the public system was very good. If i didn’t have private insurance, I would gladly use the public system, and am grateful it is in place..
Prior to being on private insurance, for regular checkups we found a provider that will include 12 checkups a year with a variety of specialists (dermatology, ear/noise/throat, gynecologist, GP etc..) for about $650 BRL or $130/year per person. This includes labs and tests and so forth. That was too good a deal to pass up at the time and helps us cover our preventative care efforts. We no longer use it because the private insurance is “all inclusive”.
What should you do about healthcare?
Well, that’s up to you and depends on what resources you have available to you.
Free government health care in another country can be a fantastic strategy. This is easier said than done. You need to find a county where you may qualify for free healthcare in the nationalized system. Next you need to want to live there. Finally, you need to move there.
Going to a location where healthcare is inexpensive enough to allow for self-insurance and another good strategy. This is also much easier than the former strategy. If you want to retire early in the US, you can travel to a location where you’re charged less for expensive procedures. The cost of the travel still needs to be accounted for though. Dental care in Mexico, and surgery in Thailand or Panama are some great options for those living in the US. There’s a huge hole in this strategy though: emergencies. If you’re having a heart attack and need coronary bypass, it’s impractical to book a flight and wait for it to leave.
Again, for those US readers, you can get healthcare on the healthcare.gov marketplace. Your costs for premiums are linked to your income relative to the poverty level. The key here is it is not linked to your net worth. If you have a $1M in the bank, but you have relatively little ‘income’ you may still quality for dramatically reduced cost premiums.
There are also insurance-like programs. These are generally referred to as health cost sharing. They have issues based on my cursory research but seem to be popular amongst the US based FIRE community. Christian Healthcare Ministry is a frequently cited option.
-Sirsandals