An American retiree in the Philippines recently asked me a very interesting question about emergency services and medical care in general for retirees in the Philippines. One thing you have to keep in mind, when planning on retiring here, is that in many cases there are no good answers. You have to think this through carefully.
Those considering moving to the Philippines mostly ask questions about how much groceries or electricity costs or other minor money issues. I live in the Philippines and I’m happy with my decision. However I would be the first to state that I am taking some big risks by doing so … risks that make the number of pesos in my electric bill pretty
inconsequential.
The is no effective emergency service in almost all of the Philippines (Davao City and Makati two notable exceptions). You don’t call 911 and get a cardiac care team at your door, when there’s a pileup on the NLEX and people are lying broken and bleeding in the road no “flight for life” helicopter swoops done and transports the victims. It just doesn’t exist almost anywhere and it’s not likely to in the lifetime of anyone reading this. One of the important indicators that the leadership and “movers and shakers” in the Philippines are not even thinking of this sort of service in the future is that in many major cities, the “911″ phone number isn’t even reserved for future emergency services … in much of Metro Manila, for example, dialing 911 will get you a pizza delivery service. To not even reserve the number for future us means nothing much along the emergency services line is likely to happen any time soon.
One of the reasons I chose to live on the outskirts of Manila is medical care. I can get into major medical facilities in Manila in an hour or so … nice for seeing specialists or for having elective procedures done at good hospitals.
But I’m under no false illusions here … if I have something like a major heart attack … I’m dead … simple as that. Those who depend upon or expect world-class emergency medical services are not going to find them here. Air evacuation services might offer some help )I even promote a very good one, here), but air evacuation/MedEvac back to your home country is not always medically feasible. (for those of you who are retired US military, the network of medevac flights the USAF used to fly ’round the world’, is essentially gone. The C-9 Nightingales are gone, the medevac squadrons are gone and likewise many of the scheduled flights those with less serious conditions one could “hitch hike” to military hospitals on are gone too … they will never return.
I don’t want this to sound strictly gloom and doom, but I have talked to many who just haven’t thought through what would happen to them if there is no 911 to call.
photo credit: Werner Vermaak
As a side note, one of the bigger news stories the week I first wrote this article was the death of a fellow named Max Soliven, perhaps the most illustrious Filipino journalist ever. He was in Japan and suffered a heat attack in the departure lounge at Narita airport, Tokyo. Japan has excellent medical care and has emergency services operated in a manner that makes most US services look like amateurs … and helicopter evac is readily available and frequently used … especially for VIPs which
Max certain was. However, he was dead in seconds … when it’s your time, it’s your time and no amount of insurance or technology can ‘fix’ things.
The real problem seems to be to me that those still living in the US seem to think they have the best medical care in the world, when, in fact the US can’t come up to better than a dismal 37th in WHO’s latest rankings. France (number 1) would be a much better choice, but I don’t see many moving there.
This recent article shows me US medical care seems to be slipping rapidly:
This past Wednesday, ABC News reported on the the “spike” in maternal deaths in the United States over the past several years with due shock.
The news report stresses how shocking it is to hear that so many women die of complications in childbirth when we live in the United States of America. How could this be? They wonder. How could be be ranked so far below Greece, The Czech Republic, and Japan? How could this be happening in our country?
The U.S., in fact, ranks 33rd out of 33 industrialized countries in maternal deaths per year. Our infant outcomes aren’t much better, either…
But reports, real or imagines, detailing how the most expensive health care system in the world is slipping badly, doesn’t do anything to change the fact that health care, especially emergency services here in the Philippines is not nearly up to the standards of the US.
When you make the decision to move to the Philippines or not, or when you decide where in the Philippines you want to live … better give health carer a little more thought than the local price of a Sam Miguel.
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Good thoughts Dave.
I’ve carefully explained the symptoms of heart attacks and strokes to my partner and said that if they strike, it should be a taxi to St Lukes Quezon City without the slightest delay. But I have no great confidence that it will save my life.
The consolation is that if I get cancer or one of the other illnesses that take you away slowly, I’ll get a lot more care and consideration here than I would in Australia. I have no wish to endure the endless tortures inflicted on sick people by Western medicine for the sake of prolonging life by a few months.
God grant me the gift of a Max Solivan departure … some time after my 90th birthday
.
Cheers, Ken
Good idea, Ken … having had the experience of having someone die en-route to the hospital in my car (or perhaps the person was already dead when we started …) I’ve given this plenty thought. There are no taxis where we live. A lot of folks who chose to live out in the provinces need to give this careful attention. I don’t want to be maudlin or depressing, but I’ve caught plenty flack in the past for (allegedly) painting rose colored pictures of things here … so I try to present both sides.
Even at our little local hospital a few blocks from our house, I feel the level of care is quite good … although the place is a bit scary to look at.
Your point about along-term debilitating disease is a good one too …in the US, you can get government help for serious conditions but you have to make yourself (and thus your partner) poor in order to do it … here the surviving partner has more choice in the matter.
Were you a Max fan then? I always read his columns, without fail .. and I certainly had him on my list of people I wanted to meet .. didn’t come to pass, though. But you are so right, it would be hard to imagine a better way to go … busy with his life, and rushing off to get yet another story when he could have been the typical ‘sit at the desk’ executive … not Max, though, it was never his way.
Hello Dave;
I went to my clinic last month and they informed me they no longer wanted to deal with Tricare or Tricare for Life. I spoke with the Doctor who owns the place and his complaint was the eight months to a year it took for him to receive payment back from them. I went to the RAO and asked about this and they said all hospitals that used to readily accept Tricare, still will, in as much as you pay cash for the service, and then you wait for the eight months to a year for your refund. (Sounds like no TriCare to me!) It was recommended that I bring in a few thousand USD, and keep it in one account for medical only. The RAO agreed that the fault belong on the Tricare side of the house. This is the same Government that wants to have Health Care for the entire country, and run it like TriCare? Well they’ve done such a fine job with the Post Office; Health Care should be a snap for them.
I went back to the Clinic, and asked if I paid a little extra, would they fill out the claims for me? The Doctor thought that was a good idea and he‘ll get back to me on that. He’d get the cash up front, and my lazy butt won’t have to fill out the paper work. I can wait the 8 to 12 months for the money. What have you heard?????
Hi Paul,
You caught me in a really blue and ‘down’ mood this morning, and on my way back up to my normal, cheerful and sunny self, I am not going to take a turnoff on TRICARE lane. There is no clinic (and no legal way I know of) a clinic in the Philippines can legally make money with the existing TRICARE system. Thge program is basically what you describe … the individual user pays the reasonable and proper local price and then submits a claim to TRICARE-WPS, who reimburses the allowable portion in their own sweet time. I don’t know if you or any of my military retiree readers is familiar with:
http://groups.yahoo.com/group/US_Military_Retirees_Of_The_Philippines/
but I’d suggest you try them out. The owner, Jim Houtsma, is retired NCO/retired civil servant who works hard at trying to explain and make better the f-ed up flavor of TRICARE we are blessed with here in the Philippines. Unlike most of these sites/discussion groups, Jim runs a tight ship and you actually have to _be_ a US military retiree and be in the Philippines to join the group, so the noise level is significantly less than some of the general interest groups … but there is no easy answer. and I purposely have taken all my TRICARE articles and links off this site because I don’t need the elevated blood pressure. Thanks for understanding.
Dave: Another important article, and one that should be read by anyone thinking of retiring here…Resign yourself to the fact that unless you live very near a hospital in Manila, your chances of survival of a real emergency are, perhaps at best, 25% of likewise in the States.
One point you forgot to mention… In most Barangays, the ambulances are seldom, if ever, used for medical emergencies. They are normally appropriated by Barangay Captains, Mayors, or other officials as vehicles for private use. Illustrating that, about 4 months ago Becky and I stopped near Gattaran to by vegetables from some Aeta who set up roadside in the Marcos Forest. In 10 minutes, 4 ambulances full of family members of various towns’officials stopped to buy vegetables. In each case, they were headed to beaches for famiy outings!
Isn’t that the truth, John. I spent many years in Colorado … which I would not put high on any list of rich, advanced or caring states. But let people be hurt in a car crash 150 miles from Denver and people will bitch that it took the Flight for Life helicopter and hour to get there. And a dingaling eastern lowlander snow boarder gets lost? They’ll even scramble USAF reserve C-130′s to search through the mountains at night … etc.
Here, flight for life brings up the image of a guy in the wrong bedroom after her husband comes home unexpectedly
. In our barangay th e ambulance is frequently in use as the raod repair vehicle, carrying loads of dirt out to fikl the most egregious potholes.
Not bitching about it, you understand, just need people to know what is what and how things work ’round here.
Excellent choice of topics Dave. I second Ken Lovell’s suggestion. First Aid training for adult members of the household is always a good idea. If you have a heart condition it might even be worthwhile to get a defibrilator and train your spouse to use it. The best emergency response in any situation, regardless of the country you live in, is to have the adult members of your family trained and ready. They can respond much faster than anyone rushing to your aid (assuming they even would). Have the appropriate drugs and equipment on hand and people who know when and how to use them.
Note: I have first hand experience in this area. If I hadn’t been trained in CPR, my best friend would have died long before the EMS folks arrived.
I agree 100% … but just wanted to point out the very clear differences. It’s not only health care issues. Many Americans are used to calling the police for all sorts of issues .. their child was bullied coming home from school, the neighbor’s dog barks at night, there’s a gang of rowdy teens walking the streets, etc., etc.
If you live here, except for a very few large-city exceptions, no one is going to come and settle these sorts of things for you … if you can’t take care of issues like this on your own, or don’t know how to ask your neighbors for help, better think twice.
Great article Dave,
One of my older roommates used to live in the Philippines (born in the US) where he raised his 2 adopted children until they moved here (somewhat of a backwards scenario from what you have presented). Apart from the occasional weather bashing (humidity), he has nothing but good things to say about the country provinces and his experiences there. While I’m nowhere near senior citizen status nor have physical preoccupations of any kind, this has certainly given a new insight for what it is like there and the things need to be taken into consideration for anyone thinking about moving there. Hope I get to at least visit, and if I decide to stay – I’ll certainly heed your Advice. Thanks again for the post!
Any time Steve, I write often, upon occasion I even mange to say something. Welcome.