The cost of living in Uruguay is not low but healthcare is good and affordable. Find out how the Uruguay healthcare system works and how to be eligible.
Last week I woke up feeling poorly and after deciding that I really didn’t want to head out to the closest emergency clinic–which is literally three blocks away from my house–I picked up the phone. Through the emergency service of my healthcare provider I was connected with a physician (yes, on the phone) who asked if I’d like an over-the-phone consultation or a house visit. Forty-five minutes a doctor was at my bedside. It turned out I had a seasonal virus and I was prescribed painkillers and bedrest. Unfortunately I had a relapse several days later (I had not bed-rested as much as I should–naughty, naughty) and just to make sure that the relapse was not serious I called the emergency again. It was a busy Sunday and this time, having gauged that I was not an urgent case, the doctor came by at the end of the day. Having grown up in the UK where housecalls are no longer available, at least in South Wales where my family lives, I was once again impressed by the public/private healthcare system here in Uruguay.
So how does private healthcare work in Uruguay? Mark Teuten shares some background and facts.
The Uruguayan healthcare system is known by its abbreviation Fonasa, the Spanish term “Fondo Nacional de Salud” (National Healthcare Fund). It was created by the Frente Amplio government in 2007 with the aim to entitle all employees and pensioners to health care outside of the public health system. The public system would still be free, but was to be reserved for those outside of these broad categories.
Latest government figures state that there are currently 2.5 million people registered with Fonasa – out of a total population of just over 3 million. This would mean only 500,000 people are left using the public system or having to pay the full amount for private health care.
Who is entitled to Uruguay private healthcare coverage under Fonasa?
- All legally registered employees who work at least 13 days a month or more than 104 hours per month.
- Anybody registered as a sole trader (“Unipersonal”) including the sub-category of “Monotributistas” for very small businesses. [Guru note: Self-employed expats fall into this category]
- All public employees.
- All those receiving a state pension in Uruguay.
- Coverage extends to all family members under the age of 18 and over 18 if they are registered as disabled.
What coverage am I entitled to as an expat?
You can choose between over 40 different institutions, which are a mix of:
- Mutual health care providers e.g. Casa de Galicia. These are organisations owned by the affiliated members. By signing up to one of these you will be entitled to free health care. Note though that the “free” bit means access to the basic health care package and there will be extra to pay for better attention.
- Private health care providers e.g. British Hospital. By signing up to one of these you will be entitled to a discount on their monthly fee. The discount is about 90%, but varies according to salary.
- Private insurance companies e.g. Blue Cross and Blue Shield. These insurers use any one of the private health care providers depending on the particular medical problem. Likewise signing up with one of these will entitle you to a similar discount on the monthly fee.
How much do I have to pay?
There is a sliding scale of contributions payable by employees (employers also have to make a separate different contribution) depending on your family situation:
- Single with no children – 4.5%.
- Single with children – 6%.
- Spouse/partner with no children – 6.5%
- Spouse/partner with children – 8%
How do I get the coverage?
By informing your health care provider that you want the benefits of the Fonasa scheme. They will give you the necessary forms to fill out and process them. It normally takes two to three months for the deductions to kick in.
The consequences of the 2007 healthcare reform on private healthcare in Uruguay
According to government figures over a million people moved over from the public to the private system as a result of the scheme. Viewed solely in this way the scheme would be a massive success. Anecdotal evidence would suggest that some of the care provided by the mutual health care providers leaves a lot to be desired because they are being forced effectively to offer health care at a fee fixed by the government which does not cover their costs. So they tend to recover the difference by charging for other services outside the “basic package”. [Guru note: We have found that there are longer waiting times to see specialists than previously but the waiting times are manageable and any emergency is bumped to the top of the list, with for example, cancer patients getting treatment virtually immediately. Those charges outside the basic package are minimal eg 20 USD for a pap, 10 USD for a consultation.]
Anecdotal evidence would suggest that the public system has improved as well because it is having to attend to less people and in addition the government has spent more money on it to improve infrastructure etc. However the public system still leaves a lot to be desired and is not to be recommended except for emergencies. [Guru note: I visited a friend in a brand new public A&E hospital in Montevideo and the service provided was very good.].
Offsetting Uruguay’s relatively high social security and income taxes
The Fonasa scheme is a good way to get cheaper health care for all employees and their families and for those with their own company. In this way it can help to offset the relatively high social security and income tax payments already made by all tax payers in the country.
Mark Teuten is a British lawyer based in Montevideo since the 1990s. He has law degrees from both the UK and Uruguay. He can help you with your residency applications, setting up a registered company and other legal matters. Guru’Guay has recommended him to our readers who have praised his trustworthiness, clarity, prompt communication even over great distances and careful advice regarding courses of action.