Overview
There is a public health care system for residents in Panama, with clinics in the majority of towns and hospitals sporadically across the country in larger cities. Public clinics and hospitals cost nothing or next to nothing, but if you go to private places the price is immediately goes up. All tax-paying residents have a deduction for health care taken out of their pay checks, allowing them access to the public clinics. For people with type 1 diabetes, getting a diagnosis is a challenge due to the lack of both public and medical understanding.

What happens if you need to see a doctor?
If you are not a Panamanian resident, you will have to choose whether you go to a public or private doctor. The cost of public services is significantly cheaper, but the wait times and quality of service will reflect that. There are usually clinics in most towns, but even some popular tourist locations lack hospitals.

Who decides what doctors can prescribe?
The Ministry of Health is in charge of approving which medicines are used and available in the country. The need for prescriptions varies greatly from what other countries have, with insulin not needing a prescription here. Most medicines are imported and therefore very expensive.

Practically, what is it like to live with type 1 diabetes in Panama?
Because a person does not need a prescription for insulin in Panama, there is not a need to deal with any of the aforementioned health care systems if you do not want to. The biggest challenge is that your pharmacy might not consistently have the insulin you need. The fancier the pharmacy, the higher likelihood of having common insulins (think Lantus, Homolog, Novolog, etc). There are certainly times when even the best of pharmacies simply run out.

Countryside clinics most often only have Regular and NPH but the salaries are very low so medicines are costly. Another challenge is that people wanting clinical advice for their dosing find it very hard to get. There are endocrinologists in Panama, but someone would have to go to the main cities to find any type of specialist. Again, that would be expensive if you used the private system and there would be a very long wait if you used the public system.

The price of insulin is growing, just as it is in the USA, though at a lower starting level. In the last five years, insulin has gone from costing around $30 a vial to about $80 now. Many people cannot afford this and are rationing insulin for themselves or their children, if they can get it at all. It costs about $20 for a box of 50 strips, which is quite expensive.

What about getting admitted to hospital?
Hospital admittance, like all systems here, varies between public and private. If you go to the main hospital in Panama City, your wait time will depend on your level of emergency and you will receive extremely high quality service. If you go to a public hospital in the middle of the night, you could arrive to no doctors in your field working at that time. Then you might have to wait for them to call the doctor, wake them up, and get them to your side.

The cost of hospitals is significantly lower than what is normal in North America, with a full x-ray and doctor consultation costing around $250. Knowledge of type 1, even in countryside hospitals is there, but not vast. If you go in with a dangerously low blood sugar, the ER doctors will know you need an IV of dextrose, but they will need to be reminded that it needs to be administered with urgency. If you are in the hospital because of a type 1 issue, it will help to have another person with strong knowledge of type 1 next to you.

How does diabetes care vary throughout Panama?
The difference throughout the country is entirely based on whether you are in a main city or anywhere else, and if you are in a private institution or somewhere public. Problems with the public health care system can be found in the countryside where lack of funding creates shortages of beds or lack of resources. The majority of doctors prefer to live in Panama City where there are higher patient loads and more economic opportunity. Access to endocrinologist and consistent insulin in pharmacies vary, and it is never guaranteed in any location.

Many thanks to Carter Clark who provided much of the information for this page.