The Healthcare System in Bolivia: SUS, Caja Nacional de Salud, Hospitals and Health Risks

The Bolivian system combines three components: the public sector, funded by the State and open to the population through the Unified Health System (SUS), short-term social security, which covers sickness, maternity and occupational risks for affiliated workers, and a private sector. The Caja Nacional de Salud (CNS) is a decentralised non-profit public-law institution that runs the short-term social security scheme; a Ministry of Health statement indicates that it is present in only 75 of the country’s 339 municipalities.

France Diplomatie does not describe the system in detail, but insists on one point: in Bolivia, care must generally be paid for in advance, a bank card often being requested on admission, and without cover, the risk is not getting access to care, even in a life-threatening emergency. The guide to expat insurance in Bolivia gives the overall picture.

Law 1152 of 20 February 2019 establishes free comprehensive care in the public sub-sector for Bolivians who are not protected by short-term social security. For foreigners, two categories stand out in the texts consulted: people not protected by short-term social security, subject to international instruments, reciprocity and the same conditions as Bolivians; and, secondly, specific groups, who come under the SUS even without reciprocity: pregnant women up to six months after giving birth, people needing sexual and reproductive health care, children under 5, adults over 60 and people with disabilities.

To register, a foreigner presents a photocopy of their identity card, passport or birth certificate; for a newborn, the live birth certificate. The Ministry of Health opened a registration campaign for migrants living in Bolivia, which entitles them to free care in first-, second- and third-level establishments, throughout the country. The first level (health centres and posts) is the entry point, then the patient is referred to hospitals; emergencies can be handled at any level.

For an employee, the CNS takes over: the employer pays 10% of the payroll and is required to affiliate its workers. The page on healthcare reimbursement in Bolivia details who pays depending on status. The arrangements for a non-salaried resident foreigner should be confirmed with the Ministry of Health, because the texts consulted are of varied dates.

In the SUS, the first-level health centres and posts provide the primary care consultation, then refer to second-, third- and fourth-level hospitals, such as the Viedma hospital in Cochabamba, a public establishment cited by the ministry for the registration of migrants. CNS members consult in the fund’s units. Private-sector fees are not published uniformly: ask the establishment before treatment, and advance payment is the general rule.

The French embassy cannot in any case cover medical costs. France Diplomatie considers it imperative to have insurance or an assistance contract covering all medical costs, hospitalisation and medical repatriation; for high-mountain climbing, you must check that the insurance covers assistance above 5,000 metres. See the guide to how a medical repatriation works.

Acute mountain sickness occurs above 2,500 metres when the body has not had time to acclimatise to the lack of oxygen; it can cause shortness of breath, headaches, nausea, vomiting and sleep disturbances, and can worsen to the point of death. La Paz lies between 3,300 and 3,800 metres and El Alto airport at 4,058 metres. France Diplomatie recommends gradual acclimatisation, an elevation gain of no more than 400 metres between two consecutive nights from 2,500 metres, good hydration and no alcohol or heavy meals.

If symptoms appear, you must stop ascending, descend as quickly as possible to at least 4,000 metres below, be accompanied and see a doctor; a sick person is never abandoned. High altitude is advised against for children under 7, and pregnancy as well as a history of heart, lung, neurological or kidney problems are contraindications. Specialist medical advice is essential before a high-altitude hike.

France Diplomatie asks you to be up to date with the French vaccination schedule (diphtheria, tetanus, polio, whooping cough, measles). Bolivia has triggered a measles health alert in the regions of Santa Cruz, La Paz and Potosí. The yellow fever vaccine is recommended, preferably at least 10 days before departure, and compulsory when entering via the Amazonian Brazilian border, with heightened vigilance in the north and east of the country. Depending on the stay, hepatitis A and B, typhoid fever, tuberculosis for children under 15 on a long stay, rabies, chikungunya and dengue may be indicated.

The risks cited are dengue, with an epidemic every year from November to April, notably in Santa Cruz, chikungunya, yellow fever (severe forms fatal in 20 to 60% of cases), the Oropouche virus, malaria present all year in rural areas below 2,500 metres, in the north (Beni, Pando) and in Santa Cruz, zika, Chagas disease (departments of Cochabamba, Chuquisaca, Tarija and Santa Cruz), hantavirus and leishmaniasis. The sheet strongly advises against consuming ayahuasca and San Pedro cactus.

The precautions are protection against mosquitoes, food and water hygiene, and caution around animals; pregnant women see a doctor before departure because of zika and Oropouche.

France Diplomatie does not list a general emergency number for the police, the fire service or rescue services in Bolivia: it is prudent to check local numbers with the Ministry of Health and with your hotel or landlord on arrival. The free number of the police unit specialised in violence (FELCV) is 800-10-8004. The French embassy in La Paz (Avenida Hernando Siles No. 5390, Obrajes) can be reached on +591 50 701 207, and the consular section on +591 2 214 9920.

Social mobilisations and road blockades can delay a medical evacuation: France Diplomatie advises building up a stock of medicines, water, food and warm clothing in case of a prolonged blockade, and checking the blocked-roads map of the Roads Administration.

For residents as for travellers, France Diplomatie recommends protecting yourself from mosquitoes (covering clothing, repellents, mosquito nets), observing food and water hygiene, avoiding risky sexual behaviour and seeking advice quickly in the event of exposure. For rabies, preventive vaccination is to be considered depending on the stay, especially for young children, and any exposure requires an immediate consultation, even with up-to-date vaccination.

For high-mountain climbing, local guides are compulsory, acclimatisation of at least ten days is recommended and the insurance must cover assistance above 5,000 metres. Trips to Rurrenabaque, in the Amazon, are made with a reputable agency, without travelling alone.

The SUS and the CNS do not cover every profile: a non-salaried resident foreigner who is not eligible for the SUS groups depends on a private contract. The expat health insurance comparison presents the plans, and the CFE (Caisse des Français de l’étranger, the French expatriate health fund) is the option for keeping a link with the French scheme. Expavy helps you compare these choices according to your profile.