The Healthcare System in Ecuador: Public Network, IESS, Hospitals and Emergencies

Healthcare in Ecuador rests on a public network and a private sector. On the public side, the Red Pública Integral de Salud brings together the establishments of the Ministry of Public Health, the IESS and the social security institutes of the armed forces and the police; the IESS runs the compulsory health insurance for employees. The private sector is concentrated in Quito, Guayaquil and Cuenca, the three cities where France Diplomatie reports good hospitals (France Diplomatie).

Access depends on status: a declared employee is covered by the IESS, a non-salaried resident can affiliate voluntarily, and other people turn to private insurance. The public documents consulted specify that resident foreigners have access to the healthcare system under Ecuadorian law and that an establishment cannot refuse urgent care on grounds of nationality or migration status; this point should be confirmed with the Ministry of Public Health for each case. The guide to expat insurance in Ecuador gives the general overview.

According to the IESS, a private-sector employee contributes 20.60% of pay in total: 9.45% payable by the employee and 11.15% payable by the employer. This rate funds all the risks managed by the institute (sickness and maternity, invalidity, old age, death, work accidents). To be entitled to care, the member or their beneficiary must show three months of continuous contributions just before the illness begins; cover for occupational risks applies from the first day of work, and a member who has stopped working for more than 60 days and who has acquired the right recovers it with one month of contributions.

Dependants are children under 18 and the spouse or partner, the latter for an additional premium of 3.41% under voluntary affiliation. Voluntary affiliation is open to people over 18 with no arrears towards the IESS, including resident foreigners holding a resident visa or a refugee card; the self-employed go through their RUC number. Voluntary members receive the same sickness and maternity benefits as compulsory members.

No social security agreement links France to Ecuador in the lists of CLEISS (the French liaison centre for international social security): the local employee therefore comes under the IESS with no coordination with French social security. For retiree or remote worker residence visas, national or foreign health insurance valid for the whole duration of the visa is required; if taken out abroad, it must cover Ecuador (gob.ec). The page on healthcare reimbursement in Ecuador details who pays depending on status.

The details of the care pathway of an IESS member (primary care units, referral to the network’s hospitals) are confirmed with the institute at the time of affiliation. Without affiliation, private-sector consultations remain payable by the patient. Fees are not published uniformly: ask the establishment before treatment.

France Diplomatie specifies that Quito, Guayaquil and Cuenca have good hospitals, but that costs are high and a deposit is always required on admission; you should check in advance which establishments are covered by your insurance. A private hospital stay is very expensive, hence the strong recommendation of assistance or insurance covering all medical costs. In the Galápagos, the medical level is judged insufficient and evacuations to the mainland pose difficulties.

The French embassy in Quito cannot cover medical costs. The steps for a medical transport are explained in the guide to how a medical repatriation works.

911, pronounced “nueve uno uno”, is the single emergency number run by the Servicio Integrado de Seguridad ECU 911. It coordinates the National Police, the fire service, the armed forces, the Ministry of Public Health, the IESS, the Ecuadorian Red Cross and other bodies, from any landline or mobile, free of charge, 24 hours a day. The old numbers 101, 102, 103, 131 and 149 are permanently deactivated for emergencies.

The ECU 911 app lets you trigger the call by holding the 911 button for three seconds: the service then calls the user back to coordinate the response. France Diplomatie also indicates that tourists can register on this app to report incidents or accidents. The contact details of the embassy’s consular section in Quito are +593 2 29 43 840.

France Diplomatie asks you to be up to date with the French vaccination schedule (diphtheria, tetanus, polio, whooping cough, measles). The yellow fever vaccine is strongly recommended; it is compulsory for travellers coming from countries where the disease is endemic and, since May 2025, after at least 10 days in Peru, Colombia, Bolivia or Brazil, and it must be given at least 10 days before travel. Depending on the length and conditions of the stay, hepatitis A and B, typhoid fever, meningitis ACWY, tuberculosis for children under 15 on a long stay, rabies, chikungunya and dengue may be indicated.

The risks cited are dengue, sharply on the rise on the coast (Esmeraldas, Manabí, Guayas), chikungunya, yellow fever, whose severe forms are fatal in 20 to 60% of cases, and the Oropouche virus. Malaria is endemic below 1,500 metres in several provinces (El Oro, Esmeraldas, Guayas, Manabí, Los Ríos, Morona-Santiago, Napo, Pastaza, Sucumbíos, Zamora-Chinchipe); Quito, the Galápagos and the Andean centre are not affected. Cholera, leptospirosis and leishmaniasis are reported on the coast and in the Amazon, especially in the rainy season, and tuberculosis is resurgent.

The precautions are protection against mosquitoes (covering clothing, repellents, mosquito nets), food hygiene (bottled or purified water, well-cooked food, peeled fruit and vegetables) and caution around animals: in the event of a bite, wash the wound and seek urgent medical advice. Pregnant women or those planning a pregnancy see a doctor before travelling because of zika and Oropouche. Anti-inflammatory drugs are to be avoided in the case of dengue. The sheet advises against consuming ayahuasca because of the cardiac and psychological risks.

Women affiliated to the IESS, including under voluntary affiliation, receive the institute’s sickness and maternity benefits, and children under 18 are covered. For expectant mothers, France Diplomatie asks them to see a doctor before travelling because of zika, which can cause neurological complications and microcephaly in the newborn, and Oropouche, for which no vaccine or specific treatment exists; pregnant women reconsider non-essential travel in the event of an epidemic.

For young children, the sheet cites rabies among the vaccines to consider in rural areas, and tuberculosis for children under 15 on a long stay. The CFE (Caisse des Français de l’étranger, the French expatriate health fund) requires conception after joining for maternity, and international contracts generally apply a waiting period: the simplest course is to choose cover before the pregnancy. See children’s cover abroad.

The lists of medicines covered by the IESS or by the Ministry of Public Health are published by those bodies, and their availability varies by establishment; a resident on a chronic treatment confirms the availability of their drug before departure with their usual doctor and their insurer. Medicines bought at a pharmacy are payable by the patient unless covered by their contract.

For a retiree or a remote worker, the insurance required for the visa must cover Ecuador for the whole duration of the visa. See the guide to retirees’ health insurance abroad.

France Diplomatie considers it imperative to have an assistance contract or insurance covering all medical costs, including hospitalisation, and medical repatriation. IESS affiliation requires declared employment and a contribution period: supplementary cover avoids a gap with no protection. The expat health insurance comparison presents the plans, and the CFE is the other option for keeping a link with the French scheme. Expavy helps you compare these choices according to your profile.