The Healthcare System in Paraguay: IPS, Public Network, Private Sector and Emergencies

The Paraguayan system combines three pillars. The Ministry of Public Health and Social Welfare (MSPBS) runs the public network open to the population, governed by law 5099 of 2013 on free healthcare fees: the law provides for free promotion, prevention, diagnosis, treatment and rehabilitation services in the ministry’s establishments, as well as free supply of the medicines on the national essential medicines list, with gradual implementation depending on each year’s budget. The texts consulted do not specify whether this free care distinguishes by nationality.

The Social Welfare Institute (IPS) is the social security fund for employees: it covers sickness, maternity, work accidents and retirement. The third pillar is the private sector, made up of clinics and private insurance, used mainly by unaffiliated residents. The guide to expat insurance in Paraguay gives the overall picture.

According to the Ministry of Labour, a private-sector employee contributes 9% of their pay, withheld on their payslip, and the employer 16.5%, that is 25.5% in total. If the employee receives less than the minimum wage, the employer tops up the contribution base. The legal minimum wage is of the order of 3 million guaraníes a month, adjusted each year, which serves as a benchmark for estimating the cost of affiliation. Affiliation is automatic from formal hiring.

IPS beneficiaries are minor children, disabled children over 18, the spouse or partner and, under conditions, the insured person’s parents. For foreigners, the IPS asks for the Directorate of Migration card of the holder and of the dependant, the identity document from the country of origin and legalised or apostilled birth or marriage certificates; the Paraguayan cédula must be presented within two years. The beneficiary must not be a dependent employee, a registered employer or a retiree of another fund. Registration is free, and only the presence of the insured holder is required (IPS).

No social security agreement links France to Paraguay in the lists of CLEISS (the French liaison centre for international social security): the IPS is not coordinated with French Social Security. The page on healthcare reimbursement in Paraguay details who pays depending on status.

The MSPBS publishes on its portal a “where to consult” section that directs users to the health units in their area. IPS members follow their pathway in the institute’s units and hospitals, the terms of which are confirmed at the time of registration. Non-members turn to the ministry’s public network or to the private sector, whose fees are not published uniformly: ask the establishment before treatment.

France Diplomatie insists on one point: without an assistance contract or insurance covering medical costs (surgery, hospitalisation) and medical repatriation, access to care may be refused, even in a life-threatening emergency. The French embassy cannot in any case cover these costs. The guide to how a medical repatriation works explains the steps.

141 is the number of the MSPBS Medical Emergency Service (SEME): free, open 24 hours a day and accessible from the main telephone operators. Anyone with a health emergency who needs to be taken to hospital can use it. 911 (police) and 132 (fire service) are linked to 141: calls about a health problem are redirected there. A source from the judiciary cites other numbers, which do not match the ministry’s numbering: it is prudent to check the numbers on the MSPBS website.

The French embassy in Asunción (Avenida General Santos 465, +595 21 213 840) has reduced staff; the consular emergency number is +595 971 995 656 during opening hours and, outside them, that of the consulate general in Buenos Aires, +54 9 11 4470 3202.

France Diplomatie asks you to be up to date with the French vaccination schedule (diphtheria, tetanus, polio, whooping cough, measles). Yellow fever is endemic in Paraguay: the vaccine is strongly recommended, to be given at an approved centre and preferably at least 10 days before departure; the certificate is required for travellers coming from Brazil, Bolivia, Peru or Venezuela. Depending on the length of stay, hepatitis A and typhoid fever are advised, hepatitis B, tuberculosis (children under 15 on a prolonged stay) and rabies (young children, rural areas) depending on the type of stay, and chikungunya and dengue in the event of an epidemic or a prolonged stay.

The risks cited are chikungunya, dengue, yellow fever (severe forms fatal in 20 to 60% of cases, with possible transmission in Paraguay, notably during the Southern Hemisphere summer), zika, typhoid fever, rabies and tuberculosis. The precautions are protection against mosquitoes (covering clothing, repellents, mosquito nets, elimination of standing water), food hygiene (safe drinking water only, well-cooked food) and caution around animals: in the event of a bite or scratch, wash with soap and water and then seek urgent medical advice. Anti-inflammatory drugs are to be avoided in the case of dengue, and pregnant women or those planning a pregnancy see a doctor before travelling because of zika.

France Diplomatie recommends taking only the medicines you need, in their original packaging, with a prescription stating the international non-proprietary name, and checking that they are authorised in Paraguay. It advises against buying medicines in the street, because of the risk of counterfeits. Law 5099 provides for the free supply of medicines on the essential list in the ministry’s establishments, depending on availability.

For maternity, the IPS covers sickness and maternity for insured people and their dependants. Outside the IPS, the CFE (Caisse des Français de l’étranger, the French expatriate health fund) requires conception after joining and international contracts generally apply a waiting period: choose your cover before the pregnancy. See children’s cover abroad.

In daily life, prevention rests on a few simple rules recalled by France Diplomatie: see your usual doctor or an international vaccination centre early enough before departure, including your dentist, avoid risky sexual behaviour and seek advice quickly in the event of exposure, choose reliable transport, stay careful on the road and with two-wheelers, swim only in supervised areas and protect yourself from the heat and sun. This advice applies to tourists and residents alike.

On the road, France Diplomatie points out that roads are sometimes in poor condition, with pedestrians, animals and unlit vehicles, and that only third-party liability insurance is compulsory: an accident can therefore generate medical costs to be advanced. In the event of an accident, you must notify the police immediately and draw up a report. See the page on living in Paraguay for driving advice.

IPS affiliation requires declared employment; a self-employed person, a retiree or a new arrival looking for work does not have access to this scheme from day one. The expat health insurance comparison presents the possible plans, and the CFE is the option for keeping a link with the French scheme. Expavy helps you compare these choices according to your profile.