Richard Bexon: Good morning, Johnny.
Johnny Umana: How you doing? Another beautiful day in Costa Rica. That’s true, man. I mean, when isn’t it? You know, it’s, it’s tough, but you know what?
Richard Bexon: Somebody has got to live here, right? That’s very true. That’s very true. Well, Johnny, I appreciate you taking time to join us here on the podcast. My first question for you, which I love to ask everyone is, you know, markets have had a, they had a good start to 2024, a bit of a jitter midway through, as we’ve saw over the last couple of weeks, but seeing things seems to be improving. I mean, what are you seeing happening here in Costa Rica, Johnny?
Costa Rica’s Economic and Healthcare Outlook
Johnny Umana: Well, you know what? I think the shift in the government and such on doing so many things, trying to attract business to the country, doing things to try to better it, I think it’s in a positive direction. The only thing I believe is I do healthcare. So I believe that the healthcare infrastructure also has to come in line with that, not just for a retiree, but people that are trying to invest that adequate amount of services are available. That’s more of a direction of some people don’t, don’t take in consideration, you know, you buy something, you buy something too far out. There’s not enough health services or services at all. You have to take consideration. And I always think that people that are professionals in the area, like yourself, to point people in the right direction, don’t make those big mistakes, those costly mistakes.
Richard Bexon: Yeah. I mean, I think it just depends on, you know, who you are, age, if you have any healthcare kind of, you know, situations. I mean, if you’re thinking, I think if you’re very elderly, moving down to the Osso is probably not the best thing to do, you know, but, you know, being, I don’t know, you know, up in the Central Valley where there are multiple public and private hospitals and facilities available, I think is a, is, you know, is a good option, but, you know, Costa Rica has some pretty, I would say good standard healthcare in some areas, but we’ll get to kind of private versus public in a minute, but what are the services that you guys are typically helping clients with?
Johnny Umana: We’re typically helping them with a variety of services. A lot of it is, focuses on dental, senior living and medical services as a whole within about 200 different types of surgeries, including both the dental and the medical and then also even end of life. Okay. Okay.
Richard Bexon: And I mean, who typically are your clients? Would you say the majority of them are, I don’t know, 60 plus, 40 to 50? I mean, where would you put the, where would you put the majority of your clients?
Johnny Umana: If you’d asked me that five years ago, I would tell you that most of my clients were between the ages of 60 to 75 in that range, but now, but nowadays there’s been a lot of an increase of patients, people that come in from the US and Europe at the early, late forties, early fifties. So it has changed a lot.
Costa Rica’s Public Healthcare System (Caja)
Richard Bexon: Well, maybe you could just for anyone listening to this, give them kind of just a summary of what healthcare is available to them in Costa Rica, both public and private, because I think people get confused sometimes because they get residency, they get care, you know, and what should they understand? I mean, just kind of give us a little bit of a summary on the, on the private versus public.
Johnny Umana: All right. Let me go, let me go with the public first in Caja. What you’re saying is the universal healthcare system here in Costa Rica. It’s comprised about with about 1200 health facilities within those 1200 facilities. There’s four levels of care here. There is care that’s visiting from the home. There’s advices, which are urgent cares. There’s peripheral hospitals. There’s also regional hospitals, and then there’s a national hospitals and specialized hospitals, and it’s a level one, two, and three, the level three hospitals are particularly located in this, the central Valley, San Jose area, all of them are there. And then the regional and peripheral hospitals are in the different provinces throughout the country. And the advices, which are your urgent cares are throughout the country. And that’s about 1200 on the public sector.
And then also you have the different programs for depending on what your age or demographic group is, which also comes into play of what’s being supported because as a citizen or a resident, you’re, you’re allowed to participate in these programs. But one key thing about this Richard is this, is that a lot of people make the biggest mistake of, you know what? I don’t, I only paid the GA because it’s a requirement, but you’re in a healthcare system that if for some reason, you’re not close to a private facility, you’re going to have the problems that you check in with, with them, and you don’t have a health record. A lot of people say, you know what, I paid the system, but I don’t want to use it. And the biggest mistake is not going in and trying to use a little bit of it. Yeah, that’s all that’s on the public side.
Richard Bexon: Yeah. And look, I mean, we have private healthcare in my family. We do use the public for certain things. Like again, I mean, if it’s small stuff, we’ll go to the advice with the kids rather than going to the hospital, you know? So yeah, I mean, you know, we use both public and private.
Medicina Mixta: The Hybrid Approach to Healthcare
Johnny Umana: I think we depend probably more on private than we do public, but you know, not that we try to visit the healthcare system that much, but I don’t think nobody wants to go to healthcare, but you know, one thing that you should also try Richard is there’s a thing called medicina mixta, which is mixed medicine, which is a combination of public and private, which some practitioners participate in. And it’s basically, they can get your, you can go to a private doctor, get medications and tests done through the Caja, but through medicina mixta. That’s something I think a lot of people would take advantage of, but the physician has to participate in that particular area.
Richard Bexon: How would one find out about that medicina mixta? And the reason I ask this, because we have a lot of people that get residency here in Costa Rica. And again, as you said, they’re just paying for the Caja and never really use it. And healthcare can be, you know, very expensive. I mean, for me, my wife and my two kids, I think we spend, you know, about, I think it’s probably three and a half thousand dollars a year on private healthcare, you know? So how does that medicina mixta work? Like, how do you become part of that?
Johnny Umana: Okay. Medicina mixta is the physician that you’re seeing. He participates in the program with the Caja of the universal healthcare system as a doctor that is certified to be using that. So you have to ask your physician that does he participate in that? And that’s how you can mix both the public and the private.
Richard Bexon: Okay. There’s not a list somewhere of all doctors that are in medicina mixta.
Johnny Umana: Yeah, it’s actually there. You can go to the Colegio de Medicos and you can look on there. They have there. And also the Caja itself can also verify which all you need is the medical code for the physician and they can look it up also.
Richard Bexon: Okay.
Johnny Umana: Fantastic. Fantastic.
Private Healthcare Options in Costa Rica
Richard Bexon: And I mean, what’s private healthcare like in Costa Rica, Johnny?
Johnny Umana: Well, private healthcare has a unique approach here in Costa Rica. You there’s like you said, there’s a majority of a lot of private facilities in the GAM, the Greater Mountaineering Area, which are the five major hospitals, Clinica Biblica, CIMA, Metropolitano, La Catolica, and UNIVI, which are the main private, bigger private hospitals. There are some smaller, more, I call it urgent care on steroids, but they’re smaller. But something particular that once you leave the Greater Metropolitan, the Central Valley, they’re scarce. So in certain areas, they have smaller hospitals with maybe seven, eight beds, rather than almost a hundred that you have in the center of San Jose. So you have to be careful that the access to that service, the farther you’re out, the less that service is available.
They have a lot of urgent cares that can do your primary care. But if you get into a serious situation, you have to be careful of knowing where you’re going. And that brings me to this. Now, Richard, how about, do you have an emergency plan right now that with your family, you know what, if Richard falls and hits his head, what’s the closest hospital? What facility is going to do? What the next steps are? Because a lot of people don’t do that. I don’t know. Do you do that, Richard?
Richard Bexon: No, I mean, I don’t do it. I mean, I have a will, which basically allows my wife to make all decisions for me, but no.
Johnny Umana: But what about, let’s just say Richard can’t drive, and your wife’s got to drive you to the hospital. Do you have a predetermined route you’re going to go? Or which hospital are you going to go to first? Or even which one you’re assigned to?
Richard Bexon: Johnny, I would have my wife run across the door to the CAHA surgeon or the private surgeon that’s next door and have them take care of me and do me whatever. Thank God I’ve got friends that are surgeons, urologists, you know, yeah.
Johnny Umana: You know what, you’re blessed, Richard.
Richard Bexon: I think so.
Johnny Umana: You’re blessed, because most people won’t have that. And it’s something that I also recommend a lot of people to create their emergency medical plans. And then a lot of people, some people don’t all drive. So you know, you have to alternate driving to see how long it’s going to take you to get to a medical service. But you have the pleasure of having people around you.
Personal Healthcare Experiences
Richard Bexon: Yeah, you know, I would say, unfortunately, unfortunately, in 2015, my appendix blew, and I walked around with it for four weeks without knowing it. And I was in and out of hospital. I spent a week in SEMA, came out, had tons of tests done, and found the family internist. And he’s basically been the best thing for me on anything. Anything I have, I go to see him. He’s in both CAHA and also private as well. And he basically is an ER doctor in CAHA. But he’s actually an internist and just sees a lot of stuff. And he picked up what was wrong with me in about two minutes, whereas it took, you know, other private doctors a long time to figure out.
Johnny Umana: Richard, I’m glad you touched that subject. One of the things, there’s no offense to physicians that are family doctors or just physicians themselves that go in, they’re surgeons. An internist is one of the physicians that I go to on a constant basis because they have a well-rounded view of health. Actually more accurate. And sometimes I tell you, skip the physician, go to internist, pay a little bit more. But you’re going to get more of an accurate health diagnosis. And rather than, let’s try this or let’s try this. They have more training, like you said.
Richard Bexon: Yeah. And again, you know, I mean, he’s part of the family now. So, you know, we drink beers and have fun. And yeah, he’s just a great guy. So let’s change gears a little bit into senior, you know, kind of residential kind of healthcare. I mean, are there many, you know, senior residential communities here in Costa Rica? Do you think there’s demand for more? What’s the cost? I mean, give us kind of the rundown of what’s happening there.
Senior Living in Costa Rica: Current State and Future Demand
Johnny Umana: All right. Let me give you a little bit of statistics right now. Right now in Costa Rica, there’s about 500,000 seniors right now in Costa Rica. We’re represents a little bit more than a third of the population, which means that it’s increasing every day. Now it’s projected to be 2032, 2035 to double. So that means there’s going to be about a million seniors here, which equates to, there’s not going to be enough senior space around here that’s currently. So there’s going to be a huge opportunity of senior living. Now, senior living also involves to make sure that there’s enough resources around the area to support that because you can build a senior living facility and a beautiful view by the beach, but you’re an hour away from a real medical facility. So those are the kinds of things that kind of take consideration.
Richard Bexon: So, I mean, is there enough facilities today or communities today to, you know, manage that demand or that doubling of, you know, I would say, you know, people needing senior care.
Johnny Umana: There is, but there isn’t. It depends really on your pocketbook, Richard. There’s the levels of care from a facility. And I’m going to give you an example. Some facilities go into about 800,000 colonas to 700,000 colonas, which equates to be between 14 and $1,800 per month on senior care, which as a community is okay, but that’s on the lower end side. You’re actually going on to the higher end side, which you also have to include in your equation is that there’s three types of senior care.
You have regular senior living, you have assisted living, and you have skilled. Now, depending on which level you’re at, it also depends on how much you’re paying. The regular assisted living is between that margin I tell you between 1,800 and maybe 3,500. But when you get into skilled, which a person needs 24-hour care that they need to be moved around so they don’t get bed sores and things like that, that’s when it starts getting pricey. Now, pricing, it’s much less than obviously the US or a lot of countries, but it still gets pricey. So people need to plan about, plan for, I’m sorry.
And then one last thing on this is that some people like, you know what, I have my home and I built in a maid course. And I did the math just recently, Richard. And it’s actually sometimes less expensive to be in a community facility than it is to have your home care. Because this is what happens is that in Costa Rica, when you have a person working for you, anything after eight hours is overtime. And particularly, you’re going to be going that over that time. So you’re going to need a majority of two people coming over, taking care of you. So you’re going to be paying quite a little ducat. Not everybody’s saved up for that.
Richard Bexon: Yeah, no, definitely, definitely. Look, my grandmother’s in the UK at the moment. She’s paying, what’s that, nearly $8,000 a month for it. But it is that highest level 24-hour care. It’s incredible. And I think that there’s going to be more demand for it. I just don’t know why there aren’t more facilities being advertised in Costa Rica. We’re developing condominiums and apartment towers all over the country, but really not much in those three steps. And you can have those three steps in a community.
Johnny Umana: Oh, yeah. You have to follow the life as it comes. You can work independently when you do need assisted, and then also preparing for that memory care. That’s the other thing, too, is that we don’t know if we’re going to be mentally sane to need the memory care. That’s another level that you’re also within skills. So people just have to prepare for that.
Services Needed in Costa Rica
Richard Bexon: Yeah, yeah. I mean, what other services do you think are still missing in Costa Rica, just in general, Johnny? A lot of people are looking to invest here. A lot of people are looking to come down and run businesses. I mean, what some of the services, it doesn’t need to just be in health care, it could be anything. But what are some of the services that you think are still missing here in Costa Rica?
Johnny Umana: I think the transition from where they’re coming from to the automated services that where you’re living at, you’re living closer to the city, that automated to your door to having that express Amazon package show up at you. There is kind of a, they’re having it, but it’s not fluid. The other thing, too, is preventative health care or preventative planning on a global scale in the public system. Right now, Richard, if you don’t go to the Gaha to get your services done, they think you’re totally healthy. And then you have to wait for a service. There needs to be more of a preventative approach to health care in the country as a whole, instead of to react to a situation, prevent it rather than react.
Richard Bexon: Yeah, I mean, public health care systems are so expensive from what we’ve seen. Again, taxes are high here in Costa Rica. It’s always that balance. And I think that that’s why I like that Gaha Mixta, which is that, look, the Gaha is there, but if you want to pay a little bit more, you can go and get service straight away, which I kind of like rather than just going the whole private. Because again, as you said there, it allows you to still keep a record because I think it’s important to keep a health record. But also getting the service that you need when you need it.
Johnny Umana: Right. And you just honestly have to also know how to work the system, how to use the digital app within the system and knowing when to pick, to be able to connect to it, to know that it exists and that they are trying to go to the digital system. It’s just it’s taken some time. And then the program that I’m working with them is to educate on how important preventive health care is to get to that system. So a person like you that is paying every month is able to use it more seamlessly.
Richard Bexon: I mean, paying the Gaha for my employees every month is painful, dude. I know I have to do it, but it’s a lot of money, man.
Johnny Umana: Yeah, it’s usually about 50% of their salary. Yeah. And that takes a hit on you. So you got to plan for it. But also too, it also covers you from those lawsuits, those labor suits of, hey, you know what? He didn’t pay me. It just saves you a lot of headache on the other side. And honestly, you came here for just applying a service. But yes, it’s tough.
Richard Bexon: Yeah, yeah. No, I mean, look, I always say to people, you never understand how expensive it is to run a business until you run a business. It’s all the little things, if that makes sense. It’s like if you’ve ever moved into a house, buying the house is the cheap part. It’s furnishing it all and putting up curtains. And it’s all those little bits at the end. And that’s like running a business.
Johnny Umana: Oh, yeah, definitely. No, in Costa Rica are going to nickel down you in certain areas. But you know what? You also got to look at the positive, the areas of, hey, you know what? The property taxes, you know, you’re not going to… Or if you build correctly, you know what? That you build in such a way that when you’re… There is little tricks and things on how to present things that I’ll save you a few bucks here and there. Yeah, I agree.
How Would You Invest $500,000 Inheritance in Costa Rica?
Richard Bexon: Well, Johnny, this has been great kind of getting an overview of health care and residential care and kind of medical care here in Costa Rica. But my last question for you, Johnny, if you had $500,000 and you had to invest it into a business or real estate in Costa Rica, what would you invest it in and why?
Johnny Umana: That’s a really good question. And I’m going to give you an answer that I think you first have to study the markets around where you’re planning to do your business. The biggest thing is the pool. You know, the pool…
Richard Bexon: What would you do though, Johnny?
Johnny Umana: Oh, well, I personally would do… I would open up a senior living facility that covers all three stages. All three stages of life as you become a senior. But I would buy an existing hotel that maybe is not doing well, but has all the facilities that you need to make sure that quality of life is pursued. And they’re wanting to do that. And then also that facility to be close enough to a health care facility that can respond in case of emergency. Because I could build something in Guanacaste, which I love going to the beaches. I don’t know about you, but me… But I know that if I build something in Tamarindo, I’m about an hour away from my closest real resources. So I’d want to build it closer to San Jose, the Gam, Escazú area, that section to have a greater pool and not have to fight for resources.
Richard Bexon: I agree. Johnny, great answer. I kind of knew that I thought that you would respond that. But I mean, I think there’s huge demand for that in Costa Rica. And there’s only going to be more and more demand as the world gets more expensive. You know, there is highly educated and trained individuals here and we could do it at a fraction of the cost. So yeah, that’s a great idea, man.
Johnny Umana: Yes, sir. Well, thank you for taking the time to listen to me a little bit about health care. And I hope your listeners can take advantage of some of the stuff that we shared. And in the future, if they should need something, you know what? You guys have our contact. Awesome.
Richard Bexon: Well, I’ll put all of Johnny’s contact details in the description down below for anyone that wants to get in contact with him. But Johnny, very much appreciate your time, sir. All right, sir. Take care. Thanks. Bye.
