Living with IESS (Part 2): Use it for the Small Stuff, Run for the Big Stuff.

After that first “reality check,” most expats ask: “Okay, so how do I actually handle this system long-term?”

Here is the unfiltered truth: The IESS is a tool for your routine, not a safety net for your life. If you’re thinking about the IESS for a surgery or a major medical procedure, you’re playing a dangerous game. We’re talking about a system that, as of late 2025, has over 13,300 surgeries on its waitlist, with people waiting months—sometimes years—just to get into an operating room.

And it’s not just the wait. Hospital reports and news outlets like Primicias have highlighted a chronic medicine shortage that often hits 40% or more, meaning even if you get the surgery, the hospital might not have the basic supplies or painkillers you need for recovery. That’s not a system you trust with a scalpel; that’s a system you use for an X-ray when you’re not in a hurry.

So, how do you play it smart? You use it for the basics.

The IESS is “fine” for your annual blood work, routine check-ups, or getting a prescription for standard meds—assuming they have them in stock that day. It’s for the stuff that doesn’t keep you up at night. But the second things get serious, or if you need a specialist who actually has the tools to treat you? You go private. Period. You don’t wait in limbo while the bureaucracy figures out its budget.

The only real “heavy” value the IESS provides is for catastrophic conditions—things like HIV, Cancer, or Hemophilia—simply because the State is legally obligated to cover those astronomical costs. But even then, it’s a constant battle against stock shortages and paperwork.

In hindsight, the expats who are most satisfied with their healthcare in Ecuador are the pragmatists. They keep their IESS contribution active for the routine “maintenance” and the legal backup for rare diseases, but they keep a private plan (or a very healthy emergency fund) for anything that involves a hospital bed.

Living with IESS isn’t about blind faith. It’s about knowing exactly where the system breaks—and making sure you’re nowhere near it when it does.

Click here to see Part 1: https://cuencahighlife.com/classifieds/iess-in-ecuador-the-safety-net-vs-the-reality-check/