This is a good question. The answer may be different for each person.
This is my opinion:
1. if you are healthy, have no pre-existing conditions and live a good life, I recommend giving up your IESS insurance.
If you want to keep it, it is fine for minor things like checkups. However, a full checkup once a year in Cuenca can cost $100 VS Monthly IESS costs $80.
You could get catastrophic insurance instead and pay for your checkups out of pocket.
Or you could purchase insurance with a low deductible and high coverage.
2. If you have a pre-existing condition such as high blood pressure, cancer, or other complicated pre-existing condition, be sure to get IESS and private insurance.
Why?
Because if you only purchase private insurance, your pre-existing conditions will be covered up to $8,500 per pre-existing condition after a two-year waiting period. And $8,500 is not enough money to pay for cancer treatment.
Private insurance could cover new illnesses unrelated to the pre-existing condition and provide access to the best private hospitals in the country.