Healthcare in Bolivia: the SUS from age sixty, the Cajas for employees
Bolivia gives foreigners aged sixty and over who are not insured through an employer free care in public healthcare, the SUS. Anyone working as an employee falls under short-term social security. A Dutch health insurance through the CAK does not exist there: Bolivia is not a treaty country.
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If you are sixty or older and not insured through a Bolivian employer, you are entitled to free care in Bolivian public healthcare. That is in article 5 of Ley 475, as rewritten by Ley 1152 of 2019. That law builds the SUS, the Sistema Único de Salud. Anyone working as an employee falls under the Seguridad Social de Corto Plazo, the short-term social security of the Cajas de Salud. There is no Dutch solution: Bolivia is not on the CAK's list of treaty countries.
| Who | Where you get care | What it costs |
|---|---|---|
| Employee of a Bolivian employer | Caja de Salud of short-term social security | through your employer |
| Foreigner aged 60 or over without a Caja | public care (SUS) | free |
| Children under 5 | public care (SUS) | free |
| Pregnant women, up to 6 months after giving birth | public care (SUS) | free |
| People with a recognised disability | public care (SUS) | free |
| Foreigner between 5 and 60 without a Caja, outside those groups | not named in the law | own insurance |
| Emergency | any hospital, any level | |
| Dutch health insurance through the CAK | not possible |
What exactly does the law say?
Article 5 names three groups that get free care in the public sector. First, Bolivians without social insurance. Then foreigners without social insurance from a country with which Bolivia has an international agreement based on reciprocity. The Netherlands has no such agreement, so you do not fall under it.
The third group matters to you: foreigners who are in Bolivia and do not fall under the second group, if they belong to one of five groups. These are pregnant women up to six months after giving birth, women for sexual and reproductive care, children under five, men and women from age sixty, and people with a recognised disability.
Under article 6 the care is extended step by step, based on the productos en salud set by the ministry. That means: the SUS covers what the ministry has included, not automatically everything.
How do you get into the SUS?
Through primary care. Article 7 provides that you must first go to a primary health centre, preferably the centre where you are registered (adscrito). You only reach a second-level hospital with a referral from primary care, the third level only with a referral from the first or second level. In an emergency that does not apply: then every level must help you straight away. Under the same provision older people get priority in care and in administration.
Which papers you need to register is not in the law. Ask at the health centre in your neighbourhood, and bring your cédula de extranjero as soon as you have it; see registration and numbers.
If you are under sixty and not employed, the law does not name you for free care. Then arrange your own international insurance before you leave, and check whether it continues after you turn sixty or until you are in the SUS.
How does it work if you work in Bolivia?
Then you fall under short-term social security, through a Caja de Salud. Article 48 of the migration law provides that foreigners with a permanencia who work have the protection of the labour and social security laws. Anyone covered by that security does not count for free public care; article 5 is about people who are not covered by it. More in working in Bolivia.
Why no CAK?
The CAK only arranges Dutch health insurance for people living in a treaty country, NederlandWereldwijd writes. Bolivia is not on that list, nor among the 36 countries outside Europe with which the Netherlands has a social security agreement. After emigration without Dutch income you are no longer insured for the national insurance schemes, including the Long-term Care Act. You cancel your Dutch health insurance; see cancelling health insurance without a gap.
What else should you take into account?
The altitude. Many areas are above 3,000 metres, including La Paz, Oruro and Potosí, NederlandWereldwijd warns; there you can suffer from altitude sickness. If you have heart or lung problems, discuss a move to the high plateau with your doctor first. Bring your medicines for the first months; see medicines across the border.
What the pension and tax mean is in AOW, pension and tax.
In Vertrekklaar this is phase 1 of 5 of the journey, step 1.2: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Bolivia or go straight to step 1.2 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- Ley 1152 of 2019, articles 5 and 7: who is entitled to free care in the public system, and access through primary care — diputados.gob.bo
- CAK — the treaty countries for health insurance, without Bolivia — hetcak.nl
- NederlandWereldwijd — health insurance through the CAK only applies in a treaty country — nederlandwereldwijd.nl
- Belastingdienst — after emigration without Dutch income no longer insured for the national insurance schemes — belastingdienst.nl
- Answers to parliamentary questions 2024Z02891 — the 36 countries outside Europe with a social security agreement, without Bolivia — open.overheid.nl
- Ley 370 de Migración, article 48: foreigners with a permanencia fall under labour law and social security — diputados.gob.bo
- NederlandWereldwijd — travel advice for Bolivia, altitude sickness above 3,000 metres — nederlandwereldwijd.nl
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