Panama operates a two-tier healthcare system: the public sector, made up of Ministry of Health (MINSA) facilities and Social Security (CSS) hospitals, and a robust private sector. Leading private hospitals in Panama City include Hospital Pacífica Salud in Punta Pacífica (affiliated with Johns Hopkins Medicine International), Hospital Nacional, Hospital Paitilla and Clínica Hospital San Fernando. Many physicians trained in the United States and speak English. A private consultation typically costs $50-100, and private health insurance for expats commonly runs $100-300+ per month depending on age and coverage (prices vary and change; verify with providers). Quality is concentrated in the capital; in the interior, David (Chiriquí) has good hospitals such as Hospital Chiriquí and Mae Lewis serving Boquete's expat community. Retirees holding the pensionado visa receive legally mandated discounts on medical services under Law 6 of 1987.