CHAPTER 5
HEALTH CARE OVERSEAS
PRACTICAL CONCERNS
| Health care in your new country can be on a par with or below that to which you've become accustomed in the US. Despite recent debate over the future administration of health care in this country, there are few who will deny that the quality of health care in the US is among the best in the world. Having said that, expats may find the health care in their host country to be in some ways different from the US. Just how different can to some degree be determined in advance, and this is advised. |
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Before you accept your assignment, it would be wise to acquaint yourself
with the health standards and health risks you can expect to encounter
in the proposed country. If poor health care standards or a high degree
of medical risk for you and/or your family are likely to outweigh the
allure of an overseas assignment, it is best to determine that before
you get there! It is important to look this issue squarely in the face
and discuss it with your spouse and family. There are certainly places
in the world that are dangerous. One human resources executive pointed
out that several of the company's overseas assignments in Third World
countries had to be canceled because of the health care issue. "In
countries where medical treatment is deficient and health standards are
deplorable, there are very few employees who will consider subjecting
themselves, let alone their families, to that kind of environment."
Obviously, if you or a member of your family has any special medical
condition or needs, you will need to assure yourself that those needs
can be met in the new country. Even if health care concerns do not
discourage you from accepting the overseas assignment, it would be wise
to learn as much as possible about the health conditions in your host
country so that you can take necessary and available precautions.
For an overall picture, areas of the world can be classified as low,
moderate, or multiple risk, according to the health risks they pose to
travelers. The United States, Canada, Northern European nations
(including France), Australia, and New Zealand are considered low risk
countries. Moderate risk nations include European countries bordering
the Mediterranean, countries of the Caribbean islands (except Haiti and
the Dominican Republic), Israel, South Africa, Japan, and the countries
in Eastern Europe. Health risks in these countries include those of the
low-risk nations plus food and water-borne illness and some insect-borne
diseases. All the remaining countries are considered to pose multiple
health risks. In these countries, insect-borne diseases are significant
dangers, and the problems experienced with food and water-borne
illnesses are greater. Swimming is also often much more dangerous due
to water pollution and/or dangerous freshwater parasites.
SEE YOUR DOCTOR BEFORE YOU LEAVE
Regardless of the relative riskiness of your target country, you (and
your family, if applicable) should consider a visit to your doctor
before you leave the US. Get a thorough checkup, review your routine
immunizations to be sure they are up to date (do you need a tetanus
booster, for example? Or have you had rubella?). If you have any
pre-existing medical problems, ask your doctor for a letter describing
the condition in detail indicating whatever prescription medications
(with the generic names) you might need. Carry this letter with you
when you go. If you have allergies, reactions to certain medicines, or
other unique medical problems, consider wearing a medical alert bracelet
or carrying a similar warning at all times.
Discuss with your doctor the potential health risks you will face and
possible preventative measures you can take. Depending on where you're
planning to live and travel, recommended immunizations may include
cholera, hepatitis A, hepatitis B, Japanese encephalitis, meningococcal
meningitis, plague, rabies, typhoid, and/or yellow fever. You may also
need to procure a supply of malaria prevention medications
(quinine-based pills) and/or diarrhea medications. Many countries will
require proof of specific immunizations, so you will obviously need
these. For example, under the International Health Regulations adopted
by the World Health Organization, some countries require International
Certificates of Vaccination against yellow fever from international
travelers. A few countries still require a certificate of cholera
immunization as well. However, just because an immunization is not
required for entry into the country you might still need it. Get expert
advice on this matter.
A helpful guide to immunizations and preventive measures for
international travel is the US Center for Disease Control's booklet,
Health Information for International Travel, available from the
Superintendent of Documents, US Government Printing Office, Washington,
DC 20402. You can also call the CDC international travelers' hotline at
(404) 332-4559. Specific information may also be obtained from local
and state health departments, physicians, or travel clinics that advise
international travelers. You may also call the US Public Health
Service's Quarantine Division at (404) 639-2572 for immunization
recommendations.
MEDICATION
For individuals with any medical condition that requires prescription
medication, it is important to check with the US embassy or consulate to
confirm whether that particular drug is legal in the country of the
assignment. As far as clearing prescription medication through US
customs, it is recommended that the expat carry all relevant information
pertaining to the drug itself, including the generic name. Keep in
mind, a US doctor's certificate does not necessarily provide
authorization for prescriptions to be taken overseas.
For your protection, leave all medicines in their original, labeled
containers. If you require medication containing habit-forming drugs or
narcotics, carry a copy of the doctor's prescription attesting to that
fact. These precautions will make customs processing easier and also
will ensure that you do not violate the laws of the country in which you
live.
AIDS TESTING
Many countries require long-term foreign residents and students to
submit proof that they are free of the HIV virus. Some of the countries
that require this proof may accept certified test results from the US.
Consult the embassy of the country you will be residing in on whether an
AIDS test is required and if test results from the US are accepted. If
not, check on the type of test to be performed and whether it is
permissible to supply your own disposable needle. If you are overseas,
consult the nearest US embassy or consulate for information and advice,
keeping in mind that you are in a foreign country and are subject to its
laws and requirements.
FOR MEDICAL ATTENTION WHILE THERE
Moving to and living in a new land and environment brings accompanying
stress. In all probability the US expat (and family) may require some
type of medical assistance while abroad. Illness during this adjustment
period, and especially during the first year, is common. It is
therefore a good idea to locate a physician with whom you are
comfortable as soon as possible once you get settled in.
One good information resource to keep on hand is the International
Association for Medical Assistance to Travelers (IAMAT). They can be
contacted at 736 Center Street in Lewiston, NY 14092 (716) 754-4883.
This organization offers a free booklet containing information on
worldwide physicians, hospitals, and other medical institutions. The
objective of IAMAT is to pair up individuals with physicians who can
speak their language when they need medical treatment abroad. You might
also refer to the Directory of Medical Specialists published by the
American Board of Medical Specialists and its 22 certifying member
boards. Major credit card companies also maintain lists of local
doctors and hospitals abroad.
The US consulate can also help you find medical assistance nearest
you. In the case of an emergency, the embassy can also help you contact
family and friends and arrange for the transfer of funds from the US.
However, you will be held accountable for payments to hospitals or other
service providers.
HEALTH INSURANCE
If your company is offering medical insurance to cover you while abroad,
be sure all details regarding the coverage are clearly spelled out in
the compensation package before leaving. Wherever possible, get the
best medical insurance available. Check whether the coverage offered
abroad includes both routine and emergency medical treatment,
hospitalization, and medical evacuation.
If you must arrange for your own coverage, first find out how citizens
of the country where you will reside pay their medical bills and whether
the same coverage is available to resident foreigners. Some countries
have government-sponsored health insurance that may also provide
coverage to foreign residents, while others have a dual system with
national health supplemented by private insurance. In countries where
many American expatriates reside, such as Mexico, you may find that
local private international health insurance companies will offer
coverage to US citizen residents. If good coverage is not available
where you will live, you may have to rely on a US or international
insurance company. Check with organized groups in the American
community in your area to learn about these companies. Once you obtain
health insurance, remember to carry your policy's identity card and to
keep a supply of insurance claim forms handy.
There are a number of emergency medical assistance companies operating
internationally who offer urgent medical treatment for their member
travelers. Although the service is designed primarily for tourists who
encounter a medical or personal emergency while on vacation, some
companies offer yearly memberships which may be available to Americans
residing overseas. To learn about these emergency assistance companies
contact a travel agent.
It is important to note that the US Government cannot pay for hospital
or medical services for Americans overseas and cannot pay to evacuate
you for treatment in the United States. The Social Security Medicare
Program does not cover hospital or medical services outside the United
States. The Department of Veterans Affairs will only pay for hospital
and medical service outside the United States if you are a veteran with
a service-related disability.
