Overseas Emergency Health Plans - eight Questions

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Overseas Emergency health plans - eight questions to ask yourself

One of the first question that comes up when you start considering a move overseas is "Is it safe? What if something happens? What kind of healthcare is there?" And if you've got small kids, then, socially, there is a near-moral-imperative that you be within a 15-minute radius of a world-class health care facility at all times.

On a certain level, this makes sense, especially if you have smaller kids. Especially if those kids, hypothetically, of course, like to play "monster" which involves putting blankets over their heads and run around the house at full speed while screaming their heads off. The point of the game appears to be trying to find the concrete walls of their house with their faces.

Or maybe they like to play "jailbreak" which involves turning off all the lights and running at full speed in the dark, screaming. Again, the walls of my house are all concrete.

All of these games end… poorly.

But this brings us back to the topic at hand of healthcare, health insurance, medical emergencies, and a whole host of other unpleasant topics. But the reality of the matter is that in a medical emergency you don't want to be trying to figure out what to do, where to go, what you care about, and how you'll pay for it. You certainly don’t want to do this in a foreign country in a foreign tongue.

To that end, here are some questions that will help you be more prepared before a medical emergency arises. Talking to other expats and nationals alike is likely your best source of information on this topic, especially if you can find people with medical expertise who are willing to give you their opinions on where to go and who to see. A word of caution though, many expats love to tell their medical "horror stories" - so take those with a grain of a salt!

1. What quality of healthcare is available locally, nationally and regionally?

Quality of healthcare can vary incredibly within a small geographic region. An SOS hospital and a local standard care hospital can sit within a kilometer of each other, but the care can be worlds apart.
Singapore has amazing healthcare, and there are certain cities such as Bangkok and Kuala Lumpur which draw a significant amount of medical tourism. Knowing what is or will be available to you personally is important to evaluate.

2. What level of need can be addressed locally?

Knowing what level of need you're willing to treat at a local hospital, and knowing when you need to pursue higher quality health care. For stitches for a cut knee you may feel OK with your local doctor. For setting a bone with a break on the growth plate, you may want to fly to another country to ensure the bone is set correctly. A few stitches? Maybe local. Stitches on your kids face? Again you might reassess.


3. What level of health risk are you comfortable with?

For some people, proximity to healthcare trumps quality of healthcare. And that makes sense in some scenarios. Would you rather give birth in a "pretty good" hospital, or give birth in a traffic jam in a taxi en route to a great hospital (because the 30 minute drive is suddenly going to take you 3 hours)?
For me and my family, when my son had breathing issues (viral induced asthma) we decided it was worthwhile to fly to a specialist to get him evaluated and treated. The doctors in Singapore were fantastic and they had a very thorough preventative care and symptom mitigation plan. Totally worth it to see a specialist.

4. What are your views on traditional medicines and traditional remedies?

In Asia there is a different view of illness and health then the model that most Westerners are comfortable. Often karmic influences are cited as the cause of illness. This can be difficult for Westerners to accept, and the remedies can also be difficult for some to accept.
What do you think about suction cupping and scrapping with hot coins? What about acupuncture or reflexology? Traditional medicine is held is high regard in some parts of the world, and can be incredibly effective. Know what you feel comfortable with and what you do not is helpful.

5. Who is part of your health safety net?

Knowing who you will call when there is a medical emergency is important. This can be expat friends, trusted neighbors, but it is essential that they are able to help in a moment of need.
Sometimes, extended family can help. My parents made the 10,000 mile trip to help during the birth of one of my kids. It was really humbling to have them come literally across the world to help us with our other kiddos while waiting for the new arrival. Plus they brought literally an entire suitcase of candy and toys. It was fantastic.
I would just say choose wisely who you ask to serve specific roles. Some people do great with kids, other deal really well with doctors and nurses and blood. One of my favorite emergency safety net people was the expat friend who sat in the delivery room calmly reading a book while my wife labored. She never batted an eye at the heavy breathing, complaining, straining or vivid descriptions of the birthing process. She would occasionally look up from her book to ask if we needed us to say anything to the nurses or doctors in the local language. Totally nonchalant. Like she sat in on humans being born every other Tuesday. Good friends are worth their weight in gold.

6. What does your health insurance provide?

Sitting down with your insurance paperwork is literally no-ones idea of a fun Friday night. But grab a glass of wine, and do it. You'll be thankful you did down the road. It'll provide peace of mind, or as in my case you'll discover benefits that you didn't know you had. Such as per-Diem payments for hospitalizations, or coverages that vary dramatically by country. Knowing where you're covered and for what can prevent you from making some very expensive medical missteps.
Also knowing what your covered for can help you make a better health maintenance plan. I discovered that I could save upwards of a thousand dollars a year by flying my family to Singapore for a long weekend versus getting them all in to see doctors while in the United States. Immunizations, checkups, tests, etc, etc are all covered completely by my plan in Singapore, but if I receive the same treatments in the USA, they're three times more expensive (at least) and only 70% covered after a massive out-of-pocket. So we plan a fun trip to Singapore. Knock out our appointments and head to the Gardens by the Bay, or the Singapore Botanical Gardens. The MRT in Singapore (their subway) is easy to use, the kids think it's the best ride of the trip, and Singapore is a photographers dream. So we make the most of it, enjoy some family time and save money while we're doing it. What's not to love?

7. How far will you trust your local doctor?

I hesitate to write this, but I do think that its important for you to know what you are willing to listen to your doctor on and what you're not. The point is that in some cultures, there is a near-god-like deference paid to doctors (what they say is always true and correct and you obey their commands to the letter) and sometimes the doctor is looking to scam a few bucks by recommending unnecessary services. For instance, when I asked at a hospital for a HIV blood test (required for my visa) they said I would need to go down to their new psychiatric evaluation clinic to meet with a psychiatrist for an evaluation before my blood test. I argued (successfully) that generally, HIV is in the blood, not the mind, and therefore I only wanted my blood tested (the test results were negative for those who are wondering). Another friend of mine had a lump in her breast, and her doctor recommended an immediate mastectomy without doing any further tests, which he would provide at an astronomical rate. My friend wisely balked at the suggestion, and got a second opinion. It turns out that it was a swollen gland, and she has been fine since.
Follow your gut. If things don't seem right, seek a second opinion. Ask for other people's insight. But remember at the end of the day, it's your body, your health or your family. Take the time to find a doctor that is highly recommended and highly qualified. It's worth the effort of asking your friends and neighbors about their experiences.

8. What is your health-issue prevention strategy?

By far, the best question you can ask yourself is how can you keep yourself from needing this list in the first place. People get out of balance overseas, their stress levels skyrocket, their positive stress-relieving practices are gone, and their body pays the toll. Living overseas can be a difficult adjustment, especially in the initial adjustments period, after the adrenaline has worn off, but you haven't quite figured out how to manage your new life.
So take ownership of what you can. Maybe consider your diet. Focusing on reducing your stress levels. Ramping up the exercise, trying to intentionally have more fun, experience something new, enjoy a super cheap massage or movie. Make healthy choices with your diet and ensure you're getting the vitamins you need.
There's a lot of things we can do to improve our health situation, so resist the inclination towards fatalism in this area. You can take charge of your health, and the quicker you do so, the better. So many people end up in medical emergencies because of easily preventable illnesses. Is there one thing you could change? A slow walk? A short run? A simple change to your diet? The diet and health choices we make today will pay dividends down the road, but a healthier, happier lifestyle can make a significant difference in how much we need to worry about healthcare options.

In summary, please have the conversation developing your health plan while it can be a thoughtful conversation and not a panicked reactions. No one likes to worry about these scenarios, but when a crisis happens, you'll be so very glad that you did.