Healthcare overseas

Kate says:

Getting healthcare overseas can be a nerve-wracking and annoying enterprise.  If you spend enough time in a foreign country, you will most likely need to visit a doctor or have your teeth cleaned. I will be detailing some situations below that may make me sound like a total wreck of a human being, but really, generally, I am a pretty healthy person.  I just have a few things that need some maintenance, and you may find yourself in similar situations!

 Issues that may affect your healthcare experience: 

• The nationality and gender of your provider(s).  Different people have different cultural expectations of what a doctor visit is like, and how doctors and patients should behave.  If one or the other of the people involved violate expectations, that can cause a visit to become stressful and possibly non-productive.  In my experience, I expect a certain level of communication from my doctor about the details of my diagnosis and treatment that many non-American doctors are not used to.  For many cultures the doctor tells you what you need to do, and gives very little detail about the situation beyond "take this pill twice a day for 3 weeks." 

• I am prone to skin cancer, and need to have my skin checked for possible problems every 6 months.  This means getting fully naked and having someone look all over the place for possible cancer spots.  I now am in a culture where many male doctors (who dominate the doctor rolls) are not culturally comfortable examining a female patient that way.  You may have to visit several doctors to find one that you are comfortable with as a patient.

• Rules and regulations about the treatment of chronic conditions such as asthma may differ from what you are used to.  In the UAE (currently) you cannot get a prescription with a refill.  So to manage my asthma, I have to go to a doctor for an exam to get a prescription EVERY TWO MONTHS.  This is vastly irritating, but the way things work here.

• Be aware that the US has a very commercialized and regulated pharmacy industry, which makes visiting a pharmacy a pretty standardized event for most people.  Not every country has a similar approach to pharmacies, and you may have to dig a bit to figure out the system in your host country. 
  
  For example, in the UAE there are different levels of pharmacies, with hospital pharmacies licensed to stock the widest array of medications, and smaller pharmacies barred from stocking items like injectable medications such as insulin or epipens.  As well, pharmacies here may stock a general class of medication, like insulin, but the brand or type of insulin available in the country may vary from month to month.

• If you take anti-depressants or other psycho-pharmacological medications, nose around online to see if managing your condition will be problematic in your host country.  The US is very open about treatment of depression, but much of the world sees a medical diagnosis of depression as "Mental Illness" and the standard of care to treat it may be burdensome (monthly psychiatrist visits for your prescription, for example) or not available. 

 Steps you can take to manage your healthcare overseas:

• Before you accept a job offer, ask about medical benefits.  If your employer doesn't provide or subsidize medical care, how do people handle doctor's visits and routine healthcare, and what about emergency situations?
  

• Get copies of your health records and any other people accompanying you to live in your foreign destination.  Digitize them and store them in on a cloud drive or some other place you can quickly access them if needed in an emergency (like as a file on a smartphone).

• If the information is available before you go, find out if there will be any problems accessing any prescriptions you or other family members will need while living overseas.  

• If the information is not available to you before you go, make sure that you bring at least a 3 month supply of any needed prescriptions with you.  Also make sure that you have refills left on your prescription in the US.  

• Be aware that some medications you may be used to taking are illegal in your new country (no narcotic cough syrups for me in the UAE!) or are legal but simply unavailable.  In my case, the UAE is not big on birth control pills, so while they are legal to have, there is pretty much only 1 brand in the UAE, and it's not the one I want.  I have to pay full price in the US, have a 3 months supply shipped to me (the max allowable for import at once). 
  
  This also means that when I come back to the US I need to visit a doctor at least once a year to get a new prescription.

• Some, but not all overseas insurance companies will reimburse you for a portion of medical care that you seek in your home country.  My UAE health insurance will pay for 80% of doctor's visits and legal medications I receive in the US, but I have to fill out the paperwork correctly for this to happen.
  
  
• Some medications are available in your country and not covered by your insurance.  A friend of mine can get her medication for hot flashes (although it is pretty rare and a pain to find stocked in a pharmacy) but our insurance doesn't cover it.  At this point it may be cheaper to get the medication from the US (and less hassle!)

Lara says:

• In Fiji, many over-the-counter medicines (for sinus, allergy, etc.) cost twice what they would in the US, but prescriptions (even if not subsidized by your insurance) are often much cheaper than US prices. Some medicines that are prescription in the US are OTC here (and vice versa).

• If over-the-counter medicines in your host country are imported from Europe and Asia instead of the US, they may have unfamiliar names. Acetaminophen is referred to as "Panadol" in much of the world because that's the most common brand, and ibuprofen is better known as "Nurofen". Generics and store brands (ie Walgreen's "Walzyr" as a cheaper version of Zyrtec) may not exist.

• Common ailments have different names also. What Americans call a yeast infection is called "vaginal thrush" in Oceania, and if you ask the pharmacist for "something like Monistat", they may not know you mean "something like Canesten" (the well-known brand in Australia and Europe), and you may need to have a somewhat embarrassing conversation before you figure out what the appropriate medicine is. Using wikipedia in advance to get the clinical words to tell the pharmacist (candidiasis for the condition, clotrimazole for the treatment)  when you know the common terms will save you some trouble (even for less embarrassing medical concerns).
  
• Because this is a developing country with less than a million residents, many specialized medical procedures are not available here. Private health insurance often has a provision for flying you to Australia or New Zealand (and increasingly, India) should you need an organ transplant, brain surgery or similarly advanced procedures.