International Man of Mystery's blog

Living abroad: healthcare systems and cover

If you go abroad to live, then who looks after your health?

Since the NHS is a healthcare system that's based on the residence (ie the UK) of its users, this obviously means that when you no longer reside in the UK,  you can no longer access its services.

For many who move abroad, the health system in the new country of residence is an important factor in terms of deciding what's required healthcare-wise. For instance, you may move to a country where there is an adequate state system that you have access to and can enrol it. But it may be that the system works significantly differently from the one at home - and often this is the case.

Quite often - even if you have the same access to a healthcare system as a national of that country, you'll still have to pay towards treaments and medicines.

On top of this, a lot of times there can be long waiting lists for various things. And additionally there's the language barrier too. All of which means that getting international cover is recommended and in the case of people working abroad on an international assignment it's often provided by their employer as part of the employment package. This is especially important if employees are being sent to work in areas where the facilities are basic.

If you're an employer it's worth checking out the different levels of international health cover that are available - it's possible to add optional cover compnents to suit the requirements of your employees and also your budget as an employer.

 

International health insurance boosted by expatriates

This week it was reported that the health insurance market appears to be in pretty good shape, with one of the major inrternational medical cover providers reporting an 11% rise in the number of members year on year, with a large part of that down to international PMI (iPMI).

In many ways, although the gradient of this particular uptick is pretty steep, it wasn't unexpected (to me at least) that iPMI numbers would be on the up. I say this for a couple of reasons:

• Firms expect the number of international assignments to continue rising for a number of years yet, according to a survey carried out last year. This should mean continued uptake among newly expatriated members of the workforce
• In some cases firms who employ staff abroad are unaware of the difference between travel cover and international PMI, and as awareness of this increases, there will be a likely further uptake of iPMI among those who are currently expatriated but not fully health insured.

International PMI in 2012

The world of international health cover is one that is likely to be of interest not just to those of us hwo spend time living and working abroad, but also to people running businesses that send people abroad on international assignments. 

In fact it's been estimated that the number of international employees is set to grow, even despite the wider economic backdrop that has seen the last 4 years become challenging for business the world over. Some even speculate that the vast majority of businesses will one day have overseas dealings - and this makes a lot of sense when you think about just how communications technology is developing, and the pace of that development.

This week health Insurance magazine published its Market Intelligence 2013 report (you can view it here) and there's a whole lot of fascinating info in there for those interested in the iPMI market and what's going on there.

According to HI Magazine's report, a lot of UK businesses are looking east towards India and China to do business - in fact a very large percentage (41%) of survey respondents expressed an interest in expanding into these markets.

International PMI was also mentioned in other news this year as being one of the most popular employee benefits for expats. The other top benefit indicated by research was a relocation allowance. This makes sense as many going abroad will require homewares, white goods and possibly the deposit on a property as well. In terms of health insurance, given the often vast differences between countries' health care systems, private medical cover is pretty much a necessity for most who go to live in foreign climes.

 

Health care in Russia

As one of the much talked about BRIC economies ( a group that also includes Brazil, India and China), Russion continues to be the focus for many companies in terms of investement and expansion into new markets.

This vast country spans continents starting in Europe with the Kaliningrad Oblast (administrative region) - an exclave which borders Poland and Lithuania to the west, all the way east to Vladivostok which is closer to Tokyo than it is to Moscow. And then even further east, so far in fact that the Russian mainland is a close next door neighbour the the U.S. state of Alaska.

As such a large country, it's of little surprise that the quality of its health care system varies depending on where you go. In the time since the end of the communist government, life expectancy in the country is often reported to have actually got shorter, with the average male life expectancy quoted ina  Guardian article as being just 59. Compared with one of Russia's next door neighbours, Japan (life expectancy 79) this does seem a pretty big gap.

The Russian government has a reciprocal agreement with the UK which means that UK nationals can receive treatment free at state Russian hosptitals. However, the British government Foreign & Commonwealth Office (FCO) advises that the treatment that you receive in a Russian hospital is likely to be "limited".

The FCO also advises that you have an adequate level of health cover that includes covering the cost of eligible treament and also medical repatriation. Travel cover and international health insurance policies both cover these - and repatriation is particularly expensive in cases where people require this service but are uninsured.

 

Healthcare in India

With its population currently at around one and a quarter billion, India is a country that’s set to grow significantly both in terms of population and economy in the coming decades. In fact, experts predict that India’s population will overtake that of China in the first half of this century. And the country’s economy is also set to overtake that of other countries too, becoming one of the most powerful on the planet.

For now, though, India remains within the BRIC group of economies, a select group of emerging economies that are fast-growing and attracting a lot of investment.

In terms of healthcare, India is (as you’d probably expect) a bit of a mixed bag, with the standard of treatment varying from place to place within the country. The local medical facilities are according to the Foreign and Commonwealth Office “not comparable” to those found in the United Kingdom, however in the larger cities private health care is available.

The Telegraph’s expat guide to India states that there is a “need for a hugely expanded healthcare sector”, which will no doubt see massive investment as the country’s population and ecomony continue to grow.

Expatriates are advised to purchase comprehensive  international medical insurance in order to ensure that you get the right level of care and treatment in the event that you require assistance.

India also has a growing reputation for medical tourism, which is partly down to the cost of procedures generally being lower than in other centres of medical tourism.

All in all, India is likely to become more and more of an expat destination in the time to come, as investment flows into the country and more overseas assignments become available within firms who require staff to move there.

International SMEs

SMEs - small to medium enterprises - are an essential part of the British economy, and highly regarded by politicians. The Mayor of London even went as far as to say that SMEs are the 'gold medal winners' of the economy earlier in the autumn.

Traditionally, most SME organisations, by nature of their size, were locally based and also traded locally too. But as the global markets open up, more and more firms of this type are finding themselves in a great position to look beyond the shores of their home nation. 

Earlier this year the Independent reported that "exports of goods to non-EU countries rose to ... the highest level since records began in 1998" last year. And obviously the bigger the countries exports become, the more business opportunities there are likely to be abroad.

Of course, sending staff on overseas can be a challenge for any organisation given the scale of the HR work involved - ensuring visa requirements are in place, purchasing international health cover and so on. 

There's a good overview of international assignments over at the CareerCast website, which makes a very important point, namely that an overseas assignment "can be an exciting, rewarding experience. Unless of course you get sent to the 'wrong' country".

It's one of the most important aspects of global HR - matching the skills, expertise and personality attributes of the candidate to the post itself. As global markets continue to expand, the more likely it will be that the vast majority of companies have overseas dealings. In addition, more and more organisations  will be likely to require people working for them in other countries.

Overseas assignments: employer challenges

A recent conference organised jointly by the Association of Medical Insurance Intermediaries (AMII) and the Association of International Medical Insurance Providers (AIMIP) - reported on by the Telegraph yesterday - brings some food for thought for anyone involved in expatriate management and global mobility, or anyone seeking international relocation.

Essentially, the main theme of the newpsaper'rs report on the conference is that the world of global mobility is changing due to a series of factors. Where once people were given assignments mainly in what they term as "congenial" locations, the economic downturn has meant that commercial entities are now looking to strengthen their hand by moving into new markets - amking them less dependent on their home turf as the main place of business.

The upshot of this, says the report, is that in many cases people are now being sent to locations where conditions are far more challenging, such as the advancing economy BRIC countries - Brazil, Russia, India and China. The challenges employees face - linguistic and cultural - are far greater than when people are posted in, say, Australia or Canada. Add in the fact that many employees posted overseas have families and thus have to cioncern themselves with the education fo their children - and their families' integration - and it is no surprise that assignments sometimes don't work out.

A further problem highlighted in the article is that in some cases employees have been given health cover that isn't valid in their destination country, sometimes with serious consequences such as the cancellation of their visa. Any employers seeking international health coverage for their staff are advised to ensure that the insurance is good for the destination country. And of course as always it's always important to check the small print so that you're clear on what level of cover you have purchased.

 

The Gulf for expatriates

The Persian Gulf has long been an expatriate destination. The area is of course oil and gas rich, but there is abundant activity in retauil, healthcare, banking, and other industries.

People going to the Gulf will generally need to prepare for a bit of cultural acclimitisation on arrival, as its countries are very different from the west culturally. For instance during Ramadan if you're in a Muslim country you can actually run into quite serious problems is you smoke, eat or drink in public during the hours of the fast. In Saudia Arabia a warning was issued to foreigners this year to the effect that, if this happened, offenders were at risk of having their visa revoked.

Living in the Gulf differs from country to country for expatriates. For instance in Saudi Arabia people from overseas live in compunds, while in countries such as the AUE and Kuwait there is more opportunity tosocialise with local people.

The Gulf is becoming more and more known for healthcare tourism, and Dubai as well as other Gulf countries have high numbers of private practitioners. Depending on which country expatriates are working in, international medical insurance is either recommended or necessary as in some places it's compulsory while in others you will still need to be insured to cover costs of eligible treatment. Make sure you are acquainted with your policy's key features and read small print so that you know what you're covered for.

These days, the Gulf is a highly established expat destination, so many of us will know people who have lived out there if we're looking for some info on the area. Or if nit, there are extensive resources available online in the form of country guides, forums, and expat websites.

Europe: healthcare and the downturn - expat update

The Telegraph reported yesterday on the increasingly challenging economic conditions affecting expats in Europe. Certainly, since the economic downturn that began in 2008 and is still causing turbulence now - nearly four years later - the dynamics of the Eurozone have altered massively. And it's countries like Greece and Spain that are really feeling it right now. The latter country isn't just one of the most popular for tourists either, of course - it's also a major centre for expat brits.

The article mentions one very interesting phenomenon that's happening right now in some European countries - namely that British expatriates are turning to "creaking national health care systems" in a bid to economise - or even paying for medical treatment upfront out of their own pocket.

However the article points out that people living in West Africa and other places outside of Europe are "very aware" of the need for medical insurance abroad. But some in places like, say, France - according to the report - you're covered for accident treatment under the European Health Insurance Card (EHIC) and could - if needed - fly home for elective treatment. But of course that's a contingency plan that would be unavailable for those further afield - and that's not even taking into account the queston of what the individual country would provide in the event of an accident.

How the current Eurozone drama will work out - in the wider economic sense - is still anyone's guess. But for the time being it looks like there is some belt tightening going on. If you're planning on travelling abroad either for a holidayor to work, then check out the Foreign & Commonwealth country guides for info on healthcare systems, and a lot more besides.

New expat worker study: costs and concerns

A brand new study into global talent mobility by the consulting firm Towers Watson holds some interesting information for anyone with an interest in the worldwide employment market – especially in the light of widespread economic downturn, and all of the many challenges that holds for business.

The intro to the report states that multinational firms are ‘re-examining their mobility practices’. Given the economic backdrop you’d think that might mean that organisations would be looking to deploy fewer people in overseas locations. But, in fact, it looks like that isn’t the case at all – the research findings suggest that the majority of US based multinational companies expect the number of international postings to go up until 2014 at least. The figures for European companies are less optimistic, with 26% expecting an increase and a third expecting the number of overseas assignments to stay about the same.

One of the primary challenges when posting overseas, the study shows, is the cost of the exercise. The high cost of housing is one example, along with – more generally – the cost of living. Concerns for the employees posted abroad, according to the report, include education, tax, and adapting to a foreign culture. The latter example is held as a concern by about half of employees but only a fifth of employers. Interstingly there’s no mention of healthcare, presumably because international health cover is offered by employers.

Given the sometimes massive cultural differences Europeans and Americans will experience in some countries , the fact that adaptation is a concern comes as no surprise. An example of this would be Saudi Arabia, where warnings have been issued by the country’s ministry of interior that expatriates must respect Ramadan while in public places. This means that eating or smoking in public during the fasting part of the day could result in expatriates having their visas cancelled.