Chapter 6 Health Care Abroad

Obtaining Health Care Abroad

Carolina Uribe

While overseas, travelers may seek medical care ranging from treatment for self-limited minor infections to care for chronic conditions to sophisticated medical management of major illnesses or injuries. Because insurance plans may not cover emergency health care received abroad, travelers should check with their carriers before departure to confirm the limits of their coverage and to identify any additional coverage requirements. For example, travel health insurance alone does not usually pay for the cost of an emergency medical evacuation or an altered itinerary. Travelers may buy specific policies to cover these expenses, understanding that such policies often do not cover expenses related to preexisting conditions. Supplemental medical insurance plans purchased prior to traveling often furnish access to preselected local providers in many countries through a 24-hour emergency hotline (see Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance in this chapter, for more details). At a minimum, travelers should be prepared to pay out-of-pocket at the time services are rendered (in some instances, even before care is received) and then afterward provide insurers with copies of bills and invoices to initiate reimbursement.

LOCATING HEALTH CARE PROVIDERS AND FACILITIES ABROAD

The level and availability of medical care around the world varies from country to country and even within countries. Before going abroad, travelers should consider how they will access health care during their trip should a medical problem or emergency arise (Box 6-01). Encourage those likely to need health care to research thoroughly and identify potential health care providers and facilities at their destination. Dialysis patients, for example, need to arrange appointments in advance at a site with appropriate equipment. Pregnant travelers should know the names and locations of reliable obstetrical medical centers. More choices are generally available in urban areas than in rural or remote areas.

Travelers, particularly those with preexisting or complicated medical issues, should know the names of their condition(s), any allergies, their blood type, and current medications (including generic names), ideally in the local language. They should carry copies of prescriptions, including for glasses and contact lenses, and wear medical identification jewelry (such as a MedicAlert bracelet), as appropriate. Any number of mobile applications enable travelers to download their medical records, medications, electrocardiogram, and other information so that they are accessible when needed.

The following list of resources can help international travelers identify health care providers and facilities around the world. CDC does not endorse any particular provider or medical insurance company, and accreditation does not ensure a good outcome.

  • The nearest US embassy or consulate (www.usembassy.gov) can help travelers locate medical services and notify friends, family, or employer of an emergency. They are available for emergencies 24 hours a day, 7 days a week, overseas and in Washington, DC (888-407-4747 or 202-501-4444).
  • The Department of State maintains a list of travel medical and evacuation insurance providers at https://travel.state.gov/content/passports/en/go/health/insurance-providers.html.
  • The International Society of Travel Medicine maintains a directory of health care professionals with expertise in travel medicine in more than 80 countries. Search these clinics at www.istm.org.
  • The International Association for Medical Assistance to Travelers maintains a network of physicians, hospitals, and clinics that have agreed to provide care to members. Membership is free, although donations are suggested. Search for clinics at www.iamat.org/doctors_clinics.cfm.
  • Travel agencies, hotels, and credit card companies (especially those with special privileges) may also provide information.
  • A number of countries or national travel medicine societies have websites related to travel medicine that provide access to clinicians, including the following:

People who receive health care abroad may require ongoing care or experience complications afterward. They should request documentation of any medical care received, including a list of medications received, and share that information with any health care providers seen subsequently.

Box 6-01. Patient checklist for obtaining health care abroad

  • Consider travel health and evacuation insurance before travel.
  • Evaluate health and avoid travel if feeling ill.
  • Identify quality health care providers and facilities at destination.
  • Download travel health mobile applications to input medical records, medications, and other health information so that it is accessible if needed.
  • Pack adequate supply of medications and know how to get additional safe and effective medications while abroad.
  • Request documentation of any medical care received abroad, including medications, and share with health care provider abroad and at home.
  • If a blood transfusion is required while traveling, make every effort to ensure that the blood has been screened for transmissible diseases, including HIV.

AVOID TRAVEL WHEN ILL

Advise travelers to self-evaluate before leaving home to ensure they are healthy enough for their itinerary, and to self-monitor for illness during their trip. Traveling while ill increases the chances that a person will have to interact with an unfamiliar, and—in some locations, at least—inadequately equipped health care system. Moreover, ill travelers pose a risk not only to themselves but also, potentially, to other passengers and travel partners. For a variety of reasons, then, traveling while ill is best avoided.

People may be reluctant to postpone or cancel travel, however, due to loss of financial investment. Make travelers aware that some airlines conduct scans of people in the waiting area and during boarding; if a passenger appears visibly ill, they can be prohibited from boarding. Trip cancellation insurance can protect some or all of an investment in a trip, and may increase compliance with the recommendation not to travel when ill.

DRUGS AND OTHER PHARMACEUTICALS

The quality of drugs and medical products purchased abroad may not meet the same regulated standards established by the US Food and Drug Administration. Worse yet, they could be counterfeit and contain no active (or even harmful) ingredients (see Perspectives: Avoiding Poorly Regulated Medicines and Medical Products during Travel, later in this chapter). If a traveler’s original supply of medication is lost, stolen, or damaged, he or she should take steps to try to ensure that the replacement medicines they buy are safe and effective.

To minimize risks associated with substandard drugs and pharmaceuticals, travelers should:

  • Bring with them the medicines they think they will need for the entire time they are away; include additional supply in case of trip delays. Hand carry all medications in carry-on luggage and not in checked baggage.
  • Insist that health care providers use new needles and syringes when administering injections. Travelers who know they require injections can bring their own supplies along with a letter from their provider attesting to the need for this equipment.
  • Carry an epinephrine autoinjector (epi-pen) in carry-on luggage, to treat known severe, potentially life-threatening allergies. Include a letter from the prescribing physician explaining the allergy and a copy of the prescription.

BLOOD SAFETY

A medical emergency abroad, such as a motor vehicle crash or other trauma, could require a life-saving transfusion of blood or other blood components (e.g., platelets, fresh frozen plasma). Not all countries accurately, reliably, and systematically screen blood donations for infectious agents, putting recipients at increased risk of transfusion-related diseases. CDC recommends that travelers to developing countries receive transfusions of blood and blood products only when critically necessary. Although it can be difficult to ensure the safety of the blood supply, travelers can take a few measures to increase their chances of a safe blood transfusion, if needed:

  • Ask about blood supply screening practices for transmissible diseases, including HIV. Although this is difficult to do at the point of service, travelers with known medical conditions that may require transfusions can increase their chances of obtaining higher-quality care by identifying medical services at their destination in advance of travel.
  • Register with agencies that attempt to deliver reliable blood products rapidly to members at international locations. The Blood Care Foundation (www.bloodcare.org.uk/blood-transfusionsabroad.html) is one such organization.

All travelers should consider receiving hepatitis B virus immunization. This becomes especially important for travelers who frequently visit developing countries, longer-term travelers to developing countries, those with underlying medical conditions that increase their risk of requiring blood products while traveling, and travelers whose activities (such as adventure travel) put them at higher risk for serious injury.

BIBLIOGRAPHY

  1. Kolars JC. Rules of the road: a consumer’s guide for travelers seeking health care in foreign lands. J Travel Med. 2002 Jul–Aug;9(4):198–201.
  2. World Health Organization. Medicines: spurious/falsely-labelled/falsified/counterfeit (SFFC) medicines [fact sheet no. 275]. Geneva: World Health Organization; 2012 [updated January 2016, cited 2016 Sep 22]. Available from: www.who.int/mediacentre/factsheets/fs275/en/.
  3. World Health Organization. Blood safety [fact sheet no. 279]. Geneva: World Health Organization; 2014 [updated July 2016, cited 2016 Sep 22]. Available from: www.who.int/mediacentre/factsheets/fs279/en/.