Obtaining Health Care Abroad
CDC Yellow Book 2024Health Care Abroad
While abroad, travelers might seek medical care ranging from treatment for self-limited minor ailments, to care for chronic conditions, to sophisticated medical management of major illnesses or injuries. Insurance plans might not cover emergency health care, and travelers should check with their insurance 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 itinerary alterations needed to receive medical care during travel. Travelers can buy specific policies to cover these expenses, but should understand 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; some even provide medical assistance via a nurse- or physician-backed support center (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance, for more details). Travelers should be prepared to pay out of pocket when services are rendered and, in some instances, even before care is received, then provide insurers with copies of bills and invoices to initiate reimbursement afterward.
Travelers also should be aware (in advance) of destinations on their itinerary where coronavirus disease 2019 (COVID-19) vaccine coverage of the local population is low, or where case rates and hospitalizations are high. Availability of health care resources in such places could be strained, and treatment options (for severe COVID-19 and other conditions) could be limited. See destination-specific COVID-19 travel recommendations.
Locating Health Care Facilities & Providers Abroad
The level and availability of medical care around the world varies by country and even within countries. During pretravel preparation, travelers should consider how they will access health care during their trip should a medical problem or emergency arise (Box 6-03). Encourage travelers likely to need health care to research thoroughly and identify potential health care providers and facilities at their destination. For example, people who require regular dialysis treatments need to arrange appointments in advance at a site with appropriate equipment. Pregnant travelers should know the names and locations of reliable obstetric medical centers. Travelers should be aware that more choices are generally available in urban areas than in rural or remote locations.
Travelers, particularly those with preexisting or complicated medical issues, should know and ideally have documented in a doctor’s letter the names of their conditions, any allergies, their blood type, and current medications, including generic names. If possible, this list should be in the local language of the travel destination. Travelers also should carry copies of prescriptions, including for glasses and contact lenses, and wear medical identification jewelry (e.g., a MedicAlert bracelet), as appropriate. Travelers should check with the foreign embassy of the countries they plan to visit to ensure current medications are permitted. Many mobile phone applications enable travelers to download their medical records, medications, electrocardiogram, and other information so that they can access these when needed. Remind travelers to request documentation of any medical care received during travel, including a list of medications received. Travelers can then share this information with any health care providers seen subsequently in the event they require ongoing care.
Box 6-04 includes a list of suggested resources international travelers can use to help identify health care providers and facilities around the world. The Centers for Disease Control and Prevention does not endorse any provider or medical insurance company, and accreditation does not necessarily ensure a good outcome.
Box 6-03 Obtaining health care abroad: a checklist for travelers
☐ Identify quality health care providers and facilities at destination, prior to traveling.
☐ Carry a provider letter that lists all active medical problems, current medications, and allergies. If possible, download travel health mobile applications to input medical records, medications, and other health information (e.g., electrocardiogram) so these are accessible if needed.
☐ Pack an adequate supply of medication in original, labeled containers, 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 providers delivering subsequent care while traveling 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.
Box 6-04 Finding a health care provider overseas
The nearest US embassy or consulate can help travelers locate medical services and notify friends, family, or employer of an emergency. Emergency consular services are available 24 hours a day, 7 days a week, overseas and in Washington, DC (888-407-4747 or 202-501-4444).
The US Department of State maintains a list of travel medical and evacuation insurance providers on their website.
The International Society of Travel Medicine maintains a directory of health care professionals with expertise in travel medicine in more than 80 countries.
The International Association for Medical Assistance to Travelers maintains a list of physicians, hospitals, and clinics that have agreed to provide care to members. Membership is free, although donations are suggested.
Travel agencies, hotels, and credit card companies (especially those with special benefits) also might provide information.
The following travel medicine websites, organized by country, provide access to clinicians:
- AUSTRALIA: Travel Medicine Alliance
- CANADA: Health Canada (Public Health Agency of Canada and Government of Canada)
- CHINA: International Travel Healthcare Association
- GREAT BRITAIN: National Travel Health Network & Centre and British Global & Travel Health Association
- SOUTH AFRICA: South African Society of Travel Medicine
Avoiding Travel When Ill
Advise travelers to self-evaluate before leaving home and to avoid or postpone travel if acutely ill with fever or other signs or symptoms of a communicable disease. Traveling while ill increases the chances that a person will have to interact with an unfamiliar and potentially inadequately equipped health care system and that they could transmit their illness to travel partners and/or other passengers. Moreover, travelers should be aware that airlines can request that they complete a brief health questionnaire and that local health authorities might conduct body temperature checks anywhere in the airport, including the waiting area and during boarding; passengers who fail such screenings might be prohibited from boarding their flight. Because people often are reluctant to postpone or cancel travel, trip cancellation insurance can protect some (or all) of their investment and increase compliance with the recommendation not to travel when ill.
Drugs & Other Pharmaceuticals
The quality of drugs and medical products acquired abroad might not meet the same regulated standards established by the US Food and Drug Administration. Worse yet, drugs or medical products could be counterfeit and contain no active ingredients or could contain harmful ingredients (for more information, see the following chapter in this section, . . . perspectives: Avoiding Poorly Regulated Medicines & Medical Products During Travel). Travelers whose original supply of medication is used up, lost, stolen, or damaged should take steps to ensure that the replacement medicines they buy are safe and effective.
To minimize risks associated with substandard drugs and pharmaceuticals, travelers should bring enough medicine for the entire time they are away, and include an additional supply in case of trip delays. Travelers should carry all medications in the original labeled containers in their carry-on luggage, not in checked baggage; this also applies to travelers who might require an epinephrine autoinjector (Epi-Pen) to treat known severe, potentially life-threatening allergies. For Epi-Pens, travelers should carry a letter from the prescribing physician explaining their allergies and a copy of the written prescription.
Travelers who need injections while abroad should insist that health care providers use new needles and syringes. Travelers who know they require injections can bring their own supplies, but also should bring a letter from their provider attesting to the need for this equipment.
A medical emergency abroad (e.g., a motor vehicle accident, other trauma) could require a lifesaving transfusion of whole blood or blood components (e.g., platelets, fresh frozen plasma). Not all countries accurately, reliably, and systematically screen blood donations for infectious agents, putting recipients at risk for transfusion-related diseases. Consequently, all travelers should consider receiving hepatitis B virus immunization before travel (see Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis & General Principles, and Sec. 5, Part 2, Ch. 8, Hepatitis B). Hepatitis B vaccination is especially important for travelers who frequently visit or have long-term stays in low- and middle-income countries, travelers who have underlying medical conditions that increase their risk of requiring blood products while traveling, and travelers whose activities (e.g., adventure travel) put them at increased risk for serious injury.
Ensuring the safety of the blood supply can be difficult, but travelers can take a few measures to increase their chances of a safe blood transfusion. For instance, the traveler or a companion, if the traveler is incapacitated, can ask about blood supply screening practices for transfusion-transmissible infections, including HIV. Because obtaining information on the safety of the blood supply can be difficult at the point of service, travelers with known medical conditions that might require transfusions can identify medical services at their destination before travel to increase their chances of obtaining higher-quality care. Travelers also can register with agencies (e.g., the Blood Care Foundation) that attempt to deliver reliable blood products rapidly to members at international locations.
The following authors contributed to the previous version of this chapter: Carolina Uribe
Kolars JC. Rules of the road: a consumer’s guide for travelers seeking health care in foreign lands. J Travel Med. 2002;9(4):198–201.
US Department of State, Bureau of Consular Affairs. Your health abroad. Available from: www.travel.state.gov/content/travel/en/international-travel/before-you-go/your-health-abroad.
World Health Organization. Blood safety and availability. Available from: www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability.
World Health Organization. Substandard and falsified medical products. Available from: www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products.
World Health Organization. Technical considerations for implementing a risk-based approach to international travel in the context of COVID-19: Interim guidance, 2 July 2021. Available from: www.who.int/publications/i/item/WHO-2019-nCoV-Risk-based-international-travel-2021.1.