My Expat Medical Plans

Dateline: Pattaya, Thailand

One of the major challenges of expat life is making sure you have decent medical care and coverage. I’ve noticed that the 20-somethings who travel the world seldom talk about this. But I’m 57 years old and my wife is only a few years behind me, so it’s already important to us, and it will only be more important as the years tick past.

I’ve lived under several medical systems. I started out in Canada with it’s much-hyped “free” medical care. Of course, it isn’t free — because nothing is — but everyone is covered and the technology is about as good as anywhere else, more or less.

I also lived briefly under the UK’s National Health Service. I have to say I received excellent care there when I had an urgent issue that required an ambulance ride and multiple days in the hospital.

The limitations of western medical services

As you know, both countries have universal healthcare paid for by taxpayers. But there are problems in these systems. There are too many sick people for the budgets that back these services. Wait times for care are so long they would be considered medical malpractice in the United States. “That triple bypass you need to clear those blockages? We’ll get to those in August.”

The underfunded medical services problem is occurring all over Europe. Pharmacies in Spain and Greece have not been reimbursed by the government in months. Many have closed or will only take cash for medications that are supposed to be “free.” Hospital workers, nurses, and even doctors are going on strike. Wait times at Emergency can stretch to many hours, sometimes most of an entire day.

The wheels are falling off.

I also lived in the US for twenty years and have experience with that medical system. Medical insurance in the US does not provide much peace of mind. Sky-high deductibles and big premiums are, at least, obvious and transparent. But the bigger issue is how often you find out the insurance company has a way of wriggling out of covering the really expensive medicines, operations, or long term care you might need.

Submitting a claim can be like buying a lottery ticket. Maybe you’ll win, likely you won’t.

And now the Affordable Care Act (ObamaCare) is moving the US toward the European system. Of course, it has a slightly fascist tilt in which it mandates enriching the insurance companies that help get these folks elected. But that’s for another post.

Rest assured, the US will soon have the same budget shortfall issues that the other national insurance systems have all over the world. Pay more, get less.

So What’s an Expat to Do?

I want to quickly go on record that I don’t personally endorse any of these approaches to healthcare. Like you, I’m just forced to use them because alternatives have been driven from the marketplace by legal coercion. So I’m left to carve out a solution using what’s available to me.

In a way, the US system and the European/Canadian systems have opposite polarities. In the US I always felt like the physicians were running the meter on me. First of all, there’s always an invisible lawyer sitting in the room with my doctor and me. That lawyer is looking for excuses to sue the doctor, and the doctor knows it. So I end up paying (deductibles, co-payments, higher premiums, whatever) for every conceivable test and procedure that — if left out of my treatment — could be grounds for a lawsuit.

Add to that the fact that many physicians have to be entrepreneurial so they can offset the beating they take on Medicare, Medicaid and other mandated rules. So my GP might have a 50% financial interest in the lab next-door or the radiology clinic across town. which explains why I get sent there a lot. Maybe more than necessary. Ka-ching.

In the UK and Canada, it’s the opposite. All the incentives are to spend as little as possible on each patient. There is never enough money to go around. “CAT scan? Let’s wait and see how you’re feeling next month.” You have to gripe, exaggerate, and fight for every scrap of medical care and diagnostics you can get. Yuk.

The hybrid expat medical strategy

So here’s my strategy. I’m using elements of each system to try to find a workaround. We’re going to set up residence this year in an EU country, likely Ireland. We’ll be legal residents, taxpayers, and part of the national healthcare program in Ireland. By the way, that system has reciprocity with the rest of the EU as far as urgent medical is concerned. That’s good for frequent travelers like us. We can augment the government plan with private insurance that will give us higher levels of service.

But all of that is still subject to the “You’re fine, go home” mentality inherent to government systems spending the minimum on each patient and private insurance looking to minimize claims. So we are going to visit a hospital in Thailand or Malaysia about every 18 months and pay for one of their comprehensive packages.

Here’s what $2,800 gets you in this part of the world. And this is from an internationally certified hospital that meets the same standards a US, Canadian, or European hospital would meet. (Some of these are male/female specific, so nobody would get all of them, just most of them.)

This is a “grand executive” package where you get all of these tests for $2,800. Other packages cost less.

Physical Examination
Vision Acuity, Uncorrected and Corrected
Eye Screening Examination
Dental Screening
Hearing Test
Complete Blood Count (CBC)
Fasting Blood Sugar (FBS)
HbA1c
Cholesterol
Triglyceride
HDL Cholesterol
LDL Cholesterol
Kidney function test
Blood Urea Nitrogen
Creatinine
Liver function test
SGOT – Aspartate Transaminase
SGPT – Alanine Transaminase
Alkaline phosphatase
Total Protein
Bilirubin
GGT – Gamma GT
Blood Uric Acid
Urine Examination
Stool Examination
Thyroid Hormone : T3, T4, TSH
Thyroid Hormone : T3, T4, TSH, Free T3, Free T4
Hepatitis B Profile :HbsAg, Anti-HBs, Anti-HBc
Anti Hepatitis C Virus Antibody
Anti Hepatitis A Virus Antibody
Anti HIV
VDRL
AFP
CEA – Carcinoembryonic Antigen
Total & Free Prostate Specific Antigen
Pulmonary Function Test
Chest X-ray
ECG – Electrocardiogram
ABI – Vascular Screening
EST – Exercise Stress Test
Ultrasound Whole Abdomen
Coronary 128 Slices CT Scan
CT Chest + CT Whole abdomen
MRI & MRA Brain
Carotid Duplex Ultrasound
Sinuscope
Gastroscopy
Colonoscopy
Uroflow
Pap Smear
Human Papilloma Virus
Mammogram and Ultrasound Breast
Bone density 2 parts
Hospital Stay 1 night

I wouldn’t have a prayer of getting all this in the EU. They won’t do any of these tests unless I’m showing obvious symptoms. And if I have all the symptoms this list requires, I’d need an undertaker more than a doctor.

Yes, I could likely get all of these in the US, but I see single items on this list that could cost $2,800 in the US. I can’t imagine what the whole list would cost.

This isn’t something we need to get often. And some of these tests use radiation that you don’t want often anyway. But when something shows up as a potential problem, I can return to my residence and have it looked at, based on the black and white medical evidence I can show my doctors. Or, I can just pay to have the procedure done in Thailand or Malaysia where it’s cheap, fast, and about the same quality.

This is a hybrid plan that is the best I can figure out in our crazy world of medical care. A national plan run by some government augmented with private insurance to deliver higher levels of service and safeguarded by visiting another country to pay for comprehensive medical diagnostics that will identify serious problems early.

Being a longterm expat is what forced me to come up with this strategy. But it would work for anyone who just wants better healthcare and is willing to take personal responsibility for making it happen, rather than hoping a politician will save him.