Opinion: Accessing Care While Abroad

Adam C. Powell, Ph.D. / July 10, 2018

Over the past half-decade, I have spent about two months per year living away from my home in the United States. I have taught an annual five-week course on Health Information Technology at the Indian School of Business, and then embarked upon trips to China and Europe at other points in the year. My adventures have taken me to many wonderful places; from the Taj Mahal to the Great Wall.

While my lectures have led me to meet numerous Chinese and Indian hospital administrators and physicians, I have also had to experience the healthcare systems of my host countries first hand in times of medical need. As a patient or caregiver, I have seen a student health center, a hospital outpatient care department, a diagnostic testing center, and a retail pharmacy, in addition to visiting countless hospitals as a researcher.

While these experiences have not diminished my enthusiasm for travel, they have changed my approach to planning for my health needs.

I have been followed abroad by an increasing number of Americans. During the 2015-2016 academic year, the number of American students increased by 4 percent from the volume during the prior year, to a total of 325,333 students. While more than half of American students studying abroad do so in Europe, about an eighth do so in Asia and an eighth do so in Latin America. As today’s American students spend time in a wide range of countries, they encounter variation in both how medicine is practiced and how care is financed.

I enjoy spending time abroad because it enables me to see different ways of doing things. Countries have different cuisines, architectural styles, musical traditions, and languages.

Just as countries differ in other aspects of their cultures, countries all have unique medical cultures. There are international differences in the nature of care available, beliefs on when and how care should be delivered, and in how care is financed. As a result of this variation, I must make preparations to ensure that I will have access to healthcare away from home which is consistent with my preferences.

Countries offer different types and brands of some products and may not offer some products at all. A stubborn pimple led me to discover that it is difficult to buy benzyl peroxide cream in some Chinese pharmacies.

On a similar note, after experiencing an intractable infection, I had to purchase antibiotics at an Indian retail pharmacy. While the antibiotics were readily available — without a prescription — the manufacturer of the antibiotics available was unfamiliar to me. Given that there have at times been quality issues with generic manufacturers, I researched the manufacturer in question before taking the medication.

In addition to there being international differences in the availability of medications, there are also international differences in the definition of what constitutes illness.

Due to differences of opinion between medical societies, as well as physiological differences between populations, not all nations are consistent on even numeric thresholds, such as the minimum body mass index indicative of being overweight.

There are likewise international differences in how different nations address different diseases. Before receiving care for a serious illness, it may be helpful to communicate with an American physician for a second opinion via telemedicine, as the approach to diagnosing and treating illness can vary between nations.

Attitudes towards the use of healthcare also differ between nations. As outpatient and hospital care is more affordable in India than in the United States, many of my students in India have sought formal treatment for conditions that would have likely been addressed with watchful waiting in the United States. Students have sent me hospital records, and even copies of x-rays, in unsolicited emails in order to justify absences from class.

I am always a bit surprised when I receive these medical records, as they demonstrate to me that there are differences in expectations of medical privacy when justifying absences across cultures.

Furthermore, the illnesses described in the records — in one case, a stomach ache, and in another case, a sprained ankle — would likely not have warranted a hospital visit nor an absence from class had they occurred in the United States.

Different institutions have different approaches to providing care to students in need. The approach used varies depending on the structure of the health system in which the institution resides, as well as the need to integrate with local versus global resources.

At the Indian School of Business, primary care is available from an onsite clinic, with referrals to off-campus care at nearby facilities as needed. NYU Shanghai offers its students an onsite Health and Wellness Center, in addition to access to “The Wellness Exchange Hotline,” a 24/7 line available to NYU students around the world seeking to address mental and physical health concerns. Students studying at the University of Cambridge, and other UK universities, are required to pay a fee to cover healthcare services while obtaining a visa.

In exchange for paying this fee, students are offered access to care through the National Health Service (NHS) in the same manner as permanent UK residents. The University of Cambridge additionally offers onsite counseling and a peer hotline.

While there is a degree of care that must be taken when receiving medical attention abroad, it is important to not let concerns over healthcare place too great of a damper on international travel.
In some cases, care will be provided the same way as it would at home, in some cases care will be provide in a different fashion which may or may not be associated with inferior health outcomes, and in some cases, there may be a lack of access to certain types of quality care.

When there is an access to care issue, one must weigh the value gained from the time abroad against the potential danger of delayed care.

As there are also problems with receiving some forms of access to timely medical care in rural areas within the United States, people should also weigh the access to care risks that they are willing to accept at home in making a decision.

Finally, there can also be healthcare benefits to living abroad. As the cost of care is lower in some countries, spending time in them may provide an opportunity to undergo elective diagnostics or elective procedures.
Before doing so, it is important to review the quality and safety record of the facility providing the medical care, the care’s medical necessity, and the potential for a quality issue while delivering the care to cause injury.

Joint Commission International accredits healthcare facilities across the world, providing an indicator of the quality of care delivered. Thus, it is possible to treat time abroad as an opportunity for medical tourism, in addition to managing the risk of needing non-elective care.

The following steps can be taken to help ensure a safe and healthy time while studying abroad:
• Notify your physician about your plans during a travel medicine visit before leaving, so that you may receive any applicable vaccines, any necessary prophylactic medicines, and prescriptions for medications that you may potentially need while away.
• Bring the over-the-counter and prescription medications you are likely to need to address basic issues with you when abroad, so that you do not have to worry about the availability or quality of medications locally.
• Determine if it is possible for you to contact your home physician by email or telephone while you are away in order to receive advice on non-urgent illnesses that arise.
• Research the extent to which minor and major medical treatments are affordable in the country you are visiting. Cost and insurance considerations are more of an issue in some countries than in others, as the cost of care can be quite low in some locations.
• Evaluate the availability of on-campus healthcare resources at your institution abroad and determine the situations in which you will need to supplement the care available with care from off-campus facilities, telemedicine, or care at American institutions.
• Examine the quality and availability of medical facilities near where you plan to visit to determine the extent to which you feel comfortable with receiving care locally or will need to evacuate the country in the event of illness.
• Read the fine print of your American health plan to determine the extent of your coverage outside of the country. If it appears inadequate, consider purchasing additional insurance for catastrophic situations or for emergency evacuation. When visiting nations with national health insurance, review your eligibility to access it.