November 17, 2016

The Best Places in the World for a Heart Attack—a roundup of international healthcare

Okay, there really isn’t a good place for a heart attack, or any medical emergency. But with almost eight years of international travel under our keels, we’ve now experienced medical care in far-flung destinations that ranges from the biopsy and diagnosis of skin cancer, to treatment for ear infections, eye infections, pneumonia and whooping cough, to the ongoing management of Evan’s heart issues.

What we’re found is that in most places, basic health expenses were easy for us to cover out of pocket. But short of full travel insurance, having some sort of back-up plan; whether it’s evacuation insurance, catastrophic insurance or self-insurance (aka a credit card with a very high limit and the ability to pay it off)—is also pretty essential. What we’ve done has varied depending on where we are, but for the most part we’ve relied on self-insurance and paid expenses out of pocket.

Curious about the standard rate for an EKG and visit to a cardiologist? Read on:

Mexico is one of the countries that’s considered great for routine healthcare. Both La Paz and La Cruz are popular for check-ups and prescription updates. Typically treatment is excellent and modern—my skin cancer checks (I went for two, Ev had one) were accurate and affordable ($125 for a full screen and biopsy with Dr Alma Vargas in PV). Treatment for pneumonia was straightforward--two doctor visits ($30, $50), x-rays ($25), inhalers ($50).

During our 18 months we also visited local dentists every six months—basic cleanings were around $30, fillings another $30 and Evan needed a root canal which ended up in the $600 range. Keep in mind Mexican dentists rarely use x-rays and rely on physical signs of decay. So our rule of thumb is to visit the same dentist at the same time as another family. If too many cavities are found we know we’ve hit on someone who’s too enthusiastic with the drill and we all move on. (Note this was five years ago so prices have likely gone up some.)

Crossing the South Pacific we carried DAN evacuation insurance which has evolved into DAN Boater. This insurance can evacuate us to a place we can be treated—but it doesn’t cover treatment costs once you’re there—so having a plan about where to go is vital. We did get some prescription drugs—anti-malarials in Vanuatu ($20), cream for a skin infection in French Poly ($30) and free vaccinations in the Marquesas.

In Australia we were required by Ev’s work visa to buy basic insurance (from $150/per month per family). Dental was out of pocket—Ev and I went to the local dental school and had checkups ($60 each), Maia went to a local dentist and her check-up and cleaning ($200 and a filling was $210). But before our insurance went into effect we paid out of pocket. I had a ‘well-woman’ check-up ($110) and a skin check ($185). Evan saw a Dr. for sore knees ($75 plus $133 for x-rays).

We left Australia with updated vaccines including jabs for rabies. These were all out of pocket and the total cost was about $1000. We also updated our First Aid kit with new antibiotics.

Our first medical experience in Malaysia was when Evan began having heart problems. He saw a private cardiologist in Penang ($80), then a short while later ended up in the emergency room at the public hospital in Lankawi for blood work, and an EKG ($20).

Crossing the Indian Ocean we opted for insurance with Skymed, which evacuates you to the country of your choice, a detail that made it preferable to DAN. Some sort of evacuation insurance was also a requirement for visiting Chagos (and later St Helena and Ascension Islands).

In South Africa we looked into visiting both a cardiologist (Ev) and a skin doctor (me) both had long wait lists and high fees ($400 for the cardiologist) as well as questionable records (one friend paid to see a well-regarded skin doctor then returned to Australia for surgery, only to learn the skin check had missed a melanoma). Evan did see a doctor to get prescriptions (about $50) and Maia saw an optometrist for new glasses ($50).

In St Helena, Maia developed an eye infection and visited the hospital—where her care was free because of her age. In Suriname I had an ear infection treated (two appts at $45 each + prescriptions) and Evan had his suspected heart attack: three days in Cardiac Care Unit an angiogram and other tests: $2800.

Since the episode in Suriname Ev has required ongoing cardiac care. Luckily both Curacao (Bloodwork $70, EKG and Cardiologist visit $70) and Panama (EKG and Cardiologist visit $125) have well-trained, English-speaking cardiologists who he was able to get next-day appointments with.

So all this said—there really is no one medical insurance answer. It varies according to how long you are away from your home country and where you spend your time while away. Our basic plan has been to stay up to date on all preventative healthcare—we vaccinate for whatever the locals are vaxing against (assuming we may be even more susceptible), we get check-ups, we don’t let things linger (too long…) and we buy insurance when we're in more expensive countries.

What we’ve learned though is in countries of mid-level affluence, healthcare options are usually often both excellent and affordable.
* all amounts USD

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