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An international perspective on health
Friday, 24 April 2009 12:09

Understandably, standards vary widely throughout the world

by Karen Teasdale, Marketing Manager, AXA PPP healthcare


The standard of care received within the USA’s health care system is high and medical professionals and specialists are generally highly proficient. The medical facilities are ranked amongst the best in the world, and are well equipped to deal with most medical conditions and their treatment. In larger cities there are excellent public hospitals and they are operated by municipal governments and subsidised out of public funds. They are less expensive for the patient, but they are typically less well equipped and more crowded than the private hospitals. There are also some teaching hospitals that are affiliated with Universities and these are well equipped for this purpose. Additionally there are private for profit hospitals, some of whom are operated as chains by corporations that also sell medical insurance plans.

With all of the above types of hospitals admission typically involves completing an admission form, presenting evidence of insurance coverage, signing a consent form for treatment, and specifying what form of payment is to be made, i.e. credit card, cash or billed to insurance. If you don’t have insurance, a deposit is normally required, which may run to several thousand dollars.

It is definitely worth noting that the USA is the only developed country in the world without a comprehensive national health programme. The elderly are covered by Medicare and the very poor can obtain limited care through Medicaid. Most employed Americans and their families are covered under group health insurance plans provided by their employers, although they may be expected to pay a portion of the insurance premiums and services offered could vary depending on the employer. Therefore if you are planning on working within the USA you may wish to check with your employer regarding their arrangements prior to you commencing employment.

Newcomers to the country must also consider medical insurance before moving there. You must also ensure that you have adequate benefits that will cover you in the USA as some policies may not cover this. The Foreign and Commonwealth Office state: “Medical treatment can be very expensive; there are no special arrangements for British visitors. The British Embassy and Consulates-General cannot assist you with medical expenses. You should ensure that you have comprehensive medical insurance, which includes hospital treatment and medical evacuation to the UK.”

Currently there are no vaccinations required for travel to the USA. However, it is always worth checking with your GP before departure.

Hong Kong

Even though pollution is a problem, the life expectancy of Hong Kong’s residents is quite high. Living Abroad estimates that women live, on average, for 81 years and men for 75 years. This could be due to the fact that the health standards in the region are higher than most other Asian cities.

When Hong Kong was handed to the Peoples Republic of China the UK and Hong Kong Reciprocal Health Care Arrangement was terminated, so UK expatriates are required to fund their own medical treatment whilst in Hong Kong. The standards of healthcare are excellent, as evidenced by the fact that it is the centre of treatment for Asia.

Hong Kong has several regional public hospitals, in addition to private hospitals. Both types of hospital offer high standards of care, and are used by expatriate and local residents, although the private hospitals are more often chosen by expatriates. Admission to a private hospital is by referral from your physician or specialist, except in the case of emergency. All public and some private hospitals have emergency rooms open 24 hours.

Another consideration is the availability of pharmaceutical medicines. Non prescription drugs are widely available and your physician will be able to advise where to have your prescription dispensed.

A key factor to consider before you travel to Hong Kong is the vaccination requirements and recommends that you receive the following inoculations:

•    Typhoid – 10 days before.
•    Hepatitis A – two weeks before.
•    Diphtheria – three months before.
•    Tuberculosis – three months before.
•    Hepatitis B – two months before.

All travellers are also advised to ensure that tetanus and polio vaccinations are kept up to date. Although not designated a malaria area, every year several cases of dengue fever are reported in Hong Kong so it is wise to take precautions to avoid being bitten.

Finally, as with all countries that require you have vaccinations, requirements may vary from time to time. In light of this, you will need to check with your doctor well in advance of your departure date.


The CIA World Fact Book estimates that in July 2009 there were 1.16 billion people living in India. It is not surprising then, that the capital New Delhi is one of the most polluted cities in the world, which may present health concerns for many expatriates and travellers. For example, pollution may have an affect on people with respiratory problems like allergies and asthma. However, the level of pollution has reduced since the introduction of Compressed Natural Gas (CNG) fuel vehicles.

With the increasing volume of British nationals living and travelling throughout India, it’s not surprising that English is widely spoken and that there are large numbers of English speaking doctors and dentists. However, if you are considering moving to India, the healthcare needs of you and your family are extremely important and there are many factors to take into consideration.

For example, it is important to recognise that the medical facilities in the major cities, such as New Delhi and Mumbai, are of a significantly higher standard than those in more rural areas of India. The quality of medical attention also tends to diminish the farther away you are from urban areas. This is confirmed by the Foreign and Commonwealth Office who state: “Local medical facilities are not comparable to those in the UK, especially in more remote areas.”

Whilst most drugs and medicines can be obtained from pharmacies in the major cities (such as Mumbai and Bangalore) the same cannot be said for more rural and remote areas, as they are practically non-existent. It would therefore be advisable that you bring a supply of any medications you may require if you are planning on travelling to the country.

In addition, you may also wish to take a proactive approach and find a local doctor and identify a good hospital for emergency treatment as soon as you arrive and before you have a need to use them. You may also want to consider private medical care which is readily available in India and this is of a much higher standard than public care. Recently, a number of hospital chains have been created, offering high quality medical care, although these are aimed at the wealthy and are quite costly. However, it’s worth knowing that some private clinics can’t handle serious emergencies, but they are mostly well-staffed and provide clean facilities and modern equipment and can undertake most common procedures.

As just mentioned, private medical care in India can be expensive, so it would be worth taking out private medical insurance to cover the costs should you wish to receive this care. The Foreign and Commonwealth Office “strongly recommend that you obtain comprehensive travel and medical insurance before travelling. You should check any exclusions, and that your policy covers you for all the activities you want to undertake.”

Another key factor to consider is vaccination requirements. Expatriates should carry an international certificate of vaccination with them as this is helpful upon entry into India and for personal knowledge. recommends the following vaccinations before travelling to India:

•    Typhoid  - 10 days before
•    Hepatitis A – two weeks before
•    Diphtheria – three months before
•    Tuberculosis – three months before
•    Hepatitis B – two months before
•    Rabies – one month before
•    Meningococcal meningitis – one week before
•    Japanese B encephalitis – one month before

A certification of vaccination for yellow fever will be required if you are travelling from an infected area. There is also a risk of malaria and dengue fever so appropriate preventative medicines and mosquito repellent will need to be used. Also expatriates planning to stay in the country for more than 12 months are normally subjected to a health examination which includes an HIV test. Any individual who tests HIV positive or refuses to take the test may face deportation.


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