One of the main concerns when moving abroad is what kind of medical follow-up one can expect. Health systems vary (private or public insurance) and offer different medical follow-up and prevention services. So, how do you navigate these to ensure you won't miss any steps, from vaccination schedules to routine exams and recommended consultations for specific age groups?
Prevention and medical follow-up vary from one country to another
Wouldn't it be easier if health recommendations were uniform worldwide? People moving from one country to another must navigate through different government policies, available resources, and public health priorities. This can be particularly challenging for monitoring children's health, especially considering vaccinations and adherence to schedules.
For example, since 2018 in France, 11 vaccinations have been mandatory, while in the United States, their number varies by state and are recommendations rather than mandatory. Even within countries enforcing the same vaccinations, the schedules can significantly differ. In Germany, for example, booster shots for diphtheria, tetanus, whooping cough, and polio are scheduled between ages 9 and 16, while in France, they are recommended between 11 and 13 years. This can be confusing when transitioning from one system to another. The advice doctors give is to stick to the recommendations and the schedule with which the child began their vaccination journey. You may then need to coordinate with your pediatrician to administer the vaccination slightly earlier or later, depending on the scenario, and obtain the vaccine if it is not typically available in the host country.
For adults, the variations in medical follow-up are also considerable. While most countries recommend a regular medical check-up, the frequencies range from once a year to every three or five years. The National Health Service (NHS) in the UK, for example, offers a check-up every five years for adults aged 40 to 74 (excluding those at particular risk). In Japan, by comparison, the "Ningen Dock" is recommended annually, a practice that may help explain the longevity of the Japanese. This check-up includes a comprehensive package: tests for upper gastrointestinal and physiological functions, urine and stool tests, radiographic examinations, an abdominal ultrasound, a complete blood test, and a gynecological exam. Therefore, basic follow-up and prevention are more closely integrated into this system.
Countries also vary significantly in their preventive measures, especially as the population ages, but recommendations vary greatly from one country to another, particularly regarding cancer screenings. For instance, in Spain, a mammogram is recommended every two years for women between 50 and 69, while in Australia, the recommendation starts at age 40. Similarly, guidelines for colorectal cancer screening vary according to public health policies.
Additional tests such as osteoporosis screening, sensory disorders, mental and cognitive health evaluations, fall risk assessments, and certain vaccinations like the flu shot are commonly added for older individuals. This last example highlights the differences in prevention found from country to country: in France, the flu vaccination is free of charge from the age of 65, while in Spain, it is recommended but not necessarily covered by social security. Dental check-up disparities are similar: some countries include an annual check and scaling, whereas in others (like Switzerland), additional insurance is needed for dental follow-up.
Expatriates: Key practices for health prevention and monitoring
As can be seen, it can sometimes be challenging to navigate the different recommendations and health systems abroad. The first step before moving should be to complete a comprehensive health check-up, typically provided by your employer. These assessments take into account the specific country you are moving to and the prevalence of certain diseases in that region. Specific vaccines, such as Hepatitis A or Yellow Fever, may be recommended based on your destination. Certain dietary precautions and hygiene recommendations should not be overlooked, especially for higher-risk destinations. In any case, you can find the main health recommendations for your destination on the website of the consulate.
If your employer includes international health insurance in your contract, you are advised to review in advance the different services it offers regarding follow-up and prevention. These insurance companies usually provide various packages, and you should ensure they match your needs and include regular health check-ups and other routine preventive consultations. International health insurance generally covers more than the bare minimum offered by national health funds when you are insured through the public system. For example, we conducted a simulation for a 40-year-old expatriate in Thailand. The monthly contribution would amount to about 300 to 500 euros for routine care, hospitalization, and dental and optical services.
You should then look into the details of the medical follow-up and prevention coverage offered. To get an idea: one of the options from the simulation, for example, proposes an annual health check-up, including cancer screening, at a cost of 400 euros per year.
Note that international health insurance also covers your medical care in your home country (in case of travel or vacation). This might be an option to consider if you are not familiar with the medical follow-up and prevention practices in your host country.
If you are fully dependent on the local health system, you will need to follow the local recommendations for medical follow-up and prevention. Try to get a clear picture of all the usual medical exams conducted for prevention and follow-up by visiting the local health insurance fund's website. If you're lucky, the explanations will also be provided in English. In case of doubt or misunderstanding, seek assistance from your employer or the expatriate community in your host country. It is often challenging to navigate a system you are not familiar with.
Lost in this maze of different recommendations? Consider health apps and telemedicine services, which have rapidly developed in recent years. Many apps can help manage and monitor your health, including daily advice and reminders for medical visits and medications. For example, check out the Medisafe app (specifically for managing medications) or Ada. Many governments are also developing their telemedicine services. The advantage, as with apps, is staying connected to services that you are more familiar with, either because they are based on recommendations from your home country with which you are familiar, or because you are proficient in the language. For an overview of the telemedicine services offered, consult, for example, the website of Canada Health Infoway or simply search for "telemedicine service" on the Internet in the language of the country that concerns you.
