Healthcare has become a recurring hot topic since the start of the pandemic, with health systems being under strain. Political scientists, economists, scientists, researchers, and of course, doctors point to the upheavals shaking health systems around the globe. The cost of healthcare is another issue, especially for expatriates and prospective expatriates. Should you choose your next destination based on the quality of its health system?
Health systems crumbling under the pandemic burden
In reality, the pandemic - and all its consequences - shines the spotlight on the vulnerability of health systems around the world. A pillar to a country's balance, health nevertheless seems to have been sacrificed to benefit the economy. Is the Covid pandemic a game-changer? In France, the discontent of nursing staff led to the Ségur de la santé agreements, signed last July. Still, some consider themselves left out by Segur. Situations are similar in Italy, the UK, India, Nigeria, South Korea. How does this affect moving abroad plans and expat life?
“Before the pandemic, I could easily have left without health insurance and without proper knowledge about my host country's health system. I was more interested in the "real daily life": salary, housing, etc. I am young, active and healthy. I have never had any health issues, so I thought that was enough. But the Covid reminded me that health is also part of everyday life. I am fortunate not to have any illnesses", says a computer scientist with moving abroad plans. "And, this time around, I'll take a closer look at the host country's healthcare system. Everyone is at risk anywhere, even in safe countries like Australia and Canada".
The Global Health Security Index 2021 (GHS) assesses the strength of state health systems to give you a clear idea of what you should expect. Following a study from August 2020 to June 2021, and based on six criteria (or six pillars) defining the role of health in the economy, it is an assessment of prevention (the capacity of countries to anticipate health risks), detection (key role of research), response (effective emergency plan), the quality of the health system, public policies, the global climate (international tensions, level of confidence in the country's health system, etc.). The United States ranks first, with 75.9 points out of 100. Although it is a very slight drop, it shows that the USA is well ahead of other States. Australia comes next (71.1), followed by Finland (70.9), Canada (69.8) and Thailand (68.2). Slovenia ranks 6th, ahead of South Korea (9th), France (14th), Japan (18th), and Italy (41st). Africa and Central Asian countries, as well as part of South Asia and Western Asia (Arabian Peninsula), occupy the majority half and the bottom of the ranking. Qatar ranks 49th, South Africa 56th, India 66th. Far behind, the United Arab Emirates rank 80th. Kenya is 84th, Somalia last with 16 points (down 1.9 points). The GHS assesses not only the current position but also progress. In the middle of the ranking, Qatar shows overall progress. At the bottom-down, Kenya recorded the most significant drop (-4.8 points), mainly linked to the Covid-19 crisis. Lichtenstein (54th), improved more significantly, with +14 points.
Should you consider healthcare before moving?
The Covid-19 has definitely changed the game. Expats were already cautious before the health crisis (especially those moving to countries with precarious health systems), but today they are being extra careful. Health standards can play a key role in moving abroad plans. The WHO points out that contamination figures might have been underestimated. Without sufficient capacity for Covid testing, 6 out of 7 contaminations might not have been counted on the African continent. While most African countries are now open to vaccinated people (although there are exemptions for non-vaccinated travellers as long as they have a solid reason), the situation is still complex, considering the low vaccination rate, overloaded and under-equipped hospitals, and an upsurge in Covid cases. Classified orange, the Democratic Republic of the Congo has changed to red since January 3. The situation is quite similar in Nigeria where there are barely 4 doctors for every 10,000 inhabitants, added to a poor budget with a deficit worsened by the pandemic, underpaid health workers, etc. This explosive cocktail lead to an indefinite strike in April 2021. Things have not improved yet. With barely 2.2% of the population fully vaccinated and the arrival of the Omicron variant since December 1, Nigeria is struggling against the crisis. With the tense politico-economic situation and GDP affected by inflation and child abductions, the population is traumatised.
Still, caution is highly recommended, even in countries with high vaccination rates. So what should an expat with health issues but without health insurance do? A Frenchman who left for Mexico last December to visit a loved one whose vital prognosis was threatened (considered a solid reason), has a real nightmare. "He is not anti-vax, but he thought he was rather young (45 years old), and since he's athletic, he thought that he had less risks of being infected", explains Marie, his wife. Marie is desperate to find a solution for him through the Internet and aid organisations. “He caught the Covid soon after arriving, and it's been a hassle ever since. Public hospitals are overwhelmed, private clinics are too expensive. He did not take out Covid insurance, relying on his credit card insurance. But apparently, he doesn't qualify for repatriation. His case is indefensible. Which airline would agree to take an unvaccinated voluntarily left in the middle of the Omicron storm? Even I can't believe it", says Marie. In Mexico, health is expensive, even more since the pandemic. Two systems coexist. Public hospitals offer affordable prices, but lack cannot guarantee quality healthcare since they are saturated. Private clinics have the means to offer quality healthcare, but the prices are high. For expatriates, the best solution is to get complementary health insurance, and if they work for a Mexican company, they have to make sure that their employer is contributing for them.
Countries with more efficient health systems are also facing the fury of healthcare workers. France had high hopes for the Segur agreements. Yet, the world-famous French health system - based on solidarity - no longer has the means to fulfil its ambitions. The whole vision and an economic and social organisation is carrying the burden of the pandemic. So today, it is crucial to be aware of the condition of a country's health system before moving there since you will have to rely on it in case of need. So health systems can play a significant role in the process of choosing your next destination. While the infrastructure and equipment are important factors, the language barrier can be another significant issue, especially for those who have no health insurance.
Things to consider before moving abroad
Ask yourself the right questions
Each situation is unique and deserves special attention. In most cases, you will have to get a medical check-up done. Do you suffer from any pathology or allergy? Are they influenced by the climate? Are you undergoing medical treatment? Do you use a wheelchair or a cane? Do you wear prostheses or a hearing aid? Do you need reinforced dental, ophthalmological, etc. follow-up?
Do you plan to drive on your arrival? If so, what type of vehicle? Do you know the highway code of your host country? These are some of the things you have to consider thoroughly before making any decision.
What to do before leaving?
Get a medical check-up done and make sure that all your vaccines are up to date. Also, enquire about any specific vaccines requested by your host country. Currently, Covid vaccination is, of course, mandatory for travellers.
Enquire about the quality of tap water and the presence of mosquitoes. If necessary, get some mosquito nets and tablets to disinfect the water.
If you need medical treatment, check with your doctor and renew your medication (find out about the rules for their transport from your airline). Take the original prescription with the translation of the medicines and make sure to keep in touch with your doctor; ask him for a possible contact in your host country. You can also get a list of practitioners from your embassy or consulate in your host country. However, their rates can be high. Teleconsultation, on the other hand, has become the new norm since the beginning of the pandemic. So in case you prefer to keep in touch with your doctor back home, make sure that you will have good Internet coverage in your area.
Get all your health equipment checked and renewed, if necessary.
Have a closer look at your host country's health system to anticipate future changes better and take out the best insurance according to your situation and needs.
We are here talking about the role of health systems in travelling and moving abroad plans. Most people are traumatised by the idea of seeking healthcare in overcrowded hospitals, let alone in their own country. But that does not mean that your choice will depend on that only. The current overall situation, economic growth, the politico-social climate, career prospects, the atmosphere, the education system, etc., are equally important.
