Expat Focus International Healthcare Update January 2019

Expats overseas require a 'duty of care'

More than two thirds of expats working overseas say they are dissatisfied with the time they have available for spending with family, a survey reveals.

The findings from Cigna, a global health services company, also found that 24% of expats who are living alone or are single admit to being lonely.The findings come from the firm’s Wellbeing Survey which highlights that expats working overseas worry more about their family and their own health and wellness than when residing in their home country. Also, 76% of expats report that they cannot take care of their children’s various well-being needs when living overseas. Just 42% believe that their employer is offering them an adequate duty of care and 40% say they do not receive any medical benefits from their employer at all.

The chief executive of Cigna Europe, Phil Austin, says it is crucial that employers are aware of the needs of their overseas employees. He explained:

"While working abroad has benefits, the reality can be emotional for people when in a new country. Working practices are different, along with the lifestyle and the cultural and language changes means coping with challenges are more difficult."

Austin added that the survey shows expats have a deep insecurity over their families’ well-being and health and, along with increasing loneliness and social isolation, there’s also the loss of their support network to contend with.

Health challenges facing expats in 2019

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The range of health challenges facing expats and employees who regularly travel overseas during 2019 have been revealed by one global travel risk management firm.

Healix International says that disease continues to top of their list of concerns but employers also need to be aware that the big risks are not necessarily always overseas but can be closer to home.

In a statement, the international medical and security assistance provider said:

"Diseases that we tend to associate with far-off regions are top of the list of concerns and these include the Zika virus, Ebola and malaria. Employers should be mindful that some diseases are just as common at home. For example, mumps and measles can present a serious risk and they remain prevalent because many parents have shunned the MMR vaccine. Employers need to ensure they are monitoring all of the health risks when they are posting staff overseas."

Healix also highlights that one of the big issues in trying to keep a disease outbreak under control is the resistance from local communities to accept the advice of healthcare professionals.

The firm is also predicting that poorer tropical countries face a potential big increase in malaria cases this year, with a reduction in mosquito prevention programmes leading to potential growth in problems.

In addition, Helix says that the big worry for health experts is the potential reappearance of bird flu that is capable of infecting humans and that it’s important for employers to have adequate pandemic planning so they know what to do should an outbreak occur and they can reduce risk.

Overseas employees need HR intervention

Meanwhile, expats working overseas are facing specific health risks that need to be addressed by HR managers. The firm says that potential difficulties of an expat working overseas can be mitigated through the detailed assessment of the expat’s suitability for the posting and preparing them thoroughly beforehand.

The firm’s head of medical communications, Dr Simon Worrall, said:

"Living away from familiar places and people can be challenging and these challenges can be exacerbated for those with a pre-existing psychological issue. The negative aspect when working abroad can be pronounced for those with a mental health issue but HR professionals can do a lot in offering the support people need in making a successful move abroad."

The firm says it is crucial that before an employee is posted overseas that a medical assessment which includes physical well-being and mental health is carried out. This will then deliver medical clearance to ensure the employee is suitable for their posting. It will also identify any medication requirements and enable the employer to ensure that the country where they are heading is suitable for their placement, since some countries will have restrictions on some types of medication.

Dr Worrall added: “An effective HR intervention will help workers prepare for difficulties and offer necessary support. If issues do arise, then working with an international assistance company will give immediate access to the most suitable support which can be difficult for the employee or their HR department to obtain in another country.”

Expats in Thailand need health insurance

New proposals from the government in Thailand will see expats having to arrange compulsory health insurance cover for the first time. The new rules will see expats with a one-year, non-immigrant visa having to take out an insurance policy for their stay with a minimum of Bt400,000 (£9,693/$12,588) inpatient and Bt40,000 (£969/$1,259) outpatient medical bill coverage. Expats who have an overseas insurance policy meeting the minimum criteria will not have to buy the new health insurance policies.

The new law will also mean that expats who have moved to the country for retirement must be willing to keep Bt800,000 (£19,384/$25,175) in a separate bank account before their annual visa is due for renewal.

One issue is that most insurance firms will refuse cover to any applicant over the age of 60 in Thailand and there’s little chance for any expat over the age of 75 to access insurance coverage, so Thai authorities say they will need the money available to help cover any potential medical expenses.

Health cards for less well-off expats

The Dubai Health Authority has unveiled plans for distributing 100 health insurance cards among poor expats in the country. The cards will be valid for one year and have the essential benefits package and a maximum limit of Dh100,000 (£20,970/$27,229) per person of health cover attached to the card.

It has also been revealed that expats in Dubai with a basic insurance package will be able to enjoy unlimited coverage for three types of cancer treatment under a new initiative. The move from the Health Authority will see treatment being granted for the treatment of hepatitis C and cancers including cervical, breast and colorectal.

Healthcare worries for expats in Cyprus

Expats in Cyprus may be paying more for their national health coverage under plans to increase payments. The new rates start from 1 March with employees and pensioners having, by law, to contribute a larger slice of their income with a further increase planned for 1 March next year.

Critics say the move will see many expats being unable to afford the payments and having to live without health care coverage. There are some exemptions, including for the island’s large population of British expat retirees who have an S1 certificate.

Employers not providing health insurance to be fined

Employers in Saudi Arabia are being warned that if they fail to provide employees with health insurance coverage they face hefty fines. The warning comes after the kingdom’s Council of Cooperative Health Insurance (CCHI) unveiled a number of measures to boost participation numbers, including the stopping of computer services and the introduction of fines against those firms not complying.

The employers will have to pay the required instalments and also be fined an equivalent amount for failing to provide health insurance cover.
All companies in the kingdom’s private sector must provide health insurance to their expat and Saudi employees along with their dependents and spouse.

Health cover for expats with pre-existing conditions

Employers may struggle to source health insurance coverage for expat employees with pre-existing medical conditions, but a new offering may help.

Verisk, a data analytics provider, has launched a new service in Europe, Canada, Asia and Australia to help insurers understand the risks posed by those with pre-existing medical conditions. The firm uses an algorithm to help the insurer use pre-existing medical conditions and how they affect their underwriting strategy. There’s also a calculation for the likelihood of the insurer incurring medical expenses for these and the expat’s repatriation risks.

In other news…

Oman’s government is said to be considering compulsory health insurance for all public listed companies in the country. Employers may be compelled to pay for health insurance coverage later this year and a consultation is now underway. Meanwhile, the country’s Ministry of Health has announced plans for replacing expats who work in 19 job positions as part of its Omanisation project. The jobs will see expats being replaced in categories include cardiologists, nutritionists and mental health technicians.

Research from GlobalData reveals that expats can expect to see health tech rising in prominence this year with artificial intelligence and big data becoming ‘transformational forces’ in healthcare. Firms will increasingly move to digital health records and artificial intelligence will increasingly help expat healthcare insurers deliver better value and products, the firm says.

Research in Ireland has revealed that two in three people there with a health insurance policy are, potentially, on the wrong plan. The findings come from Total Health Cover who say that because of this, people either have insufficient cover or are paying too much for it – and people should check what coverage they have.

Expats in the Chinese city of Chongqing can now enjoy the first international hospital that has opened there. The Raffles Medical Group has unveiled the 700-bed facility offering expats and locals alike a range of treatments, particularly those that many will have headed overseas to enjoy.

A new international healthcare proposition for employers with employees living and working in Saudi Arabia has been unveiled by Axa. From January, multi-national firms with employees in the region have been able to access health care plans which deliver the firm’s full global medical network and offers access to medical treatment when the expat is outside of the kingdom.

One of the fastest growing aspects of delivering healthcare around the world, particularly for expats, is the growing spend on wearable tech to record the user’s health. Juniper Research says that remote patient monitoring devices and health trackers will increasingly become ‘must haves’ and by 2023 the firm says we will be spending $60 billion (£46.2bn) every year on them.

It looks like it may be getting more difficult to fraudulently access healthcare in foreign countries with growing numbers of healthcare agencies and organisations adopting chip cards to adhere to regulations and beat the health fraudsters. Numbers of these cards grew by 10% last year, according to the International Card Manufacturers’ Association. Expats will find that their chip card will have extra features, including those that work as national ID cards and drivers’ licenses.

A report in the Financial Times highlights that health insurance has rocketed in popularity in China, creating opportunities and a better choice of products for expats there. The country has also opened up the market to outsiders so the likes of Axa and AIA have moved in to offer healthcare plans to supplement the country’s poor public health coverage.

Researchers have found the reducing out-of-pocket health costs leads to better health across the wider population, particularly in low and middle income countries. The findings have been published in BMJ Global Health and by reducing financial hardship from healthcare costs will boost health outcomes and health equality. As many expats will know, paying for medical out-of-pocket expenses is still the main method of meeting their healthcare costs and researchers say this is a critical global challenge. They say that fees worsen health outcomes and reduce access to medical solutions.

A new health insurance programme has been unveiled in New York which will help citizens and, potentially, low paid expats too. The aim is to bring coverage to 600,000 people living in the city and will cost $100 million. NYC Care will offer an insurance card giving the holder access to a doctor – with any fees being determined by the person’s income.


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