When you have no medical insurance …

Dr Michael Moreton graduated from the Liverpool Medical School and trained as an obstetrician and gynecologist in Montreal, Canada. He is the International Medical Co-ordinator at Bangkok Hospital, Bangkok. Moreton@bgh.co.th

British, Canadian, Australian and New Zealand travelers are more casual about purchasing travel type of insurance than are Americans or Europeans.

Their government health plans, with all their faults, are always there for them, and many people rarely think about private health insurance. This is spite of the fact their coverage is of no help when you are out of the country.

The concept of the “uninsured patient” is not part of the British, Canadian, Australian or New Zealand experience. Neither is the phenomenon of patients being turned away from hospitals if they have no insurance or cannot document their coverage.

But if you are taken ill or injured in a foreign country and don’t have travel insurance, you are an uninsured patient and may have trouble getting care.

Robert Jackson was looking forward to his visit to South East Asia, spening several months planning his trip, reading the history of the countries he would visit and creating a demanding schedule for himself.

He was planning to travel to the less visited areas in Northern Thailand and visit as many of the holy sites as he could cram into his schedule. He had not had any serious illness for several years and his Family Doctor and the local hospital had taken care of all his minor Health problems. He did not obtain any travel insurance.

He had many plans and certainly wasn’t planning on visiting the Intensive Care Unit of the Bangkok Hospital, or spending over 48 hours unconscious, or having multiple surgeries. Nor planning on intensive rehabilitation but that’s what he got.

In spite of the fact that he was not too agile and had never ridden a motor-bike in over 10 years, he decided to rent a motorbike and ride around the back roads in Thailand. A truck that he was following too closely suddenly braked. Robert flew through the air and landed on his face in the road.

Fortunately he was transported into the city quickly and brought to the Bangkok Hospital Medical Center, a tertiary care JCI Accredited facility. As he was unconscious, he was admitted to the Neurological Intensive Care unit.

His family was contacted and consent for treatment obtained.

They were not aware if Robert had any private health insurance and were reluctant to guarantee payment for the care. In spite of this, he received excellent care and is now on his way to full recovery – after multiple surgeries for his facial fractures and skin grafting to other wounds.

He was obliged to take out a considerable bank loan to cover his care.

Melanie Albert was working as a volunteer in a children’s care home in Cambodia. After eating a very spicy dinner one evening, she started to have abdominal pain. Thinking it was indigestion, she initially ignored the pain but by the following morning realized that this might be something more serious than an upset stomach.

She had not obtained any insurance when she left Canada and naively thought that the province would cover her medical expenses while out of the country.

After been seen in the clinic she was flown to Bangkok. A diagnosis of Appendicitis was made and she had an operation on the same day. Her family came out from Canada and were able to have funds transferred to cover the cost of her care.

She was particularly fortunate as she was able to get to Bangkok on a commercial flight. If she had needed to have a special air-ambulance the cost would have been enormous. One of the features that’s always included in travel insurance is evacuation insurance, which covers the cost of being transported to a good medical centre close to your accident or where you were taken ill.

Recently another British patient needed to be transported back home after surgery and intensive care treatment for a collapsed lung, which happened quite spontaneously and without warning.

He needed a nurse and a doctor to travel with him as he was taking anti-coagulants and there was the possibility that he might need extra oxygen on the flight. He was flown from Bangkok to London; he traveled business class with his two attendants. Luckily he had good coverage for this very expensive journey.

These three patients, by the way, were all fit, young people with no previous medical illnesses who had no reason to believe that they would need hospital care during their vacation

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