Health Care Abroad: Something to Consider

Several months ago, I found myself, once again, in a Taipei City Hospital emergency room. It was a fairly busy evening patient-wise and I was lying on a gurney in the far corner of the lobby with an IV drip tagged to my wrist, waiting to be admitted for further care. This vantage point offered me a better-than 180-degree panorama of the entire ER and pharmacy – not that I was particularly interested in the comings and goings of hospital staff and the hoi polloi.

The painkiller had just started coursing through my system when another foreign guy came hobbling in, obviously favoring his left leg and/or foot. He proceeded to the registration counter where he explained, in heavily-accented English, that he had just arrived in Taiwan on a flight from Paris, and was staying at the hotel around the corner. The hotel desk clerk sent him here.

The man continued to explain that he had worn a special pair of travel socks designed to prevent blood clots during long flights; but in this case, caused a tremendous, almost crippling pain in his lower left calf and ankle. The woman behind the counter had no idea what he was talking about – socks and blood clots? – but she, and I, too, could see he was really hurting.

The registration clerk’s English was weak, at best, but between the two of them, it quickly became apparent the man was not a resident and therefore, did not have a Taiwan National Health ID. But he did have a French passport, and that’s all he needed. Fifteen minutes later, the Frenchman emerged from the triage station with a prescription for, I’m assuming, painkillers. He hobbled over to the pharmacy and back to the cashier’s counter where he began asking, “Is this a public or a private hospital?”

Strange question, I thought to myself.

The woman behind the counter had no clue, not even a hint of what he was asking, nor did the nurses who had coincidentally assembled for some chit-chat nearby.

Seeing where I could be of help, I answered “Public. It’s part of the Taipei City Hospital system. This is the Renai branch.”

“I see,” he replied. “I was wondering because it was not expensive at all.” He gestured toward his outpatient receipt, a bewildered smile on his face. “This is incredible – less than 10 Euros?!”

“Welcome to Taiwan.”

Meanwhile, on this particular occasion, I would go through a series of tests, procedures, and medications that ultimately cost me less than US$50, out the door.

So, clearly, the Taiwanese health care system works for me. And it most likely worked for the visiting Frenchman. The question I’m going to ask you is: Will the health care system work where you’re headed?

That depends, doesn’t it?

No matter where you travel and for whatever purpose, the need for access to health care does not change. You can break your arm in Switzerland just as easily as Venezuela. Suffice to say, on principal alone you’d most likely be better off in Zurich as opposed to Caracas – Switzerland has one of the best health care systems in the world; Venezuela isn’t even a part of that conversation. On the contrary, your ability to access health care will present the important and wide ranging, real-world contingencies.

The health care variables begin with the type of traveling you’re going to be doing and ostensibly, where you’re going. The Switzerland vs. Venezuela comparison demonstrates the relative subjectivity of the quality of health care available. There’s nothing you can do about that. However, you still undoubtedly face a litany questions about insurance and/or universal care.

Imagine you have agreed to sit down for a brief interview with me prior to your departure for a foreign land. Here’s a selection of the questions you’ll be asked:

– Where are you going?

– How long will you be staying in [your destination country]?

– Do you think it’s necessary to have any health care insurance?

– Do you have home-based insurance?

– Does your home-based insurance coverage extend overseas?

– How does your home-based insurance provider pay for hospital visits, procedures, etc.?

– What is the health care situation in your destination country?

– Is health care insurance necessary in the country?

– Can you purchase health care insurance in the country?

– Does the country have universal health care?

– Will you qualify for universal health care in the country?

– What are the out-of-pocket expenses for health care in the country?

– Have you looked into any home-based expatriate health care plans?

Meanwhile, here’s a considerably more intense set of Q&A exclusively for soon-to-be expatriates.

So, you see, health care is as complicated as it is vital to your survival. Moreover, the politics of how to pay for it is a hot topic in the U.S., and I’m not here to argue politics. What I can say is based upon my own experience (and the accounts of other expats): Subsidized, universal, and/or national health care is not a blanket cure-all for the ills of every society. No ultra-inclusive system run by the gears of bureaucracy can be flawless. Jeremy Bentham’s “For the greater good of the greatest number of people” means some people, maybe even a lot of them, are gonna get the short end of the stick.

That said, I’ve been enrolled in Taiwan’s national health care system since qualifying for my first Alien Resident Certificate nearly ten years ago. All foreigners legally working and living in Taiwan are not only eligible for national health care, they’re required to pay into the system whether they ever end up using it or not.

Health care in Taiwan is good if not great. You gotta problem? You go see someone. You don’t need an appointment, you simply roll up on the nearest hospital, present your National Health ID, and tell them what’s up – it hurts here. You’ll pay a small registration fee of NT$150-500 (US$5-25), take a number, and see a doctor. If you’re familiar with specialized clinics, they’re usually under the umbrella of the national system, and you’ll see the sign below, an invitation: “Come on in.”

Then, of course, there are the myriad, non-subsidized Chinese traditional medicine clinics, and I don’t even want to get into acupuncture and cupping and stinky herbal mud packs. Your mileage may vary in those joints. But my point is, for a very real medical emergency in Taiwan, such as acute and prolonged gastrointestinal distress, you follow the above instructions and they’ll do what you can to set you straight. And it absolutely will not cost you a fortune.

For the duration of my residency in Taiwan, I have paid a NT$500 (US$26) a month for standard coverage, which includes dental and emergency services – to certain degree. The nationalized system covers an insanely comprehensive range of treatments and service, but it doesn’t cover everything. At the dentist, NT$150 will cover most procedures except teeth whitening. Last year, I had an old metal filling fall out, leaving a significant sinkhole on the left side of my jaw. Went down to the dentist, laid back in the chair, he looked in my mouth, said, “Oh yeah, big hole” and proceeded to fill the gap with some kind of plastic enamel. The whole thing took 30 minutes and cost five bucks.

Once again, having said all that, insurance is not absolutely necessary in Taiwan, mainly because as a result of having subsidized health care, the cost is already pretty low across the board. Medicine is still big business in Taiwan; it’s just not predatory.

I wasn’t and I’m still not surprised the Frenchman with the bad leg was shocked to have received decent, reasonable health care in Taiwan. However, a lesson to consider is that health, and health insurance, isn’t something to gamble.