What do expats think of virtual health? How does it help achieve wellness?

This short article is part of the What is Wellness? Expat Family Wellness Survey 2018, in which we spoke to 32 families living around the world to explore what ‘wellness’ means to expats.

What is virtual health? Access your doctor through your mobile or computer, get referrals to specialists, have prescriptions sent to you and manage ongoing conditions with improved access — wherever you live.

The move to virtual health is as much about changing culture as it is technology. While some people can see its beneficial powers and welcome it with open arms, others are reluctant to give up face-to-face primary care.

The majority of our families have not used any form of virtual health or telemedicine before, but they made a strong connection to self-diagnoses via websites and could see the benefits of having virtual access to a health care professional for health care diagnosis, advice, prescriptions and referrals instead. Generally, insurers were felt to be appropriate providers of this type of service and instill a degree of trust that isn’t always there in local health systems. Most are positive towards the concept of virtual health, especially those who had had negative experiences with local health services.

The Holton family (Brits in Spain) likened virtual health to WebMD:

“I’m a big fan of WebMD, I used it a lot through pregnancy due to not being able to speak Spanish fluently.”

More than one of our families said that this type of service should be made available to local populations not just expat populations:

“Everyone could benefit from this.”

Views on virtual health

“Virtual health sounds very interesting, we would definitely use it. I’ve had to send pictures to my sister back home for advice. Currently you can go and buy anything in Nigeria without a prescription so you could be misdiagnosing. It’s better to have a second, unbiased opinion.” — Godwin (Americans in Nigeria)

“The best doctors aren’t available in Dubai so it would be good to get a second opinion from the doctors in India” — Anish (Indian in Dubai)

“It would be good to speak to specialist doctors” — Anish (Indian in Dubai)

“For ongoing conditions like diabetes, it would be great when periodic assessment is needed.” — Anish (Indian in Dubai)

“I can see virtual health saving time and money. Plus, if they could send prescriptions we would definitely use it” — Agbo (Nigerians in India)

“It would be good if you could do mental health appointments, it would be less embarrassing” — Prusty (Indians in Canada)

“We used something like this in Brazil, would be great if we could access in Canada, especially for the kids. However, I wouldn’t pay on top of insurance for this I’d expect it to be included” — Lagnado (Brazilians in Canada)

“I like the idea of this because we currently have to travel 20 minutes to see the doctor” — Birchall (Jamaicans in Canada)

“I have used the NHS helpline in the UK. I love the idea of being able to use this for the children, especially for minor issues” — Sek (Chinese in Singapore)

“This would be great because we are so remote. Especially for mental health issues” — Kirwan (Australians in Hong Kong)

“I like the idea of not having to queue!” — Anonymous

Challenges to virtual health

Familiarity and trust

The key challenges to virtual health lie with the lack of familiarity and trust in the doctors who are providing the service: “Who is actually providing the service and are they real doctors?” asked one respondent.

Caution

Some of the families from the U.S. expressed a view that American doctors would be very cautious and unlikely to prescribe medication or give a definitive diagnosis remotely. The fear of errors being made and litigation would limit their input to general advice.

Language barriers

Language could be a potential issue if having to use local doctors. The general preference would be to be able to access doctors from their home country — or, better still, to have the choice between the two options available.

Skepticism and the limits of technology

Some of our families were skeptical that anything more than a simple diagnosis could be done by phone or Skype call. Others worried that the technology may not work in some countries, adding that it “could be intimidating to people who don’t use technology.” — Lynch (Americans in Mexico).      

Even those with reservations about the details of virtual health said that they could see it would be a benefit as part of their health care coverage, but added: “I wouldn’t pay for something like this on top of insurance. I’d expect it as part of the coverage.”

Virtual health at work

Aetna International had a customer who accessed our vHealth service because he was concerned that he had diabetes. He was keen to try vHealth as he didn’t have access to a quality primary care doctor where he lived, and didn’t want to see a diabetes specialist without a confirmed diagnosis. We arranged a 30-minute consultation with the patient, took a full history and we understood all his medical issues and concerns. The vHealth doctors decided that he needed a fasting blood glucose test and we sent a phlebotomist to the person’s house with the right instructions so that they could take the blood test at the right time.

The blood tests then came back to our vHealth doctor who, 24 hours later, phoned the patient and talked them through the results.

The customer was diagnosed as diabetic, so we talked them through their treatment options and together took the decision to start the customer on a prescription medication. We issued the prescription and it was delivered to the patient’s door.

Now, we review our customer’s condition through the video health consultation on a regular basis. We also have his blood sugars because he submits them through his phone. This means that before the consultation, the doctor can see what the blood sugars have been doing since the last check-in and give a much more in-depth consultation and advice.

The customer is happy as his diabetes is now being managed and it’s all been diagnosed without the need for a single in-person doctor appointment.

Click on the links below to read what our families said about various topics:

• Introduction and conclusions
• Wellness while living away from home
• Expat mental health
• Physical health, diet and exercise
• Expat health care 
• Personal security and safety

‘Download the 'What is Wellness?’ Expat Family Health & Wellness Survey 2018

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