International doctors: the difference

International doctors — the difference

Today, there is enormous disparity in the number of doctors and standard of medical facilities available across the globe. Even wealthy countries have to bring in physicians from abroad to fill gaps in the workforce. Naturally, challenges arise where there are too few facilities or personnel to ensure the quality, impartiality, availability and affordability of proper health care.

What does this mean for international travellers, particularly those who choose to relocate to another country? What are the options available if you’re away from your home country and you need emergency treatment or elective surgery? How can you find the right doctor?

What about travelling internationally for treatment? Where do you turn to for help?

A brief history of medicine

The principles behind modern, Western health care underpin today’s unprecedented initiatives to improve lives. Medical professionals at all levels, from strategists and operations managers to front-line physicians and nurses, are key to their delivery.

It’s surprising to think that the first physician, the multitalented pyramid builder Imhotep, was practising medicine thousands of years ago. But the birth of what we now recognise as modern medicine came about with the Greek academic Hippocrates, born in 460 BCE.

During the Age of Enlightenment in 18th-century Europe, more avenues of exploration and research opened up. These developments led to previously unimaginable procedures and the therapies we’ve become familiar with today. Advances in areas such as anaesthesia in the 19th century, and antibiotics in the 20th, meant patients could be kept stable throughout more and more complex procedures, while developments in aftercare meant greater numbers had a better chance of survival.

A wider approach

It wasn’t long before the concept of public health began to take hold, and those with the purse strings caught on to the idea that taking care of everyone’s health was good for economic development as well as human comfort. But it soon became clear that this didn’t quite go far enough.

A world view

The development of an increasingly international marketplace and greater opportunities for personal travel meant it was now more necessary than ever before to keep the transmission of harmful diseases in check. Coupled with this was a need to work towards improving health care provision and policy around the world — not just on a country-by-country basis.

In 1948 an agency of the United Nations (UN), the World Health Organization (WHO), was set up to address these issues.

WHO league table of countries

Now a respected force in the implementation of the UN’s health-related, sustainable development goals, WHO is a major player in developing international policy. In a unique position to gather and analyse data, its influential 2000 report on world health care systems gives an interesting insight into what constitutes effective health care and the countries in which this is more likely to be found.

Particularly interesting is its ranking of the countries examined, and how their approaches to spending and policy affect health outcomes for their citizens.

For example, it looks at where the most effective funding for health provision comes from: it suggests that demanding health care to be paid for directly out of an individual’s pocket causes high levels of poverty. It also considers how resources are managed, and concludes that the larger the pool, the greater the spending power and efficiency.

Life at the top of the list

High on the list of rankings from the 2000 report are France, Italy, San Marino, Andorra and Malta (places 1 to 5 respectively), with the UK coming in at 18, Germany at 25, Canada at 30, Australia at 32, and the U.S. at 37. Reflecting this, all these countries are in the top 25 for life expectancy, meaning the types of health care they deliver, from maternity and child care to support with problems associated with old age, are working. The rankings represent a comprehensive view, including a country’s public health care initiatives to prevent disease as well as direct medical interventions.

The struggle at the bottom

At the lower end of the list are countries from developing areas in Africa and Southeast Asia. Here, life expectancy is shorter, with more deaths from infectious diseases and a high infant and maternal mortality rate. Often recovering from periods of political unrest, lack of investment in infrastructure and in public health care means that, while health initiatives are underway, there are too few doctors to deliver them (according to humanitarian news site IRIN. One solution is to use less qualified staff in places where need outstrips capacity, particularly where there are high incidences of malaria and the complications associated with HIV/AIDS.

A world problem: a shortage of medical professionals

According to the WHO’s 2016 statistics report, the global health workforce is made up of 43 million skilled professionals, of which 20.7 million are nurses or midwives, and 13 million are physicians. WHO estimates there is a deficit of 17.4 million health professionals worldwide, primarily in developing countries, but there is also a striking lack of doctors in more prosperous nations.

To highlight the issues faced by some countries, consider that Andorra has four doctors per 1000 citizens; in Guinea, the figure is just 0.1.

International doctors

Organisations like Médecins Sans Frontières and the Red Cross are invaluable in providing care on the front line at times of crisis, but what about the longer-term problem of gaps in the workforce?

Better wages and working conditions drive some qualified personnel to move to wealthier countries for a higher standard of living. Meanwhile, in more developed countries, a lack of home-grown doctors is blamed on a shortage of medical school candidates. On a worldwide scale, public health care provision is under immense pressure.

A 2015 Organisation for Economic Co-operation and Development (OECD) report shows that, despite having a healthy density of more than two doctors per 1000 people, the U.K. was bringing in nearly a third of its doctors from abroad, mainly from India, Pakistan and other European countries. A quarter of those practising in the U.S. came from Asia, the European Union and the Caribbean.

At the higher end of the scale, nearly half of New Zealand’s doctors were imported, with the figure being nearly a third in Australia. Countries like Denmark, Austria and the Netherlands had a much lower need, with fewer than one in ten doctors coming from abroad.

In the United Arab Emirates, with just a handful of medical colleges spread across the seven emirates (mainly offering basic medical schooling), the majority of the clinical population are expats from other Gulf countries, Asia, Europe and the U.S.

What the internationally mobile need to know

So, despite the rise of an international approach to human health, disparity remains between the level of health care, and the number of doctors and standards of facilities, from country to country. In some areas where there has been rapid economic growth, it has been necessary to import specialist talent from abroad in areas such as engineering, education and finance. This has been less noticeable in health care and newcomers may find the level of care they have enjoyed in their home country more difficult to source or prohibitively expensive.

What you’ll need if you’re ill or injured abroad

Good quality health provision is vital to physical and mental wellbeing. An accident, sudden illness or the onset of a chronic condition can make someone vulnerable in a moment. So what should you do if you’re thinking of relocating to another country?

The advice is to secure the right kind of international medical insurance you’ll need beforehand, so that should the worst happen, you won’t be out of pocket and you’ll have access to quality health care. The costs can soon add up. Should you need to be moved, there are flights, accommodation and aftercare to think of, not to mention the medical bills themselves.

But it’s not just a matter of finance; there are other practical things to consider. When you fall ill away from your home country, you need:

• Certainty that your wellbeing is a priority, what the next steps are, and what the long-term outlook is likely to be. In rural or difficult-to-reach areas, this could mean access to a virtual primary care network offering remote support.  
• Continuity of care that promises end-to-end assistance from initial referral through to transfer, treatment and recovery.  
• Access (including evacuation by air) to clean, efficient, well-equipped facilities to minimise the likelihood of further injury or infection and promote recovery.  
• Reassurance at a time when you may feel vulnerable and in pain, and someone you can talk to about the details of your symptoms and anxieties – in your own language.  
• Access to a network of medical professionals, who have a good relationship with your medical provider, and are trained across a range of specialisms so a second opinion and the right treatment can be arranged.  
• Confidence you will get the right kind of aftercare: whether this is transportation to the comfort of your own home to be cared for by your relatives, or a clean, safe hospital with the right level of personnel and facilities.

Networking puts the patient first

To make this happen, preparation is vital. An international private medical insurance organisation like Aetna International has a dedicated management team to make sure working relationships are already in place. Working in each region, they know where to find the best expertise and knowledge. By the time an emergency arises, the legwork is done. Sourcing the best facilities and physicians, access and rates are negotiated well in advance and these well-established links mean there are admin protocols in place, so that patient care and wellbeing is the primary concern.

There is also a care management team. “Requests come in from different parties,” says Aetna Case Manager Erika Garrido, based in Singapore. He explains how quickly things swing into action:

“In an emergency where a member needs to be evacuated, our in-house evacuation team coordinates the flight with the provider, hospital or doctor. If the situation requires an elective procedure, and there’s no doctor available for the treatment requested, we work with our regional partners across the globe. They help us identify the right providers and doctors to help.”

It’s a very personal service, tailored to every member. Erika says, “As our customers’ health advocate, we conduct outreach calls to answer questions on their individual health issues, so that every customer knows they are being taken care of.”

What you can do

International travel and global migration is now as ingrained an idea as the need for a solid, sustainable, worldwide health policy. A complex web of socio-economic conditions affects the way in which each country takes care of its citizens, inpats and visitors, and it’s clear there is a worldwide shortage of doctors to deliver this.

For now, at least, there will be a continual movement of medical professionals, whether driven by career development, compassion or a need to find a better way of life. Individuals and their families, or those on international work assignments, will need to ensure they make adequate provision before they leave home.

Take the first step in planning your health provision in your destination country today. Talk to one of our experts to find out more about our network of medical practitioners and for advice about the right level of private medical insurance for you.

The information included in this email is provided for information purposes only and it is not intended to constitute professional advice or replace consultation with a qualified medical practitioner.

Aetna^® is a trademark of Aetna Inc. and is protected throughout the world by trademark registrations and treaties.