Insurance decision will cost an expat no matter what

Part 4: It’s gonna hurt

(In my three previous posts, I explain the complicated decisions expats must face regarding their healthcare, especially when the unexpected occurs.)

When expats consider medical insurance, they quickly learn the decision about getting or foregoing it can be complicated.

What they don’t always accurately take into account is how the costs of insurance will grow and how risky the lack of it can be.

Having it is expensive. Not having it can cost a bundle too.  Worse, not having it can be dangerous.

With insufficient insurance, inadequate personal resources or both, a patient who is unable to receive quality care in his or her adopted country or another one could end up permanently maimed.  Or dead.

Maybe that patient had a terrible accident and received substandard treatment for resulting injuries. In the event of a stroke or heart attack, a patient in any of Phnom Penh’s hospitals could die as a consequence of some combination of inadequate equipment, poorly educated providers and haphazard care.

(One gravely injured patient being transported overland to Bangkok in September needed oxygen on the way, and both tanks that a hospital put in the vehicle turned out to be empty. Only an emergency trip to a veterinarian’s office saved the day: A  tank that the vet stored there kept the patient from dying on the half-day journey.)

I was fortunate in that all I needed was treatment of my broken hip after a fall and could afford the excellent care I received in neighboring Bangkok.

So what did my treatment cost me?  Forgive me for being a bit coy; I’d like to retain just a modicum of privacy and will only generalize.

Five years of insurance premiums to a reputable company probably would have run me close to $40,000.  My surgery, hospitalization, airfare for two of us, our hotel for nearly two weeks and ordinary living expenses ran less than half that sum.  (We stayed a few days longer than necessary, even with me on crutches, so as to take advantage of being in a city we know well and like very much.)

My good fortune was not having a life-threatening injury that required a chartered flight and immediate treatment.

Certainly, every thinking expat will make his or her own decision about how much and what kind of insurance to purchase, if any.  

Sometimes there is no choice.  In a number of countries including Malaysia and Portugal, health insurance is a requirement.  If a nation demands it, you won’t be allowed in without it or you’ll be booted out when you try to renew your visa.

It cannot be stated too often that expats, travelers who go without and even locals dependent on loans for emergency expenses can face dire consequences.  I occasionally see them begging for donations on Facebook.  Clearly, their risk-benefit analysis, if it occurred at all, was overly optimistic and their financial resources, decidedly meager.

Analyzing my own situation, I realized from the outset that the decision should not be made lightly whether to pay premiums or forget about additional insurance in Cambodia, where it is not required.  When I determined to self-insure, rest assured that I didn’t make the decision casually.

I do understand that a medevac as far as the States in the company of a healthcare professional and partner would affect how much future travel I could afford.  With that perspective, I swallowed hard at the risk I was taking when I moved to Phnom Penh and accept with wide-open eyes the risk that I continue to take.

I fully appreciated then and do now that not everyone can adopt my approach to meeting unforeseen healthcare needs. After all, so many such needs are unforeseen.

Most of my life, I have been lucky.  I cannot complain.  Indeed, the experience of breaking my hip was the worst thing that has affected me physically in all the decades since my bicycle came in contact with an immovable object at the bottom of a hill when I was 9.  I rocketed over the handlebars, broke my nose and sustained a mild concussion.

I am, therefore, philosophical about my recent spill and its consequences.  Stuff happens.  And my cloud did, after all, contain a glittering lining: Now, I have learned to say in the Khmer language, “I have a broken hip.” Moreover, my recovery was pretty much uneventful and quick.

I still am not sorry about having passed up an insurance policy.

Well, okay, one related regret: I should have looked down and noticed how slippery the floor was.


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