Living abroad without health insurance isn’t as risky as you might think

In a more perfect world, every citizen everywhere would have affordable access to high-quality health care and medicine. But most of the world isn’t even close to this ideal, and for many it’s all about risk and trade-offs and hoping for some good luck. Some people seem to be terrified of leaving the United States or Europe without knowing that they have air-tight insurance coverage no matter what happens, and this post aims to add a little balance to the debate.

If you are considering moving to Asia or South America or other parts of the so-called developing world, the situation there is probably better than you might imagine for those without health insurance. There are doctors and hospitals almost everywhere and they have to be affordable for the average middle-class resident in their area (and you will likely be above their middle class).

Putting risk in perspective

It’s natural that many of us automatically gravitate to the worst possible scenario when discussing health care and insurance. People ask, “What if I move to Laos or Guatemala and I get a rare brain tumor with no health insurance?” Well, in that case you could at least be in financial trouble, if not health trouble. But consider that you are probably a thousand times more likely to break a leg in a motorbike accident than get a brain tumor when living abroad. What happens then?

In most cases if you break a leg in a motorbike accident in a developing country you’d be taken to the local hospital (perhaps in a taxi or by a local in their car) and you’d get similar treatment to what you’d get in the US or Europe. When you left the hospital on crutches a few hours later you might owe US$100 or US$200 for the whole thing, instead of US$2,000 that you might owe in the US without insurance.

The point is, for normal healthy people without preexisting conditions, you are likely to get similar care for a fraction of the cost for the vast majority of things that are most likely to happen.

What about drugs and prescriptions?

Many people are aware that the majority of the modern drug industry is funded by American (and to a lesser degree, German) consumers and insurance companies. The good news about that is that prescription drugs in addition to most popular over-the-counter drugs are available barely over their wholesale costs in most of the world.

A drug that might cost US$2 per pill in the United States might be available for US$0.20 per pill in most of the rest of the world. And slightly controversially, in most countries you won’t even need a prescription to get them. It seems that drugs (such as Xanax) that are sometimes used recreationally do in fact require a prescription in most of the world, but most everything else is available at a low price for the asking.

My brother works in the pharma industry in Germany and I asked him about the situation of most drugs being available without a prescription in developing countries. He said the common wisdom on the subject states that the majority of people in these countries can either afford a doctor, or the drugs, but not both.

It’s not a perfect system of course, but it does seem to work reasonably well that pharmacists in these countries are often the first and only health care professional that most people see. You walk in and tell the pharmacist that you are constipated or you have a skin rash or whatever, and they’ll ask a few questions or have a look and then sell you something cheap if they don’t think it seems more serious than that.

Two short personal stories to illustrate the point

When I was living in Chiang Mai last year I had a problem that I needed to get checked out. Some research showed that the university hospital just down the road from me was the best option for a first visit. I walked down there without an appointment, and about two hours later I walked home.

During those two hours I was helped to fill out admission forms (in English) and then I got to see a doctor about my symptoms. I had blood and urine tests done, and an hour later the doctor gave me a prescription and told me that the problem didn’t sound serious. The bill for the whole thing was US$32, which already sounded cheap until I realized that US$25 of that was for the prescription drugs. So yes, I saw a doctor in a Thai city, and had two lab tests done, for about US$7. This is the normal price for a local, who might make US$7 a day as a cook or chambermaid.

The other story is that I have a skin condition that flares up at times and is controllable by a prescription antibiotic drug. Instead of US$0.50 to US$1 per pill in the US, I’ve paid anywhere from US$0.05 to US$0.20 for them from Vietnam to India to Turkey.

Insurance isn’t even needed for most of the things that might go wrong and healthcare is affordable and of good quality. Some people insist on living within 10 miles of a Mayo Clinic in case the worst suddenly happens, but it very rarely does and the world isn’t as scary as our fears sometimes tell us it is.

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