Ensuring quality care at a reasonable price

Written by by Karen Teasdale, Marketing Manager, AXA PPP healthcare

Tuesday, 03 March 2009 10:30

Standards of care and the cost of treatment vary enormously, even within Europe.

With over 400,000 Britons leaving the UK in 2006 the demand for the expatriate lifestyle is on the increase. Europe can be viewed in many ways as a single entity as British nationals continue to move throughout Europe to live, work or retire. Whilst the European expat may face little exposure to the types of tropical diseases and health issues faced in other global destinations, the need nevertheless for quality healthcare provision remains apparent.

In many parts of Europe quality healthcare does exist and the state system provides reputable medical facilities. There is, however, an increasing amount of legislation which impacts on both the extent to which the expat is eligible to receive state healthcare and the corresponding costs.

Although the price of comprehensive insurance can be perceived as relatively high, the benefits and services can outweigh the cost. For example, they can cover costs of prescribed out-patient drugs and dressings, and members are usually able to choose where they are treated. Many expatriates may be considering the value of their insurance policies and if they can justify the costs associated. It is only when you look at the costs of a hip replacement (up to £18,000) or having a baby privately (up to £7,000) in France, for instance, that you realise that cancelling or taking a reduced benefit policy may be a false economy.

European expertise

The healthcare systems across Europe vary enormously in quality and cost. Even though a national health system does exist in Greece access to medical treatment and doctors on its islands may be limited. Even on the mainland, where there are numerous private hospitals and clinics, standards can vary greatly. Additionally, standards of care post-treatment in the public sector are seen to be behind those found in the UK.

British nationals in Poland are able to access emergency medical treatment. Fluent English is not widely spoken by medical staff, however, so many expats choose to be covered by a provider who can locate English speaking doctors, or who can gain access to an interpretation service.

Other countries in Europe, Finland for example, have a good state health system although access to treatment may be slower than in the private sector.

AXA PPP healthcare’s European policy provides cover for members living, working and travelling in Europe, giving them the freedom to move around the EU knowing they are still protected by their policy. They can also choose to go anywhere in Europe for treatment (although transportation costs aren’t covered). By choosing a policy that covers the whole of the EU people have access to a greater range of facilities across a number of countries. This might not be available on policies sold through local providers who may only provide cover in the country where the policy is sold.

We constantly review our policies to meet the needs of individuals and corporate groups taking out international insurance. For example, we have enhanced benefits on our policies taking effect from October last year by removing our £20 excess on out-patient benefits. This means members can now access healthcare without having to meet some of the costs themselves. In addition we have also increased our benefit for pregnancy and childbirth from £4,000 to £10,000.

Expatriates looking into purchasing private medical insurance should contact the Department for Work and Pensions to establish their welfare rights. They should enquire about the cost of receiving treatment abroad, consider the level of cover they require, and, if the policy will cover them for emergency evacuation and repatriation. As with all healthcare insurance policies, terms and conditions apply and your insurer will be able to advise you of these.

France

Typical costs for the procedures in France will vary by hospital and by provider and whether or not the hospital has an agreement with the French national health system. The price for a private hip replacement includes all non-procedure costs such as meals, consultations, drugs, the cost of the actual prosthesis and so on.
Some 200,000 Brits live in France and an additional 250,000 Brits own second homes in the country and take regular holidays there.

Health services are seen as generally of good quality, although expensive. The new Government of President Sarkozy has already moved to restrict the health benefits available to foreign nationals. From March 2008 foreigners resident in France who are under 65 and not working no longer were eligible for state-subsidised healthcare. This has prompted an increase in the number of people purchasing private medical insurance, although people disqualified under this new rule that were registered as living in France prior to 23 November 2007 should not be excluded. In addition, once a foreign national has achieved five years of regular uninterrupted residence in France, they qualify as a permanent French resident and again the exclusion will no longer affect them. Those foreign nationals caught by the new exclusion are however required to have private medical insurance.

Cyprus

Typical costs in Cyprus are difficult to establish but will increase in broad line with the quality of the hospital facility. The prices quoted are those likely to be expected in the higher categories of hospital. Prices for hospital expenses vary (for example, accommodation charges, theatre expenses, medicines) but fees for surgeons and other specialists are largely fixed irrespective of hospital. It is generally common for some additional fees to be charged, for example £36 for a pre-op consultation through to £160 for pre-op tests. These prices vary and are not included in the price table.

Local Cypriot citizens are covered by their own Government hospitals, and the amount they are covered is based on their annual earnings. Foreigners relocating to Cyprus who are covered by their home country’s healthcare system will qualify for free public healthcare, but this is capped.

The FCO records some 59,000 Brits registered as living in Cyprus. There are few issues with availability of health services as there are plenty of hospitals and clinics. However, the standards of public hospitals may sometimes be lower than those found in the UK.

Spain

There is a high degree of variability in terms of quality of care and service between various healthcare providers, though generally good quality services can be found quite easily and are seen as comparable to those in the UK. The quoted private costs include all consultation costs, drugs etc.

There are however variations in qualification for healthcare services in the country. Valencia for example has introduced a new law called “Ley de Aseguramiento Sanitario” which took effect from 5 June 2008. This affects British nationals who do not have access to the State Health System through an E121 or E106, or who do not pay Spanish social security contributions. In essence this new law aims to regulate and control free access to the health system in the autonomous region of Valencia. Early retirees who are unable to access the system with either E121 or E106 will have to take out private medical insurance or self-insure.

Bulgaria

There are relatively few Brits registered as living in Bulgaria at the moment. But with its recent accession to the EU, remarkably cheap property prices and the same weather as the French Riviera, many commentators are suggesting that Bulgaria might become the new Spain.

However, as with many developing countries, facilities in large towns and cities are often better than those in rural areas. The FCO states “Facilities in most Bulgarian hospitals are basic and old-fashioned compared to those in the UK. Standards of medical care are acceptable, although specialised equipment/treatment may not be available, and hospital staff invariably do not speak English.”