Access to quality healthcare is not always readily available in some countries and regions around the world. Dr Ulrike Sucher, Medical Director for Allianz Worldwide Care, explains the role of international private medical insurance in helping people get to the best care in neighbouring countries or close to home.
The international private medical insurance (iPMI) industry is experiencing significant increase in medical evacuations and repatriations due, in part to the growing number of international companies with staff working overseas and workforces in remote and often hazardous regions (eg mining companies), together with the rise in climate-related natural disasters.
With ever more companies seeking business opportunities overseas, employers recognise the compelling need to provide global healthcare cover for their staff.
In many countries medical insurance is a legal requirement and domestic cover may not offer as comprehensive a level of cover as iPMI.
Healthcare is a major concern for expats and their families and it is hugely reassuring for them to know that they are covered, regardless of location, by a health insurer who literally speaks their language.
When it comes to providing international health insurance for staff, particularly those working in remote areas where there may not be easy access to medical facilities, consideration of evacuation and repatriation cover becomes paramount.
Medical evacuations are carried out when international workers or their dependants get ill or injured and the required medical treatment is not available locally, at which point they need to be taken to the nearest suitable medical facility.
The countries from which Allianz Worldwide Care clients are most frequently evacuated include Mozambique, Libya and China, where specialist medical care is limited. South Africa and Germany are among the countries to which members are most commonly evacuated, due to the availability of centres of medical excellence and specialist care facilities.
The difference between medical evacuations and medical repatriations is that for repatriations, the insured member is returned to their home country for treatment, where medically appropriate and possible.
The details and process of evacuations differ from insurer to insurer, so the following is based on Allianz Worldwide Care’s practices.
Our 24/7 multilingual helpline provides a rapid response service, escalating potential evacuation or repatriation cases to our Evacuation Team, based on the medical information they receive. Somewhat unusually for the industry, the Allianz Worldwide Care Evacuation Team is made up almost entirely of nurses and doctors and all cases are lead by a senior medical doctor.
This specialist team is the single, central point of contact for clients and the families of insured members, providing updates to concerned parties at every stage of the evacuation process. Inhouse multilingual skills support the evacuation team, meaning that language never becomes a barrier to assisting clients, wherever they are in the world.
Clear lines of communication, right throughout the process and between all parties is critical to achieving a successful evacuation or repatriation.
The Evacuation Team will identify the nearest, appropriate medical centre, given the person’s condition, before deciding on the most suitable form of transport. Choosing the right form of transport is a crucial stage of the process and there are several factors to consider. For instance, an air ambulance is essential if the patient requires ventilation or invasive monitoring, as it is not possible to carry such equipment on a commercial flight. Logistically, the Evacuation Team has to ascertain the proximity of the nearest available air ambulance and crew and their ability to provide the necessary, in-flight medical care given the condition of the patient. Helicopters are often chosen for evacuations in remote locations, where landing and take-off can be difficult. Each evacuation is unique, but the experience and local knowledge of the specialist team allows it to make an informed decision on each individual case.
As one might expect, managing medical evacuations on a global basis is not without its challenges. Insurance companies have to overcome a range of potential obstacles such as failing, archaic or sometimes non-existent communication infrastructure, restricted air space, the impact of weather, or even political or rebel unrest. However, global providers are well prepared for these kinds of challenges and experience and determination are a formidable combination.
We always strive to find the nearest medical centre but they may not always have the most suitable facilities. For example, a member that recently needed medical evacuation was located in Papua New Guinea, but while the capital Port Moresby was nearby, the hospital did not have the required medical facilities.
Instead we had to evacuate the member to Cairns in Australia which was the nearest centre of excellence.
To evacuate a member, we need a copy of their passport plus, where required, a visa or permit for the country to which they will be moved. Visas can be difficult to obtain, particularly given the very tight deadlines to which we are operating, but with a strong network of medical partners located all over the world, we are always able to assist the member.
To apply for an emergency visa, the following items are needed:
1. Medical report by the treating physician including a justification for needing treatment in the chosen country.
2. Invitation letter from the admitting medical facility in the chosen country, confirming the acceptance of the patient and willingness to provide treatment. (This letter should also include the estimated length of stay and estimated costs).
3. Letter from either the insurer, patient’s family or patient’s employer confirming financial cover for the patient’s transportation, medical and living expenses.
Following the application, there are two different scenarios that may occur:
1. Emergency visa is issued on arrival.
2. Emergency visa is issued after application – a representative or family member needs to attend a visa application centre or embassy and make an application on behalf of the patient.
We will have the experience, local partners, knowledge and emergency procedures in place to deal with the visa application on behalf of the client, if support is needed. Technology has played a significant role in helping us to overcome many challenges, increasing the survival rates during evacuations. Advances in technology can be seen at every stage of the evacuation process, from communication, to portable medical equipment, to the air ambulance themselves, where technology allows them to fly at altitudes and speeds that minimise the risk of medical deterioration.
Falling ill or having an accident in a remote location can often be a matter of life and death. With appropriate insurance cover in place, employers and their globally mobile staff know they will have access to medical care if it is urgently needed. For the employer, choosing a provider with a strong knowledge of the hospital network in the location in which their staff are based is an important factor.
A medical emergency situation relating to a loved one or employee is always distressing, particularly if they are overseas and difficult to contact.
Communication is at the heart of everything we do and we understand that being updated on a loved one’s medical status will at least provide some level of assurance. That is why we ensure constant lines of communication during all evacuations and repatriations from the moment that first call is answered. After that, there is a tried and trusted process in place which is based on making sure the member gets the care that they need as quickly as possible.
Five continents, hundreds of evacuations
At Allianz Worldwide Care we have managed evacuations and repatriations in 83 countries across five continents and here we take a look at two very different cases, which we recently managed.
A five year-old boy with advanced Non-Hodgkin’s Lymphoma was admitted into hospital in Erbil, Iraq for chemotherapy. However, he needed to be evacuated to a specialised centre and Amman, Jordan was identified as the closest location with suitable medical facilities. We immediately contacted the evacuation providers who could enter Iraq, one of which was based in Amman, and activated the mission. Visas were arranged for the young boy and his father and the hospital admission in Amman was confirmed. All elements of the evacuation went as planned and our local partner in Amman ensured that their doctor was present at the hospital during the admission process to oversee the smooth handover and ensure that the appropriate treatment commenced.
A 42 year-old male had a heart attack on an oil rig in Gabon in West Central Africa and was evacuated to Libreville on-board his employer’s emergency helicopter. Initial investigations were undertaken and basic treatment was administered in Libreville.
This article was first published in our In Focus supplement on iPMI which is available as a free download here.