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Special Report: Health Care Abroad

Seeking Treatment: What to Expect

By Michelle Andrews

MEDICAL STANDARDS

For the most part, health care in foreign countries is not regulated to the extent that it is in the United States. Physicians are less likely to be trained as specialists, so board certification is uncommon. And many countries are just beginning to put hospital accreditation programs in place.

"Accreditation procedures aren't very advanced in Central and South America or Asia and Eastern Europe," says Paul vanOstenberg, executive director of accreditation for the Joint Commission International (JCI), the overseas arm of the organization that accredits U.S. hospitals. "But we've been working with countries on accreditation." Those include France, Spain, Ireland, Portugal, Germany, and Brazil.

A hospital accredited by the JCI meets standards equivalent to those in the United States for infection control, blood-banking practices, patient assessment and care, and ensuring the competency of medical personnel, among other criteria. Go to www.jcrinc.com and click on Joint Commission International to find a list of the 40 or so hospitals worldwide that meet these standards.

If you're traveling in an area where you don't have access to a JCI-accredited hospital, you can probably find one with similar standards by checking with the American Embassy or Consulate where you're staying. They can typically refer you to an English-speaking doctor or a hospital that they recommend for their own employees. Some travel insurers and medical assistance companies also maintain lists of approved doctors and facilities that you can access if you've purchased their plans or services.

PAYMENT

Even if you have health insurance that covers medical care in a foreign country, you'll almost always need to put money on the table to receive treatment—and that often means cash, not a credit card. In many cases, you'll have to pay up front, even in an emergency, although travel health insurance and medical assistance providers may be able to help by guaranteeing payment.

Individual doctors and smaller clinics are the most likely to have a cash-only policy for foreigners, even in developed countries such as Japan, Australia, and Spain. Hospitals are more likely to accept credit cards, though they may demand that you surrender your passport and/or make a cash deposit before they'll treat you.

The Germans calculate fees based on, among other things, the services received and the patient's finances. But prices elsewhere are not so predictable. In fact, travelers may be charged inflated fees. The State Department cautions that travelers to Mexican resorts like Cancœn, for instance, have been charged exorbitant rates and been billed for services not provided. The best advice: whenever possible, agree on a price before you agree to treatment.

PRESCRIPTIONS

If you've forgotten your prescription drugs or lose them while traveling in Europe or any developed country, you can most likely get the same medicine you use at home. In developing countries, that may be more difficult. Either way, know what to ask for: drugs overseas will probably have different names from the ones you're used to. The antacid Prilosec, for example, is called Losec in Canada and Gastroloc in Germany. So ask for a drug by its generic name—in this case, omeprazole. (Go to www.drugstore.com and type in a drug to learn its generic name.) Note that dosages may differ as well; the 20-milligram pill you take may come only in 40-milligram strength overseas.

Although you should always carry prescription information for any necessary medications, many can be obtained over the counter abroad. "In Brazil, 'dispense only with a prescription' isn't really the law, it's a recommendation," one pharmacist there recently told Paul Doering, a pharmacy professor at the University of Florida.

When an overseas doctor writes you a prescription, be aware that many drugs used in other countries have been rejected or pulled from the market here. For instance, a heartburn drug with the generic name domperidone that's commonly prescribed in other countries has been repeatedly rejected in the United States because of its side effects. If you get a prescription for an unfamiliar drug, ask the doctor whether it is available in America. If it's not, request one that is or ask for an explanation of why the proposed drug is an equally good—and safe—choice.

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