Expats, like people everywhere, worry about their health. And like people everywhere, what they worry about isn’t necessarily what they ought to be focusing on, experts say.
Here, Charlotte Beugge talks to insurance experts about expatriates’ real and imagined health concerns – and why it really does matter, when it comes to buying health insurance for themselves and their families.
There’s a huge gap between the illnesses expatriates tell their healthcare providers they’re most concerned about – and what they are most likely to need their iPMI coverage for, insurance industry experts say.
While cancer, heart attacks and strokes are among the concerns experts cite as being at the top of many peoples’ worry lists, whether abroad or in their home countries, they are not always what they should be focusing on when choosing their insurance plans, these experts point out.
And for expats, who are typically a long way from home – and thus from familiar surroundings, language and culture – worries about health can be magnified, they say.
According to a recent report by Aetna International, health issues topped a list of major concerns for expats, easily beating such other worries as political instability where they live, the threat of terrorism or the cost of living.
In carrying out its research, the insurance company examined the gap between the experience of illness, as people describe it, and their worries about it.
Damian Lenihan, executive director of distribution for Aetna International, explained: “Heart disease and cancer are not currently experienced by many, but have the highest level of concern, with more than 25% of those we surveyed saying they were worried” about suffering from one or both of these serious illnesses.
This is in spite of the fact that the research found that only a little more than 5% of those surveyed reported that they had actually suffered from heart disease, and just 3% had had cancer.
There was also a notable gap between expatriates’ concern over the threat of diabetes and their actual experience of it, with 25% saying they were worried about it, but only just over 10% having actually been diagnosed with it.
Such findings, Lenihan went on, indicate clearly that “it is the seriousness of the condition, not the likelihood of actually contracting it, which dictates the impact it has on people”, and their perceptions of what they should be worrying about.
That people worry more than they actually experience serious ailments emerged clearly from the study: of all the illnesses Aetna International asked the expats it surveyed about, only dermatological conditions were experienced more than worried about.
However, the researchers found, the level of concern the expats they surveyed clinical obesity, diagnosed mental health conditions, respiratory conditions and arthritis or bone disease, meanwhile, showed no gap between actual experience and concern on the part of those questioned.
Of course, there are some conditions which understandably are worried about the most for a good reason. The three diseases most reported to international private medical providers are cardiovascular disease, cancer and respiratory illness, according to the Willis Towers Watson 2017 Global Medical Trends Survey, and this is predicted to continue to be the case for at least the next five years.
However the report says that before 2012, gastrointestinal disease took third place – it is currently in fourth place, but is predicted to slip behind musculoskeletal/back disorders and mental health.
The report says that cardiovascular disease claims “have significantly increased in prevalence in the Middle East and Africa over the last five years”.
It adds that while there are more sufferers from diabetes, “it is difficult to evaluate…since its treatment (largely outpatient) doesn’t show up as an insurance claim in many countries”.
A pain in the neck?
So what should concern expats about their health? Zahir Sharif, managing director of Asia, the Middle East and Africa for Hong Kong-based Now Health International, said “musculoskeletal problems” are the No. 1 health issue his company’s policyholders face, based on the costs of the claims they file, even though they, too, worry more about such illnesses as cancer and cardiovascular disease.
Only 22% put musculoskeletal conditions in their top three concerns, noted, citing company research.
What’s more, while respiratory and gastrointestinal illnesses in fact account for a fifth of Now’s overall claims costs, Sharif points out, fewer than a quarter of its members surveyed even ranked such conditions as one of their top three health concerns.
Echoing the comments of other insurance industry experts, Sharif noted that Now Health International policyholders typically rank mental health issues as being among those health problems they are least concerned about, even though “recent evidence suggests this is an increasing issue for expats”.
Mind over matter?
For Andy Seale, global head of sales for International Health at Allianz Partners, the impact of mental health should be taken seriously by expats and insurers.
“We are increasingly aware of the prevalence of mental health challenges and its impact on our clients, particularly expats who may be required to work in challenging regions around the world or spend extended periods of time away from loved ones,” he said.
Seale added that there has been a “noticeable shift across the health insurance industry” over the last few years, moving more towards helping prevent illness than paying claiming.
Routine health checks and screening can not only help catch serious conditions early, but can also alleviate the worry expats might have about contracting them, he noted.
Jelf: ‘Different worries among expats’
However, there is a difference between expats with iPMI and their UK policyholding counterparts, according to Adam Harding, international business manager at brokers Jelf.
“The concerns and worries we see from clients really does vary, but interestingly, we very rarely have discussions with them (expats) around serious illnesses such as cancer or heart conditions, [even though] this is a very common subject to discuss with UK schemes,” he said.
Instead, expats are more likely to be interested in pre-embarkation questions, such as where and how they can get prescription medicines when overseas, and what the health facilities are like where they are going, he explained.
As it happens, most insurers offer pre-travel vaccinations and health checks, so issues are often identified at this stage, before they have a chance to develop later on, he noted.
Don’t forget income protection coverage
Lee Gerry, group director of the Expatriate Group, a UK-based insurance provider focused on the expat market, stresses that expatriates urgently need to consider their iPMI needs alongside other types of “protection” coverage, including income protection insurance, since even the best iPMI plan won’t be much use if the insured individual dies, or is left in an expensively ill state that means they will no longer be able to earn a living.
Gerry’s comments echo the findings of a recent report published by Zurich International Life, which found that 75% of expats living in the United Arab Emirates have no provision in place to protect them in the event of illness, incapacity or premature death.
“Expatriates can often focus on the how they can treat a major condition, such as cancer, heart disease, life changing accidents, etc, but the truth is that most healthcare products on the market cover all of these, even at the most basic level of cover,” Gerry notes.
“Customers too rarely look beyond iPMI, though, and what would happen if they couldn’t return to work, or if they become limited in their ability to earn.
“The financial situation can become exacerbated if the insured individual wants to return, or is forced to return, to their country of nationality, and suddenly have to deal with such unexpected scenarios as a disparity in the cost of housing [compared with the overseas location],” he notes.
“And then, if they haven’t paid sufficiently into the local welfare system while they were overseas, they may find they can’t access disability benefits that they had assumed would be there for them.”
With respect to the NHS, though, he notes that it works on a “residency basis”, so that “the moment an individual who has been living abroad becomes a permanent resident of the UK [again] you can access this service, whatever state you’re in”.
For income protection reasons, though, Gerry says, individuals who are signing up to an iPMI plan should be encouraged to at least consider the range of other products that act to supplement an expatriate’s coverage, which “can either protect their income, in the form of a monthly payment to age 65 if they’re unable to work, or which pays a blend of short-term disability, and a larger lump sum”.
“These benefits can be used to complement a reduced disability, or invested to provide long term income – or simply used to ensure that the individual can afford the move back home, and to maintain their family’s existing lifestyle.”
Life insurance is always another important element of the protection umbrella, Gerry notes, but he cautions against the assumption that it is, by itself, enough to protect against the possibility that the individual in question survives their illness or injury, but can no longer work.
“It sounds harsh to say it, but if you’ve only got life insurance, your family would be better off if you were dead, because if you survive but can’t work, then you become a financial burden, and if you need continued medical treatment and nursing care, a potentially costly one as well,” he points out.