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Keeping expatriates Healthy

A pre-assignment screening process will benefit employees

Expatriate placements are a major investment for firms and also for the employees and their families. A simple screening process before each assignment starts will help to identify actual or potential health issues and help the employee and employer plan accordingly. Experiencing ill health in a foreign country can be daunting and so a little preparation beforehand will pay dividends if the worst does happen. As well as keeping your expatriates and their families healthy while on assignment, it’s best practice to start this before they even leave their country of origin. A simple pre-assignment screening process can identify health issues and help you provide the assignee with valuable information about how to access care in the destination country.

The pre-assignment screening

Expatriate placements involve an unfamiliar healthcare environment for each and every employee and their family. A screening process in the country of origin before placement overseas can be helpful in establishing both existing and potential medical conditions which could affect performance during assignment. Whilst major illness is a possibility, much more likely is the existence of benign conditions that can be triggered in the destination country. Simple differences in environmental factors such as pollution and humidity, for example, can affect respiratory disorders such as asthma or allergies like hayfever.

For employees with a diagnosed existing condition, it is important for them to understand how to access healthcare in the destination country as this may differ significantly. For example, high blood pressure, a common condition, requires regular monitoring and can also require drug treatment: are the drugs available over the counter or do they require a prescription? Is best clinical practise for high blood pressure management in the destination country similar to that in the country of origin? How will the employee access these services?

Delivery of care is important, but so is funding. It will benefit the employee if they are clear before leaving whether their company medical insurance cover provides funding for treatment for their condition. Common pitfalls here include cover for chronic conditions, anti-natal and childbirth, and pharmacy benefits as some medical plans are country specific and others take account of only a limited variation in how local healthcare is delivered around the world.

A structured pre-assignment screening process also has other benefits, for example identifying vaccination requirements for the employee, their spouse and any children; or any health issues affecting the employee’s family, as these can also have a significant impact on employee performance whilst on assignment. It is also possible to identify latent risks like low-grade stress or lingering conditions such as mild periodic back pain for which the employee has not sought active treatment, but which could be triggered by the substantial change in environment and circumstances associated with an overseas placement.

Keep it simple and personal

The keys to an effective pre-assignment screening process are touch, time and tenderness, not lab samples, scans and physiological tests. The first stage is a 360-degree medical history covering past conditions, family medical history, and existing conditions of the spouse and any children who are moving with the assignee. Key lifestyle factors should also be considered, such as diet, exercise, smoking, and alcohol consumption, as well as social factors. Lab samples and other diagnostics need only be performed where the history or lifestyle indicate a high risk and such tests have not already been carried out previously. This kind of assessment can be carried out either by a doctor or a nurse and the output should be a simple plan covering the following:

• Healthcare access in the destination country, with explanatory notes describing those services that will most likely be required, such as primary care, children’s health services, dental, optical, pharmacy, and emergency services. A “how to access” guide will help the employee understand what the local healthcare processes are, for example registering with a primary care doctor, where to find relevant information on the web, what to do in an emergency, and so on.
• Clarification of benefits coverage. Are there any existing medical conditions that are not funded under the employee’s overall benefits plan? What are the likely costs in the destination country?
• Specific conditions. Simple medical guidance on each existing medical condition including how to monitor it and how to access the associated healthcare services locally. Translation of key terms into the destination language can also be helpful – disease descriptions, symptoms, and drugs.
• Contact details for the employer’s local HR and/or occupational health and wellness team.
• Action plan during assignment: a schedule of regular checkups for all the family to assess general health as well as key risk factors identified during the screening process.
• Other relevant information requested by the employee.

One less thing to worry about

You’ll probably find that your expatriate assignees really value this simple screening process – it’s one less thing for them to worry about. It’s also an opportunity for the employee to review their lifestyle and use the catalyst of the different physical and cultural surroundings of the destination location to make one or two key lifestyle changes to improve their health and wellbeing. For example, for those traveling to a warmer sunnier climate, an outdoor exercise programme could help reverse the effects of creeping middle-age weight gain. For the employer it’s better to anticipate potential issues before they arise so that they can be planned for.

Where do I start?

How can you put this type of process in place if you don’t already have one? A good place to start is with your in-house medical team, which can develop a checklist that can be incorporated into your general expatriate assignment preparation processes. For key countries where you see the most movement of employees (origin and destination) try and identify the key differences in healthcare facilities, care delivery structure and access points and processes between the countries. Put together a list of “approved” local primary care doctors who have an appropriate level of training and who also have experience of providing continuous family care to expatriates – the local HR team can help with this. A good family doctor in the destination city is the most important factor.

You should also identify key providers of health services in the destination cities so that each expatriate can be provided with an information pack, including contact details for local doctors, pharmacies, accident and emergency treatment, general hospitals, maternity hospitals and paediatric hospitals. And if you already have an international health benefits advisory firm engaged, talk to them as well.

Chris Adams is the Commercial Director for HCA International which operates six internationally renowned acute hospitals and four outpatient diagnostic centres in London: The Wellington Hospital, London Bridge Hospital, Princess Grace Hospital, The Lister Hospital, The Harley Street Clinic, and the Portland Hospital for Women and Children. 3,000 consultants in over 50 specialties base their practise at these hospitals.

For further information, contact:
Tel: +44 (0) 20 7616 4880
E-mail: chris.adams@hcahealthcare.co.uk

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