What happens to those without insurance in a foreign land?

Factual Questions
1

An American named Joe Sixpack took a trip to England (or France, Italy, Japan, etc.).
While there Joe had a massive heart attack and his wife was told he needs emergency bypass surgery or he will die within the day.

Joe has no health insurance and did not even buy basic trip insurance.

What happens? Do they stick him on the next plane back to Anytown USA and hope he lives long enough to get back home?

If they operate on him, how do they get their money? Joe will leave the country when he’s well enough. Are there treaties that allow Joe to be sued here in the U.S. by foreign entities?

Something like this has had to have happened at least once.

2

In any country with a decent public health system, he’d be treated. There’s no way he’d be denied emergency health-care even in a third-world country. I doubt even in the US they’d simply let a tourist die because he wasn’t insured.

3

This was actually an issue in London last year:

4

In France (and I would assume in any first-world country at least, possibly also in developping countries) he would be treated and billed (or from an anecdotal evidence, sometimes not even billed for something minor like a broken arm).

Now, I don’t know to what extent the treatment would go past life-saving/stabilization procedures. I’m not aware of any public policy similar to what is described in the previously linked article about the UK, but on the other hand, I don’t think you could show up in a french hospital with some non immediately threatening condition which would, for instance, require several lenghty and costly surgeries and just walk out two months later with a bill (that you don’t intend to pay) in your hands.

As for whether the hospital could sue you in the USA, ask someone who’s better informed than me, but I suspect it could, since the possibility to sue someone in country A for debts incured in country B seems necessary in our current society. I guess however that the bill would have to be quite high for such a procedure to be worth it. But again, what do I know about this issue?

5

It depends on the country. I know two stories, one in Canada and one in Denmark.

A friend’s brother-in-law, an American, faints while visiting her with his wife (friend’s sister) in Canada. Turns out he needs a pacemaker. It was installed, they billed him $25K and he and his insurance paid it. End of story. Actually, I know another Canadian story. My son and his wife were snowboarding in Whistler, BC and the wife fell and broke both wrists (that was a pain in the ass, especially in the ass since she couldn’t wipe herself for three weeks). They treated her in the local clinic, charged her a few hundred bucks. They were so impressed with the service, they made a voluntary donation to the clinic.

Getting back to Denmark. A mathematician I knew (he has died since) was spending a sabbatical in Denmark. He had a heart attack. They treated him well and then there was a hearing to determine whether he had traveled to Denmark for the purpose of having a heart attack (I kid you not). They determined he hadn’t and therefore was covered by the national health insurance and he paid nothing. But I have no idea what would have happened to a short-term tourist.

6

That’s a different issue - people travelling with express intent of being treated for some condition or other. (ETA on reflection the article conflates that issue with genuine emergencies. Hmmmm)

This is purely anecdotal, but one of my Australian relatives was over here in Scotland on holiday and managed to break an arm. She needed a pin inserted, and spent a couple of nights in hospital. She did ask about payment but everyone kind of hummed and hawwed about it and she ended up paying nothing. The hospital sent her away with a letter detailing her treatment for her doctor at home and some x-ray prints.

7

In the film Sicko, Michael Moore told the story of an American citizen vacationing in London. He wanted to get his picture taken walking on his hands across the famous Abbey Road intersection. When he tried to do this, he suffered a painfully dislocated shoulder.

The National Health repaired the American’s injury, at no charge to him. Moore did his trademark annoying Socratic irony schtick, buttonholing successive UK officials and asking them what the charges would be, and being told there were none.

8

And for many developing countries, quality medical care just isn’t that expensive for less extreme sorts of things. I got food poisoning in one Latin American country and had to get an IV and various antibiotics. Although my travel insurance paid for it, the total bill was in the neighborhood of $300. I shudder to think what the bill for similar services would have been in the US.

9

I had to go to the hospital in Germany, and they did send me a bill.

I was living in Hungary at the time and had just recently quit my newspaper job there, so was no longer under the Hungarian health insurance. I did not have any coverage from America, either. Long story short, I was on assignment at the scene on an autobahn accident when I tripped and fell on my camera lens, which completely gouged into my eyebrow. I was taken to a hospital in an ambulnace, given a tetanus shot, and got sewn up with three stitches. While I was there, they took my passport and I gave them my address and other personal information.

A couple months later, I got two bills in German in the mail to my residence in Hungary: one for the ambulance, and one for the hospital visit. The total was about $1000. From what little German I could read, the method of payment was supposed to be some sort of European bank draft, but I had no European bank account, and, besides, I didn’t have enough at the time to cover it. So I made a good faith effort to pay them, sent them a letter stating the above, give them my credit information, and said, I give them authorization to take the money from my credit card. If they couldn’t do that, please send me a way to pay by credit card, because I don’t have the resources to pay via a bank draft.

They sent me another letter of dunning a few months later, with no reference to my correspondence. This time, they threatened something with the embassy or another (I have no idea, I’m not very good in German.) Once again, I sent them a letter saying that I want to pay the bill, but I could only do so with a credit card or some sort of payment plan, and once again gave them my financial details.

Whatever happened with that, I don’t know. They never charged my card, and they never contacted me again.

ETA: Oh, and I had gotten sick and visited the doctor or hospital in Hungary several times. The thing is, I could afford it there without insurance.

10

If you go to a 3rd world place like Nepal you can buy medical evacuation insurance that will fly you out of the country and treat you on the plane if you need major medical care. I think they fly you all the way back to the US but it’s possible they could also take you to a place like France or England since that is closer.

11

So, in lieu of Med Insurance. Make sure your travel companion packs a hand shovel and gloves? :smiley:

12

I noticed in the comments section of the linked article, someone mentioned it would be easier to require all people entering the nation to provide some proof of medical insurance. Though I’m guessing it’d be hard to enforce and easy to forge coverage or get temp coverage and let it expire.

13

In Thailand, if you die in one of the Western-style hospitals, they will refuse to release the body until the family or someone pays. And the bill can get pretty hefty at such a hospital. I have seen this happen. At Bumrungrad Hospital, an elderly heart-attack victim of my acquaintance had racked up almost a million dollars worth of debt, what with all of the extreme life-saving measures that finally did not work. (The family was able to negotiate the price down a bit.)

If you do not die, they will hound you mercilessly unless you’re able to get out of the country somehow. I knew a guy who was on disability back in Colorado due to a chronic brain disorder, came over here for a trip and suddenly had a seizure of sorts. Then it turned out his insurance would cover him upfront only stateside; he had to pay first here and be reimbursed later. Even though he was sick as a dog, a lady from the credit department of Samitivej Hospital was in his room hounding him every day until finally someone from the embassy arranged for payment to be made by his family back home.

14

This happened to Charlie Rose in May, 2006. He was traveling in Syria and had to be flown to France for emergency heart surgery. He didn’t get back to the U.S. for over a month.
http://www.cbsnews.com/stories/2006/03/30/entertainment/main1455475.shtml

15

D’oh! :smack: I meant baht, not dollars. The wife has reminded me the final bill was 1.5 million baht. Still a good chunk of change. That’s about US$50,000 now but “only” somewhere between $37,500 and $43,000 at the time. (The baht has strengthened dramtically in the past year or two.)

16

The interesting factoid in that article is this:
*
A Standard investigation today reveals they have failed to pay £7 million owed to the NHS in the past year.*

That figure was the uncompensated portion of £12 million in care provided to those not covered by the National Health Service.

This figure is amazingly small compared to uncompensated care in US hospitals. This article says that uncompensated care of the uninsured cost over $60 billion in 2009.

17

$2,151.75

I got food poisoning and wound up in the ER December 19 of last year. I needed three or four plastic bowls for the vomit, one liter of IV saline because I was dangerously dehydrated, one blood draw to run some inconclusive tests, and two shots of Reglan to make the vomiting stop.

They brought me bowls when I needed them. The nurse spent an hour rubbing my arm and applying a hot compress to get a usable vein. I hadn’t been able to keep anything, even little sips of water, down for about 18 hours at that point. When I finally passed some urine again after the IV, it was brown. Someone helped me back and forth to the toilet because I had diarrhea as well, and I was unsteady on my feet. Mostly, they just watched me puke and nap for a bit. After around four hours, someone brought me a small cup a of ginger ale and said if I could keep it down they would send me on home. My Mom picked me up and I slept for most of the next two days.

From the bill:

Pharmacy $164.25
Med/Surg Supplies $65.50
Laboratory Tests $447.50
Emergency Services $1038.50
Therapeutic Services $436.50

18

My father was visiting me in Spain (he’s American) many years ago and reacted poorly to a bee sting and we went to the local health clinic. All they asked for was my Social Security card and treated him for free.

19

I came down with pneumonia in England (as an American citizen without insurance). Spent eight days in hospital.

Total bill: £0. Nothing. Nil. Nada.

20

I had my first taste of public healthcare 35 years ago. Stepped on a nail in London, drove to the first hospital I saw, got a tetanus shot. The surprise was the funny looks I got when I asked where should I go to pay the bill.

I get seen at the local clinics in Thailand for free, even though I have no resident status. Recently I went to the best private hospital in the area to take a bed in E.R. thinking my severe angina might be mild infarction. ECG, oxygen, medicine (including month’s supply of prenolol), examined by two doctors, used up E.R. bed for an hour. The total bill was about $27. (I won’t bore you with the obvious by contrasting recent experiences in U.S.A.)

For serious problems (e.g. heart attack) remoteness may be a problem as well as lack of insurance. I seem to recall a story about heart attack in Cambodia where a helicopter had to be hired to deliver patient to Bangkok! :smack: