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Expat Investor : March April 2009
EXPAT HEALTH Health issues in the United States A country profile from AXA PPP Healthcare With a population of approximately 298 million people, the United States of America is the third highest populated and fourth largest nation in the world. It also has the largest and most technologically powerful economy in the world. The US occupies 40% of the North American continent, as well as several island territories, and is made up of 50 states. The climate varies throughout these 50 states, ranging from arctic in Alaska to subtropical conditions in Florida. In January the temperatures in the coldest parts of the country average –12 degrees centigrade (10 degrees Fahrenheit), but can drop to –40 degrees centigrade or even lower. In July the temperatures in some parts of the nation can top 30 degrees centigrade (100 degree Fahrenheit). Although the US is the fourth largest nation in the world, the level A potentially fatal form of pneumonia In this regular column on medical conditions, Dr Sneh Khemka, Medical Director, BUPA International, explains Legionnaires’ Disease. of sanitation is high and a lot of care is taken over its repair. The water systems are well maintained, therefore it is safe to drink the tap water. However, if you prefer bottled water this is readily available. There is also no need to disinfect or peel produce in the US, and rinsing fruit and vegetables in water is sufficient to protect yourself from stomach upsets. If you do require a pharmacy (known locally as drugstores), these are easily accessible and some are open 24 hours a day. The standard of care received within the US health care system is also high, and medical professionals and specialists are generally highly proficient. The medical facilities, ranked amongst the best in the world, are well equipped to deal with most medical conditions and their treatment. In larger cities there are excellent public hospitals, and they are operated by municipal governments and subsidised out of public funds. They are less expensive for the patient, but they are typically less well equipped and more crowded than the private hospitals. There are also some teaching hospitals that are affiliated with universities, and these are well equipped for this purpose. Additionally there are private for- profit hospitals, some operated as chains by corporations that also sell medical insurance plans. With all of the above types of hospitals admission typically involves completing an admission form, presenting evidence of insurance coverage, signing a consent form for treatment, and specifying what form of payment is to be made – that is, credit card, cash or billed to When we hear Legionnaires’ Disease, we immediately think of outbreaks in unkempt, shoddy buildings that can cause death, and for which there’s someone to blame. And mostly we’re right. 14 EXPAT INVESTOR ? Legionnaires’ Disease is a potentially fatal form of pneumonia, caused by a bacterium found naturally in the environment called Legionella pneumophilia. This bacterium thrives in warm March/April 2009 water and warm, damp places and can reproduce very rapidly given the right conditions. Legionnaires’ Disease is, therefore, linked to poorly maintained artificial water systems, particularly cooling towers or expatinvestor.com evaporative condensers associated with air conditioning and industrial cooling, hot and cold water systems in public and private buildings, and whirlpool spas. The bacterium Legionella pneumophilia was first identified in 1977 as the cause of an outbreak of severe pneumonia in a convention centre in the US in 1976. Legionnaires’ is perceived as being a rare condition, but in fact it happens relatively commonly. This is partially due to many cases not being detected, and not all detected cases are reported to public health authorities. Mostly, cases in the United States and the United Kingdom occur infrequently and in small clusters; only a small percentage of cases occur as part of a multi-case outbreak, which then comes to the general public’s attention. The early symptoms of Legionnaires’ Disease include a ‘flu- like’ illness with high temperature, fever, muscle aches, tiredness, headaches and dry cough. Sometimes diarrhoea occurs and confusion may develop. Because of the generic nature of the symptoms, Legionnaires’ Disease is often diagnosed quite late and at a stage where the disease has become quite serious and a number of people have been infected. This is what gives it its notorious reputation. The incubation period (the time insurance. If you don’t have insurance, a deposit is normally required, which may run to several thousand dollars. It is definitely worth noting that the US is the only developed country in the world without a comprehensive national health programme. The elderly are covered by Medicare and the very poor can obtain limited care through Medicaid. Most employed Americans and their families are covered under group health insurance plans provided by their employers, although they may be expected to pay a portion of the insurance premiums, and services offered could vary depending on the employer. Therefore, if you are planning on working within the US you may wish to check with your employer regarding their arrangements prior to you commencing employment. Newcomers to the country must also consider medical insurance before moving there. You must also ensure that you have adequate benefits that will cover you in the US, as some policies may not cover this. The Foreign and Commonwealth Office states: “Medical treatment can be very expensive; there are no special arrangements for British visitors. The British Embassy and Consulates-General cannot assist you with medical expenses. You should ensure that you have comprehensive medical insurance, which includes hospital treatment and medical evacuation to the UK.” Currently no vaccinations are required for travel to the US. However it is always worth checking with your GP before departure. between exposure to the bacterium and the development of symptoms) normally ranges from two to 10 days. In rare cases some people may develop symptoms as late as three weeks after exposure. However, most people exposed to Legionella do not become ill, as their natural immune systems are able to mount an adequate response to fight the bacterium. Smoking, alcohol misuse, chronic lung disease and weakened immunity all increase the risk of a person developing the infection following exposure to the bacterium. The very old and the very young are more susceptible, as with all infections. Antibiotics are effective in treating Legionnaires’ Disease, but there are measures that can be taken to reduce the risk of contracting the disease. Appropriate and regular maintenance and cleaning of possible sources such as air conditioning systems and cooling towers can help prevent the spread of the Legionella bacterium. Cases are more common in the developing world, where infrastructure and maintenance are of a poorer quality. Luckily, awareness of the condition has grown amongst both the medical and the building communities and so cases are identified, treated or prevented much better than previously. For further information, go to http://www.hse.gov.uk/ legionnaires/
January February 2009
May June 2009