Health issues are some of the most significant that have to be faced when engaged in the cruising lifestyle. We take too easily for granted the easy access to health care when we are on dry land. We know how to get the care we need, and where to go for it. We can even speak the language!
Our general state of health is perhaps a major constraint on whether we can go, or continue to cruise. Sadly it is very often a health crisis in one or other that forces the abandonment of the lifestyle. Sometimes it is the creeping realisation that we are simply no longer up to it. Here the choice of boat, and cruising ground, may have an impact.
In four seasons out from the UK, we have suffered major disruption to our plans in two of them due to health crises. The first occurred in 20005 when John suffered a heart attack in Spain, followed hospital care in Spain, and then heart surgery in the UK. In 2007, for 12 weeks of the season we have been constrained by a mysterious infection in John's leg. Wherever this originated, it required hospitalisation and a lengthy convalescence in the UK. Each of these occasions has resulted in significant expenses, for storage of the boat, guardianage, travel, accomodation and living expenses, that were not anticipated.
At the risk of being parochial to the UK, it is worth noting that access to the free care that we are used to is not a given right. Theoretically, absence abroad for more than 3 months disqualifies us from receiving care from a general practitioner, who is supposed to de-register you. Access to hospital care is normally through the general practitioner, who must refer you. People returning from abroad, even within the EU, have found that they have had questions asked when presenting with injuries suffered abroad for which they have been treated. The lesson here is to maintain an address in the UK, and your relationship with your GP, wherever possible, and be cautious what you say to anyone. Close reading of the relevant regulations does suggest that if you are ordinarily resident in the UK, then you are entitled to treatment in the UK, and the 3 month rule is simply one way of trying to ensure that this matter is reasonably policed. Different hospitals apply the rules in their own way.
How easy it is to obtain care abroad will vary depending upon where you find yourself. Many countries have reciprocal arrangements and access to free health care is not normally a problem. You should carry the new 'European Health Insurance Card', although in practice we have hardly ever had to produce it. Our experience in Spain, when John required emergency treatment for a heart attack, was excellent. This was followed up with an angiogram within days, that would normally have taken months in the UK, and the results were provided on a CD for use by the UK consultant. Having been super-sensitised to any pain in the chest, John subsequently had two visits to the emergency department in Sardinia, both being fully investigated but proving to be false alarms with other explanations.
Our experience in Croatia (not yet in the EU) was rather different. We were advised that a local GP would not see me, and that we needed to go to an emergency centre in Zadar for assessment. John received treatment there twice (free on production of a passport), but follow up was difficult. The resulting infection got out of control, and had to be treated in the UK.
People reported no problems in France or Portugal.
Mo found it difficult to see a Physiotherapist in Italy. One private clinic she visited insisted that she first saw a doctor, who was convinced she had advanced osteo arthritis, and needed blood tests and x-rays. We subsequently found another establishment who managed without.
Where you have to buy drugs against a private prescription (to be claimed back 'on return'), it can be an eyeopener! So many drugs are cheaper than the standard NHS prescription charge that we are used to in the UK! Often pharmacists will provide drugs, such as antibiotics, that in the UK would only be obtainable on a doctor's prescription. They are generally most helpful.
The big problem that you will encounter in most places is one of language. If you are lucky you will find someone who can help interpret: in Italy a patient who happened to be around was pressed into service! It is particularly difficult if you are hospitalised, and cannot speak with the staff. John nearly had a second heart attack in Spain because he could not understand why he was not receiving his allocation of water: the doctor had simply not ticked the box.
In Spain, the staffing within hospitals assumes that the patient will have a member of his family present to take care of personal necessities, etc., on a continuous 24*7 basis. We did not realise this, and John cheerfully sent Mo on her way back to the boat once settled in the Emergency Unit at the hospital. John managed without this help, but finally, when was sent for the angiogram, the doctor insisted that Mo should be ready and waiting to go with him at 7 a.m. This required an uncomfortable vigil in a chair all night, with the malodorous company of the son of John's room mate. Another feature that John found difficult was that in one adjacent sideward a raucous party with many relatives present continued well into the night!
It is sensible to ensure that as far as possible you are not going to encounter avoidable problems. It is a good idea to take advantage of any opportunity for a general health check, or to investigate anything about which you are doubtful. Visits to the dentist should be undertaken.
Normal travel insurance does not cover you for trips away sailing, where you are out of reach of the normal emergency services and hospital infrastructure. Equally, most insurances have a limited trip duration built into them, making them inapplicable to the cruising lifestyle. Pantaenius offer two types of policy designed for the cruising sailor: one is a limited duration multi trip policy, and the other is a single trip up to a year. In the latter case, however, it is only a single trip, and at the end of the period of insurance you must return (to the U.K.). Acquiring a suitable policy is therefore something of a minefield, and relatively costly.