Americans visit Thai hospital

International Healthcare As A Nomad

When we dream about exploring the world we envision dramatic landscapes, swimming with whales, and exciting new food.  Not exotic rashes, food poisoning, or dengue fever.

So, what happens if you get deathly ill at sea? Or have a serious injury on a remote island?  What do you do about regular doctor’s visits while in a foreign country?

All good questions we’ll get to shortly.  But first, we’re in Thailand and I (Nikki) needed to see an ENT and get all of our regular checkups done (OBGYN, Dentist, Dermatologist).  So we thought why not get it all done and then some!?!

Jason passed out, had a wardrobe malfunction and I got some stuff shoved up my nose.  It turned out to be a much bigger (and cheaper) adventure than we expected!


An Ounce of Prevention is worth a Pound of Cure

Just as we maintain our boat to prevent aging and fatigue, we need to maintain our bodies and minds.  Something we haven’t been as good at as we would like…but we are working on it!  We read The 4 Hour Body years ago and learned a lot from that book.  But we recently read Outlive by Dr. Peter Attia and it was such a clear, scientific picture.  Preventative health is the key to a long, happy life.  It has re-motivated us to get serious about our overall well being.  Because we have a lot of exploring ahead of us!  We highly recommend the book but here are a few of our favorite optimizing health and well being podcasts (one by the author of Outlive).

And of course, drink your vitamins!  Because it’s almost impossible to get everything our bodies need from food.  So we fill in the nutritional gaps with AG1: 

International Health Insurance

We sailors and digital nomads don’t live in a world built with us in mind. Domestic health insurance doesn’t work abroad and while some countries may have universal health coverage for their citizens, that doesn’t mean they will fit the bill for us travelers (in most cases, they won’t).  Even if you are lucky enough to be a citizen of a country with a good health program, it won’t do you any good if you aren’t in your home country.

Thankfully, there are plans tailored for all types of traveling lifestyles.  And we are not talking about old-school travelers’ insurance aimed at the typical vacationer.  We’re talking legit global health plans for full time travelers and expats.

In 2022 I had my first surgery in a foreign country and filed my first claim with my international health insurance.  So, right after that, it felt like a good time to cover the subject of healthcare abroad.  The costs, quality of care, and in general share what we’ve learned over the years from our smattering of global medical experiences.

Quality of Care Abroad

Overall, we’ve been able to find caring, knowledgeable, and experienced doctors throughout our travels.  In some places, like Panama, South Africa, Thailand and New Zealand, we have experienced an incredible quality of care at a fraction of what it would cost in the USA.

Research.  It’s the key to setting realistic expectations and planning out routine appointments.  There will be a few countries, or remote areas, you’ll want to be self-sufficient and avoid medical services.  But there will be some countries you will want to get everything taken care of and then some!

Medical For Extreme Remote Travel

For the extremely remote islands we’ve been to, the services and facilities have been bare bones.  On some islands, there is nothing…because there are no people.  In these cases, we have our satellite communications and make sure to come fully prepared to take care of ourselves.

We have insurance that includes telemedicine, emergency evacuation and repatriation.  We have taken first-aid classes and have had some additional training on severe wounds.

We have an extensive medical kit specially designed for sailors who might not have access to a hospital or trained medical personnel. These kits can be purchased online or at boat shows.  They are great for most situations and you can always add extras to suit your needs.

If you want to really kick it up a notch, some companies specialize in offshore medical training, telemedicine & custom kits used by cruisers and professional Yachts.  Like these:

FREE Ships Captains Medical Guide

If nothing else (or in addition), download the Ships Captains Medical Guide. It is put together by the UK government for practical medical guidance (non-doctors) working onboard a ship.  It covers just about everything including basic first aid, poisoning, sexually transmitted diseases, and how to deal with a burial at sea.

You May NEED Proof of Insurance to Travel

More and more it’s becoming a requirement to have international health insurance to enter certain countries.  Especially as sailors or anyone applying for visas.  For example, Panama and New Zealand both requested we have proof of health insurance before they approved our visa.

Murky Waters of Global Health Insurance

There are a lot of different options out there and they are NOT created equal.  It’s all in the details and what your specific needs are.  But it’s also about the reputation of the insurer.  No point in paying for insurance if they don’t pay the claims.

There are websites like TrustPilot that have reviews, but navigating the murky waters of health insurance isn’t my forte.  This is why we use an agent.  Having an agent doesn’t cost us anything extra, but it means we can get quotes from multiple companies all at once.  And, we have someone who can help guide us to the right plan based on our style of travel, locations, and needs.

Arno has been our agent for several years now.  He is a fellow traveler and sailor who makes it his business to know all the plans, which company has a good reputation, and which doesn’t.  He helps travelers from all over the world.  A quick glance at his website will give you an idea of some of the companies and services out there.  We don’t get anything if you click or buy insurance through him…but if you reach out, tell him we sent you.

Some things to consider

  • What countries are covered? Some companies are specific to a handful of neighboring countries while others cover practically every country except a handful of ones where health care is more expensive, such as the USA. (For example, our insurance works anywhere in the world except the USA). To include these, you can expect an additional cost or you may be required to purchase another plan entirely to cover that one “special” place.
  • Types of Coverage:  Most policies will have a huge list of treatments that are both covered and not covered.  If service is not covered automatically, you may be able to add it such as dental, vision, maternity, physical therapy, and mental health services.
  • Sports/Diving? Sports can be something as benign as hiking – you don’t want to find out you’re not covered after you break your leg on a tree root.
  • Emergency health coverage, evacuation, and repatriation.
  • Pre-Existing and chronic conditions:  I don’t have a lot of experience with this, but I have heard both good and bad stories.  Read the fine print and understand exactly what you are covered for and if there are limits or special requirements.
  • Telemedicine:  Access to doctors through phone, email, or video.  Very handy in remote areas or when there are limited healthcare facilities.

Our Health Insurance

The premiums for international health insurance vary dramatically.  Because there are so many factors like age, location, medical history, and coverage needs. There is no such thing as a straightforward comparison of plans because no two plans are the same.  Different levels of coverage, limitations, and exclusions, each of which affects the overall cost of a plan.

So, take these numbers with a grain of salt.

Our current plan (2023) is through a company called Expatriate (purchased through Arno we mentioned above).  It is a Catastrophic plan that cost us just under $2100 for our premium and has a deductible of $5500 per incident.  

Our catastrophic plan ONLY covers emergencies or major medical proceduresCatastrophic plans are the most affordable because we pay out of pocket for general care.  Which outside of the USA isn’t a big deal because, in comparison, it can be very affordable!

Our insurance works worldwide (excluding the USA).  If we spend time in our home country, we would need to get a USA-specific plan for while we are there.

hospital costs around the world


We’ve found Meds and prescriptions are easy to get, and easy to stock up on as we travel.  It’s common to have a doctor write an extra prescription, or even recommend ones as a precaution for our travels.  Especially as offshore sailors.  If you are headed into an area with malaria or want some broad-spectrum antibiotics or steroids to keep on the boat, just ask.

Anytime we schedule a consultation with a doctor, we check our medical kit and make notes on what we need to update.  We tell the doctor about our situation, where we’re sailing and what the scrips are for.  So far we’ve never been told “no”.  For safety at sea, we keep a wide variety of prescriptions in our kit with notes on what they treat such as “bacterial infection” or “severe sinus infection”.

medicine costs around the world


Final Thoughts

We’re not experts and can only speak from our own experiences.  But from our 13+ years of travel, we’ve found healthcare abroad can be great…as long as you’re prepared and do a little research on the area you are visiting in advance.

If you have questions or want us to elaborate on something, drop us a note down below.  I can’t promise I will have the answer, but we’ll do our best.



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Hello there! I honestly don’t know what to say, so I am going to tell you a bunch of random facts instead. I'm a fish eating vegetarian who hates spiders and loves snakes. I almost never took vacations growing up. I wanted to be Pippi Longstocking (still do). I misspell about every other word I write and still struggle with grammar. I love splurging on a good high tea (which is really hard to find these days). And whatever you do, don’t tell me I can’t do something, because then I'll HAVE to do it!

Comments (61)

  • Melissa

    Nikki, I stumbled upon this article and so happy that I did! I too am reading Peter Attila’s Outlive. I am wondering if in your years of travels you have come upon any international destinations focused on preventative medical testing, education, health care- most specifically those recommended by Atilla?

  • Joanna

    Hi Nikki and Jason, Nikki a cyst on your Liver is no joke and its certainly nothing to be casual about, It’s very serious it can cause a lot of issues. Might I suggest when you are in India go to an Ayruveda doctor, they should give you some Indian herbs that can through a series of cleanes and strictly vegan diet, remove the cyst. Or go to/call consult my Ayruveda doctor in the states/Sparks NV, Dr Harish will hook you up. Take care you two I really enjoy your vlogs💝.

  • Michael

    It is even cheaper in Singapore; less than $400 (not including dental).

  • Pam

    Thank you for another wonderful video. So full of information.

  • MyLy

    Great article Nikki! Thanks for the links and general information. Thailand is definitely on our list now for medical tourism!

  • Alan Solomon

    Thanks Nikki and Jason for this video. It is interesting to see it all in your video and read what everyone has to say about it. I don’t really have to think or worry about healthcare as of YET, even though I am a very young, past middle-aged person. I work a lot and healthy for the most part and I am covered medically through work. However, change is inevitable!! Today, international travel is really not in the cards unless my ship comes in big!! Currently, for the most part, I am content in my life.

    I am confused about one thing though. Earlier in these comments, above my name appears with a comment. However, I just watched this video for the first time like 30 minutes ago and I am not sure where this above comment came from? Are there (2) two Alan Solomon’s?? Can you help me figure this out?
    Thanks. Best as always,

    • Curious Minion

      Hey Alan,
      So I thought Nikki had just copied some of the material from her NZ post about her surgical experience and their medical coverage and pasted it here, but it looks like they’ve actually been combined into a single post. So that other “Alan Solomon” guy is actually you from the past! Congrats on being a successful time traveler!
      Curious Minion

  • Jess

    I didn’t know I needed to see this video. A week ago my daughter ended up in the ER (USA) due to an ovarian cyst that had gone south on her. She went from no idea she had one, to septic in about 8 hours. Her aunt drove her because the $2,800 ambulance ride isn’t covered by insurance. (The hospital was 6 miles away- we live in a different state) -She was in the hospital for 3 days; they wanted her to stay longer because she was struggling, but due to cost, she left. She has horrible insurance because that’s what her employer offers. (She makes about $17 an hour). Her ER visit and CT scan alone were over $10k. The hospital stay with the care she needed is going to be around $60-70k. She has also needed a nurse to visit daily to pack the wound caused when they drained the cyst. – We don’t even know how much that’s going to be for 10 days. So this 26-year-old woman who makes $17 an hour working 12-hour shifts 5-6 days a week, and who PAYS for medical insurance, is responsible for about 85-90% of that bill. She now needs to consider having that ovary removed or risk the whole thing again. (This isn’t the first problem cyst on that one). I’ve been stressing out about how to help her. This was like a lightbulb moment; it’ll cost far less to go overseas to take care of it than it will here, by tens of thousands of dollars. (Or maybe hundreds of thousands??) For that matter it may be we’re all just going to go someplace like Thailand once a year for a medical/dental visit because it’ll cost far less (per person) to do that than what we pay for medical insurance every month alone.

    So thank you, thank you, thank you for this video! In the stress of it all I wasn’t thinking outside the US healthcare box. (I’m going to need a King Kong sized vitamin C dose after this last week.). This video is exactly what I needed to remind me that medical tourism is a thing. – I knew, but never put much thought into it. – Sorry for the length and rabbit hole topic of this post, but I had to let you know how thankful I am I saw this today. I needed it. My daughter needed it.

    And I’m happy you’re both healthy and happy. Health is happiness. Can’t wait for you to get your boat!

    • Wendy Weaver

      Jess –

      First and Foremost: Do. Not. Pay. Any. Medical. Bills. Until. Receiving. Explanation-of-Benefits (EOB). Statements!!!!

      An EOB will tell the insured the amount they are responsible to pay for each and every service. It can take anywhere from two weeks to two months for the insurance company to pay the company’s share of the bills to the providers. Never pay a medical provider’s bill unless you have an EOB the provider’s bill!!

      Medical insurance in the U.S. has mandatory benefits and out-of-pocket maximums for all plans. Some plans are set-up for out-of-pocket expenses to be paid upfront. Others are mostly co-pays for services and cost-sharing (ex: 90/10, 80/20) for hospitalization and a few other services. The worst co-insurance plan I have even encountered since the ACA (Obamacare) was implemented in 2010, is 50/50. But remember, there is always an annual maximum for out-of-pocket costs! The 2023 maximum is $9,100 for a single person (better plans have lower OOP maximums but those come with higher premiums).

      CAUTION: If your daughter used providers that are not in her insurance plan’s network, her out-of-pocket costs can exceed the ACA maximum.

      I suggest your daughter see an insurance specialist (many insurance agents offer this service) to make sure her bills are properly submitted and paid by the insurance company. Most state insurance commissioner offices will assist individuals with such an analysis in addition to answering questions. Please note that ALL insurance plans sold in your state are on file with your insurance commissioner’s office.

    • Curious Minion

      Check with the insurance company: some U.S. companies will pay for your flight to another country & for the cost to have some non-emergency procedures done. Good luck with it!
      Curious Minion

  • Dan LaCour

    Thank you for all that great information and time putting it all together.

  • Craig

    I stayed in that same hospital for seven days three years ago because I got pneumonia. It was a first class experience, there was a long line to get in to see a doctor but once they saw me in line a 6’4 American they came right to me and asked me what they can do for me. I told him I thought I had pneumonia because my lungs started getting worse every day. They took me right back and saw an American trained doctor. Short story they took long x-rays within 10 minutes they told me I had pneumonia and recommend that I stay in the hospital. They showed me a chart how much each day would cost varying on how many people were in that particular room and accommodations. I noticed a top-tier accommodation they told me that was the presidential suite because it had a living room attached to a kitchen. I asked him how much that was a and they told me roughly $300 per day. I told him I wanted that and they rush me to the top floor and set me up with at least five different nurses who cared for me roughly 24 hours a day. After a few hours I asked him him I got to get a menu, and they replied they did not really have a menu I just said you can have anything you want.. So I told him what I wanted for breakfast and for lunch I would like to have fresh chicken soup. Needless to say that was the best chicken soup I had in my life. The only downside of the whole experience was the young nurses wanted to give me a shower three times a day 😁 total bill a little less than $2300 for seven days. Got back to America and filed a claim and I received a check for full reimbursement within three weeks. Seven days in American Hospital probably have cost me $20,000 dollars or more.

  • Martin Deresky

    I once had a private flight into Switzerland (2006) and one of my passengers had a heart attack about an hour out. Air traffic control decided that we could get better medical attention faster by completing the journey. Upon landing, the immigration officers that met the plane would not allow us to off load our barely conscious passenger without posting $10,000 as security for their medical costs! The individual did not have international medical cover and nor did the aircraft operator. There is a blurred line between immigration, tourism, refuge(e) and transit which makes some of the comparisons that Nicki and Jason discuss, quite difficult to apply in practice. Just try arriving in the (highly ranked) UK and trying to get medical attention without an NHS number or the means to see private practice. Its very difficult, time consuming and complex. I cannot speak to emergencies as I had in Switzerland but I have no reason to expect HMG’s immigration officers to be any more accommodating absent citizenship reciprocal or otherwise.

  • Fred Mertz

    Aloha! I just wanted to say y’all are smart to keep on top of the skin care. I grew up in Florida. Full beach life living, surfing, sailing you name it. Now some 40 years later I have had 115+ Basel cell skin cancers sliced off. Plus a few other tumors and I can’t tell you how many pre cancers frozen with liquid nitrogen . Growing up in the 1960s we just didn’t know as much. All the girls on the sand with baby oil or Hawaiian Tropic oil! Talk about paying the piper! Good for you two. Stay on top of it. Can’t wait to see you back under sail again! And Nikki, do you still break out your ukulele now and again?
    All the Best to you, Fred

  • Patrick Burneson

    thank you for sharing your Hospital trip. I look forward to your next voyage. stay safe and healthy.

  • Jan

    Thank you for the update on traveling healthcare. All good to know.
    Am waiting to see the new boat!!!! You must be getting close.

  • Ray

    You may want to read Sally Norton’s Book, “Toxic Superfoods”. Safe Travels!

  • Dieter R.

    Are the two annual cost examples $6500 and $3500 per person or for two people please ?
    Thanks for all your hard work!

  • Michael

    Thank you both for the wonderful and eye-opening information. It is always a pleasure to watch and learn from you folks. I like how it is simple and easy to understand, and up-to-date. Keep up the great work!

  • Alan Solomon

    Thanks for another Awesome Sunday Video. Thank you for videoing your doctor appointments and the like. You both do a great job bringing us along for most things.
    Always went to the doctor in the U.S. After reading all the comments I guess I am used to paying through the nose. Ha Ha. My cousin had the same thing done and it positively changed her life forever.
    Feel better. Heal quickly. Enjoy newfound breathing.
    Safe Boating and Travels,
    Happy and Joyous.

  • Sharon Krallman-Barker

    We were traveling in Naples Italy with a friend that fell and broke his finger and a big gash above his eye. An ambulance came and took him to the hospital where they set the finger, stitched the gash and did X-rays. No charge at all. He was expecting a big bill. Pleasant surprise.

    • AlainCh2

      Italy has Emergency AND Basic Health Services completely free for everybody… ambulance, stitches, drugs whatever >but Dentalsthey got an ER surgery + a harm plaster. Got so surprised: They walked away without paying a cent, they got it all for free.
      I’m a french Out-Pat living in Italy.
      When in France once upon a time, I needed 4 stitches done at night in Er, that cost me 290€ 😀

  • Debi Simmons

    🤦‍♀️Oops! With reference to salaries for UK’s GPs/Consultants it should read £80,000 ($99,880) and £90,000 to £100,000 (£112,365 to £124,850), based on today’s approximate exchange rate.

    • Debi Simmons

      Duh! I did it again, the salary equivalents in round brackets should reflect the USD ($). Sorry. Nikki, for messing up your lovely Comments page. Thanks again for your help.

  • Debi Simmons

    Please accept my apologies if many of you already know the following information. I live in the UK and am bemused as to where John Morris and the Ennis couple get some of their information. I truly appreciate Nikki’s good and thoughtful report. Well done, Nikki, that’s a lot of research to sort through, very helpful.

    I will add that when I first moved here NHS services were completely free to foreign visitors. That has since changed. (I believe our A&E/ambulance services are still exempt from recent government changes.) Our NHS healthcare is ‘free at the point of use’ (one of its main foundational principles). We do indeed pay taxes for the privilege of the NHS however our annual individual taxes (income taxes) are nothing near the high costs reported by the Ennis’. (The National Insurance is the UK equivalent of the IRS/Social Security.) Their misinformation has been propagated by America’s healthcare industry since the 1950’s, which I quickly learned when I moved here and had to schedule my first appointment with our GP. I am an American expat (British hubby) and we both have extensive experience with both systems.

    As well our medication/repeat prescriptions become free at the age of 60.🍾 However there are some medical items that are not freebies (NHS resource links below), but you will note the costings for most of these items are very reasonable and in some cases lower than prices on Amazon. If someone cannot afford these items or qualifies with a low income the NHS has schemes that will assist and take care of the costs, without miles of attached red tape (no debts incurred). In today’s economy (with the Tory/Conservative government sitting in Parliament) all of our prescription items (inclusive of monthly repeat prescriptions) we pay only £9.35 per item. My family uses PPC’s (prescription prepayment certificate) which are great! That costing will be gone when we turn 60. Remember we use pound sterling as our currency in the UK (England, Wales, Scotland, Northern Ireland). Ireland – the Republic of Ireland – has always used the Euro (€) as their currency (as with European nation members of the EU) and are part of the EU system whereas the UK is no longer a part of the EU system due to Brexit. Many Americans (inclusive of their media) mistakenly believe the UK is part of Europe but it is its own separate sovereign nation as is the Republic of Ireland – they just chose to use the Euro as their currency rather than keeping with the pound sterling.

    Do bear in mind all NHS GPs’/Consultants’ salaries are significantly lower than their American counterparts. GPs make around $80,000/annum whilst Consultants might make $90,000-$100,000/annum. Many of them supplement these incomes by having a private practice in addition (usually with colleagues).

    NHS prescription charges:

    Who can get free prescriptions;

    NHS Charges for Overseas Visitors::

    • Cruiser Doc

      All interesting pieces of information, but any comparison between health care in the US and other countries has to take into account these facts as well:

      – It costs a physician in the United States hundreds of thousands of dollars to complete college and medical school.
      – Annual malpractice insurance premiums depending on your specialty and region can be as high as $100,000 a year.
      – Over the past three decades, the number of physicians in the United States has increased by 150%, while the number of workers in medical administration has increased by 3200%. This second group adds nothing to direct patient care, and doesn’t work for free.

      • Debi Simmons

        Thanks Cruiser Doc, all good and so noted.😊 Many of our foreign and British consultants (specialists) and GPs do their medical studies in other countries, including at prestigious American university schools of medicine, and are quite familiar with debts they incur as well as their American counterparts. We can all agree medical training is not globally equitable financially, nor are the medical administrative systems or government regulations.

        UK county (state) regions also vary in how their councils manage their regional medical staffs and resources even though they are all part of the NHS. This autonomy of management greatly affects the trust budgets and others for maintaining and retaining resources and healthcare programmes within their specific region. In addition the UKs private health care insurers operate to a different set of standards and codes. UK Consultants, GPs and nurses make a fraction of the cost in salaries comparatively with medical professionals in America. In fact when I’ve asked American friends of mine (now debt free) to come work here in the UK, they all moan and say ‘No way!’😂 They would take massive pay cuts to relocate. The systems are just so different even though the care and skills are stellar in both locales.

        Thanks again, it’s good to learn the different angles. I’ve really appreciated Nikki for her time in addressing this global healthcare issue, as my husband and I – each an expat (one British, one American) – travel abroad frequently and have had to face some aspect with each visit to a different place in our beautiful world. We’ve noticed especially on our trips back to America how the healthcare seems to keep changing locally when we need care but have no American insurance coverage. It’s changed a lot since we last had an American prescription discount card or paid a premium for American healthcare coverage. Although we’re not sailors (my husband used to be) THANKS NIKKI for keeping us up to date!👏

  • Paul Smith

    The link below is the Ships Captains Medical Guide PDF without the annoying “withdrawn publication” sprawled across the pages, copy and paste into a browser:

      • Michael

        You do have to give your personal info to get the download.

  • LM

    P.S. I forgot to mention…
    1. Nikki, Congratulations on the success of your surgery. I, too, have severe allergies all my life. It was not until last Summer, I had the same surgery you had. I can not begin to tell you the positive impact the good outcome of my surgery has had on every aspect of my life. I sleep MUCH better (which has such a positive impact on the quality of my life, it is truly unbelievable) now that I can breathe and my airborne allergy symptoms have GREATLY diminished. I wish I had done this surgery decades ago!
    I hope your results are as good, if not better than my own.

    2. We watch your videos every Sunday morning. You and Jason have had such a positive influence on our lives, that we are looking into the RV life full time.
    Thank you, two for sharing your lives with others; but most importantly, inspiring us to ‘live our lives’ with adventure and curiosity and not to ‘live to work’. 👍

  • LM

    All very good comments, thus far, with many mentioning ‘Government provided / subsidized’ healthcare.
    I too have had family in Canada and the USA need very similar procedures, to find that the wait time for example, the start of cancer treatment was much faster in the USA. By faster I mean, the family member in the USA was starting chemo months before the family member in Canada was first seen by the Oncologist, in Canada. (Both family members being both Canadians, and one being a US citizen too, and both diagnosed, within 3 days of each other, with the same type of cancer in the same location.

    Aside from the anidodical examples, one major difference in many countries vs. the USA, is that other countries set cost and price limits on drugs and procedures.
    Thus, when referring to drug prices, with the cost of R&D benefiting all, the citizens of the USA are, indirectly, subsidizing the drug costs overseas.

    This isn’t to say that there are not many other factors that contribute to health care costs; but just remember, the great Economist Milton Freedman said that when it comes to Government spending, Government cares nothing about Costs nor Quality.

  • Michael J. Bahr

    Great article!
    As to other issues commented on, when it comes to government and the word “free” you have to look at what you are giving up for that “free”. When you start paying up to, and in some cases over 70% of your income to get “free” then you are basically an employee or even a slave to the government. If you are a hard worker and innovator who uses your intellect to its full ability your abnormally higher income is being confiscated for those with less drive and ambition in many cases. If that is fine with you great, but if you want to decide who your earned wealth benefits there are still a few countries like the United States that still allow that.

      • Michael

        Right you are, Nikki.

  • Joan Varga

    Unfortunately the UK gov’t no longer makes it available. All pages have “document withdrawn” and if you keep following the updates, you’ll get a message that they no longer make it available for free because there is now copyrighted updating in it.

    “Where There Is No Doctor” can be found on Amazon, Kindle, or can be downloaded in its 2020 edition for free here:
    It’s been invaluable for our family here in Mexico.

  • Casey B

    Been watching your adventures for years now. Appreciate you sharing about your surgery and healthcare info. My nose hurts just thinking about that surgery! 😮Bless you. I can’t imagine you having anymore energy then you already have, but wow, can’t wait to see what you’re up to next. 😉Wishing you and Jason safe travels.

  • Fred Kaluza

  • Jacquie Mason

    I live in Canada and have never paid for all the many surgery’s I have had from cancer etc. our medical is free and before that very cheap if you where not working.
    I moved my 90+ elderly parents back to Canada. For example my elderly mother broke her pelvis in three places and they would not let her stay in the hospital past two days because Medicare would then have to pay for all the rehab. she needed.
    She was turned away from the hospital at 89 twice, they refused to see her to rule out if she was having a stroke. The second time my brother said I will leave my mother here alone if you don’t look at her now. It was the only way the hospital staff would look at her. And when they did they saw she was having a stroke. If they took her in hours earlier they could have prevented the stroke. Again, they released her immediately so Medicare would not have to pay for the proper rehab. She needed. Then they sent her home from rehab. far to soon and the next morning she had another massive stroke which paralyzed her. Their health insurance cost over 1,300.00 a month over a third of their pensions.
    My parents thought they had good medical in the US and talked like the Ennis’ . Wait till your old, see how your treated in the US. Your now a burden to the Government costing money.
    That’s how I witnessed it with my parents. They are alive today at 94 and 93, in Canada with great free medical care.
    I have family in the states in California, Washington, Idaho, and Hawaii and this is where I get my info. The us taxes for everything, even inheritance tax or lotto winnings.
    I think your article is great and you are bang on correct with your info. So is John Morris.

    • Craig Olsen

      I have Family in Canada as well and personally are a born and bred Aussie, I can say that for both situations (family overseas and her in Oz) we have never had the costs you list, BUT I think its important to point out to anyone else thinking this that This article is not accurate based on their experiences living in those countries, or for countries where your government has arrangements for universal health care (for example Australians can go to New Zealand or the UK and get the same costs as a local and vice versa) that their experiences are not correct.

      What this article is explaining and comparing i believe is comparisons for if you visit a country where you have no existing coverage and are not a citizen then these figures seem accurate for all the countries listed, and this is why the international coverage is such a great idea.

  • Stacey C

    Congrats Nikki! It is so important to breathe! Thanks for updating us on this, as I remembered it being one of the reasons that allowed you to get into NZ. Thank you for sharing your experiences cause I think you have the best attitude and outlook!

  • Roy E Hardcastle

    glad you are doing good after surgery. Roy H

  • John S.

    That video (and this website) is crammed full of good information for travellers. Thanks for posting.

    I would like to be the first to say “Thanks You” on behalf of Canadians who live in border towns that already appreciate the many many Americans who visit Canada to drink at age 18, to see a moose, or to visit a pharmacy. There are bus tours for the last two and after this video there will be even more interest in the last one.

    Very glad to see you taking deep breaths (and not having the sound edited out).

    • John S.

      That middle paragraph refers to the chart at 7:06 in the video.


    Medial guide:

    This publication was withdrawn on 17 October 2019
    This version of the document is no longer valid. Please contact HMSO for the current document.


  • Kara Krantz

    The UK medical guide was removed in 2019.

  • Lenny

    One quick note: I don’t think the medical guide is free any more. “Due to intellectual property included in the 23rd edition. the SCMG will no longer be freely
    available from “.

    I followed the links and it looks like the 23d Edition of the Ship Captains Medical Guide now sells for about $50.

  • Leslie and Audi Ennis

    We love your show and watch it often. Something you failed to mention on your US vs World Heathcare system is that most foreign countries have much higher taxes that help pay for their healthcare. Some as much as 70 to 80%, so regardless of the exact amount the relative tax rate is higher.
    Also, the US will take care of people without insurance or cash unlike many foreign countries. I’m sure that is not a blanket statement but the relative difference needs to be noted. Someone has to pay for people that get free healthcare one way or another, whether it’s through higher insurance costs or higher taxes.

    • John S.

      When I researched healthcare one of the main factors is that is unique in the US is how much healthcare management/executives get paid. No other country has such a plethora of multi-million dollar compensations.

      Perhaps one reason is that when the national government pays the executive salaries (via taxes as you point out) the voters would not stand for it.

      • Michael

        Damn straight, Nikki!

    • Debi Simmons

      Those of us travelling to America must pay with cash out-of-pocket to receive any medical care there. We are not cared for until we pay up front, which also means we are expected to fill out detailed paperwork when we’re not feeling well before we pay. We noticed while travelling in Texas there seems to be a big development of community walk-in clinics near strip malls, a noticeable addition since we lived there many years ago. Seems like each visit begins, at least for us, at $80-$90 per person, always with additional costs for any blood work, tests, X-rays, etc. We don’t have medical insurance and in speaking with the Americans waiting in the clinic to be seen many of them could either no longer afford to have medical insurance or their employers did not offer it. When they lost their insurance they also lost their family doctor (GP) so these community clinics have become vital. Maybe other states in America offer free medical/emergency care for those of us traveling from other countries – it would be great to know which states.🙂

      Travellers from other countries to the UK weren’t charged for until 2015 (EU citizens have other measures, such as EHIC or PRC.) Foreign visitors are now charged 150% of the national NHS rate. That said, if foreign visitors to the UK have an emergency and need to go to A&E (ER) or see a GP they will be cared for without charges. Other medical needs might incur charges but treatment will come before any required payment. BTW our overall tax contribution to the NHS is about 20% total, some income levels might be a little higher but reasonably so.

      Our medications are a lot cheaper for travellers from America (for UK citizens they are free from aged 60). Americans can find their prescription needs here for a lot le$$, they might be called something different but the pharmacists will know exactly what you need. UK pharmacists are also trained to give superb expert professional advice on medication. It was great to have Nikki point this service out about the pharmacists in Thailand. Also fun to see Nikki & Jason filmed a BOOTS in Thailand, Boots is our big national pharmacy – even our hospital uses Boots. (There are of course other smaller pharmacies – we have a dispensary within our doctors’ medical practice.) Many of our UK supermarkets do not have pharmacies, so it might be helpful for those travelling from other countries where pharmacies inside grocery stores are the norm to be aware. Boots is everywhere. Their pharmacists might also be able to direct you to any GPs in the area should you need to be seen medically.

  • John Morris

    Great article , the European countries you mention all have free universal healthcare , for example the UK medical care is free for Uk residents including all medication , in Ireland it’s free if you are below a certain income and for higher incomes all medication is capped at €200 a month for a family , so you could have a child with diabetes and someone else in the family on cancer drugs it’s still capped at €200 , if you are a high earner.
    France and the UK are the gold standard, it’s free for everyone.
    For Americans 🙂 Free = paid for out of general taxation .


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