Indonesia - Healthcare
Bali Medical services
The lack of good medical services is the most concerning issue when living in Bali, especially for people who are in their 60s and beyond. This is especially complicated by the fact that after five years living overseas, your Australian Medicare coverage ceases to exist. To acquire re-entitlement to Medicare benefits, you need to return to Australia and prove that you have returned here to live. You need to provide copies of a rental lease or employment contract, for example.
John and Sandra have no health insurance and said their private medical cover lapsed when they left Australia. That’s dangerous when you’re 65. ‘We have to fly to Singapore for treatment. It is expensive,’ said Sandra, but she added, ‘We are about to buy health insurance.’
The insurance they are considering is very expensive at about A$12,000 a year. However, this covers them for every medical need, including emergency evacuation. But for many others like Geoffrey, Michael and Elizabeth, the cost of international health insurance is just too high. Yet for them this is not a deal breaker. After all, as they pointed out, there are medical services in Bali and these are not expensive.
Geoffrey, who is uninsured, recently had what he described as a ‘heart episode’. It was frightening, but ultimately not too difficult to manage. He went to a local, private hospital in Denpasar, not a hospital for foreigners or tourists. The cost of a specialist, five days in intensive care, an additional five days in a private room, with all medication, was about A$2700 in total.
After that experience, Geoffrey decided that health insurance was too expensive compared to the actual cost of treatment in Bali. And he was more than happy with the standard of service he received. ‘I am confident that most illness or injury I get here will be able to be treated at the local hospital’ Geoffrey said, adding that if it were more serious, he’d just have to get on a plane back to Australia. ‘And if I can’t, well, that’s okay. You know, I haven’t missed out on much in life.’
For Elizabeth, the decision is simple—she simply cannot afford medical insurance. However, she pointed out that she can go to local hospitals for treatment any time she needed to, and said she has ‘great confidence in many Indonesian doctors, although all are not great .’ But, most Australians should consider having medical insurance, If you can afford the premiums, get the insurance.
For example, what happens if you have a car or motorcycle accident, or suffer a life-threatening disease? There may be medical treatment in Bali but it may not be adequate. You may need to travel to Singapore or Australia for specialist treatment. And what if you are too ill to travel on a commercial flight? You will need to be medically evacuated and that is expensive. These evacuations are provided by private companies and, with medical expenses, could set you back A$40,000. Ouch.
The annual premiums for medical insurance plans range from about A$2500 to A$12,000. The more you pay, the better the cover. Some new Bali residents hold travel insurance policies at a cost of about A$700 for a year. This covers baggage losses as well as medical costs including evacuation, but has a limited time span, often of about two years, depending upon the insurance company (see Health Insurance chapter).
It’s also worth remembering that Australian private health cover can be placed in suspension for two years. This suspension is renewable for up to six years with many of the big insurance groups. After six years you must resume payment of premiums or lose your cover. Suspension ensures no loss of benefits, and no waiting periods when you return to Australia.
But there is a very positive flipside to medical services in Bali—and this is particularly relevant to the over-70s who would prefer to be cared for in their own home, rather than move to a sterile aged-care accommodation facility, their only option in Australia.
In Bali, there is a very affordable opportunity to employ wonderful and reliable Balinese staff that act as carers and nurses at a fraction of the cost of similar services in Australia.
Vaile Home, 65, a Melbourne native but a resident of southern Bali in 2012, has been reliant on a walking frame for the past four years after she fell and broke a kneecap. More critically, she suffers from cerebellar degeneration, a disease affecting her motor function and balance.
‘I won’t leave here. I will be carried out in a box,’ she told Deborah Cassrels of The Australian newspaper (18 August 2012).
Vaile’s husband, Richard, who severely injured his back seven years ago, was treated for tongue cancer five years ago in Singapore, a two-hour flight away, and where the couple regularly undergo check-ups.
The Homes encapsulate a common expat theme, wrote Cassrels. That is, the idea of residing in an antiseptic nursing home’ or being a burden on their children won’t happen. Their children live in Asia so they see no reason to be in Australia.
They, like many other aging Australians, foresee Balinese pembantus (housekeepers) assuming increasingly intensive roles as providers of aged-care—unqualified, yet well suited because they are seen as patient, respectful, gentle and affordable.
Vaile is dependent on a rotating roster of four Indonesian pembantus. For some time after her accident she was immobile. The pembantus bathed and clothed her and tended to her every need. They are now instantly at her side when necessary. Local doctors’ mobile numbers are on hand.
The Homes pay about A$100 a month for each pembantu. They are also considering hiring a live-in nurse in future, costing between A$300 and A$600 a month, depending on qualifications.
Richard calculates similar home help would cost about A$40,000 a year in Australia. ‘We could never afford this in Australia,’ he said. ‘It just wouldn’t happen.’