Cruising With Disaster
What about health insurance? Will it cover you? Most plans do not cover medical services on board, which means you will pay out-of-pocket for any costs incurred. The bill can range from a few hundred to several thousand dollars. If you receive treatment or medicine from the ship’s medical team, the cost will be charged to your personal account. You could then file a claim with your personal insurance carrier to recoup whatever is covered by your health policy.
Travel insurance, which usually costs between 5% and 8% of the total cost of the trip, could cover the rest. In addition to medical costs, you can buy insurance policies that cover a wide range of trip interruption and cancellation situations, as well as medical evacuation.
Travel health insurance is your best protection. Consumer Reports recommends avoiding commission-driven policies sold by tour operators, cruise-line representatives, and travel agents. Instead, check out an online broker (such as insuremytrip.com) that sells coverage from multiple companies and allows you to tailor a plan to your needs.8
Many employers purchase travel insurance for their employees, which covers both business and pleasure trips. This type of policy is particularly convenient if an expensive emergency procedure, such as evacuation from the ship and/or a hospital stay in a foreign port, is necessary.
Not all perils at sea are contagious. Norovirus and motion sickness aren’t the only health concerns onboard. Falls and cardiac problems are also quite common. The CDC estimates that injuries, typically from slips, trips, or falls, account for 12% to 18% of shipboard medical visits. Obviously, anyone can fall, but those with limited mobility or who require assistance (eg, cane, walker, or wheelchair) are particularly at risk from wet decks and rough waters. (Factor in a cocktail or two, and even the normally ambulatory will have trouble navigating!)
If you have a bad outcome, don’t expect to win a lawsuit against the cruise line. Be sure to actually read the lengthy form you sign before boarding the ship. Courts have ruled that a cruise line may not be held vicariously liable for the negligence of a ship’s physician. There is no medical malpractice for care rendered on board. Traditionally, the physician and nurses are private contractors.
Ultimately, I think pleasure cruises are worth the time and effort for the prepared cruiser. I intend to go again. And this editorial is not an indictment of the physicians and nurses who work hard and do a wonderful job on cruises to maintain the health of passengers and crew. I just don’t want anyone caught unaware if they set sail for an adventure and find more than they wanted.
I would love to hear about any experience, positive or negative, that you have had with cruise medicine. Contact me at PAEditor@frontlinemedcom.com.
REFERENCES
1. Diskin AL, Caro GM, Dahl E. Acute gastroenteritis and video camera surveillance: a cruise ship case report. Int Marit Health. 2014; 65(1):20-22.
2. Williams S, Dahl E. Briefing notes on emergency medical disembarks by helicopter at sea in North America. Int Marit Health. 2014;65(1):7-12.
3. Brown CM, Cetron MS. Crossing borders: one world, global health. Clin Infect Dis. 2012; 54(11):v-vi.
4. Stefanelli P, Fazio C, Neri A, et al. Cluster of invasive Neisseria meningitidis infections on a cruise ship, Italy, October 2012. Euro Surveill. 2012;17(50):pii20336.
5. Gibbs RA, Nanyonjo R, Pingault NM, et al. An outbreak of Cyclospora infection on a cruise ship. Epidemiol Infect. 2013;141(3):508-516.
6. Bert F, Scaioli G, Gualano MR, et al. Norovirus outbreaks on commercial cruise ships: a systematic review and new targets for the public health agenda. Food Environ Virol. 2014; May 17. [Epub ahead of print.]
7. Bouricha M, Samad MA, Levy PY, et al. Point-of-care syndrome, rapid diagnosis of infections on commercial ships. J Travel Med. 2014;21(1):12-16.
8. Consumer Reports. 7 things you need to know about medical care on cruise ships. www.consumerreports.org/cro/news/ 2014/04/7-things-you-need-to-know-about-medical-care-on-cruise-ships/index.htm. Accessed July 17, 2014.
9. Dahl E. Cruise medicine: call for an international standard. Int Marit Health. 2001;52:24-26.
10. American College of Emergency Physicians. Guidelines of care for cruise ship medical facilities. Ann Emerg Med. 1996;27:846.
11. American College of Emergency Physicians. Health Care Guidelines for Cruise Ship Medical Facilities. www.acep.org/content.aspx?id=29500. Accessed July 16, 2014.
12. Cruise Lines International Association, Inc. Medical facilities. www.cruising.org/regula tory/policies/medical-facilities. Accessed July 16, 2014.
See also: Dr. Bukata's comment on this editorial
[Rick Bukata is the editor and founder of Emergency Medical Abstracts and has been studying the literature of emergency medicine in depth since 1977. Rick was awarded the Education Award of the American College of Emergency Physicians in 1993 and the College’s “Outstanding Speaker of the Year” award in 2000. He is a Clinical Professor of Emergency Medicine at the University of Southern California.]
