Cargo ship or a large cruise liner are very different places to work on, but looking at these 2 places from a perspective of a crew member health and safety actually we can see some common features. The risks for the wellbeing and health, the reasons of signing off board the ship and the need to get good quality treatment in a home country, in many cases, is very similar.

According to the research of Institute of Occupational Medicine, 56% of crew members reported an injury or illness which had prevented them from working and 30% of these reported being off work for a significant period of time. The most common health conditions reported were conditions affecting the back and neck (25% of those reporting an injury/illness), broken bones (15%) and other injuries (15%).


The work on board of a ship is conducted in a high stress environment. The shifts are intense, the time spent away from home and family is very long, which contributes to the lack of concentration and motivation. Apart from these factors, working on board of a ship is always working in a multinational environment, which from one hand adds exciting variety and cultural diversity, but at the same time, it makes the co-existence even more challenging and stressful for crew members.

Considering the above facts, crew managers have to deal with sick leaves of their international crew members with different diagnosis almost on a daily basis.

According to MLC 2006, the ship owner has an obligation to provide a quality healthcare for the crew members, therefore when the seafarer is signed off board, he or she, has to be treated in their home country in a best possible and efficient way.

Here are the main challenges for the ship owners:

  1. The crew members nowadays may come from more than 80 different countries. The medical care and the standards of this care differ a lot from country to country, but the crew member has to get medical help which will correspond to the international standards.
  2. While the crew member is off board, the ship owner has a lack of professionals and if the leave is a long one, the ship owner will have to look for a substitution.
  3. During the sick leave the ship owner will have to pay both the salary for the substitute and the sick leave.
  4. If the medical service does not meet crew member´s expectations, he or she may request help from legal advisers, and the number of legal cases increases every year.
  5. The quality of medical care in the home country should be is a high standard to ensure quick recovery
  6. Re-employment medical examination should be very detailed and reliable, in order to make sure the crew member is healthy and fully recovered and will not have to get off board due to the same medical condition in a near future.

The main matters to take into consideration while organizing medical treatment in the home country of the crew member are:

  • Crew members may come from more than 80 different countries and the ship owner will have to be able to access high quality medical providers to support the crew members in their countries of origin and to provide them with adequate medical care;
  • The ship owner will have to make sure, these medical providers will correspond to the international standards of medical care;
  • The medical facilities tend to overcharge for the treatment of the seafarers.

To be able to meet and resolve all these challenges, organize time and cost efficient help, the ship owners would require an extensive crew medical department, that would contract with hospitals, negotiate prices, make appointments, get the documentation and, at the same time, control quality of medical care. This is not a general practice, and even a very large cruise lines corporations cannot afford a department that would deal with purely medical assistance function, which is generally outside of the scope of maritime industry.

Therefore, this function is frequently fulfilled by HR department, doctors on board of the ship, and ultimately, the crew members, who would get the treatment wherever and then just reimburse the medical expenses.

These practices lead to overpayment, lack of satisfaction, poor quality medical services, long term sick leaves and finally a huge loss in the ship owner’s budget.

What kind of solution can be proposed for these matters? As experts in the field of international medical services, we suggest to delegate these service to professionals in this area: international health insurers and specialized medical assistance companies. Using their own medical provider network and extended knowledge in the healthcare field they can make sure all the criteria is met and the case is managed in the most efficient way.

Just to put all this theory in practice, please allow me to bring to your attention one live example from AP Companies practice in a form of a case study below.

One of the cruise liners contacted AP Companies regarding a case: Maria Hodzic (the name is not real for the sake of GDPR purposes) 30-year-old cruise line crew member, suffering from total bilateral paralysis of the upper extremities, hospitalized in New Caledonia.  There were no relevant specialists for her diagnosis. Maria was from Bosnia, but she requested to be hospitalized in one of the clinics in Switzerland, where she had a support from one of her family members, who was actually working in the rehabilitation hospital. The cruise line decided to provide this extra effort considering such a serious condition. AP Companies organized air evacuation on commercial flight from New Caledonia to Switzerland, with a change of air craft in Tokyo, the crew member was accompanied by medical specialist during her entire trip.

Once in Switzerland, the crew member’s condition improved, as she was already together with her family, she went through necessary treatment, and once she was fit to travel, AP Companies found the best qualified hospital in Croatia, where the member could get all required physiotherapy, hydrotherapy and other rehabilitation therapies, that helped her to get back her full mobility and return on board.

In this case, AP Companies team quickly and efficiently, was able to organize medical escort and evacuation to Switzerland, then managed cases in  this country closely controlling costs of treatment arranging cashless medical care and obtaining best possible discounts with the local hospital. Once Crew member’s medical condition stabilized and treatment plan was clear and defined, AP Companies was able to arrange further treatment in the Center of medical excellence in the home country close to her family, and in her own language. Our specialists were assisting in all the appointments and paperwork up until the crew member was fully recovered, and was ready to get back on board.

Cruise Liner saved a lot of time and money by trusting AP Companies to manage such a delicate and challenging medical case. Crew member was fully satisfied with the results of her treatment and fully recovered to be able to get back to her duties onboard.

One of the challenges when it comes to managing medical cases for crew members in the home country is to ensure continuity of care, meaning that the necessary treatment is progressing and there is no delay in the process of treatment due to the crew member not attending medical appointment or due to the care not being provided by the medical facility. Based on the years of experience, AP Companies has developed a clear and well-structured protocol of managing any type of medical cases which secures constant progress of the treatment performed, requiring participation from the crew member’s side and from the ship owner to effectively obtain/provide necessary treatment. Evaluation of the progress is done on a monthly basis and give a clear understanding on the expected outcome of the case: whether crew member will become Fit for Duty and resume working on board or will reach a maximum medical improvement state, but will not be able to return onboard.

Standard set of forms, quick turn around times on obtaining medical reports after the visit, evaluating of the progress of treatment by medical doctors – all these measures successfully contribute to the positive outcome of the treatment.

Another important factor when managing home country case is actually selecting a “right” medical provider for the crew member’s medical condition. As stated above, there is more or less limited number of reasons (with certain small variation of cause) why crew members are being signed off for a sick leave to their home countries. Within our extensive medical provider networks we have been able to determine so called “centers of medical excellence” for treating various common medical conditions suffered by crew members. These selected medical providers would be initially closely examined by our Medical Director to ensure high quality of care, state of the art medical equipment and educated regarding crew member’s health concerns in general.

This thorough preparation process and structured case management help us to achieve best results for our clients when taking care of the most important aspect – crew member’s health.


By Elena Donina Glukhman, Project Manager, Development & Cooperation Worldwide at AP Companies Global Solutions

The views presented hereabove are only those of the author and not necessarily those of  SAFETY4SEA and are for information sharing and discussion  purposes only.

About Elena Donina Glukhman, Project Manager, Development & Cooperation Worldwide

Elena Donina Glukhman is Project Manager of AP Companies Global Solutions, the international leading health care management, cost containment, and emergency medical assistance company. AP Companies has the largest direct medical provider network in 185 countries. AP’s Cost Containment team consistently achieves significant savings worldwide in all kind of different medical facilities. Elena has been working in the field of International Medicine since 2009 having previously worked in Bupa Global, dealing with insurance market development for expats and crew members and has a wide experience of cooperation in terms of medical care for the crew members with global cruise line companies and  Marine Insurance companies.