Expats employed by multinational companies suffer from family stress, cultural differences and increased workloads despite their employers investing a significant amount on their well-being.

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Research by health services company Cigna and the National Foreign Trade Council points out that the global expat community has grown dramatically in recent years and while there has been a lot of research into what employers have been doing, little is known about how expats actually feel.

Some 80% of expats say that general relocation services are the most important, 65% medical cover and 63% settling in services and according to the survey, in most cases employers are providing these resources.

However, there are many unmet expectations among the expats surveyed. Some 59% said they were unaware of their employer’s repatriation assistance and didn’t know whether their employer would track what happens to them after they return home.

Overall 78% of expats or their family members have accessed medical care while working abroad but expats under age 34 were considerably less informed about the specifics of their health plans. For example, their uncertainty about claim handling was four times higher than the average of other age segments, and their lack of knowledge about where to access health care services was triple that of other segments.

The survey also indicated the extent of how having a family greatly influences an expat’s health care needs. Those with spouses or partners and children were most likely to access care, with percentages as high as 91% compared to single expats at 64% and expats without children at 67%.

When compared to expats in Cigna-NFTC’s last survey in 2001, today’s expat is older, on shorter assignments, and is leaving his or her spouse and family back home more often. In 2001, expats aged 25 to 34 made up 35% of the survey, down to 17% in 2013. In 2001, 8% of expats with a spouse or partner were travelling without their spouse or partner on their assignments, while in 2013, that number nearly tripled to 23%. In 2001, 18% of expats with children did not have their children with them on assignment, and in 2013 that number almost doubled to 34%.

The trend toward shorter assignments has doubled since the 2001 survey, with 13% expected to be on assignment a year or less in 2013, compared with six percent in 2001. Today, 37% expect to be on assignment for two to three years.

In the 2001 survey, 5% of expats were from Asia, a number that has grown to 13% in the 2013 survey. In 2001, 63% of expats were from North America, down to 49% in 2013. Other major trends in expat assignments include the shift from Europe, where 43% of expats surveyed were assigned in 2001 versus 22% in 2013, and in Middle East/North Africa/Greater Arabia, where 6% were assigned in 2001 compared with 23% today.

The survey also found that location makes a significant difference in their experiences and perceptions. Satisfaction with their employers’ efforts was lowest from expats on assignment in Sub-Saharan Africa, the Middle East and South America and highest in Australia and Europe.

It also revealed that the United States provides a lot of difficulties for expats including the ease of finding a doctor, language issues, knowledge of the health care system, understanding of financial and tax consequences and as a result expats have much lower satisfaction scores than other regions.

When asked open ended questions regarding their experiences, expats frequently cited human resource related issues. Specific concerns included a lack of understanding from HR personnel many of whom have never experienced living internationally and therefore may have low awareness of the type of challenges expats face in terms of relocation, finding a place to live, obtaining work permits and completing official forms and the cost of travel.