For up-to-date health guidelines, contact your nearest American embassy or consulate as soon as possible. In addition to what is required, you should discuss any further recommendations with your physician.

Most residents of American urban areas with adequate incomes do not have serious health problems. The major health problems are in the less affluent sections of inner cities where preventive care is inadequate or entirely lacking. Adequate treatment of AIDS remains primarily a problem of marginal population groups. Tuberculosis shows signs of resurgence but, again, it is primarily a problem of the disadvantaged.

Lyme disease, spread by ticks, is a problem in parts of the north east. Those who live in affected areas should inspect their skin after returning from walks in grassy and wooded areas.

Influenza can be a problem between the months of November and April. Vaccines are usually available through physicians and medical facilities.

Medical professionals in America are generally highly proficient, and specialists especially so. Contacting a physician is usually a simple matter, accomplished by checking either listings in a telephone directory or with a local medical association. The latter will provide several names, typically three, in the caller’s vicinity. Business associates and social acquaintances may also be able to provide recommendations.

Your medical insurance may determine which doctor you may use, although often you may be treated by someone outside your plan if you pay for it yourself.

Independent private practitioners dwindled in number during the 1980s and 1990s, as comprehensive care by health maintenance organizations (HMOs) become more prevalent. An HMO is similar to a group practice, which offers several specialties in one office, but with aspects of an insurance programme.

Patients pay a fixed fee per month or year, and their medical needs are taken care of without additional charge except in extraordinary circumstances, such as major and very expensive surgery. An HMO typically has an extensive list of participating physicians, who in some cases practice under the same roof. HMOs are set up by insurance companies, medical groups, employers, and communities, among other sponsors.

HMOs have since become less popular, and more physicians elect to operate in their own offices and accept various insurance coverage. Call ahead to inquire whether your insurance is accepted by the doctor you choose.

Facilities in America rank with the very best anywhere in the world. There are several types of hospitals. Some are public. Excellent public hospitals exist, particularly in some larger cities. They are operated by the municipal governments and subsidised out of public funds. They are less expensive, but typically less well-equipped and more crowded than private hospitals. Many large universities have affiliated teaching hospitals. They are very well-equipped for this purpose, and care is usually excellent.

Another group of hospitals is church-operated. The most prominent denominations involved are Roman Catholic, Presbyterian, Methodist, Seventh Day Adventist, and Lutheran. There are also private for-profit hospitals, some operated as chains by corporations that also sell medical insurance plans.

Which hospital or type of hospital to use most often is determined by accessibility at the time of need. If time and circumstances permit, local physicians and medical associations can advise as to the most appropriate institution for a patient’s needs.

Except in emergency situations, admission typically involves completing an admission form, presenting evidence of insurance coverage, signing a consent for treatment, and specifying in what form payment is to be made – i.e., billed to insurance, credit card, or cash. Without insurance, a deposit is usually required, which may run to several thousand dollars. Amenities such as telephone and television can be arranged, at additional cost. Accommodation in most cases will be in a semi-private room, meaning a room shared with one other patient. Private rooms may be available, but they are very expensive and insurance companies will not cover the additional cost.

Hospital bills should be checked closely for duplication or error. If an insurance company is taking care of payment, close scrutiny is not as essential because the insurance company will check the bill.

In emergency situations, you should call for an ambulance, the police, or the fire department by dialling 911. You should find any other emergency numbers in the local telephone directory, keeping them on hand in case of any emergency. If you need other emergency services and do not have the direct number, call 911. The police station, which answers the 911 call, can direct you to the emergency service you need.