The tweet: "I want to fund the 'Uber' of medical tourism
Needs 5 star service, simplicity and safety
Let me know if you apply - http://www.ycombinator.com/apply/"
It really has to happen. Health care in the US is just fucked, and everyone knows it.
Well, the "Uber" business model is actually pretty hard to do in an industry as heavily regulated as medicine (and honestly it's a difference between getting into an unrated driver's car or putting yourself under the knife of an unrated developing country's doctor)...
Then again, our friends at Medigo seem to do great service in this direction so far and have just raised a series A ( https://www.crunchbase.com/organization/medigo#/entity ), the competition seems to be heating up in this space and honestly, I can't think of anything to truly "disrupt" this industry, as the margins are pretty well known, the market is reasonably mature and the order volume is very low.
> Health care in the US is just fucked, and everyone knows it.
And yet people still move here for the "fucked" health care because it's cheaper, better, and available unlike other countries held in high regard, such as Canada. I am one such person who was lucky enough to be able to do that, and would never return to Canada after the abusive treatment handed out by the health care "professionals."
I am originally from India and came to the US 10 years ago. I still can't believe that you can not call up a doctor/clinic/hospital in US and get a price quote for something routine.
Chris's experience is representative of what one can expect from the Indian health care system. If you are a working, middle class person, the free market health care works extremely well.
Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high.
They lobbied against it for years, arguing no machine could possibly replicate their skills or handle an emergency if something went wrong. Putting someone to sleep is an art, they said. Too little sedation, and the patient feels pain. Too much, and the patient dies. Anesthesiology requires four years of training after medical school, meaning careers might not launch until the doctors are in their 30s. It’s one reason the profession’s median salary is $277,000 a year, according to research firm Payscale."
Ha. Back when our son was having regular lab exams, we were in the States. When we asked Bloomington Hospital for a price for one lab exam, the receptionist asked us, "Why? Don't you want the best for your child?"
Yeah, lady, that includes not giving you all our money without asking how much you'll be taking.
In addition to what itg said, another is that with various insurers the doctors and even the billing people do not actually know what you'll pay. They know what the service costs them to perform (irrelevant to what is charged to the consumer), they know what they're going to bill the insurer (a grossly inflated number that is a big cause of these massive 6-figure bills you see to uninsured folks), but they have no idea what the insurer will actually reimburse them, so they honestly can't tell you.
It's a broken system and there's no excuse for it, but at least in the US it is not because they're being intentionally obtuse.
We have too many middle-men in US healthcare. They obscure costs and prices while preventing individuals from getting more involved with their own healthcare decisions.
Rather than a one-size-fits-all approach to healthcare through single payer or other subsidies, my fondest wish for government intervention would be for laws that force doctors and hospitals to provide price and likely outcome information to the general public. Give healthcare consumers the data they need to make informed decisions and the ensuing competition could drive down prices while improving outcomes.
>I still can't believe that you can not call up a doctor/clinic/hospital in US and get a price quote for something routine
You can. Routine, profitable procedures are not hard to arrange in the US. I have personally worked in a clinic where the exact experience described in this post happens every day.
>If you are a working, middle class person, the free market health care works extremely well.
It's pretty easy in most places in the world to get people to do something that makes them money, like the discectomy discussed here.
Managing a system where the poor and the unlucky get care is a little tougher. The US does it lousily, but so does most of the rest of the world. India doesn't do it at all.
Yes- my friend goes to India and does his annual checkups/ dental checkups and fillings for a few hundred rupees which is cheaper than the deductible of his dental insurance here. Last time he had heart pain and went to a top heart specialty clinic and his bill was $11 to get checked out.
You actually often can (or at least, could -- not sure how Obamacare might have changed this) -- you need to state that you are uninsured; you may very well get a lower price for your routine than you would have to pay out of pocket with insurance.
It's true that healthcare is terrible in the U.S. if you don't have health insurance, but he overstates his case. Chris compares a 1 in a 1000 nightmare scenario to his very average experience.
A $112,000 error happens in the U.S. but is rare. Typically the type of surgery he mentions costs between $20,000-$50,000. Or 50-100% of a the U.S. gdp per capita. This is smaller than in India where the cost of his surgery was 130% of the Indian gdp per capita.
And the issues with rounding errors has to do with the large amount of health insurance in the U.S. not necessarily free market vs. regulation. When the majority of consumption in a market is driven by enterprise customers, the pricing can become strange and very unfriendly to individuals.
As a patient, US healthcare is terrible even if you have health insurance. Patient is at the bottom of totem pole in US healthcare, and just a number for doctors, hospitals and insurance companies and everyone else involved in the system.
Just a couple of anecdotal personal recent experiences with US healthcare.
1. Recently I witnessed the trouble my primary care physician (PCP) had to go through with insurance company to get approval to perform CT scan. I couldn't believe the 30 minutes, my PCP had to spend on the phone with the United Healthcare person. This is the doctor spending time on the phone explaining all the medical reasons for recommending CT scan and not some administrative person in doctor's office.
This is in contrast to a friend's experience whose PCP kept prescribing pain killers and other prescriptions instead of pushing insurance company for further tests for abdominal pain. The friend later was diagnosed with stage 4 cancer when showed up at ER with same symptoms.
2. While researching a local major hospital rated highly for quality of surgery, I came across the reports of quite a few cancer patients complaining about hospital quickly discharging patients after major surgery and restricting pain medication while in hospital. The claims don't make sense as hospital is rated so highly for Quality of Surgery and might be considered anecdotal. Until I found that two of the measuring criteria for Quality of Surgery was how long a patient stayed in hospital after surgery and dosage and duration of pain medication administered after the surgery. Talk about incentive misalignment. There is all the incentive for surgeon and hospital administration to discharge you quickly to maintain and improve Quality of Surgery rating.
The US health care system sucks. I'm generally happy to be back in the US, but not about this particular aspect of it.
It's more bureaucratic than Italy, costs more, isn't appreciably better, and wastes people's time more.
What's more, even though Italy has a single payer system, there is also private care available that is quick, cheap and efficient - which it has to be, since the competition is "free" (tax funded).
The US has neither a free market, nor a good government provisioned system, but some mess that's neither fish nor fowl.
An error that large may be rare, but the overall experience of massive/unexpected financial load is fairly common via my experience hearing from customers (full disclosure: I founded a medical tourism startup called Emissary two years ago: https://www.emissarymed.com)
We talk to people all the time who don't have insurance (20-30M last time I checked), don't have dental insurance (~150M), or whose insurance comes with coverage caps as low as $1K-$2K that render insurance effectively useless for them in large operations. Most of the time, customers we talk to actually don't even get as far as the author did, because they can't afford the estimate, let alone the risk of over-shooting it. They just avoid getting treatment (and often get worse in the meantime).
The trick then is how to find a doctor you can both afford AND trust. If you'll excuse the plug, we started Emissary to solve that when a friend's mother had this problem. Our mission is to help connect people to high-quality options they can afford, regardless of where they live in the world.
> the large amount of health insurance in the U.S. not necessarily free market vs. regulation
Erm, health insurance companies are essentially the opposite of a free market. They're as close you can get to government run without actually being called "government". With USG's recent push to make patronizing these behemoths mandatory, even the last little sliver of "exit" has been lost.
My wife had some complications after pregnancy. UK and Ireland has GP referral system, where single doctor coordinates all specialists. In theory it is good system. But our GP ignored basic symptoms and pushed bullshit like "depression" or "have you tried acupuncture?". We paid each GP visit, even for saying hi and collecting results, it was obvious GP was just pushing for more visits.
This was going on for several months.. Eventually we visited doctor in Athens, the whole thing was diagnosed and solved in weeks. Solution was $2 pill and routine surgery.
I really recommend to anyone with some 'mysterious' health issues to visit REAL doctors.
Cash friendly places are getting more prevalent in the US, but you have to look for them. For example, one of the hospitals in my area publishes this (very sane) price list: http://swedishhospital.com/patient-financial/?page_name=pric... I go to them. :)
There are urgent care centers that are the less-crazy version of ERs, and a lot of primary care stuff can be done self pay. While I have access to insurance through my work, I vastly prefer the quality of the self pay system. You do need to do some research in advance, but there are some pretty cool innovations out there, and services you just can't get via the insurance system.
Be careful when picking an urgent-care center. Some are now for-profit emergency rooms. They can treat a much broader set of maladies & injuries than an urgent-care, but they're priced accordingly.
My understanding is doctors in US are trained to scare you about every possible negative outcomes. I find visiting a doctor here is much much more stressful than doing it in India.
For a simple chest pain, doctors here would tell you 145566 possible scenarios that may happen with your body, and wouldn't confirm any unless he sees a lab test. And then, a tide of lab tests would start, which will cripple you financially, and emotionally because all you are thinking is which test would be +ve, which -ve; diving on internet where people usually blog about their -ve experiences. Usually, it could be just a muscular pain, etc, which become so irrelevant as you are undergoing all these lab exams.
I don't want to blame the doctors here as such, because that's how they are trained here. I guess it boils down to this robust "suing infrastructure" here, that if you missed out a rare symptom with a patient, he will sue you and finish your career.
One thing which I couldn't understand is why in a developed country, lab tests are so expensive. An Xray, costs about $100; similar thing costs about Rs 80 (equivalent to $1.25). Shouldn't they be cheaper here, given there are gizmos for everything, and all electronics items are much cheaper here than India. I think these costs are all artificial.
I think a mix of both approaches (insurance + free market) would better.
Yep. Medical tourism exists when the cost of local healthcare is inflated by profit-seeking to flatly unaffordable levels, resulting in grotesque health outcomes and extreme behaviors such as traveling thousands of miles or committing crimes in order to end up in prison for care. I would like to coin a term for this kind of disturbing extreme behavior incentivized by extreme distortion of society: fever spasms. It sounds better in German, so: fieberkrämpfe.
Out of pocket price of standard blood panel lab in the USA with a follow up phone call if something is wrong, with insurance: $1500. There is no ability to estimate even vaguely what the price will be beforehand, and the bill may take a month to arrive in the mail. Your insurance agency will fight you at every turn for all but the most mundane routine procedures. There will be a billing error somewhere, and it will be to your detriment. They may refer you to collections if you do not pay the incorrect amount while disputing the charges, as happened to my girlfriend. Face time with the doctor is probably minimal, and you will be stressed by the doctor's attempts to hurry you out the door and probably forget to ask important questions.
Out of pocket price of extended blood panel lab plus two hours of doctor face to face analysis without insurance in Argentina: $50 USD, and the doctor will speak perfect English. Smartly, the doctor arranges the items on the blood panel before you visit him in the first place. No in-depth discussion of your health can begin before the doctor cannily takes your medical history via a very casual schmooze-sesh which plays out more like old friends catching up. You leave the office relaxed, understanding your health action-items.
Where do you think I'm going to go when I need serious treatment? The US medical system is a failure and an international joke.
I'd recommend doing some more reading on the health care system in India. I believe that it worked really well for the poster; my initial research seems to indicate that there's a huge difference between the health care you can get in urban areas of India and the health care you can get if you're poor and rural. It's easy to build a health care system that works for people with money.
The infant mortality rate in India was 38 per 1,000 in 2015. That's really not good.
Thanks for saying this is more friendly terms that I did.
What's also interesting, is that the US is likely a large net 'exporter' of medical tourism. I currently work with hospitals that are rapidly developing large businesses in medical tourism, because for all our needless systemic problems, people trust that, if you have the cash, you can find a good doctor.
yeah, yeah, yeah... when someone visit the US for tourism, they don't go to Alabama and Mississippi. They go to the big apple, las vegas and disney world.
When you are applying "Free market principles", you go to the place that maximizes your enjoyment/treatment per $$ spent.
Nowadays every doctor that is required by law(started in assam I think) to go to poor and rural areas and serve there for a minimum of one year. Things are getting way better than one thinks, there is a sense of socialistic way of doing things along with good old capitalism. Rural health missions are sponsored by the government and nurses and doctors are well paid(as per Indian standards).
My brother broke his leg horribly in Australia when he was 17. It was the worst break they'd ever seen at the hospital.
Ambulance ride, first surgery. Helicopter ride, second surgery, a month in hospital and third surgery and then another month or so in hospital to ween him off the morphine he had become addicted to, and to get walking again.
My own experience in Thailand is similar to the author's in India: see a doctor on short notice, prices quoted in advance, short wait time for surgery, prices low enough to pay out-of-pocket. The icing on the cake is how friendly and warm the medical care is. My biggest fear when I visit the US is that I will get sick or injured and be subject to that awful system. I lived in the US most of my life, had excellent insurance, and had routinely poor experiences with healthcare.
Your treatment in the US would have involved something like 5 doctors, $100,000 billing (probably not payments since those things are only vaguely related) and 2+ years of your time.
One thing I've never understood about the US system is why do the doctors charge more for paying cash e.g. $200 for a visit, whereas insurance reimburses them less than half e.g. $80. In everything else e.g. car repairs, the cash price is always lower than insurance covered price. Any ideas why this is so?
> In everything else e.g. car repairs, the cash price is always lower than insurance covered price
For starters, insurance smooths risk. It is not there to save you money. By definition, insurance will always cost more than than paying out-of-pocket in the long run[0]. Think of insurance as a luxury that mitigates (but does not eliminate!) the worst-case scenario for you. It costs more (a premium[1]) because this luxury has value to you.
The fact that this does not always apply to health insurance is a sign that health insurance isn't entirely (in the economic sense) insurance; we just happen to use that word.
> One thing I've never understood about the US system is why do the doctors charge more for paying cash e.g. $200 for a visit, whereas insurance reimburses them less than half e.g. $80.
In general, Medicare and Medicaid reimburse the least - the amount that they reimburse is actually less than COGS (not on all individual services, but in the aggregate, it amounts to 7% less)[2]. As a result, providers have to overcharge private insurers and uninsured patients in order to cover their own costs.
The price that you see on your bill is basically a starting point for negotiations. A company like Aetna will say "okay, there's no way we're paying that, but we will pay you 250% of what Medicare reimburses for the same procedure".
As an uninsured patient, you can do this as well if you know to ask. It's less of a practice for outpatient care, since that tends to cost less and also have more predictable costs associated with it, but for (e.g.) unexpectedly large bills for inpatient care, you can always just tell them "I will pay $X today in cash if you reduce the bill to that amount." They'll always be willing to do it, because they literally do not care about the money that they get from uninsured patients - the large bill is intended to be received by an insurance company, not by an individual.
[0] ie, on an infinite time horizon.
[1] The fact that your fixed monthly payment to an insurer is also called a premium is not a coincidence.
[2] To preempt the inevitable question: COGS refers to the direct costs of providing a service, so this is before even accounting for the fact that an outpatient office has to pay rent, pay its staff, etc.
So the doctors have a list price, which is then negotiated down. They set the list price high for the same reason many sophisticated goods are set at a high price (cars, houses, enterprise software, etc.).
However most, if not all, doctors will absolutely charge you less if you pay cash, you just have to ask for it and have the conversation.
This isn't universal. Several times I've gone to "urgent care" clinics for e.g. persistent illness without insurance, and my bill showed a 50% discount for paying cash. Perhaps if I had had the right insurance the effective discount would have been even higher, but it makes sense that cash is worth more to a provider than an insurance claim that might be disputed or delayed. This is kind of the "sweet spot" for cash, though. For more expensive procedures even a 50% discount wouldn't make it easy to pay cash. Anyway, it's clear that a portion of the high prices for care in USA are specifically for dealing with insurance companies, both for "negotiating room" and to compensate for the hours that must be spent every day dealing with insurance companies.
Insurance companies contract with providers and set reimbursement levels. An insurance company might go to a hospital and say "we'll pay 30% of your chargemaster rates". So when a patient has surgery that costs $50,000, the insurance company shells out $15,000.
If you don't have insurance, you just pay the chargemaster rate. Keep in mind this is negotiable.
I wish there was a site like NomadList, but for medical tourism. I'm up for going further afield for treatment, but the lack of information and good local knowledge makes it riskier than I'd like.
Cant really speak about orthopedic issues but have had some experience when my partner had cosmetic surgery abroad. Cosmetic surgery makes up a significant chunk of treatments and is much more of art than science. There is no way I would ever risk having surgery anywhere before i knowing all the facts.
My partner had a face and neck lift from a "reputable" doctor in Los angeles and honestly looks worse afterward than he did before. About 5 years he became painfully aware that he needed it done again so he went to a well-regarded surgeon in Bangkok that really improved his appearance and cost about half as much. http://www.thaimedicalvacation.com
One interesting thing about her experience was that he was told by the doctor in Thailand that he would not be able to offer a surgical facelift since he already had one 5 years earlier. It was very interesting to see doctors saying no rather than risking poor results with multiple surgeries. A person like Joan Rivers is a good example of what can happen when you have way too many surgeries.
Overall though my opinion is that for rare or esoteric conditions, there is no place on earth better than the US. However for common elective or nonelective surgeries, going abroad may not be a bad idea.
Nice piece, although it's a bit misleading to call this "medical tourism" as the author was living in India at the time. Not that it discounts his experience but I'm sure his local connections and familiarity made it easier than it would be for the average American coming it from abroad.
Having traveled a lot for work, I've had the good fortune to have received care in South Africa, dental work in Serbia and a number of regular treatments in Mexico. I'm a born and raised US citizen though I also have an EU passport. Any day of the week I'll sit on a plane for a few hours and pay less for much better care in another country. Healthcare is a racket here.
Better believe when retirement comes I'm nowhere near the USA.
Discussion of cost-effective alternatives is almost pointless now that we have the ACA, which is effectively a transfer of wealth from individuals to insurance companies for the sole privilege of breathing.
[+] [-] clamprecht|10 years ago|reply
https://twitter.com/paultoo/status/566379518261088258
The tweet: "I want to fund the 'Uber' of medical tourism Needs 5 star service, simplicity and safety Let me know if you apply - http://www.ycombinator.com/apply/"
It really has to happen. Health care in the US is just fucked, and everyone knows it.
[+] [-] endymi0n|10 years ago|reply
Then again, our friends at Medigo seem to do great service in this direction so far and have just raised a series A ( https://www.crunchbase.com/organization/medigo#/entity ), the competition seems to be heating up in this space and honestly, I can't think of anything to truly "disrupt" this industry, as the margins are pretty well known, the market is reasonably mature and the order volume is very low.
[+] [-] ThomPete|10 years ago|reply
http://blog.jayparkinsonmd.com/post/134547527433/why-theres-...
[+] [-] drumdance|10 years ago|reply
[+] [-] jasonlotito|10 years ago|reply
And yet people still move here for the "fucked" health care because it's cheaper, better, and available unlike other countries held in high regard, such as Canada. I am one such person who was lucky enough to be able to do that, and would never return to Canada after the abusive treatment handed out by the health care "professionals."
[+] [-] mariannaa|10 years ago|reply
Tell us what you think!
[+] [-] solutionyogi|10 years ago|reply
Chris's experience is representative of what one can expect from the Indian health care system. If you are a working, middle class person, the free market health care works extremely well.
[+] [-] itg|10 years ago|reply
Here's another example: https://www.washingtonpost.com/business/economy/new-machine-...
"Anesthesiologists tried to stop Sedasys.
They lobbied against it for years, arguing no machine could possibly replicate their skills or handle an emergency if something went wrong. Putting someone to sleep is an art, they said. Too little sedation, and the patient feels pain. Too much, and the patient dies. Anesthesiology requires four years of training after medical school, meaning careers might not launch until the doctors are in their 30s. It’s one reason the profession’s median salary is $277,000 a year, according to research firm Payscale."
[+] [-] Vivtek|10 years ago|reply
Yeah, lady, that includes not giving you all our money without asking how much you'll be taking.
[+] [-] pc86|10 years ago|reply
It's a broken system and there's no excuse for it, but at least in the US it is not because they're being intentionally obtuse.
[+] [-] crusso|10 years ago|reply
Rather than a one-size-fits-all approach to healthcare through single payer or other subsidies, my fondest wish for government intervention would be for laws that force doctors and hospitals to provide price and likely outcome information to the general public. Give healthcare consumers the data they need to make informed decisions and the ensuing competition could drive down prices while improving outcomes.
[+] [-] lbhnact|10 years ago|reply
You can. Routine, profitable procedures are not hard to arrange in the US. I have personally worked in a clinic where the exact experience described in this post happens every day.
>If you are a working, middle class person, the free market health care works extremely well.
It's pretty easy in most places in the world to get people to do something that makes them money, like the discectomy discussed here.
Managing a system where the poor and the unlucky get care is a little tougher. The US does it lousily, but so does most of the rest of the world. India doesn't do it at all.
edit:copy error
[+] [-] atom-morgan|10 years ago|reply
[+] [-] vadym909|10 years ago|reply
[+] [-] xixi77|10 years ago|reply
[+] [-] s73v3r|10 years ago|reply
And if you're not?
[+] [-] JamesBarney|10 years ago|reply
A $112,000 error happens in the U.S. but is rare. Typically the type of surgery he mentions costs between $20,000-$50,000. Or 50-100% of a the U.S. gdp per capita. This is smaller than in India where the cost of his surgery was 130% of the Indian gdp per capita.
And the issues with rounding errors has to do with the large amount of health insurance in the U.S. not necessarily free market vs. regulation. When the majority of consumption in a market is driven by enterprise customers, the pricing can become strange and very unfriendly to individuals.
[0]https://pricinghealthcare.com/prices/IowaCityASC/spine-back [1]http://www.backsurgerycost.com/how-much-does-a-discectomy-co...
[+] [-] akg_67|10 years ago|reply
Just a couple of anecdotal personal recent experiences with US healthcare.
1. Recently I witnessed the trouble my primary care physician (PCP) had to go through with insurance company to get approval to perform CT scan. I couldn't believe the 30 minutes, my PCP had to spend on the phone with the United Healthcare person. This is the doctor spending time on the phone explaining all the medical reasons for recommending CT scan and not some administrative person in doctor's office.
This is in contrast to a friend's experience whose PCP kept prescribing pain killers and other prescriptions instead of pushing insurance company for further tests for abdominal pain. The friend later was diagnosed with stage 4 cancer when showed up at ER with same symptoms.
2. While researching a local major hospital rated highly for quality of surgery, I came across the reports of quite a few cancer patients complaining about hospital quickly discharging patients after major surgery and restricting pain medication while in hospital. The claims don't make sense as hospital is rated so highly for Quality of Surgery and might be considered anecdotal. Until I found that two of the measuring criteria for Quality of Surgery was how long a patient stayed in hospital after surgery and dosage and duration of pain medication administered after the surgery. Talk about incentive misalignment. There is all the incentive for surgeon and hospital administration to discharge you quickly to maintain and improve Quality of Surgery rating.
[+] [-] davidw|10 years ago|reply
It's more bureaucratic than Italy, costs more, isn't appreciably better, and wastes people's time more.
What's more, even though Italy has a single payer system, there is also private care available that is quick, cheap and efficient - which it has to be, since the competition is "free" (tax funded).
The US has neither a free market, nor a good government provisioned system, but some mess that's neither fish nor fowl.
[+] [-] staringispolite|10 years ago|reply
We talk to people all the time who don't have insurance (20-30M last time I checked), don't have dental insurance (~150M), or whose insurance comes with coverage caps as low as $1K-$2K that render insurance effectively useless for them in large operations. Most of the time, customers we talk to actually don't even get as far as the author did, because they can't afford the estimate, let alone the risk of over-shooting it. They just avoid getting treatment (and often get worse in the meantime).
The trick then is how to find a doctor you can both afford AND trust. If you'll excuse the plug, we started Emissary to solve that when a friend's mother had this problem. Our mission is to help connect people to high-quality options they can afford, regardless of where they live in the world.
[+] [-] mindslight|10 years ago|reply
Erm, health insurance companies are essentially the opposite of a free market. They're as close you can get to government run without actually being called "government". With USG's recent push to make patronizing these behemoths mandatory, even the last little sliver of "exit" has been lost.
[+] [-] clamprecht|10 years ago|reply
[+] [-] jkot|10 years ago|reply
This was going on for several months.. Eventually we visited doctor in Athens, the whole thing was diagnosed and solved in weeks. Solution was $2 pill and routine surgery.
I really recommend to anyone with some 'mysterious' health issues to visit REAL doctors.
[+] [-] Dove|10 years ago|reply
There are urgent care centers that are the less-crazy version of ERs, and a lot of primary care stuff can be done self pay. While I have access to insurance through my work, I vastly prefer the quality of the self pay system. You do need to do some research in advance, but there are some pretty cool innovations out there, and services you just can't get via the insurance system.
http://theselfpaypatient.com/ is a good resource.
[+] [-] chiph|10 years ago|reply
http://www.kvue.com/story/news/investigations/defenders/2015...
[+] [-] hvmonk|10 years ago|reply
For a simple chest pain, doctors here would tell you 145566 possible scenarios that may happen with your body, and wouldn't confirm any unless he sees a lab test. And then, a tide of lab tests would start, which will cripple you financially, and emotionally because all you are thinking is which test would be +ve, which -ve; diving on internet where people usually blog about their -ve experiences. Usually, it could be just a muscular pain, etc, which become so irrelevant as you are undergoing all these lab exams.
I don't want to blame the doctors here as such, because that's how they are trained here. I guess it boils down to this robust "suing infrastructure" here, that if you missed out a rare symptom with a patient, he will sue you and finish your career.
One thing which I couldn't understand is why in a developed country, lab tests are so expensive. An Xray, costs about $100; similar thing costs about Rs 80 (equivalent to $1.25). Shouldn't they be cheaper here, given there are gizmos for everything, and all electronics items are much cheaper here than India. I think these costs are all artificial.
I think a mix of both approaches (insurance + free market) would better.
[+] [-] cryoshon|10 years ago|reply
Out of pocket price of standard blood panel lab in the USA with a follow up phone call if something is wrong, with insurance: $1500. There is no ability to estimate even vaguely what the price will be beforehand, and the bill may take a month to arrive in the mail. Your insurance agency will fight you at every turn for all but the most mundane routine procedures. There will be a billing error somewhere, and it will be to your detriment. They may refer you to collections if you do not pay the incorrect amount while disputing the charges, as happened to my girlfriend. Face time with the doctor is probably minimal, and you will be stressed by the doctor's attempts to hurry you out the door and probably forget to ask important questions.
Out of pocket price of extended blood panel lab plus two hours of doctor face to face analysis without insurance in Argentina: $50 USD, and the doctor will speak perfect English. Smartly, the doctor arranges the items on the blood panel before you visit him in the first place. No in-depth discussion of your health can begin before the doctor cannily takes your medical history via a very casual schmooze-sesh which plays out more like old friends catching up. You leave the office relaxed, understanding your health action-items.
Where do you think I'm going to go when I need serious treatment? The US medical system is a failure and an international joke.
[+] [-] SimpleXYZ|10 years ago|reply
[+] [-] BryantD|10 years ago|reply
The infant mortality rate in India was 38 per 1,000 in 2015. That's really not good.
[+] [-] train_robber|10 years ago|reply
Infant mortality in Kerala is 6.7 (6.2 in US), life expectancy at birth is 76 (78.7 in US).
Per-capita income in Kerala is $2,271 ($53,000 in US)
So yes, you can provide good healthcare even with not a lot of money floating around.
References: https://en.wikipedia.org/wiki/Kerala_model
[+] [-] lbhnact|10 years ago|reply
What's also interesting, is that the US is likely a large net 'exporter' of medical tourism. I currently work with hospitals that are rapidly developing large businesses in medical tourism, because for all our needless systemic problems, people trust that, if you have the cash, you can find a good doctor.
[+] [-] FraaJad|10 years ago|reply
When you are applying "Free market principles", you go to the place that maximizes your enjoyment/treatment per $$ spent.
[+] [-] largote|10 years ago|reply
[+] [-] aesoprock|10 years ago|reply
[+] [-] grecy|10 years ago|reply
Ambulance ride, first surgery. Helicopter ride, second surgery, a month in hospital and third surgery and then another month or so in hospital to ween him off the morphine he had become addicted to, and to get walking again.
Of course, there was never a bill.
[+] [-] geomark|10 years ago|reply
[+] [-] anilgulecha|10 years ago|reply
The more you think about it, the more crazy it seems on multiple levels.
Edit, typed < instead of >.
[+] [-] kra34|10 years ago|reply
[+] [-] tahoeskibum|10 years ago|reply
[+] [-] chimeracoder|10 years ago|reply
For starters, insurance smooths risk. It is not there to save you money. By definition, insurance will always cost more than than paying out-of-pocket in the long run[0]. Think of insurance as a luxury that mitigates (but does not eliminate!) the worst-case scenario for you. It costs more (a premium[1]) because this luxury has value to you.
The fact that this does not always apply to health insurance is a sign that health insurance isn't entirely (in the economic sense) insurance; we just happen to use that word.
> One thing I've never understood about the US system is why do the doctors charge more for paying cash e.g. $200 for a visit, whereas insurance reimburses them less than half e.g. $80.
In general, Medicare and Medicaid reimburse the least - the amount that they reimburse is actually less than COGS (not on all individual services, but in the aggregate, it amounts to 7% less)[2]. As a result, providers have to overcharge private insurers and uninsured patients in order to cover their own costs.
The price that you see on your bill is basically a starting point for negotiations. A company like Aetna will say "okay, there's no way we're paying that, but we will pay you 250% of what Medicare reimburses for the same procedure".
As an uninsured patient, you can do this as well if you know to ask. It's less of a practice for outpatient care, since that tends to cost less and also have more predictable costs associated with it, but for (e.g.) unexpectedly large bills for inpatient care, you can always just tell them "I will pay $X today in cash if you reduce the bill to that amount." They'll always be willing to do it, because they literally do not care about the money that they get from uninsured patients - the large bill is intended to be received by an insurance company, not by an individual.
[0] ie, on an infinite time horizon.
[1] The fact that your fixed monthly payment to an insurer is also called a premium is not a coincidence.
[2] To preempt the inevitable question: COGS refers to the direct costs of providing a service, so this is before even accounting for the fact that an outpatient office has to pay rent, pay its staff, etc.
[+] [-] mattzito|10 years ago|reply
However most, if not all, doctors will absolutely charge you less if you pay cash, you just have to ask for it and have the conversation.
[+] [-] jessaustin|10 years ago|reply
[+] [-] refurb|10 years ago|reply
If you don't have insurance, you just pay the chargemaster rate. Keep in mind this is negotiable.
[+] [-] harryh|10 years ago|reply
[+] [-] MistahKoala|10 years ago|reply
[+] [-] veritas213|10 years ago|reply
One interesting thing about her experience was that he was told by the doctor in Thailand that he would not be able to offer a surgical facelift since he already had one 5 years earlier. It was very interesting to see doctors saying no rather than risking poor results with multiple surgeries. A person like Joan Rivers is a good example of what can happen when you have way too many surgeries.
Overall though my opinion is that for rare or esoteric conditions, there is no place on earth better than the US. However for common elective or nonelective surgeries, going abroad may not be a bad idea.
[+] [-] pimlottc|10 years ago|reply
[+] [-] xacaxulu|10 years ago|reply
[+] [-] bambax|10 years ago|reply
I would very strongly recommend reading that book (which will set you back a whopping $10) before undergoing any back surgery.
(I'm not a doctor, this is not medical advice, YMMV and all that. Still. If you suffer from chronic back pain, or carpal syndrome, read the book.)
[+] [-] squozzer|10 years ago|reply
Oops, forgot at include dying also.