My adventures in medical tourism • Hacker News Board

Re: My adventures in medical tourism

#41

Post by cryoshon » Mon, Dec 14, 2015, 4:38 PM UTC

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.

Re: My adventures in medical tourism

#42

Post by vinceguidry » Mon, Dec 14, 2015, 4:38 PM UTC

anilgulecha wrote: post #11

My wife is a Dentist in Bangalore, India, and it's amazing what I hear. Basically Cost(Flight to india + treatment cost) The more you think about it, the more crazy it seems on multiple levels. Edit, typed .

I went to get dental work done in Medellin, Colombia. Two whitening treatments, perhaps a dozen fillings. My Atlanta dentist wanted to do an inlay on one of my teeth. I'd already had two done that year and just couldn't afford to have them keep working on my teeth.

When I got to Medellin, my dentist did not want to do the inlay, said it was too invasive and that he would rather fill it.

It cost less to fly to Medellin, get all my work knocked out, than it would have for just the one inlay. And I absolutely believe that my Colombian dentist, who spoke English quite well, did better work than the Atlanta guy did. My teeth look better than they have in years.

I will never again have significant medical procedures done in the US.

Re: My adventures in medical tourism

#43

Post by jasonlotito » Mon, Dec 14, 2015, 4:39 PM UTC

clamprecht wrote: post #26

I should mention that Paul Buchheit wants to fund the Uber of medical tourism: 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.

> 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."

Re: My adventures in medical tourism

#44

Post by secabeen » Mon, Dec 14, 2015, 4:40 PM UTC

harryh wrote: post #27

chvid wrote: post #22

Earlier quoted context omitted.

But not for car repairs?

I guess not. Which does seem a little weird now that I think about it. Not sure why cars would be different.

Because the law allows you to go to any mechanic to get your car fixed, and they can't negotiate with every mechanic in the market. Most auto insurers have "approved" repair shops, and if you go to one of those, the rates can be cheaper than cash.

Re: My adventures in medical tourism

#45

Post by lifty » Mon, Dec 14, 2015, 4:44 PM UTC

throwaway7767 wrote: post #37

lifty wrote: post #16

Earlier quoted context omitted.

This is similar to how the Dutch system works. You normally go to your GP which will refer you to a specialist if required. The problem is that they always want to try a simple treatment first, without investigating thoroughly the causes of the illness. That means that you get sent home with paracetamol and only if you go the 2nd or 3rd time to the GP will you get sent to the specialist. My friend developed a type of…

This bugs me a lot, as I don't seek medical attention unless I damn well need it. The GPs will just tell you to take it easy, eat some paracetamol and come back in 2-3 weeks if it's still an issue. I understand the desire to not spend resources on hypochondriacs, but the last time I heard that from my doctor I ended up being admitted to the intensive care unit at the hospital the next day with meningitis. According t…

Yes, I've heard similar stories from various people. I guess you have to be very insistent and convincing to your GP when you feel ill, or else you risk delaying a proper diagnostic.

On the bright side, the Dutch hospitals have a great track record at low multi-resistant bacteria, which are more common in other countries. One of the reasons for this might be their stricter rules of admitting people in the hospitals.

Re: My adventures in medical tourism

#46

Post by crusso » Mon, Dec 14, 2015, 4:44 PM UTC

solutionyogi wrote: post #2

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.

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.

Re: My adventures in medical tourism

#47

Post by ashark » Mon, Dec 14, 2015, 4:45 PM UTC

jasonlotito wrote: post #43

clamprecht wrote: post #26

I should mention that Paul Buchheit wants to fund the Uber of medical tourism: 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.

> 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."

So I suppose there's a serious movement to reform their healthcare system to be more like ours? Maybe also in all the other universal healthcare-having countries with advanced economies (so, the entire rest of the OECD states, more or less)?

Re: My adventures in medical tourism

#48

Post by HarryHirsch » Mon, Dec 14, 2015, 4:48 PM UTC

Symmetry wrote: post #40

itg wrote: post #4

Earlier quoted context omitted.

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. 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…

Other notable problems with our medical system would be the RBRVS[1] and Nixon's scheme to limit hospital competition[2]. [1] https://en.wikipedia.org/wiki/Resource-based_relative_value_... [2] https://en.wikipedia.org/wiki/Certificate_of_need

Other people would think that fixed reimbursement rates are a feature - it's what they do in my country to hold down costs, and it works well. You can ask to be paid beyond published rates, but you better have a good case when you present the bill to the insurance company.

As far as overbuilding hospitals goes, you'd think that physicians and administrators will try to fill those beds at any cost, cost that is billed to patients and the taxpayer. Hospital overcapacity is not like airline overcapacity.

Re: My adventures in medical tourism

#49

Post by pimlottc » Mon, Dec 14, 2015, 4:51 PM UTC

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.

Re: My adventures in medical tourism

#50

Post by r00fus » Mon, Dec 14, 2015, 4:55 PM UTC

pc86 wrote: post #7

solutionyogi wrote: post #2

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.

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 i…

I went through this a few years back trying to get enough FSA to cover my portion of my daughter's long awaited eye operation. It was insane that I couldn't even be given an exact figure for my portion of the bill to plan for FSA - it's like it's all negotiated at time of operation or after the fact.

Now some of that is that if a complication occurs, there will be additional cost, but I was just asking for a baseline, and all they could give me were guesses.