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My adventures in medical tourism

chrisstucchio.com

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Re: My adventures in medical tourism

#61

Post by tzs »

CapitalistCartr wrote: post #25
lbhnact wrote: post #14

Earlier quoted context omitted.

Imagine how much a hassle car repairs would be if cars were a staggeringly complex biological system where parts could not be replaced figuring out what was wrong was difficult and all work had to be done in while it was driving down the road and it was really easy for you to die if a mistake was made and other people had to pay for it.

If that is the reason, why do many countries, such as India in the article, have systems that work efficiently and simply?

India's system works efficiently and simply for those who can afford it, which is a minority of the Indian population. For the ~70% of Indians in rural areas, and especially the ~50% who are living in poverty, they often have little access to health care. What they do have access to is often substandard.

Re: My adventures in medical tourism

#62

Post by chimeracoder »

hvmonk wrote: post #57

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 financiall…

> 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).

Many lab tests - though not all - are effectively commoditized. There is little difference in quality, and the requisite supplies are widely available at low costs. X-rays have been used for medical purposes for literally over 100 years, and it's not very difficult to train someone to take an x-ray properly using modern equipment. (Actually interpreting the results of a test is a different matter).

For tests which fall under these categories, it will always be more expensive to obtain them in the US than in India, because the cost-of-living in the US is much higher, and paying people to actually perform the tests dominates the costs of the test itself.

There's a little more to it than that, but that's the general idea.

Re: My adventures in medical tourism

#63

Post by mikecsh »

jasonlotito wrote: post #56
mikecsh wrote: post #53

Earlier quoted context omitted.

Have a read of this - the Commonwealth Fund rankings of wealthy country's health care systems, published last July: http://www.commonwealthfund.org/publications/fund-reports/20... Just to add some colour: Quality: U.S. fares best on provision and receipt of preventive and patient-centered care. While there has been some improvement in recent years, lower scores on safe and coordinated care pull the overall U.S. quali…

What does this have to do with my experience with Canada's health care system? I'm merely stating the facts of what my family had to go through and experienced with Canada's lack of mental health care support for my children, and the results. Edit: Because you decided to edit your comment. Here are some other numbers for you. -14 days vs 2+ years: US wait time vs Canada wait time to get help for my autistic son. We h…

Im sorry to hear that you had bad experiences in Canada. However your personal story is effectively one data point and not necessarily representative of a good comparison between healthcare systems. This analysis is a pretty good overall analysis of the quality, efficacy and safety of different healthcare systems. That’s not to say that just because the US is worse overall that it doesn’t perform better in a subset of medicine, in your case, mental health. But no matter what your own personal situation, you have effectively moved from a bad system to a worse system (even though it has been good for your family personally).

The original posts point which you quoted is that the US health system is Fd and everyone knows it. The analysis presented here supports that. The US spends a lot more per capita on healthcare with worse outcomes and less people having access to healthcare. I’m very glad your move has has worked out for you.

(UK Medical Student)

Re: My adventures in medical tourism

#64

Post by vinceguidry »

luciusism wrote: post #54
vinceguidry wrote: post #42

Earlier quoted context omitted.

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 Medelli…

Would you be willing to disclose the place you went?

Of course!

This guy:

http://medellindentist.simpl.com/index.html

Re: My adventures in medical tourism

#65

Post by pc86 »

r00fus wrote: post #50
pc86 wrote: post #7

Earlier quoted context omitted.

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…

Disclaimer: It has been many years since I was involved in this professionally, pre-ACA. It may have changed since then.

Depending on the arrangement with the insurer, and what the recovery period was like for that type of operation, nobody in the office probably had any idea (and I bet their guesses were pretty far apart, too). Some medication used in recovery is very expensive and can add five-figure variances if someone doesn't respond well to the procedure or is in an abnormal amount of pain. And as you mentioned any complications can double the cost in an instant.

From the insurer side, they will decide after they receive the care provider's bill what they're covering and for how much. They may decide she only need five hydrocodone, not eight, so there's (3 * $n) out of your pocket (I am not googling the cost of hydrocodone at work :)). What's more is this "justification" is rarely given to the care providers. The insurer is billed $50,000, they pay $47,000 and that's that. The cynic in me wants to say it's so they don't actually have to justify partial payment, but who knows.

Re: My adventures in medical tourism

#66

Post by ashark »

jasonlotito wrote: post #51
ashark wrote: post #47

Earlier quoted context omitted.

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)?

There is a push to reform the way they handle long term care in Canada, but it's not something people think about until it happens to them. Mental health care is generally like that. Do some reading on the lack of autistic services up in Canada and the efforts people are trying to go through to improve the lack of support up there. The services are severely lacking. I had to deal with it in 2010-11, and it's only got…

Is it a problem that's more pronounced in some provinces than others? My understanding was that there's a nationwide mandate to provide universal insurance, but that the details are left to the provinces.

As for mental healthcare in particular: thanks for the insight, I know very little about how that works in other countries. Seems like an area with room for improvement just about everywhere, unfortunately. I'll definitely keep that kind of thing in mind when reading on related topics in the future.

Re: My adventures in medical tourism

#67

Post by chimeracoder »

itg wrote: post #4
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.

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…

> 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.

The AMA is a common scapegoat, except that the AMA has literally nothing to do with the number of of doctors supply-side.

You're probably thinking of the AAMC, which has nothing to do with the AMA, and is responsible for the number of medical students who graduate each year from the US. Except the AAMC has very deliberately and openly increased the number of medical student slots each year for over a decade, specifically with this goal in mind.

But even this is a moot point, because the number of people gradating with MDs is not the bottleneck - the problem is that doctors can't practice medicine until they complete a residency program. We graduate more medical students every year than we have residency slots available, so increasing the number of graduates even further will have no effect.

Increasing the number of residency slots is up to Medicare, because Medicare funds residency programs nationwide.

Re: My adventures in medical tourism

#68

Post by blakeyrat »

chvid wrote: post #22
harryh wrote: post #19

Earlier quoted context omitted.

Insurers negotiate a volume discount.

But not for car repairs?

I don't know about your auto insurance company, but mine has "preferred shops" and I presume the reason they are preferred is because they have negotiated some form of discount.

Re: My adventures in medical tourism

#69

Post by JamesBarney »

chimeracoder wrote: post #29
tahoeskibum wrote: post #17

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 lu…

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.

I don't understand how doctors paying less to medicare/medicaid causes them to have to overcharge other customers. If they are not making money on Medicare or Medicaid patients it's my understanding they aren't forced to see them.

Re: My adventures in medical tourism

#70

Post by mattzito »

chimeracoder wrote: post #60
mattzito wrote: post #28

Earlier quoted context omitted.

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.

> They set the list price high for the same reason many sophisticated goods are set at a high price (cars, houses, enterprise software, etc.). Everything else in your comment is true, but this line is not. Healthcare is expensive, just like cars, houses, and enterprise software, but the reason that healthcare prices are high is very specific to healthcare (there aren't any other industries that have similar models).

I just meant it's yet another model where people set prices high because they want room to negotiate down. If a test was priced at $500, and insurance was willing to pay $800 for it, they've left money on the table. Far better to price it at $1500, and let insurers reimburse for $800.
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