Live data from Hacker News

My adventures in medical tourism

chrisstucchio.com

181–190 of 202 posts

Re: My adventures in medical tourism

#181

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 Ind…

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.

Re: My adventures in medical tourism

#182
post #4

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…

$277K/yr doesn't sound too bad, compared to lawyers and finance folks and business VPs. That's not why healthcare costs so much. Even if you booked 1 anesthesiologist for a whole day long massively intensive surgery, that's only about $2k of your cost

Re: My adventures in medical tourism

#183
post #4

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…

This comment is not only factually wrong (It's not the AMA) but misleading as well. The typical medical student today leaves med school $250k in debt at 8% interest then spends years in a residency where they make $50-60k working 80+ hours per week in a likely high cost of living area. If they started schooling immediately after high school they probably won't actually make that 270k (median, so many starting out are lower) until they're 30+ years old.

Contrast that to a completely mediocre web dev who can pull 100k+ at 21 putting in 40-50 hours a week and do you really still think physicians are overpaid? Keep in mind the majority end up in family or internal medicine working 60+ hours a week for ~$175k/yr. Going to medical school is a massive financial risk with an incredibly uncertain future.

If you want a human punching bag then turn your gaze towards hospital administrators, pharmaceutical executives, and exploitative vendors. The actual hospital employees are just as much victims of the healthcare shit show as members of the public are.

Re: My adventures in medical tourism

#184
post #147

Earlier quoted context omitted.

I would like to hear more about how discharging patient early and moderating pain medication is a sign of quality care? The author of original article mentioned staying in Indian hospital for 4 nights. Do you think a US hospital will keep you 4 nights for same surgery? I seriously doubt it. You most probably will be released few hours after the surgery or at most after overnight stay. Is the quality of care becomes l…

You can argue all you want about whether it's a good metric for surgery quality or not, but if you're being discharged soon after surgery, the idea is that your surgery went well enough that you don't need to be around $50mil worth of life-saving equipment 24/7. It has a valid place in the system, with pros and cons like any other metric. Hospitals are full of all kinds of hard-to-kill microorganisms. They really are…

Patient education is the only issue here, but most of the public has no desire to know anything about their care. They want a magic pill they can pop which will make it all better and they want to sit in a hospital as long as they feel like. This is because they aren't cognizant of the cost associated with them sitting around like a fool soaking up thousands of dollars in resources per day when they could be sitting at home healing instead.

One of the biggest flaws with the American health care system and single payer as well is that it's removed the cost component from peoples considerations of what care they should receive. We all pay for this idiocy in the form of our skyrocketing insurance premiums. Do you really think people would want to sit in a hospital if they actually had to pay the nursing staff $1000 per day out of pocket? If they had to pay the janitor $20 for coming into the room to clean up the mess they'd made? $200 for the physician followup? Of course not.

The above poster complaining about withholding opiates and statistically backed discharge time frames is a huge part of what's wrong with health care across the developed world- not just the US.

Re: My adventures in medical tourism

#185

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 Ind…

My home state of Kerala has one of the best health care systems in India.

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

Re: My adventures in medical tourism

#186
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.

Re: My adventures in medical tourism

#187

Earlier quoted context omitted.

Good to see you on the other side of this. Any surgery is risky and if your troubles are gone that's fantastic news. Are you still in touch with the people there for check-ups or is it done for good?

I hope it's done for good, but being 6'6" means that there is always risk of further injury. No point in a checkup - no pain = no problem. I'm not deadlifting anymore, however.

FWIW deadlifting definitely helped, not hurt, after my back injury.

(Admittedly, I hurt it deadlifting with poor form, but fixing the form and strengthening my back with it was the single biggest contributor to getting better.) MMV, of course.

Re: My adventures in medical tourism

#188
This post is unrealistic in medicine, and really only works for less serious/elective care issues, not primary medicine, or where doctor and location choice actually matters.

As a starter: I'm woman with an extremely strong family history of breast cancer before age 50. Standard clinical guidelines is to start doing heavy monitoring 5-10 years before the youngest person in the family tree was affected, since usually cases get progressively younger start dates. Since one of the people was around age 32, I'm under the age of 30 and I go for mammograms, ultrasounds, and MRIs every year as if I were a cancer patient already.

Mammograms, ultrasounds, CAT Scans, MRIs, (any form of medical imaging radiography) are actually a perfect example of how the market internationally could be more efficient, but it turns out that's impossible. At its core we're basically talking about photographs, something facebook manages to serve from location a to person b that is nowhere near location a every day. Why couldn't I go to any imaging place in the US, and have my images sent to the lowest cost provider somewhere in india to be read and interpreted by a radiologist, and then have the results sent back to me. Unlike Chris, I don't even have to meet my doctor, all I have to do is send him images.

It turns out that medically this is blatantly difficult if not impossible to do. The reasons are 2 fold

1) It turns out that age and variations in how and why the machines that used, as well as technician speciality, matters a ton in image quality.

http://www.kevinmd.com/blog/2010/09/mri-places-good-quality-...

As a patient, I have no idea if the price I am being quoted is reflected of image quality or price inflation (and this is before being read)

2)Quality of the radiology report is highly dependent on the MD reading the images. This has been well studied since the early 2000s (one of the latest examples being here: http://www.ncbi.nlm.nih.gov/pubmed/23737538 ) At under the age of 50 with dense breasts, I'm significantly more likely to have imaging misread if I went into a community imaging location, even if they had top notch equipment, because the radiologists do not have enough volume of high risk cases to make sure I am not falling into false positives/recall on a regular basis - which would mean even more imaging costs.

In order to effectively export my images, I would have to find a way to duplicate part of the specialized cancer wing I go to. Cost savings actually would be minimal - I'd be running more tests, seeing more doctors, and probably have a delayed diagnosis if/when my expected inevitable happens (which means more expensive drugs, longer treatment times, ect)

And while my example is specific to me, many people have similar sorts of conditions where treatment location, equipment used, and people involved have higher initial costs but lower lifetime costs for all sorts of conditions. Pretty much any semi-serious disease falls into this category.

I'm game for better ways of paying (insurance does cover this, because as I said, lower lifetime costs to them by paying for preventive care). I experiment with things like telemedicine - I use a compounding pharmacy and Specialized RN over the internet to manage acne that refuses to go away. I'd totally go to the Caribbean for teeth whitening or LASIK.

None of these things need regular, serious followup, or run risks of painful drawn out deaths/longer painful medical care with much higher costs if done very incorrectly on a regular basis.

Medical tourism isn't the answer - understanding what these services are in relationship to risk is.

Re: My adventures in medical tourism

#189
post #170
post #117

Earlier quoted context omitted.

I wrote about this last year on my blog. It would be cheaper to fly to Colombia and spend 7 days there while having a mole removed, than to have it removed in Chicago, with an ACA health insurance plan. The round-trip flight to Colombia alone, excluding any actual care or other expenses, was the same price as having an American dermatologist spend 30 seconds taking the initial biopsy. https://alexcabal.com/today-i-ha…

Great article. I'm fully in agreement with your analysis and am a huge proponent of free markets solving health care in the US. One striking area you can see the difference in the US is in elective surgeries -- for example cosmetic surgeries and Lasik surgeries. Insurance doesn't cover elective, so the providers take cash only (or credit/payments). Providers often have the fanciest and newest equipment with clean mod…

Perhaps you got the wrong takeaway from my post--I think free markets are the bane of life-or-death products like health care, and free markets are in part why America is in the health care mess it's in today.

When you're dying on the side of the road, you'll pay anything to get better--and a free market will take everything, ruthlessly and without pity. That's what's happening to us, right now, today. If my mole had been cancerous, a doctor could have demanded any price to remove it, and I would have paid it, because the alternative is death. If my mole had instead been a time-sensitive situation, I wouldn't even have time to shop around, and I'd have to accept any price my doctor quotes--or chance death. The ability to shop around is typically at the crux of free-market health care arguments but shopping around isn't possible in life-or-death situations like health care.

Literally every other country in the world understands this, and that's why health care is rightly socialized in every single other country on earth except America.

Re: My adventures in medical tourism

#190

Earlier quoted context omitted.

That's fairly similar to what the Spanish government does for its fishing fleet. Mercy Ships operate hospital ships, but as a charitable cause. It's something I've sometimes wondered about before.

I didn't even know about Mercy ships, seems like a for profit one wouldn't be too far fetched then.

I don't see why not - but then, IANAL and I don't know what legal considerations there might be for something so unusual like this. From a technical point of view, it seems realistic, assuming operational/logistical factors can be overcome (it would almost certainly have to be in transit whilst in operation, rather than stationary).
Post reply on HN