For Medical Tourists, Simple Math • Hacker News Board

Re: For Medical Tourists, Simple Math

#21

Post by falk » Sat, Aug 03, 2013, 9:41 PM UTC

gojomo wrote: post #16

cpursley wrote: post #5

Who's interesting in doing a healthcare tourism startup? Especially if you know the medical system well. Serious. Hit me up. My wife has gone to Russia twice for dental work (her home country). Was a fraction of the quotes here, including airfare.

It's a good idea... and also already a big thing. Look at all the AdWords for [dental vacation] and similar searches. Amish groups taking train rides to Mexico for dental work paid in cash is also apparently a thing. It could be much bigger, across more procedures... but often people needing care are, by virtue of both age and their current medical worries (and past experiences with bad providers), less adventurous.…

"A big breakthrough would be if Congress, as a cost-saving measure, allowed Medicare payments for out-of-country treatment."

If Congress cared about saving money when it comes to Medicare they wouldn't have passed Medicare Part D, which by design doesn't allow for the negotiation of lower drug prices with pharmaceutical companies like the Department of Vererans Affairs is allowed to do. The fact of the matter is that a lot of palms are getting greased in Washington when it comes to healthcare. Thus why Obamacare doesn't have a public option.

http://en.wikipedia.org/wiki/Medicare_Part_D

Re: For Medical Tourists, Simple Math

#22

Post by Nrsolis » Sat, Aug 03, 2013, 9:43 PM UTC

EGreg wrote: post #12

VonGuard wrote: post #8

Earlier quoted context omitted.

Most of the difference here is that our hospitals have to fob off the money they lose from treating patients without health care onto those that do. They charge a lot more because every 5th or 6th person coming into the emergency room has no health care, must be given treatment, and will never be able to pay for it. Thus, we all take on that burden through a backdoor, round the corner, through the mailslot, rather th…

That doesn't really explain how the healthcare can cost 5x or more. What you've said is that every 5th or 6th person is a free rider (presumably due to laws such as the COBRA http://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Rec... ) ... if that was the source of the added costs, it would suggest they would only be 1.2 or 1.5x higher, not 5x or more.

The #1 reason healthcare costs more is because of over-treatment. When providers are paid by the procedure, suddenly everyone needs a procedure (or ten). Combine that with third-party responsibility (insurance pays doctor, employer pays for insurance), opaque pricing structure (doctors are the only ones that can tell you if a procedure is necessary or not), and you have a "market" that is "broken".

Put simply, everyone wants "the best care" when they never have to actually pay for it. And as long as providers are incentivized to provide "the best care", they will do it, as lost as "best" equals "expensive".

Re: For Medical Tourists, Simple Math

#23

Post by lucidrains » Sat, Aug 03, 2013, 9:55 PM UTC

cpursley wrote: post #5

Who's interesting in doing a healthcare tourism startup? Especially if you know the medical system well. Serious. Hit me up. My wife has gone to Russia twice for dental work (her home country). Was a fraction of the quotes here, including airfare.

This is a great idea! Emailed you!

Re: For Medical Tourists, Simple Math

#24

Post by johnchristopher » Sat, Aug 03, 2013, 9:56 PM UTC

abalone wrote: post #4

The magic of the market.

FTA: > Dr. Cram, the Iowa health cost expert, points out that joint manufacturers are businesses, operating within the constraints of varying laws and markets.

> “Imagine you’re the C.E.O. of Zimmer,” he said. “Why charge $1,000 for the implant in the U.S. when you can charge $14,000? How would you answer to your shareholders?” Expecting device makers “to do otherwise is like asking, ‘Couldn’t Apple just charge $50 for an iPhone?’ because that’s what it costs to make them.”

> But do Americans want medical devices priced like smartphones? “That,” Dr. Cram said, “is a different question.”

Indeed.

Maybe mixing something that is designed to work better when no ethics is involved (free market and capitalist ideology) with a highly relative to ethics sector (healthCARE) isn't such a good idea. Well, not for shareholders of course.

Re: For Medical Tourists, Simple Math

#25

Post by mjn » Sat, Aug 03, 2013, 9:57 PM UTC

EGreg wrote: post #20

mjn wrote: post #18

Earlier quoted context omitted.

I'm a bit skeptical of crowdsourced ratings for this kind of thing, given the relatively poor quality (and frequent gaming) of ratings on sites like Yelp and Amazon. Some objective information, like third-party-audited statistics on treatment outcomes, on the other hand, would be very valuable.

Well great, you've got a problem a startup can solve :)

True, and I'd love to see that kind of information. But it's a hard problem: doing solid outcomes analysis of hospital procedures is orders of magnitudes harder than crowdsourcing reviews!

Re: For Medical Tourists, Simple Math

#26

Post by Qantourisc » Sat, Aug 03, 2013, 10:06 PM UTC

The state should also do some math. What is the cost of having a disabled person, even if slightly ?

Re: For Medical Tourists, Simple Math

#27

Post by auctiontheory » Sat, Aug 03, 2013, 10:07 PM UTC

ixacto wrote: post #7

So what are the negatives? This NYT article reads like a PR piece for medical tourism... What about malpractice insurance in Belgium/Poland and what happens if there are problems down the road with TFA's hip implant?

What happens if there are problems down the road with an implant (or any other procedure) you got in the US? You pay for more procedures, that's what.

The ability to sue for millions of dollars is the one "advantage" of buying your medical care (or airplane tickets) in the US. We each need to decide how important that is to us.

Re: For Medical Tourists, Simple Math

#28

Post by staringispolite » Sat, Aug 03, 2013, 10:12 PM UTC

cpursley wrote: post #5

Who's interesting in doing a healthcare tourism startup? Especially if you know the medical system well. Serious. Hit me up. My wife has gone to Russia twice for dental work (her home country). Was a fraction of the quotes here, including airfare.

Two friends and I are working on exactly this! Would love to talk. I'll PM you with my contact info.

Another good place to start understanding the (dis)incentives in US healthcare pricing is Time magazine's "The Bitter Pill" http://www.time.com/time/magazine/article/0,9171,2136864,00..... Though it's important to note it's not just a US -> abroad market, it's a many-many graph. People travel for cost, procedure availability, doctor specialization, for the experience of travel, etc.

If anyone is interested in talking and passionate about this topic, I'd be happy to treat you to coffee with my co-founder and I in downtown SF. Feel free to email me, my email is in my HN profile.

Re: For Medical Tourists, Simple Math

#29

Post by YokoZar » Sat, Aug 03, 2013, 10:24 PM UTC

"In addition, device makers typically require doctors’ groups and hospitals to sign nondisclosure agreements about prices, which means institutions do not know what their competitors are paying. This secrecy erodes bargaining power and has allowed a small industry of profit-taking middlemen to flourish: joint implant purchasing consultants, implant billing companies, joint brokers. There are as many as 13 layers of vendors between the physician and the patient for a hip replacement, according to Kate Willhite, a former executive director of the Manitowoc Surgery Center in Wisconsin."

A simple legal remedy here would be to invalidate this sort of NDA agreement. The government is already involved as a customer in the health care market, and having the courts simply no longer recognize contracts that prohibit disclosure of prices would bring some immediate transparency to many involved.

The law could also go a step further and actually set up/order public listings of prices (this is already done in a lot of industries where vendors try to avoid competing on price).

Re: For Medical Tourists, Simple Math

#30

Post by octatone2 » Sat, Aug 03, 2013, 10:34 PM UTC

auctiontheory wrote: post #27

ixacto wrote: post #7

So what are the negatives? This NYT article reads like a PR piece for medical tourism... What about malpractice insurance in Belgium/Poland and what happens if there are problems down the road with TFA's hip implant?

What happens if there are problems down the road with an implant (or any other procedure) you got in the US? You pay for more procedures, that's what. The ability to sue for millions of dollars is the one "advantage" of buying your medical care (or airplane tickets) in the US. We each need to decide how important that is to us.

> The ability to sue for millions of dollars is the one "advantage"

That isn't necessarily true, as some states have caps on tort damages, and more corperations are lobying for similar caps/limits on civil restitution via state law: http://www.nytimes.com/2013/01/25/us/even-with-counsel-texas...