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For Medical Tourists, Simple Math

nytimes.com

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Re: For Medical Tourists, Simple Math

#31

Post by Retric »

VonGuard wrote: post #8
EGreg wrote: post #3

It would be interesting to see a breakdown of what really accounts for the majority of the price differences. This article mentions some things in passing but ultimately doesn't conclude with the main quantitative insights.

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's important but add in increased pay, litigation, and huge medical billing overhead.

Just think every time a company negotiates prices both sides spend time which is why stores list prices and don't let you negotiate but car dealerships do.

Re: For Medical Tourists, Simple Math

#32

Post by tryitnow »

falk wrote: post #21
gojomo wrote: post #16

Earlier quoted context omitted.

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…

Precisely. I worked a little bit for a large pharma company (in a finance capacity) and I saw first hand how incredibly profitable it is for the US government to not have negotiating power on drug prices.

Pharma companies make a wildly disproportionate share of their global profits in the US simply because they don't have to negotiate with a large 'super-buyer" (e.g. medicare).

Now if pharma R&D were productive I wouldn't have a problem with this, but it's notoriously unproductive (and not just because of the admittedly overly burdensome FDA regulations).

I would support a grand compromise: 1) for pharma companies: reduce FDA hurdles for drug approval, but add more aggressive post-approval tracking (to reduce the risks associated with a lower regulatory hurdle) 2) for the rest of us: allow medicare to negotiate aggressively on price, this will have a ripple effect and lead to lower drug prices for all.

Re: For Medical Tourists, Simple Math

#33

Post by berntb »

markvdb wrote: post #11
EwanG wrote: post #2

So I get that by cutting out the insurer you are saving some funds, but where does the rest of the difference come from? Are the hospital rooms and surgeons so much cheaper because everyone in those countries pay them rather than just the few people who actually use their services?

Some possible reasons: * The hospital system in Belgium is 99% either state or non-profit owned. Less sticky fingers. Less luxury. * Infrastructure (buildings, tools, ...). The infrastructure is extremely heavily state subsidised. * Medical professional wage negotiations. Medical professionals earn quite a bit less in Belgium than in the US. Quite many (most?) medical pros actually seem to have their priorities right…

I've lived in Scandinavia, with largely similar systems (they vary a bit, I've seen Sweden and a bit of Finland). The health care systems are centrally planned and administered, and hence have the typical problems doing the work in an efficient manner.

For instance, it is acknowledged in international comparisons as really hard to get diagnosed because doctors just don't have the time, largely because of administration. Me and others I know have had years and decades of lowered life quality from easily cured problems like bacteria infections, simple knee problems, allergies and iron/vitamin deficiencies.

I've heard good things about the German health care system.

Notes: I have also lived a few years outside of the Nordic countries, so I have some perspective. And I agree that the US system seems the craziest one on the Western world.

Edit: The government has recently decided that all illegal immigrants in Sweden will get free health care, without any paperwork. If you need an expensive and can fake an Ukrainian accent in English, or something similar, there is a cheap solution for millions of Americans with a ticket to Sweden...

Re: For Medical Tourists, Simple Math

#34

Post by mjn »

Nrsolis wrote: post #22
EGreg wrote: post #12

Earlier quoted context omitted.

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, everyo…

Over-treatment doesn't explain why the same treatments cost more, though. The base charge for simply occupying a hospital bed for one day is absurdly high in the U.S. compared to just about any other country (Canada comes close, if you're a non-Canadian and therefore actually liable for it).

Re: For Medical Tourists, Simple Math

#35

Post by jfb »

Nrsolis wrote: post #22
EGreg wrote: post #12

Earlier quoted context omitted.

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, everyo…

"Fee for service" is one of the big drivers of cost inflation. Taking on the AMA requires a bigger person than anyone in Washington today.

Re: For Medical Tourists, Simple Math

#36

Post by EGreg »

mjn wrote: post #25
EGreg wrote: post #20

Earlier quoted context omitted.

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!

It is. You'd have a big barrier to entry for competitors.

Re: For Medical Tourists, Simple Math

#37

Post by moocowduckquack »

berntb wrote: post #33
markvdb wrote: post #11

Earlier quoted context omitted.

Some possible reasons: * The hospital system in Belgium is 99% either state or non-profit owned. Less sticky fingers. Less luxury. * Infrastructure (buildings, tools, ...). The infrastructure is extremely heavily state subsidised. * Medical professional wage negotiations. Medical professionals earn quite a bit less in Belgium than in the US. Quite many (most?) medical pros actually seem to have their priorities right…

I've lived in Scandinavia, with largely similar systems (they vary a bit, I've seen Sweden and a bit of Finland). The health care systems are centrally planned and administered, and hence have the typical problems doing the work in an efficient manner. For instance, it is acknowledged in international comparisons as really hard to get diagnosed because doctors just don't have the time, largely because of administrati…

"The government has recently decided that all illegal immigrants in Sweden will get free health care, without any paperwork."

If the vast majority of people treated are not subject to itemised accounting, the bureaucratic expense of having itemised accounting for one small group can actually be higher than just treating them for free as well.

Re: For Medical Tourists, Simple Math

#38

Post by jeltz »

EGreg wrote: post #3

It would be interesting to see a breakdown of what really accounts for the majority of the price differences. This article mentions some things in passing but ultimately doesn't conclude with the main quantitative insights.

Indeed it would. My gut feel from reading many articles like this is that in American healthcare everything is more expensive. There is more administrative overhead, the salaries for doctors are higher, owners of private hospitals expect more profit, drug companies has better profit margins, implant manufacturers have better profit margins. I have also heard the American hospitals spend more money on purchasing the latest equipment.

So my theory is that there is no incentive to cut costs, everyone in the healthcare industry profits form the inflated costs. Even the insurers do as long as they can keep raising the insurance costs.

Re: For Medical Tourists, Simple Math

#39

Post by IANAICANABANA »

I was a medical tourist in the opposite direction earlier this year. I'm from Canada, land of free health care, and my doctor told me that I would have to wait 6 months to see a specialist.

My ailment[1] prevented me from sleeping most nights, caused severe, productivity-ending headaches all day, and caused me to pop ibuprofens like candy. My PCP attempted to use water to eliminate what he believed was an earwax impaction 14 times on separate days. It had been almost 2 months of me completely disabled before he was willing to put in a referral to the ENT. When he did, they told me it would be six months. You can imagine my frustration.

So, I had a friend drive me to a clinic in Washington state. A bit of discussion, $900 and two visits later, I had seen an otolaryngologist, he had used a small curette to clean out the ear canal, and I was better. $900 to not cry myself to sleep all day for six months seemed like a pretty good deal to me.

Six months later I got a phone call from an office of an ENT here in Canada. I was unbelievably angry.

[1] I had a condition where the skin had grown over the eardrum in your ear. It required surgery by an otolaryngologist to remove the problem and restore my hearing.

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