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For Medical Tourists, Simple Math

nytimes.com

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Re: For Medical Tourists, Simple Math

#41

Post by refurb »

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…

It's not accurate to say the gov't doesn't use it's bargaining power to get lower priced drugs. You are correct that it doesn't negotiate lower prices like the DoD does (through an RFP and bid system), however it does:

1. force drug makers to match the lowest price that it offers to anyone else. In other words Medicare gets the same (or lower) price as big insurers like United.

2. force drug manufacturers to discount the cost of drugs for Medicare Part-D once the patient enters the donut hole. Over the next 5 years that discount will increase to 50% of the cost incurred within the donut hole (this will total several billions per year)

3. for Medicaid, force the drug manufacturers to provide a 23.1% discount off the WAC (wholesale price) OR the lowest price offered to anyone else (whichever is lower)

4. for disproportionate share hospitals (hospitals that serve the uninsured), force drug companies to provide the Medicaid discount (at least 23.1%) to those hospitals for all the drugs they buy, whether or not they go to the uninsured

5. if the drug company increases the cost of its drug at a rate greater than the rate of inflation (CPI), they have to pay CPI penalties each year. There are some drugs that Medicaid gets a 90% discount on (far lower than any insurance company could get)

So yes, you are correct that federal gov't doesn't directly negotiate individual drug prices, but it sure as heck uses it bargaining power to get some super sweet deals!

Re: For Medical Tourists, Simple Math

#43

Post by chiph »

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?

Your insurance company is likely to deny coverage for procedures performed outside the US (if for no other reason than because they can), so that's a definite risk.

But that's a reason to choose Belgium over somewhere like Guatemala -- while you won't get the gift shop or valet parking, the quality of care is much more likely to be at the same level as in the US.

Re: For Medical Tourists, Simple Math

#44

Post by refurb »

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."

They would never do it. The amount of fraud in Medicare is astounding because the gov't doesn't use a lot of resources to verify claims. Can you imagine what would happen if the services were provided outside of the US? You probably couldn't even sue the provider to recover money from fraudulent claims.

Re: For Medical Tourists, Simple Math

#45

Post by mnutt »

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.

COBRA, from my understanding, doesn't give anyone a free ride. It just means that the former employee has to pay the costs themselves:

COBRA does not, unlike other federal statutes such as the Family and Medical Leave Act (FMLA), require the employer to pay for the cost of providing continuation coverage. Instead it allows employees and their dependents to maintain coverage at their own expense by paying the full cost of the premium the employer and the employee previously paid, plus up to a 2% administrative charge (50% for the latter 11 months under the disability extension).

Re: For Medical Tourists, Simple Math

#46

Post by pessimizer »

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.

I was looking for this today, and was surprised that I couldn't find one. Wish you luck and speed, because I need some dental work done and never have any idea where I should take vacations.

Re: For Medical Tourists, Simple Math

#47

Post by joe_the_user »

IANAICANABANA wrote: post #39

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 impa…

I read a while back that the US hospitals charge foreign medical tourists competitive rates. But getting that rate as an American is another matter since the hospitals make so much with their standard rates.

Re: For Medical Tourists, Simple Math

#48

Post by EGreg »

mnutt wrote: post #45
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.

COBRA, from my understanding, doesn't give anyone a free ride. It just means that the former employee has to pay the costs themselves: COBRA does not, unlike other federal statutes such as the Family and Medical Leave Act (FMLA), require the employer to pay for the cost of providing continuation coverage. Instead it allows employees and their dependents to maintain coverage at their own expense by paying the full cos…

Not that part of COBRA - the part where hospitals can't turn away emergency room patients for failure to pay.

Re: For Medical Tourists, Simple Math

#49

Post by dome82 »

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.

I am working on an idea for medical tourism. We should talk. I'll email you soon :)

Re: For Medical Tourists, Simple Math

#50

Post by bdcravens »

Eventually I'll need a lung transplant, and possibly more (I have Cystic Fibrosis). It's one thing to talk teeth and knee joints, but lungs and livers are a completely different story. That said, paying $150K+ isn't something I'm looking forward to (or even know that I'll be able to do), so medical tourism is something I follow closely to see how it develops.
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