Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

My adventures in medical tourism

chrisstucchio.com

Post reply on HN
Print view View original

141–150 of 202 posts

Re: My adventures in medical tourism

#141

Post by icelancer »

pc86 wrote: post #7
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.

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…

This exact case is true in software consulting and various other industries, and the way to solve it is with not-to-exceed (NTE) billing. If every other industry can solve it, why can't medical?

Re: My adventures in medical tourism

#142

Post by icelancer »

diebir wrote: post #136

This guy is either an idiot or tries to sell something. More like both. He goes around self treating a serious spine condition, trying to find a doc to inject steroids for cash (which is treating the symptoms, not the root cause). Then he goes for a surgery in some third world place "because it's cheap"; a surgery on his spine no less, where he may or may not ever walk again if something goes wrong. Then, he touts a…

>I am not "buying a surgery for cash" for something as critical as my spine. Or knees. Or appendectomy. Or anything else.

That's fine. But I might want to. Have you considered this?

Re: My adventures in medical tourism

#143

Post by curun1r »

ThomPete wrote: post #127
clamprecht wrote: post #26

I should mention that Paul Buchheit wants to fund the Uber of medical tourism: https://twitter.com/paultoo/status/566379518261088258 The tweet: "I want to fund the 'Uber' of medical tourism Needs 5 star service, simplicity and safety Let me know if you apply - http://www.ycombinator.com/apply/" It really has to happen. Health care in the US is just fucked, and everyone knows it.

Interestingly I posted this on HN the other day. No love though :) But very relevant. http://blog.jayparkinsonmd.com/post/134547527433/why-theres-...

I wonder if this is a case where the actual Uber could overcome the lack of efficiency that the Doctor wasn't able to achieve on his own. Uber as a service doesn't work with just one driver. That driver would be crisscrossing around the city constantly picking up fares, just like the doctor was with his patients.

Instead, the service works by matching up riders and drivers that are close together. If the problem with the described medical practice is lack of efficiency and too much time spent in travel, perhaps Uber could make a system for multiple doctors which involves less travel time so long as patients didn't require a specific provider. Also, Uber could take advantage of the fact that its drivers' time is significantly less valuable than the doctors' time and have them pick up supplies from the pharmacy so that when they pick up the doctor, all the supplies for the next appointment are already in the car and the doctor can head straight to the next appointment.

As with many things, scale matters and trying to be a solo provider of an Uber-like service is unlikely to work.

Re: My adventures in medical tourism

#144

Post by HarryHirsch »

squozzer wrote: post #106
HarryHirsch wrote: post #48

Earlier quoted context omitted.

Other people would think that fixed reimbursement rates are a feature - it's what they do in my country to hold down costs, and it works well. You can ask to be paid beyond published rates, but you better have a good case when you present the bill to the insurance company. As far as overbuilding hospitals goes, you'd think that physicians and administrators will try to fill those beds at any cost, cost that is billed…

The Roemer Effect has never been proven, as no country has ever had the luxury of too many hospital beds. It's based on a certain plausible logic - similar to saying welfare makes people lazy - but no one has ever presented evidence to support either.

Looking through Pubmed (!) you find many papers that are in favour of the Roemer Effect.

Re: My adventures in medical tourism

#145

Post by chimeracoder »

vonmoltke wrote: post #122
chimeracoder wrote: post #67

Earlier quoted context omitted.

> 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 numb…

> Increasing the number of residency slots is up to Medicare, because Medicare funds residency programs nationwide. No, it isn't. Congress limited the number of residency slots Medicare could underwrite, but medical residency is not controlled by Medicare. Additionally, Medicare only pays for about 25% to the total costs incurred by residency programs. In fact, the law that created Medicare specifically stated it was…

> The law that created Medicare specifically stated it was to subsidize residencies “until the community undertakes to bear such education costs in some other way.” Understandably, no one has stepped up to replace the federal government gravy train.

It seems like you don't want Medicare to be responsible for the funding of residency programs, and you'll get no disagreement from me on that point. In an ideal world, this would not come Medicare, because Medicare is the least efficient funding source for - well, pretty much anything.

But the fact remains that residency programs are not a profit center for hospitals, and hospitals cannot absorb an extra $9.8 billion/year just to train residents. And there's no other funding source for these programs at most hospitals that doesn't ultimately make its way back to the patient in some form.

It's also worth mentioning that the Balanced Budget Act capped Medicare's funding for residency programs specifically to reduce the number of residency slots available and avoid an "oversupply" of doctors. It's not that the AAMC is looking for free money so that they can keep the number of physicians artificially low, as you're implying; the external funding is what drove the increase in the number of physicians in the first place.

If you want residency programs to be funded by someone other than Medicare, that's fine, but just realize that the free-market would reach equilibrium at even fewer residency slots than we have today.

Re: My adventures in medical tourism

#146

Post by atourgates »

akg_67 wrote: post #113
JamesBarney wrote: post #78

It's true that healthcare is terrible in the U.S. if you don't have health insurance, but he overstates his case. Chris compares a 1 in a 1000 nightmare scenario to his very average experience. A $112,000 error happens in the U.S. but is rare. Typically the type of surgery he mentions costs between $20,000-$50,000. Or 50-100% of a the U.S. gdp per capita. This is smaller than in India where the cost of his surgery wa…

As a patient, US healthcare is terrible even if you have health insurance. Patient is at the bottom of totem pole in US healthcare, and just a number for doctors, hospitals and insurance companies and everyone else involved in the system. Just a couple of anecdotal personal recent experiences with US healthcare. 1. Recently I witnessed the trouble my primary care physician (PCP) had to go through with insurance compa…

In a sea of difficult-to-deal-with insurance providers, United Healthcare stands out as a particularly awful provider.

If I could snap my fingers and magically disappear any single insurance provider, it'd be United.

For my wife's specialty (ophthalmology), they're they only insurer in our region that requires a referral from a primary care provider for a visit. So, if you have blue-cross and have trouble with your vision, you can just go see an ophthalmologist.

If you have United, you need to call your primary care provider, explain your problem over the phone or (in some cases) go in for a visit, and get them to refer you to an ophthalmologist.

It's a hassle for us, but much much more of a hassle for primary care providers who are wasting tons of time on referrals and paperwork an in effort to save United money. It's a good part of the reason that primary care providers have to have the most support-staff per physician[1], despite having relatively lower reimbursement rates.

[1] http://www.mgma.com/Libraries/Assets/Key-Findings-CostSurvey...

Re: My adventures in medical tourism

#147

Post by akg_67 »

Fomite wrote: post #131
akg_67 wrote: post #113

Earlier quoted context omitted.

As a patient, US healthcare is terrible even if you have health insurance. Patient is at the bottom of totem pole in US healthcare, and just a number for doctors, hospitals and insurance companies and everyone else involved in the system. Just a couple of anecdotal personal recent experiences with US healthcare. 1. Recently I witnessed the trouble my primary care physician (PCP) had to go through with insurance compa…

Have you considered that discharging patients to their home, and moderating their pain medication, may actually be signs of quality care? "The patient gets what they want" is not the only sign of quality.

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 lower because an Indian hospital kept a patient for 4 days instead of 1 day by US hospital? What does it say about relationship between quality of surgery and all these metrics such as duration of hospital stay, pain medication dosage and duration?

I found a lot of studies which used hospital stay duration and pain medication dosage and duration while in hospital as a proxy to quality of surgery but none that showed these metrics have anything to do with quality of surgery. Also, while quality of surgery takes into consideration the pain medication dosage and duration in the hospital, it ignores the pain medication dosage and duration patient was prescribed after being released from hospital. Similarly the overall healing and recovery time required by patient after the surgery is ignored in favor of the portion of recovery time patient spent in hospital. Hopefully, you see the incentive misalignment and mis-measurements.

You will get what you measure, nothing more nothing less. It is up to you to decide whether a measurement is relevant or not to what you trying to measure. You should not only worry about what a statistical study show but also what the study doesn't show.

Re: My adventures in medical tourism

#148

Post by smileysteve »

ashark wrote: post #72
cryoshon wrote: post #41

Yep. Medical tourism exists when the cost of local healthcare is inflated by profit-seeking to flatly unaffordable levels, resulting in grotesque health outcomes and extreme behaviors such as traveling thousands of miles or committing crimes in order to end up in prison for care. I would like to coin a term for this kind of disturbing extreme behavior incentivized by extreme distortion of society: fever spasms. It so…

> There will be a billing error somewhere, and it will be to your detriment. They may refer you to collections if you do not pay the incorrect amount while disputing the charges, as happened to my girlfriend. Yep. Can confirm: US hospitals and other care providers are total d-bags when it comes to billing. It doesn't help that for anything remotely complicated you end up receiving 2-3 different bills from each of 5-6…

+ 1

> It's like it's designed to screw up people's credit, even when they're trying to pay what they owe.

I had a bill that was 100% covered by insurance, only they never sent it to me. it's 3 years later and despite my insurance now paying the bill twice, countless conversations, some collections agency is still giving me calls, and it's still on my credit report.

I have insurance, I make a great income, I paid every bill that I received. Somehow it's still biting me.

(It's not a huge debt, and I disputed it as soon as the collection notice arrived, and my credit is not direly affected)

Re: My adventures in medical tourism

#149

Post by geomark »

My own experience in Thailand is similar to the author's in India: see a doctor on short notice, prices quoted in advance, short wait time for surgery, prices low enough to pay out-of-pocket. The icing on the cake is how friendly and warm the medical care is. My biggest fear when I visit the US is that I will get sick or injured and be subject to that awful system. I lived in the US most of my life, had excellent insurance, and had routinely poor experiences with healthcare.

Re: My adventures in medical tourism

#150

Post by LunaSea »

endymi0n wrote: post #33
clamprecht wrote: post #26

I should mention that Paul Buchheit wants to fund the Uber of medical tourism: https://twitter.com/paultoo/status/566379518261088258 The tweet: "I want to fund the 'Uber' of medical tourism Needs 5 star service, simplicity and safety Let me know if you apply - http://www.ycombinator.com/apply/" It really has to happen. Health care in the US is just fucked, and everyone knows it.

Well, the "Uber" business model is actually pretty hard to do in an industry as heavily regulated as medicine (and honestly it's a difference between getting into an unrated driver's car or putting yourself under the knife of an unrated developing country's doctor)... Then again, our friends at Medigo seem to do great service in this direction so far and have just raised a series A ( https://www.crunchbase.com/organi…

Just do it like Uber, it's illegal in most places but hey if you "disrupt" the market it's alright.
Post reply on HN