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My adventures in medical tourism

chrisstucchio.com

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Re: My adventures in medical tourism

#91

Post by arethuza »

jkot wrote: post #3

My wife had some complications after pregnancy. UK and Ireland has GP referral system, where single doctor coordinates all specialists. In theory it is good system. But our GP ignored basic symptoms and pushed bullshit like "depression" or "have you tried acupuncture?". We paid each GP visit, even for saying hi and collecting results, it was obvious GP was just pushing for more visits. This was going on for several m…

"single doctor coordinates all specialists"

GPs in the UK (who are most certainly real doctors) refer you to specialists - state or, if you want, private. They don't co-ordinate care after that.

Re: My adventures in medical tourism

#92

Post by arethuza »

SimpleXYZ wrote: post #74

Socialized medicine or a pure capitalistic system would both be preferable to the current system in the US. Right now it's the worst of both worlds.

Even here in the UK - where we do have a socialist health care system there is still the option of going private. The only option you don't get if you are a normal tax payer is opting out of paying for the state funded healthcare - which is fine as far as I am concerned.

Re: My adventures in medical tourism

#93

Post by JamesBarney »

chimeracoder wrote: post #76
JamesBarney wrote: post #69

Earlier quoted context omitted.

In general, Medicare and Medicaid reimburse the least - the amount that they reimburse is actually less than COGS (not on all individual services, but in the aggregate, it amounts to 7% less)[2]. As a result, providers have to overcharge private insurers and uninsured patients in order to cover their own costs. I don't understand how doctors paying less to medicare/medicaid causes them to have to overcharge other cus…

> If they are not making money on Medicare or Medicaid patients it's my understanding they aren't forced to see them. Sort of. It's less the case for outpatient practices unaffiliated with any hospital network, which is why the disparity between insured cost and out-of-pocket costs for those practices tend to be smaller. But unaffiliated outpatient practices are a dying breed. For hospitals, it's more complicated. In…

For hospitals, it's more complicated. In theory, this would be true. In practice, almost all hospitals other than the ones the VA operates do take both Medicare and Medicaid because of a confluence of other regulations that makes it unfeasible to refuse care to them. That said, despite this, the amount of money that hospitals lose on public insurance has increased to the point where a number of large hospital networks have discussed rolling back the services they offer to Medicare patients (such as outpatient care) or even cutting it off entirely.

Would you mind either explaining the regulations or pointing me at some sources that explain the regulations that bind hospitals into paying for Medicare and Medicaid? And by affiliated, does that mean has admitting rights, or is owned by the hospital network?

Sorry not trying to be argumentative just trying to learn about the convoluted world of healthcare.

Re: My adventures in medical tourism

#94

Post by Spooky23 »

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…

That's because healthcare is the largest government style procurement system.

The insurers all negotiate discount percentages, pecking order for discounts, exclusions, concessions from doctors, etc.

No human understands it.

Re: My adventures in medical tourism

#95

Post by tacon »

r00fus wrote: post #50
pc86 wrote: post #7

Earlier quoted context omitted.

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…

I went through this a few years back trying to get enough FSA to cover my portion of my daughter's long awaited eye operation. It was insane that I couldn't even be given an exact figure for my portion of the bill to plan for FSA - it's like it's all negotiated at time of operation or after the fact. Now some of that is that if a complication occurs, there will be additional cost, but I was just asking for a baseline…

I have not yet run into having to get a price out of a medical facility for a future procedure, but I read a lot of anecdotes. Alas, these stories lack any real emotion that could be used to turn public opinion for a change.

I've always thought we should build a massive audio archive of people calling for a medical quote and getting the runaround. I know I'd have my phone on record if I ever had to start calling. I live in a one-party consent state, and I'd use that to the max to embarrass these institutions, and have a public record of this bullshit. Shine that bright light of viral media onto the soft underbelly of the US healthcare system.

Re: My adventures in medical tourism

#96

Post by clamprecht »

Spooky23 wrote: post #85
mikecsh wrote: post #63

Earlier quoted context omitted.

Im sorry to hear that you had bad experiences in Canada. However your personal story is effectively one data point and not necessarily representative of a good comparison between healthcare systems. This analysis is a pretty good overall analysis of the quality, efficacy and safety of different healthcare systems. That’s not to say that just because the US is worse overall that it doesn’t perform better in a subset o…

If you have good insurance, I can't imagine the US not being top of the heap. I had an injury that resulted in a spinal fusion and other surgery at 25. Total out of pocket cost for about $250k of care and full recovery was about $500. That included second opinion visits to top doctors in Boston & NYC. If you're on limited network Obamacare with high deductibles and HMO bullshit, good luck.

There are no individual PPO plans for my area (Austin, Texas), so I was stuck with HMO for 2016. This applies to about 330,000 people in Texas who had their individual PPO plans cancelled. So as far as I can tell, it is actually impossible to get "good insurance" (a PPO plan) here, as an individual.

Re: My adventures in medical tourism

#97

Post by davidw »

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…

The US health care system sucks. I'm generally happy to be back in the US, but not about this particular aspect of it.

It's more bureaucratic than Italy, costs more, isn't appreciably better, and wastes people's time more.

What's more, even though Italy has a single payer system, there is also private care available that is quick, cheap and efficient - which it has to be, since the competition is "free" (tax funded).

The US has neither a free market, nor a good government provisioned system, but some mess that's neither fish nor fowl.

Re: My adventures in medical tourism

#98

Post by chimeracoder »

jessaustin wrote: post #77
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…

Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations? What numbers are we talking about?

> What numbers are we talking about?

In 2015 there were 41,000+ applicants for ~30,000 residency positions[0]. I don't have the 2015 numbers for medical schools, but in 2014, there were 18,000 graduates in the US[1].

Increasing the number of medical school graduates in the US would mean that a larger percentage of residency slots are taken by people who went to school in the US but not the total number of residents. Ironically, this would actually be a bad thing cost-wise, since foreign medical schools are usually cheaper and students carry a lower debt load[2].

> Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations?

Yes. You are likely to see them take jobs in industry - e.g. at a pharmaceutical or insurance company, but on the business side, since they're not licensed to practice. (Nor are they even qualified - medical school teaches essential knowledge for doctors, but they receive basically no training on actual clinical practice. All of that happens during residency).

It's worth noting that not all doctors want to practice medicine - for example, people in an MD/PhD program often go into research, and that's a good thing. But if we're talking about increasing the supply of practicing physicians, increasing the number of medical school applicants in the US makes literally zero difference.

[0] http://www.nrmp.org/press-release-2015-residency-match-large...

[1] https://www.aamc.org/download/321532/data/factstable27-2.pdf

[2] These aren't necessarily "foreign" students either; it's quite common for people in the US to go to medical school in the Caribbean and then come back for their residency.

Re: My adventures in medical tourism

#99

Post by mindslight »

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…

> the large amount of health insurance in the U.S. not necessarily free market vs. regulation

Erm, health insurance companies are essentially the opposite of a free market. They're as close you can get to government run without actually being called "government". With USG's recent push to make patronizing these behemoths mandatory, even the last little sliver of "exit" has been lost.

Re: My adventures in medical tourism

#100

Post by mendelk »

theklub wrote: post #71
anilgulecha wrote: post #11

My wife is a Dentist in Bangalore, India, and it's amazing what I hear. Basically Cost(Flight to india + treatment cost) The more you think about it, the more crazy it seems on multiple levels. Edit, typed .

Ok, how about this for a startup. We buy a cruise ship, hire a load of doctors, plant it in international waters and boat people out for service. Might be some problems for doing certain procedures because of the boat moving but it might work in some cases haha.

If they can get pool tables to stabilize on ships[0], maybe this can done too :)

[0] https://www.youtube.com/watch?v=7DNGjGH-IB8

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