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Medical Care Gets Outsourced Too
Muppy writes "Here's the summary from the most emailed article in The Washington Post today -- about an American who went to India for heart surgery, which he could never have afforded here. U.S.: $200,000 total cost ($50,000 deposit required) for heart operation. India: $10,000 total bill, including hospital, air fare, and a side trip to the Taj Mahal. And the Indian doctors are probably at least as good as those one is likely to get in the U.S. From the article: 'Eager to cash in on the trend, posh private hospitals are beginning to offer services tailored for foreign patients, such as airport pickups, Internet-equipped private rooms and package deals that combine, for example, tummy-tuck surgery with several nights in a maharajah's palace...'"
As someone who has had three open-heart surgeries due to a congenital heart defect, I can see this as a viable option if I ever have to have another surgery. I've had my aortic valve rebuilt once (valvoplasty) and had it fall apart, replaced with a Hancock prosthesis (pig's valve) which calcified when I went through a growth spurt at 16, and then had it replaced with a Saint Jude's valve. I've been ticking (literally) for the past 22 years. Yes, I had my brother tell me that I am like a Timex watch :->
My first surgery cost about $5,000 (in 1969); the second about $30,000 (in 1976), and over $80,000 (in 1982). You can thank the insurance companies for the cost of health care today. Malpractice insurance for doctors and surgeons in the USA can top $1,000,000 a year depending on their area of practice. The more delicate the organ they work on, the more they pay. In order to stay in practice, they have to charge the patient more. The patient's insurance company pays more, they raise the cost of the insurance, someone sues the doctor for leaving a sponge in them, their malpractice insurance rates go up, etc.
IANAL and I don't know about India's legal system, but I don't think they have the sue-for-every-mistake mentality we do here. Remember, doctors are people too and they sometimes make mistakes. If they doctors in India can do as good a job as the ones in the USA at a lower cost, I'll be traveling overseas if I have to have another surgery.
If "disco" means "I learn" in Latin, does "discothèque" mean "I learn technology"?
"I have a porkchop, you have a porkchop. I have a veal, you have a veal".
If you're critical you jump to the top of the queue. If you're non critical you're on a waiting list. That's how it works in Canada. My fiance's father had to get a pacemaker in. He jumped everyone to get it in. His heart beat was under 30bpm... That's critical.
09 F9 11 02 9D 74 E3 5B D8 41 56 C5 63 56 88 C0
Doesn't India "outsource" manufacturing of soft drinks to American Coca Cola and Pepsico?
...besides: which would you rather have insourced:
Well, not quite. The soft drinks that are sold in India are probably actually made in India as it would cost too much to ship bottles of Coke over from Atlanta. Yes, the American companies get some small amount of money from each bottle sold, but no American workers were employed in the process.
Software Engineering and Surgical jobs or Softdrink jobs?
Here's the weird thing about the Canadian academic medical system.
Fact 1: Canadian doctors, especially rural family doctors, are in critical shortage.
Fact 2: It is hard as hell to get into Canadian medical schools (GPA: 3.8, MCAT 30-31 + Extracurricular)
Fact 3: There are hundreds of immigrant doctors in Canada driving taxi cabs.
If you said "WTF?" you're not alone. The reason why it's hard to get into medical school is easy enough to explain: When the government pays 70% of your tuition, you're gonna get high demand for a fairly well paying job (about $7000 USD/month).
But what makes very little sense is all these perfectly good doctors roaming the country with crappy little McJobs. The reason is because they can't get into residency programs to get certified. And they can't get into residency programs because Canadian graduates get first pick, and whatever's leftover goes to the immigrants. Since there's always never enough residency spots, and the one's that go to the immigrants are less desireable (family medicine).
That means we could have the world's best opthmalogist living in Canada, and the most he can hope for is it run a rinky-dinky clinic off in the boonies, if he's lucky.
Not sure how it relates to the story, but an interesting tidbit nonetheless.
Corporations: your universal scapegoat for all society's ills.
I work for a healthcare organization and one of our hospitals is in Bellingham, WA. We get a reasonable amount of business from Canada. Evidently there are people who aren't fond of waiting lists.
Actually, a large chunk of research costs are also borne by the tax payers. The vast pipeline of research is fed by National Institue of Health (NIH)'s laboratories. The drug companies use this to do further research. However, when it comes to pricing a drug, the drug companies do not give a discount because they used free NIH research. The whole problem is about American worhsip of "Free Market". Most countries have price-control on drugs, which give good returns but not enormous returns to drug companies. Drug companies channel their profits in bringing out more "lifestyle" drugs that may reduce pain by further 10% or so. Oh not to mention that these "lifestyle" drugs have advertising budgets that are a shame. I recall reading that some single Pfizer drug had an advertising budget greater than Pepsi and Coke's combined ad-budget. A drug is prescribed by doctor, so why do u need advertising on TV? Drug advertising to consumers in banned in India. That is where a lot of saving happens. Also they did not allow product patents on medicine till recently (starts from 2005). They have price controls too.
You don't have *any* clue what you're talking about. Check the administrative costs. You're totally full of shit. Hey, California's costs are entirely on-line. You can look it up by district if you want.
Public education in the US spends a tiny amount on administrative costs, smaller than most businesses, smaller than private education.
What's more, the NEA doesn't oppose competition or accountablitiy. They do oppose crackpot schemes like vouchers where private schools get to opt out of standardized testing, or don't have to teach children with disabilities.
To date, no one has ever proposed a system of competition in public education. Rather, partisan hacks have proposed screw-ball measures like vouchers that are explicitly biased in favor of private schools.
I suppose the question is what's better - good health care for all, or spectacular health care for those who can pay and no health care for those who can't.
My fiance had foot surgery in Australia on a trip there this summer - $146 Australian for two hours of surgery. None of the waiting lines in all the horror stories about socialized health care, perfectly competent doctors, etc.
Sure, the Mayo Clinic draws people from all over the world, but the average American hospital is no better or worse than the average Western European or Australian one.
Medical malpractice is less than 1% of the total US bill. Try again, and this time without simply mimicing GOP talking points.
Did you really name your son "Robert');DROP TABLE Students;--"?
Reason being I personally know one of the world's best heart surgeons who currently practices in India. He has done thousands of open heart surgeries, on people from virtually all rungs of life, politicians to business magnets to children from Iraq.
Infact I have been thinking to start my own little medical tourism practice on the side to encourage people to seek medical help in India. India has some of the world's most renowned doctors and some of the cheapest rates. The care you will experience will be top notch as well. Most people (uninformed as they might be) tend to think "unhygienic" when they hear "India". However the private hospitals are luxurious, has the best doctors your money can find and you will receive the best care your money can ever buy.
I am not trying to discount the experience or the ability of doctors here, but when your Insurance wont pick up the tab, and your surgery costs around 100k, and you can get it done by a top notch physician/surgeon sitting half way across the planet for 1/10th of the price, you would be crazy not to take notice.
If you want to receive additional information, email me.
Rapid Nirvana
I've got to guess you've never worked in the medical industry before (on the Dr. side of things?). I have...and by and large, it is not the Dr.'s who are doing it...it is the lawyers, and patients looking to make a quick buck. That's why Doc's have to run so many tests...even though 1 or 2 might do..to cover their asses. And then, there are the bean counters that are running medicine....not the Dr.'s....but, that's another story altogether...
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
I had a Japanese society teacher who experienced something similar in Japan (and Japan is a lot more expensive of a place than India!). Both the US costs were about the same, and the cost in Japan was about what this person paid in India. Probably a rare case, but still.
The US medical system costs an utter fortune. Last numbers I saw, the average American spends - between out of pocket expenses, company-paid expenses, government expenses, etc - over 4,500$ a year. The next closest, in terms of cost, worldwide was Britain, at about 2,900$. I can check for a ref and updated numbers if anyone wants.
Compared to how much we pay, we're getting ripped off. Even Cuba, which is under an embargo that covers medical supplies, has almost as long of a lifespan as the average American does.
Did you really name your son "Robert');DROP TABLE Students;--"?
Indeed. A large chunk of the patients in hospitals in northern France have come from the UK for quite some time now.
It is faster than the NHS, cheaper than private clinics, and closer/safer than India.
The article says "a New York heart surgeon 'has to pay $100,000 a year in malpractice insurance.'" If he does 2 operations per week, that is $1000 each for insurance, which is __ 1/2 of 1% __ of the $200,000 price. Even with your larger cost, that is still a small portion of the cost of the procedures.
The federal Dept of Education handles about 6% of our nations expenditures on education, and administrative costs amount to 2% of their budget, making federal bureaucracy in education 0.12% of our expenditures on education. That's around $7/student. I wasn't able to get definitive numbers for the California DoE, though from rough numbers it appears their administration operates at under 1% of their budget. There is a national survey by the Educational Research Service reporting a national average of 1.6% to cover all central-office professionals, and 2.9% to cover local administration (including principals, assistant principals, etc.). (The article is "Perceptions about American education: Are they based on facts?", by Glen Robinson & David Brandon, 1992).
Most private industries (and private schools) operate with much larger administrative costs. Even if you live with the illusion that large organizations can exist without administration, eliminating all the administrative costs would make at most a small impact on available funds, as would eliminating the federal DoE.
Detailed data from California is here.
Someone mod this idiot down.
Confession: Im Indian, born/brought up/studied/worked there, now a permanent resident in the USA. Your child will have to compete against a million others and the only way one child is differentiated from another is the way they perform in school. A 0.0003% score difference between and the guy next to you in high-school can determine if you make in into a decent college or not. The amount of presssure the children have to take from family/scociety/friends is immense. Of course, there is no doubt about the quality of the professors etc once you are inside the reputed colleges - they are top class. But you have to be brilliant AND lucky to to even see their shadows.
Even Cuba, which is under an embargo that covers medical supplies, has almost as long of a lifespan as the average American does.
It's only a US embargo. Lots of other countries do business with Cuba.
One reason Cubans are so heatlhy is that so many ride bikes - oil is so expensive.
If some thing goes wrong then how can I sue the crap out of them?
Or take the flu-shot ferry to Victoria BC.
One line blog. I hear that they're called Twitters now.
By "Medical malpractice", do you mean just the lawsuits or does that include insurance premiums as well? And can you give us the source of your figure?
According to this report by GAO, it seems that the malpractice premiums are going up but the insurance comanies' net loss is growing as well. That leads me to believe that only one who's profiting from this are the lawyers. So try again, and this time without simply mimicing Democrate talking points.
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I call bullshit. My employer builds a next-generation EMR system (electronic medical records). Our two top executives are doctors, and I think there's a total of about 14 on staff, from a number of different specialties (since we need data for our created for doctors in all the different specialties we want to sell to).
All of them have horror stories about how hard it is to find specialists for certain fields, particularly in rural areas (which Texas, which I'm in, has a lot of), because the cost of malpractice insurance is so high for those specialties.
So no -- malpractice insurance is a real problem, and a big one, I'm not using GOP talking points, but rather hallway-conversation with my coworkers who've genuinely been there.
That is the problem, emergency rooms can not turn anyone away. However by the time someone needs to go to the ER whatever condition they were in has most likely become much more expensive to treat. Thus it costs us MORE to not have a true single payer health system.
I don't know how much money drug companies actually make from Canada, but I'm just going to mention a possibility. It is possible that, even though they don't make much money, drug companies sell drugs to Canada so that Canada won't start manufacturing drugs themselves (I'm sure Canada manufactures some drugs themselves, just not all of them).
There's not much to force a country to obey the laws of other countries (the WTO might complain). Countries in the past have stolen technology from each other. A country like North Korea wouldn't bother trying to trade for a drug they needed as long as they could make it themselves. And, considering that patents are matters of public record, it should be easy to start making drugs for your own country.
Software and book companies do a similar thing. They cut down the price in foreign markets (particulary Asia) in part to make some money and stop some copyright infringement, but probably also to prevent losing an edge to either international or local competitors. (I don't think drug companies have as many international competitors per se, since they use patents to protect a drug, not copyrights like books/software.)
I don't know if this is true, I'm just saying it's a possibility.
Certainly -- the parent poster already said that the money for most drugs is spent in R&D, and that later manufacturing costs are tiny in comparison.
But there is another factor here too. If they refused to sell to Canada, then the Canadian govt. might declare open season on their drug patent (which has to be openly viewable in order for doctors to understand and the US-FDA to certify the drug), citing a societal need for the lifesaving drug.
At least this way they get something for their investment rather than handing it over to the generics maufacturers.
The bottom line is -- the drug companies are often out for a large chunk of cash before a drug is ever brought to market, and they have to make that up somehow. If they can't spread the costs around evenly, then they'll make it up by gouging those that don't have price caps.
One post above was complaining that the Canadians don't want us (US'ians) buying their drugs since it drives up their prices, but we could just as easily make the counter argument that they should lift their price controls since we end up subsidizing their low drug prices.
AMERICANS wake UP! This is what happens in countries that have socialist medicine and it's coming here! Yes we have big problems with the cost of health care here that need to be fixed but the solution is not to do what they do in the UK and Canada.
As somebody whose family has been in and around the dental profession for over 3 generations now...
A very large percentage of Dentists will not do wisdom teeth extactions and a major percentage will not do any extractions of any kind due to the high level of malpractice insurance that is needed. Even if their insurance covers it, they will not take the risk of a lawsuit and will send you automatically to an oral surgeon.
To add to my previous statement: don't think that you aren't paying for it too. Canadians spend about $2000 per capita per year on healthcare, while we spend $4000 per capita per year on healthcare. Sure, for Canadians that money is spent in the form of taxes, and for us it's in the form of health insurance payments, but at the end of the day, that's an extra $2000USD out of your pocket every year.
A deep unwavering belief is a sure sign you're missing something...
The authors of "Critical Condition" were on NPR the other day, and talked about malpractice lawsuits and insurance. They named one state that had the highest rates of reported malpractices, and nothing done about it by the state government, such as disqualifying doctors. It also turned out that state has the highest malpractice insurance in the country.
Parent is not a troll.
There is a correlation between this behavior and socialized medicine. Especially if that medical system has "waiting lists".
Canadians have come to the US. Brits have gone to India, France, the US. I'm not saying it's a huge trend. But people with money... want healthcare *now* and they will find ways of doing it. Canada has *actually JAILED* doctors for opening a private MRI clinic. That's just plain silly.
Not to mention the story about a Canadian who's son was gravely injured... he brought is son to the hospital, but he couldn't be admitted without a paramedic or an ambulance. So they waited... while the son died... for an ambulance to come from across down so he could be admitted.
Oddly enough Americans are outraged that it's illegal for them to go north and LEECH off of Canada's heavily subsidized presription drugs.
This is a serious issue with rationing health care because now you have given people motivation to leave the country to get (possibly) substandard healthcare. (But that's better than certian death on a waiting list, no?)
Figuring out who will and who won't get healthcare is a terrible choice to make. That being said no matter how you do it it'll be unfair. I personally happen to believe that it's *least* unfair when you directly pay for a service.
~foooo
Your post was thoughtful and informative. You might also want to look at the administrative costs for the school districts themselves. The state and federal DoE are just conduits for money.
Following the link you provided, I added up the administrative salary costs for LA Unified. Out of a budget of $5.9B (which is $8100/student), about $550M was for administrative personel (supervisors, superintendents, administrators, and clerical workers). This is 9% of the district's budget, but excludes the cost of benefits. Although that data is not broken out as nicely, it probably adds another 3% (benefits are listed as about 30% of all salaries). That's 12% for administrative personel, and that does not include the maintenance costs for buildings to house the administrators (after all, not all of them work in the schools).
For comparison, my oldest son went to an unsubsidized private school. Four years ago, the (high school) tuition was $4000/year. The quality of education was by no means the best, but it was comparable to some of the better LAUSD schools. They paid the teachers less and had fewer administrators. They did not cherry-pick students, but they did get to kick out troublemakers.
My youngest son goes to an LAUSD school. The teachers take vacation during the school year (something that I never saw at my oldest son's school), and one day each week they let the kids out an hour early so the teachers have time for professional development. Abuse of sick time is so rampant that LAUSD has a program that pays teachers a bonus if _they_ have good attendance. According to the link you provided, the average teacher salary at LAUSD is $53000/yr. Teacher pay seems pretty good to me.
From the data, I would say LAUSD spends too much on administration. A number like 5% would be far more reasonable.
I would also be willing to bet that teacher pay does not correlate with student achievement. I would guess that if you studied the entire United States, you would find that teacher pay correlates positively with union strength and negatively with student achievement. If anyone knows of a study on that point, I would be grateful for the education.
I thought it was that Canada negotiates lower prices for prescription medicines, not that they actually put funds into buying the drugs.
This site says that the drugs are cheap in canada due to price controls and bulk buying.
The problem with this is that they base the price on the per unit production cost, not including research/development/certification costs. For a reasonable return, the company has to make it up somewhere, mainly in the USA. Drugs in the USA are cheaper once the generics make it to market.
I don't read AC A human right
You're out of your fscking mind if you don't think it is paid for by taxes. County USC Medical Center in Los Angeles receives over a $1 Billion in funding just from Medicaid and last I checked Medicaid comes out of your tax bill. In all, nearly a trillion dollars of tax money gets filtered into our medical "system" and virtually no one is eligible for state coverage. Basically, you have to be earning less than 25k and have children or be over 65. Everyone else gets exactly bupkis.
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U J: www.senate.gov/~finance/press/Gpress/2003/prg09080 3.pdf+%22Jeffrey+Barbakow%27&hl=en
Government buisnesses are not as efficient as private buisnesses, anyone who works for the government can vouch for that.
Really? Compare the amount of services provided by the Canadian health system to ours for the money spent. They get roughly three times the service for one third the cost.
The problem now is that prices are going through the roof. The reason for this is often argued to be because of lawsuits which drive the doctor's insurance premiums through the roof.
Wrong. The reason prices are going through the roof is that the law REQUIRES private hospitals to provide emergency care regardless of ability to pay. The government will only pay if the recipient falls into a very narrowly defined group of criteria (generally, less than 25k with kids or over 65). THE REST GETS WRITTEN-OFF. God help you if you are a non-profit hospital, because they then REQUIRE that you meet a quota of free service.
The problem with US Healthcare is people who lobby their representatives to prevent anything that resembles universal health care (read: sounds like YOU, bucko). So, we get fits and starts with the result that we end up paying triple what anyone else does for a usable, full service so we can keep the absolute fscking bare minimum in place to avoid catastrophe, and then end up having to make up the budget elsewhere because we're "charged" for this bullshit when for-profit hospitals write-off the difference between what government requires them to provide and what is actually paid for, which when combined with the similar structure of insurance price-lists, causes hospitals to drive the rates into the stratosphere just to keep the fscking lights on.
Yeah, we have "the best" POTENTIAL, but we don't even remotely have "the best" in aggregate reality in terms of what is actually delivered.
I worked in healthcare finance for nearly a decade and can tell you with great confidence that the contradictory laws, insurance carriers and hospital management companies are FAR more to blame than malpractice lawsuites.
You want to talk about the efficiency of private healthcare management? You go do a google on "Jeffrey Barbakow" and get back to me. I think you'll find it quite an enlightening experience on the "benefits" of the US system.
Try this one, for instance:
http://www.senate.gov/~finance/press/Gpress/200
or if you hate PDF:
http://216.239.39.104/search?q=cache:5Wbu79SGHf
Now, as you read that little missive, keep in mind that the man in question to this day controls roughly 30% of the US Hospital system.
Have a nice day.
One major cause is in the demographics. America (as is most of Western Europe as well) is getting older on the average, and old people cost a lot more to treat than younger people. That's only going to get worse over the next 30 years, and it's going to get far, far worse. Medicare is going to collapse under the promises it made decades ago, and nobody in Washington has the balls to do anything about it for fear of angering the AARP. The end result is that the system will come close to collapse under trillion dollars of debt, and it will have to be made up out of emergency tax increases on those of us younger than baby boomers and our children. I predict we'll see the Medicare tax go from it's already high levels to over 25% or even 30% of your income within my lifetime. The cowards in Washington DC are simply allowing this to happen.
The other big cause American health care costs so much IMNSHO is simply that it's a "for profit" system. "For profit" means that somebody is making money above and beyond the basic costs of providing the care. Look at the stock price graphs of the major hospital mangement companies, HMOs, and pharmaceutical companies. Every single point of increase in that stock price reflects a huge profit above and beyond the basic costs of providing health care. A lot of the increase in costs is going into investors pockets (including mine since I have held shares in pharmaceutical companies in the past, though not currently).
The supposed benefit behind the idea of the US system of private health care is that the profits are more than offset by the benefits of 1) competitition between different providers, and 2) increased efficiency and decreased corruption as compared to a governmental system. For various reasons, these benefits have not panned out.
Re: #1 -- Competition exists only to a certain extent between providers. The problem in health care is that the end-consumer of health care (who is insured) is relatively price-insensitive to the actual costs and bills generated from their care. Once they hit their deductible they don't care what it costs at all. The newest and most expensive thing must be the best, so we'll all go for the most costly stuff around. Supply and demand for physicians also doesn't quite follow the simple economic principles we all know and love. One or two interesting studies done some time ago (I don't have the references handy) found that physicians basically create their own demand. Even in areas supposedly "saturated" with doctors, adding more doesn't decrease the prices, it just creates more demand.
Re: #2 -- Increased efficiency is sometimes seen in private hospitals over public ones, but having worked in both I can't say that it's a big difference. Since there's little price sensitivity, why bother ever lowering your prices? Jack up the bills and buy more expensive toys! Efficiency is further decreased in American hospitals by the absolutely amazing explosion in the number of administrative (non-patient care) staff to do the paperwork, file the claims to a slew of governmental and private insurance companies, twiddle their thumbs, or whatever. American hospital CEOs make far more than their European counterparts, and they have much larger highly paid staff than in Europe. I've never worked in a hospital where the hospital CEO made less than two or three times what I do, even if they manage the hospital
"No, no, no. Don't tug on that. You never know what it might be attached to."
According to a Congressional Budget Office report on Medical Malpractice, lawsuits cost the insurance companies $24 billion dollars a year, less than 2 percent of overall health care spending. A reduction of 25 to 30 percent in insurance premiums would only reduce health care costs .4 or .5 percent. Furthmore the report says that it found no evidence that tort reforms reduce defensive medicine.
By the way, we still tax Social Security benefits. Read that again. We TAX SOCIAL SECURITY BENEFITS. We tax people who get married. We tax people who sell their house. We tax people who make just enough to eat. We tax everything at enormous, ridiculous rates.
And yet they still spend way more than we take in. THAT's the problem that has to be solved, before taxes can be cut/eliminated.
I am not a sig.
[It's always surpising when I read Slashdot readers generalizing from limited instances.]
l l/ 23/3/119
I'll provide two links that paints a more complicated picture. I suggest you read it and pay close attention to the pros and cons of the different systems/countries. There are other studies available for your evaluation. Rather than relying on the word of a tiny sample of the population from your personal experience I suggest you seek out data from studies with statistical power. Anyway, when reading please factor in the millions (45 mil???) of Americans without health coverage. If the figures are to be believed of those 45 million (let's say it's an overestimate by a few million), 1.7 million of your military vets are also without insurance. How do those millions impact on wait time --- or is it the case that they just don't have ANY options?
http://content.healthaffairs.org/cgi/content/fu
http://ns-medicare.tripod.com/hitsmiss.html
There are problems within the Canadian system. No denying it. At the same time historically Canada spends less on medicine. That said, 150% of the funding for the studied shortfall (Romanow report) in our health care system has been promised. It's a done deal. The Canadian health care system now has guaranteed funding of more than what was suggested in the Romanow Report.
Despite your strong statements you fail to acknowledge the complexity of medicine and health care. Certainly Canada is lacking in many areas (e.g., wait times for some surgeries), but excel at others. How many Americans die or suffer because they must split their doses or go without because they don't have the money to refill their prescriptions. This is especially so among the poor and/or elderly. -- You do know that Canada is now subsidizing the drug costs hundreds of thousands of Americans. Your elderly are suffering less because of the system you've so simplistically criticized.
As for strikes and closures I've lived in Southern Ontario for 30 years and have limited memory of such events here. Quebec on the other hand follows different funding rules and may have suffered a greater number of (rotating) strikes. In fact, I've been informed by a friend doing her residency in Quebec that system is in great disrepair.
The money needed will soon be in the system to address many of the more obvious complaints. At the same time, the third world picture you paint is remarkably uniformed. As in any large country regional differences can be used a weapon, hoping that the reader will not question the selective nature of the data. That's exactly what you've done! How well equiped are the hospitals in the poorest part of your country. Consider that these poor cannot afford health care, so there is no reason for state of the art health care.
There is no such thing a "routine" closings in most of Canada!
The biggest thing wrong with our system is leeches like John Edwards, who drive the cost up by suing everyone in sight for ludicrous amounts of money.
Wrong, wrong, wrong!
Snopes.Com Debunks this.
It's quite difficult to become certified in the US if you are trained as a doctor overseas, so your statement that "Places like india and south africa end up supplying plenty doctors to western countries" is disingenuous at best.
First off, they must be approved by the Educational Commission for Foreign Medical Graduates (ECFMG), then pass the United States Medical Licensing Examination(TM) (USMLE(TM)) board exam ("the boards" that you may hear med students grumbling about), and then they must complete a residency (3-7 years depending on specialty) in the US even if they were certified and practicing in their home nation. Source: ECFMG fact sheet.
On a semi-unrelated note, I am planning to apply to medical school in Canada, and through my research, its rather disturbing how little standards some USA medical schools have. Many schools will take people with MCAT scores less then 20/45 (while its almost impossible to get in here with a 30/45) and some of the USMLE grades for students are insanely low.
This is completely incorrect. There is no MD school in the US that has an average less than 23/45 on the MCAT (Howard Univ.) for their entering classes. The vast majority of MD schools (especially the top 50 schools)in the US are running between 28-33/45 for the average scores of matriculating applicants. Osteopathic schools of medicine typically tend to run a little lower but even those schools are highly competitive. Applicants in the US have a similarly difficult time getting into school even with a 30/45 and very few applicants are admitted in the US that achieve a 20/45 or lower (though some are admitted in both US and canadian schools).
The writer of the parent of this post is clearly misinformed as to the academic standards that prevail at the majority of US MD schools.
Oh, right, because the Administration and Congressional Republicans made it explicitly illegal for Medicare to negotiate bulk prices when they passed the recent Medicare prescription drug benefit. The VA's been doing it for years, but Medicare is forbidden by law.
Are you Canadian? Then I guess you can't help us undo this bit of absurdity. For all you other Americans out there, though, I hope you know why Medicare doesn't do it, who to blame, and in less than two weeks you can help the guy who's promised to undo this ridiculous restriction to reach office.
You are talking of competition in India? You have more medical schools for the 300 million pop[ulation than India has to its 1Billion!! The All Inida Institute of Medical sciences has just 40 admissions each year and the test is taken by more than 1 million students. If you are talking of competition, I could not get into a good govenment engineering school in India, but scored 2300/2400 in GRE and got out of Univ. of Penn here in US with a 3.9/4.00 GPA. So don't even get into the competition when it comes to getting admissions in schools. There are far more resources for that here in US and you should be thankful. For once try believeing there are people out there better than what you find here.
I have several physician friends who work at hospitals in Montreal, Toronto, Edmonton, Calgary and Vancouver. My sister works in Edmonton at the University of Alberta hospital, arguably one of the best hospitals in the world, too. I fired your post around for comments:
I think it is safe to say that they don't agree with your assessment.
Where in God's name do you get a statement like that? Wait times in recent years have been a shade longer than they ought to be for some cardiac procedures, but but the idea that "most" Canadian heat patients die waiting for care is laughable. More important, it's not supported by statistics. Here are links to current numbers for Ontario waiting times for heart procedures. (stats are for the three months ending June 2004; there are further links on the page for historical data.) Open heart surgery; angioplasty; cardiac catheterization.
The median wait times for urgent/emergent, semi-urgent, and elective cardiac surgery were three, seven, and twenty-five days, respectively. Four out of five patients receive cardiac surgery within the "recommended maximum waiting time". Despite that, even the ones that do wait longer usually don't die waiting--the RMWTs are a bit conservative.
In Canada, the AVERAGE wait for hip replacement surgery is THREE YEARS.
Not sure where you get this statistic, either. I agree that the wait times for joint replacement surgeries in most provinces are far too long, but three years is overstating the case. There are anecdotes reporting wait times of up to two years for some orthopedic surgeons at some facilities. The UHN (the largest hospital network in Toronto) cites wait times of 13 to 43 weeks for elective joint replacements at the moment; other Ontario hospitals are scheduled to begin making those figures available this coming April.
Her regional healthcare administrators were killing her, one day at a time, by refusing to let real specialists look at her and maybe make a difference in her life. That would have cost money.
Which "real specialists" was she not referred to? In some circumstances, I can see local specialists having long waiting lists, but outright refusal to refer a patient to a specialist for medically necessary evaluations or procedures isn't cost containment--it's malpractice. It's also perfectly kosher to ask for a second physician's opinion, and seek a referral through him. If none of the doctors who saw her were willing to refer her to another specialist then maybe, regrettably, there genuinely wasn't anything that could be done.
Canadian hospitals ROUTINELY close to all but emergency cases for the last couple of months of the year, when they run out of money. If you have a non-emergency in November, you will just have to wait until January and the new fiscal year.
Are you insane? Canadian hospitals are open and providing the same level of service year-round. You may have a longer wait for some services in the winter, particularly if you show up in the emergency room with a relatively non-emergent problem--it's flu season, and there are more slips and falls, and so forth.
I am also skeptical of your claim since most hospitals operate on the same fiscal year as the provincial governments that fund them. If they were to stop carrying out procedures because they ran out of money at the end of the fiscal year, it would be in March, not December.
From some of your other posts, I gather that your experiences were in Quebec. My own experience is with Ontario's hospitals. Since each province operates its own healthcare system (within the federally-mandated bounds of the Canada Health Act) I suppose it's possible that Quebec health administrators are the bumbling murderers you make them out to be--but I suspect that you're just full of it.
~Idarubicin
By nearly all accounts? Utter bunk.
The GAO released a report this year that showed liability costs were 1% of the total for medical expenses. So even if you eliminated every single liability case (whether it was legitimate or not), health care costs would only come down 1%.
it saves the MD about 20% to not have to go through the claims process
Serveral things to watch out for...
1. Needed services often increase dramaticaly along with fee's for cash Pt's.
2. Insurance companies establish "Usual and Customary fees" and generaly only pay those or a percentage, if the Dr. accepts the insurance; it means that he/she also accepts the fee structure. Normaly they bill the Insurance their normal fee's, the insurance pays the usual and customary, and the DR. writes off the difference. The idea is by billing more than they are willing to accept, the usual and customary goes up. As a cash Pt you may only get a portion or none of the difference how about a 10% discount on a bill inflated 100%.
3. Frequently the insurance looks at things as a package, and only pay so much for a proceedure, as a cash Pt. your probably going to get ala carte pricing i.e. pay for each and everything, offten at 100-1000X mark-up.
4. If your Dr's morals-ethics are looser than most, he'll think "no insurance, medicare-medicade audits, no ovesight of any kind, PT Barnum was right."
I think the biggest problem is the insurance in the first place, insurance is big-biz, which needs lawyers, which attracts more lawyers. This results in law suits, which attracts more lawyers ad-nauseum. All of this drains resources away from healthcare and into legal.
Apocalypse Cancelled, Sorry, No Ticket Refunds