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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.
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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 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 - $146 Australian for two hours of surgery. None of the waiting lines in all the horror stories about socialized health care, perfectly competent doctors, etc.
Sure, the Mayo Clinic draws people from all over the world, but the average American hospital is no better or worse than the average Western European or Australian one.
Medical malpractice is less than 1% of the total US bill. Try again, and this time without simply mimicing GOP talking points.
Did you really name your son "Robert');DROP TABLE Students;--"?
I've got to guess you've never worked in the medical industry before (on the Dr. side of things?). I have...and by and large, it is not the Dr.'s who are doing it...it is the lawyers, and patients looking to make a quick buck. That's why Doc's have to run so many tests...even though 1 or 2 might do..to cover their asses. And then, there are the bean counters that are running medicine....not the Dr.'s....but, that's another story altogether...
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
I had a Japanese society teacher who experienced something similar in Japan (and Japan is a lot more expensive of a place than India!). Both the US costs were about the same, and the cost in Japan was about what this person paid in India. Probably a rare case, but still.
The US medical system costs an utter fortune. Last numbers I saw, the average American spends - between out of pocket expenses, company-paid expenses, government expenses, etc - over 4,500$ 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.
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.
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.
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
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
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."
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.
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.
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
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.
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