Slashdot Mirror
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...'"
I have a friend who went to Canada to get her Laser Eye Surgery real cheap. Apparently the company has an office here in Seattle, and a shuttle to Vancouver, B.C.
"This is news" was my reaction too. I don't know how long Brits have been popping across to the Continent to beat the NHS waiting lists, but I do know that the travel insurance I got in 2000 included exceptions for people travelling abroad for medical treatment.
Places like india and south africa end up supplying plenty doctors to western countries and i'd feel pretty confident that they'd do a good job.
Makes me wonder why someone doesn't just get a ship anchored in international waters off the coast of california to offer similar cut price procedures.
My wife and I considered going abroad for the treatment we where facing too. We where in need of IVF (in vitro fertalization) and this is typically not covered by insurance companies in the US. Some numbers suggest up to 2 million americans are in need of this procedure. Looking at about $15,000 per procedure without a guarantee of success we considered getting treated in Canada (less then $10k per try) or even going back to the Netherlands where it is insured by law reducing the patients cost to ~$1200 per try.
Given that I am in the top 5% income bracket we opted for just taking the treatment and paying for it. Still not a great thing considering that it could take several treatments after which there is still no gaurantee of success (other then losing the money).
We got lucky. First time was a success.
I have been wondering how the millions of other couples in america for whom this procedure might be the last chance are dealing with the cost. Going abroad maybe?
You can thank the "everybody for himself" mentality that is what the Us is all about.
I read a newsarticle a couple of months ago where they pointed out that not even Medicare is "buying in bulk" but rather "individual packages" depending on how it goes.
Imagine all of Medicare got their act together and would negotiate ONE price with the supplier? Suddenly the prices would drop.
That's whats going on in Canada, and they are currently fighting over a Federal Pharmacare plan which would probably decrease the costs even further.
If you want to e-mail me, use my PGP Key.
Sue for malpractice internationally for a pittance?
Almost every country in the world will let Anybody sue for serious screw ups, but in almost every country in the world, the burden of proof of error is much higher. You have to prove:
(A) It was directly their fault, or their fault due to non-action or ignorance.
(B) That your quality of life is lower then if nothing had happened to you at all (after recovery and such).
(C) That the doctor did not make normal and standardized efforts for your care and recovery
(D) Also that, in the case of an accident, that if the doctor did not take Reasonable and standard steps to minimize risk.
This is vastly different then in the USA, especially in point A is a big one. In the USA, you could theoretically the doctor that delivered your child for them not making it into college, and would have a pretty reasonable chance of winning (don't doubt it).
Being able to sue, and a criminal system is important, but when it gets corrupt and full of greedy people, things like the ENTIRE MEDICAL SYSTEM get more and more expensive for everybody.
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. Often your residency programs for the same programs are a year or two shorter then here in the Great White North. As mentioned somewhere else in this article, unless you can keep some of the most trained professionals in your country as being quite smart, well educated, and socially aware, your will run into problems.
Countries like India and China have been focusing on building up that qualified and trained elite. While many/most of the people in those two countries have seen little growth in paycheck or quality/standard of life, they have, behind the scenes, a social system being developed to support first class societies.
While I hate to seem exclusionary, I think that we need to redesign the school systems across all of North America. Schools should be focusing on providing two distinct services, one is well-designed life skills training, and hard and aggressive knowledge training. Things like calculus and advanced chemistry should be introduced at as young as 9 or 10. While many will/cannot do this work, the ones that will are the important future engineers, doctors, scientists and professionals that we need.
That's complete nonsense. Sure, public hospitals in India (which are free) are in a horrible state, but no one's talking about them. In private hospitals, as the blurb mentions, the quality is about as good as in the U.S. I know, I'm from India. So quit spreading FUD.
1. Healthcare is expensive in the US because of high malpractice insurance. ... Moreover, he added, a New York heart surgeon "has to pay $100,000 a year in malpractice insurance.
From the article: Trehan, 58, a former assistant professor at New York University Medical School who said he earned nearly $2 million a year from his Manhattan practice
This guy was making $2mil a year, and paying $100K for MI; just 5%.
2. Doctors there are bad
The founder (as quoted above) was an Asst Prof at NYU, making $2M a year. In fact, a lot of the doctors you find here (in the US) are graduates from the same Indian schools. And many of them working at these top hospitals are those who returned from US/UK. You'll find a good number of them holding advanced degrees (like FRCS) from institutions in US/UK. A good friend of mine (an Indian who finished his residency here) is going back because he couldn't get into the top school he wanted for research. He has his choice of places where he can practice, but he prefers to go back because he says "if I'm going to practice, might as well do it at home". There, the good doctors are put on a pedestal and have a lot of clout in society.
3. Facilities are bad
The hospital mentioned, Escorts, is top-notch and was founded by an Asst Prof at NYU who gave up a $2M/yr package to go back. Here's another quote from the article: Escorts is one of only a handful of treatment facilities worldwide that specialize in robotic surgery,
4. Quality of care will be bad .8 percent. By contrast, the 1999 death rate for the same procedure at New York-Presbyterian Hospital, where former president Bill Clinton recently underwent bypass surgery, was 2.35 percent, according to a 2002 study by the New York State Health Department.
From the article: the death rate for coronary-bypass patients at Escorts is
5. It is cheap because it is bad
Again, from the article: For example, a magnetic resonance imaging (MRI) scan costs $60 at Escorts, compared with roughly $700 in New York
I will relate a personal story. A very good friend of mine hurt his back (slipped disk) while travelling in India in 1997. He had to be hospitalised, and operated upon. After operation, he got 1 month of in-home nursing care. The total bill? $4000.
When he came back, he told his insurance company about this. They asked him to go to a local doctor. He checked him out, and said that the job the Indian doctors had done was as good as anything they would have done locally. And the insurance company paid the $4K even though he hadn't followed procedure (called them and sought approval), saying that just the MRI alone here would have cost $4K. There, the MRI, surgery, post-operative care, etc. all came at the price of just an MRI here.
You are absolutely right. I used to sell health insurance and I am currently CTO of a company that provides medical practice automation software (which includes claims processing).
When I have had to pay for my own health insurance I get a policy with at least a $5,000 deductible and high maximum benefit. I also open an MSA (Medical Savings Account). That way I pay for my family's routine visits out of my own pocket (cheaper than comprehensive insurance over the course of a year) and I am still protected against a major medical catastrophe.
The next layer to add to this is to, before telling the MD you'll be paying cash, ask if you can get a discount for cash. Sometimes (often?) you can since, on average, it saves the MD about 20% to not have to go through the claims process.
The result is a health insurance set up which is portable and relatively affordable.
"Medical school admission in the US is extremely competitive, likely the most competitive academic process in the US."
I've had to TA pre-med students and while some were bright it was their incessant grade-grubbing that made them stand out. While in grad school I've also had three pre-med students working in lab for me. All three were smart but only one was what I'd call brilliant. All three got into med school. One declined and went to grad school because she thought it'd be more challenging. One got in because her dad made a bri^H^H^H donation, and much to her credit she's having a serious moral dilemma about accepting the spot. The appalling thing is that "donations" to try and influence the admissions committee are not uncommon. As in most things if you're rich then the rules can easily be bent, and the ones that go to med school are disproportionately from wealthy families--so much for academics. The third is now a third year med student at USC and it's largely from her (and from my having to tell a MD that antibiotics don't work on viral infections) that my opinion of med students and MDs has dropped through the floor. Her classmates almost without exception are from wealth and privilege, brought up by maids and nannies and carefully insulated against the world. She was one of the few with real-world experience (academic research, paramedic, firefighter, crisis intervention worker); most simply were memorization machines with high grades but weak problem solving skills--her opinion as a fellow med student, mind you. Most were utterly clueless when it came to dealing with patients or figuring out a diagnosis.
Perhaps this sums it up best: One of her classmates somehow made it to age 24 and was still under the impression that women have a cloaca. Nevermind never having a gf or never seeing any porn, he thought that women only have one opening down under after passing an undergraduate-level human anatomy lab! At least it being USC there's no shortage of porn stars to come in to be model patients for the med students' gynecology exams so that got straightened out real fast.