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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...'"
"Thank you...come again.!"
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.
Now we don't have to worry about having doctor's in the US anymore, also... we can just get on a plane and go to India for medical care.
Add sarcasm tags where appropriate.
"In theory, theory and practice are the same; in practice, they are not."
£0, but some serious taxes and a wait on a waiting list.
Even so, I must say I prefer universal healthcare.
Gamers Europe - Gaming News. Reviews.
"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.
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"?
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?
Something economically is going very wrong in our medical system when everywhere else in the world is getting the same goods and services we are for much less...
Remember, perscription medications are very much an IP-based business. The first pill costs millions in research and approvals. Once the pill is ready for mass production, the actual ingredients cost very little to gather and put together. That's the reason why there has to be patents on medications... without that IP-based protection, nobody would pay to do the research that creates new drugs.
Still, when Canada's getting the medications for less than they're being sold in the USA... something's very wrong. It feels like every other first world country has set price controls that the drug makers are bowing to, and because we don't have price limits, they charge us to make the money.
It's an interesting dilema... if we pull out of funding the world's research, that research just isn't going to get done. On the other hand, we're funding the research that the rest of the world is benefiting from and not paying for.
I don't understand all of this "outsourcing" outrage. Doesn't India "outsource" manufacturing of soft drinks to American Coca Cola and Pepsico? Isn't it just progress, that anyone can do what one can do best, no matter where one lives? Why discriminate against people of any given nationality instead of cooperating globally? This is a perfect example. Why should people not be able to get the best medical care only because it is not available in their homeland?
Sincerely,
Pan Tarhei Hosé, PhD.
"Homo sum et cogito ergo odi profanum vulgus et libido."
The USA already outspends Germany and Japan per student. The problem isn't that we spend too little, it's that the money gets pissed away on administrative costs instead of compensating teachers adequately. Add to that the NEA's tooth-and-nail resistance to anything resembling competition or accountability, and you get the mess that is American primary education today.
-jcr
The only title of honor that a tyrant can grant is "Enemy of the State."
American medical care is expensive because of artificial supply constraints at every step. When I went through pre-med in college, anyone could tell you that the process is designed to "weed out" the pool of potential doctors; that phrase is the mantra in every course. The weeds are people without sufficient profit motive to survive the often arbitrary, abusive process. That includes foreign doctors who move to the US for freedom, but without the financial or competitive advantages needed to get recertified. That limited supply of doctors, including less competent ("malpractitioners") in medicine, but committed to their paying careers, means extra demand for doctors for second/third/etc opinions, fixing mistakes, medical makework... If America invested more in educating doctors, the supply/demand crisis would be calmed at both ends, and medical treatment would cost less. Then we'd just have to worry about unnecessary prescriptions, pharmacy profits, insurance profits, and career malpractice fraud lawyers.
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make install -not war
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.
That's what all the media tells me: Canada's healthcare is falling apart! Canadians pay more! Canadians have hoooje waiting lists! The sky is falling!
Pah.
Canada may not have perfect healthcare, but we sure as hell aren't (a) paying for heart surgery; and (b) taking off to India to get it.
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Don't like it? Respond with words, not karma.
The school district here, decided that it was a good idea to spend several million dollars for football field upgrades. Until we decide that education has a higher importance in our EDUCATIONAL system than playing games, we are screwed.
I haven't seen a school yet that hires an economics teacher, and has them fill in as a coach, but they all seem to be fine with hiring a coach and asking them to fill in as an economics teacher.
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.
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;--"?
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.
I disagree. Americans are medically-obsessed. I work at a boarding school, and I end up in the dorms fixing stuff quite a bit. I have yet to see a room without a bottle of 'scripted antibiotics in it. The school newspaper just made a joke about how much ritalin and adderal is abused for 'studying'. We overpay for every piece of plastic and metal that goes into medical care. The list goes on.
When I got a fungal ear infection and my doctor prescribed me antibiotics, which are exactly WHY I got the fungal infection, I stared thinking about it. I haven't taken a prescription since.
When I had to get my wisdom teeth out, I decided to do it at the dentist's office instead of the oral surgeon, I saved over $1200, and the fact that I was awake and could cooperate with the dentist meant that the surgery went smoother and safer, and I recovered much faster because they can really 'beat you up' when you're unconscious. I walked home with some cotton to soak up the blood and a bottle of advil for the rest of the week.
Why on earth would insurance pay for a full-on surgery to extract wisdom teeth? It can be done easily at the dentist's office for a third of the cost.
I really don't think the problem is litigation, it's certainly a problem, but not the major factor in medical costs. The major factor is American aversion to reasonable amounts of blood and pain, coupled with excessive trust in the medical institution and it's practitioners.
"Sometimes, I think Trent just needs a cup of hot chocolate and a blankie." -Tori Amos on Nine Inch Nails
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.
Oh its easy to do that, simply cap the amount that lawyers get from the lawsuit at a fixed (not percentage) amount and a change in the way awards are done. Pain and suffering? Here's a trustfund to cover your painmeds and a shrink for as long as you need them. Punitive damages? If whatever was done was SO bad, throw the doc out of the profession. (and I'm not talking about the doctor who takes on the risky brain cancer operation that the patient was going to die in months without and patient doesn't survive even though the doc did everything right, or the people who sue the OB who delivered the baby for brain damage when their kid fails to get into Yale.)
Of course, you're not going to see the LAWYERS in charge around here fixing their profession anytime soon.
If I have been able to see further than others, it is because I bought a pair of binoculars.
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.
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.
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
The percentage of people who have the personal resources to personally pay for the worst case health problems is in the low single digits. That means that health care gets rationed here in the USA, too. It's just a different system; people who have full-time jobs at large corporations usually get first priority. (Why does the size of your employer have anything to do with health care? Who knows.) Then come the perfectly healthy people who are allowed to buy individual policies, and people who work at small employers where none of their coworkers are too sick to lose the group plan. Lowest in the rationing pecking order are uninsured who rely on emergency room triage.
Oh, I forgot that half of the healthcare in this country is fully socialized. It's just for everyone who is old enough to get on medicare so that they can get free coveraged paid for by those of us who actually have to work (but don't get to actually benefit from the socialized healthcare we pay for ourselves).
At the end of the day, almost nobody is actually directly paying for their healthcare in the US anyway.
Funny thing, if you put people's money into a pool, and a Central Committee doles it out and dictates what can and can't be done, we call it Socialized Medicine -- EVIL!!
But if the people who dictate what can and can't be done also get to own the whole thing and rake off enough to get rich, we call it an Insurance Industry -- GOOD!!
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."
50 years ago, there wasn't much that could be done for you beyond a couple of thousand dollars. Most people could be expected to pay for their own healthcare.
Now it's not unheard of to spend more than 1 million dollars on a single patient (one of my former employers mentioned in a benefits meeting that they had 5 $1 million patients in the previous year). Any reasonable person needs to have insurance, unless they're willing to die for the principal of frugality.
Health savings accounts are fine, as long as everybody qualifies, and as long as they always come with full insurance past some deductible that most people can afford. I do think that all health insurance plans should be required to have a high deductible to encourage people to shop on price. However, I also think that one way or another, there should be a single risk pool that amortizes the risk evenly over the whole population. This would greatly reduce both the outrageous costs of accounting in the insurance industry and the stress most people needlessly experience when they change jobs.
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.