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CONSUMERS/POLICY: Real people really travelling

Via HISTALK, a really interesting column about people traveling to India for surgery. Essentially the total cost slightly exceeds the co-insurance for those with insurance and of course the cost is remarkably lower for the uninsured. The people featured are those in the 50-65 age group who are pre-Medicare and finding it harder and harder to get health insurance are the obvious candidates.

And of course they are the ones for whom the health insurance crisis is biting home, and the ones who will be the swing voters about this issue. I for one cannot believe that this group of Americans will accept that they all need to travel to India and pay out of pocket, over and above whatever catastrophic coverage they are also buying. So when a politician comes up with a believable universal solution, this type of story will be behind what gets it through the Congress.

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  1. pgbMD, It seems you have a little bad taste in your mouth for overseas competition. Do you also share that bad taste with workers here that lose their jobs to lower priced labor and cost-of-living overseas? Or do you embrace free trade, the workers be damned, and the “it-costs-me-nothing” mentality?

  2. I would like to know how much an orthopedic surgeon makes for a hip replacement in these concierge hospitals in India. Here in the US I believe it is now down to around $2000. Maybe there will be a brain drain of US surgeons to India and Thailand!!! No malpractice to worry about and I am sure much less headaches and paperwork. Even if they are compensating only $1000 per hip replacement to the surgeon the cost of living and overhead are much lower than here in the US. After these overseas concierge hospitals business models mature, maybe we can try to emmulate them! 😉

  3. “the luxury hospitals put ours to shame”
    No they really don’t, except in terms of their cost. You are far too eager to trash American hospitals.
    Many hospitals in Western Europe and a few hospitals in Central/South America, Africa, and Asia do provide equal or marginally better care as in the U.S. at a fraction of the cost here. That is what I mean by “21st-century health care”. That combination of high quality and low cost may well re-define patient expectations in the U.S.

  4. Actually the 10 hour plane ride is also for a vacation as a $100,000 hip replacement for $25,000 allows for some R&R. Don’t discount Indian or Thai healthcare done in hospitals geared to foreign patients, the last thing they need is quality problems as that would dry up patients pretty fast. 60 minutes did a show on this and the luxury hospitals put ours to shame. Nurse to patient ratio is also quite high. Many Indian docs are trained in U.S. and return to help build their country, no big bucks to cloud their health decisions.

  5. “2. Would those in favor of overseas medical care, but would rather not be on an 10 hour plane trip (or longer) actually be in favor of implementing reforms in the US that would place the same level of regulation, medical liability restrictions, pure economic-based quality and availability of care, border control limiting illegal aliens access to their health system, etc. here in the USA?”
    You hit it on the head.

  6. 1. so-called medical tourism is great— but given the greater than 1 BILLION outpatient doctor visits alone last year in the US, it will never be more than a tiny segment of the picture.
    2. Would those in favor of overseas medical care, but would rather not be on an 10 hour plane trip (or longer) actually be in favor of implementing reforms in the US that would place the same level of regulation, medical liability restrictions, pure economic-based quality and availability of care, border control limiting illegal aliens access to their health system, etc. here in the USA?
    3. hooray for Peter — actually making an informed choice and choosing to bank his money as opposed to paying for insurance. Whether this is right or not is up to Peter, but he should be able to make a decision and understand the consequences. BTW, in Peter’s case, he is not ‘uninsured’, but rather self-insured, since he is making a choice to put money away for possible medical expenses. Subtract one from the uninsured roles.

  7. Prisoner organs are risky business because of the high rates of Hep C and HIV. As healthcare tourism increases, I think the insurers will have to address this issue of paid organ donation. I doubt Medicare will go this way, but who knows.
    As far as the floating hospital ship goes, I don’t think there will be any CABGs or delicate neurosurgery done onboard secondary to the motion of the ocean. Even huge hospital ships like the USS Mercy/Comfort still move up and down while at sea.
    The hospital ship question is interesting. Since the hospital ship would be in international waters, are they obligated to implement all the unfunded mandates imposed in CONUS (ie JHACO, HIPPA, etc). They certainly would save a bunch of money by not having to run an ER and take care of uninsured illegal aliens. I guess the real question is, what other factors are driving up the cost of hospital care in the US?

  8. Yes John, rip what it sews not reap what it sows. I’ve always been a worse speller than typist. Anyway, I think that in surgical terms rip/sew has more meaning. :>D

  9. “what if you didn’t have to fly to India for your 1/3-the-price surgery, but instead could take a 15 minute helicopter ride?”
    And perhaps at that range you could persuade the surgeon of your choice to accompany you and perform the surgery.

  10. Dr. Borboroglu writes:
    > If Medicare allows one to go to India for
    > example for a kidney transplant, will it
    > also allow the patient to buy a kidney
    > from a donor?
    Something worse than what you’re asking about is already happening, and its probably just a matter of time before big US insurers or even Medicare take part.
    Organ Harvesting from Chinese Prisoners
    Media outlets and the US Department of State have confirmed that China is harvesting organs for transplantation from executed prisoners. According to the Asia Times newspaper, hundreds of well to do Japanese have traveled to China to receive organs. One kidney recipient is quoted as saying “The donor was able to provide a contribution to society, so what’s wrong with that?”
    In China they go so far as to schedule the execution of the prisoner to match the surgery schedules of the transplant centers. In other words, Chinese prisoners are executed when it is profitable to do so.
    The Chinese government claims that the prisoners have consented to the harvest of their organs. And perhaps they have: it may buy them a few weeks or months of life, until their tissues match those of a well-heeled medical tourist.
    Its not much of a leap from this sham consent to the “they’re just going to throw them away anyhow” argument, and apparently at least one Japanese patient has that attitude already.
    For now, in the United States, prisoners may not donate organs at all, except to immediate family members because the fact of incarceration diminishes considerably freedom of consent.
    References:
    Asia Times Article
    US State Department

  11. Just to add to the out-of-the-box thinking that this article has sparked, let me add one more twist.
    I remember reading about a startup company that was evaluating building a hospital ship and parking it in international waters off the U.S. coast. So what if you didn’t have to fly to India for your 1/3-the-price surgery, but instead could take a 15 minute helicopter ride?
    U.S. healthcare might be resistant to “The World is Flat”, but not immune.

  12. In the case of kidney transplantation the hospital typically bills Medicare $80000. The surgeon bills $1800. I think this medical tourism will be effecting the hospitals more than the doctors if it grows. If Medicare allows one to go to India for example for a kidney transplant, will it also allow the patient to buy a kidney from a donor? Lots of interesting questions.

  13. “In the case of medical jobs going to Asia and India I think it levels the playing field for people stuck with a system that rams full chargemaster rates down their throats.”
    I think the emergence of “medical tourism” is a sign that 21st-century health care is being defined in other countries, not here, and that American medicine is not sufficiently prepared to deliver it at this time.
    At the present time medical tourism is a curiosity that a very small number of Americans have used. I think its significance lies in its potential to tap into the rising expectations of Americans as regards our health care, and to introduce meaningful competition for patients among health care providers – be they international or domestic.
    This is what I had in mind when I asked “Is the effect of competition only a positive catalyst for compliance with medical evidence guidelines?” I think the answer is obvious – of course not. Competition results in all sorts of positive effects. Or to ask it another way, “My physician tells me she won’t reduce her outrageous fees – but that her compliance rate with evidence based guidelines (McGlynn, NEJM) is 95%. Does this mean I should decide to stay in the US for my operation?” I think the answer to that one is also obvious – maybe not in 2007, but in the foreseeable future.
    I think there are three key factors to watch. First, there is not much international capacity to serve large numbers of Americans. Second, demand by Americans for space at foreign hospitals is limited; by far most working Americans are covered in group insurance plans that do not steer patients to offshore providers, and Medicare does not cover care delivered outside the US. Third, the American health care system has seemingly not made significant preparations for delivering 21st-century medicine – the high-quality, low cost medicine delivered at top hospitals around the world – and both the system and its leadership are fragmented. For the time being, the large majority of American medicine is still sheltered from the impact of international competition. It’s not clear how rapidly the first two of these factors might change and, if they do, how quickly the third factor could adjust to meet the challenge.
    “In the meantime the rest of the U.S. healthcare industry can reap what it sews ”
    Did you mean “rip what it sews”?

  14. John, I’ve never been in favor of fully open free markets unless we all understand what we’re giving up. Health and safety regs, environmental laws, availability of quality healthcare (getting harder and harder here. Our gain is often at terrible cost to someone else. Workers here always get their jobs and compensation cut but have to endure real estate and transportation costs that don’t also compensate. In the case of medical jobs going to Asia and India I think it levels the playing field for people stuck with a system that rams full chargemaster rates down their throats. Part of the decision I made to go without health insurance and bank the premiums in my own bank account was the availability of foreign hospital care for elective surgery. For people with assets it’s a good solution. In the meantime the rest of the U.S. healthcare industry can reap what it sews and look after those with insurance, getting less, or those who can’t pay.

  15. Although physicians do charge sizeable fees, I’ve had better luck with getting a discount from them than from my local non-profit hospital. ($105 to pee in the cup–not making this up!)
    Look who is touring for healthcare…the uninsured (or underinsured) middle class. Those who chose not to go bankrupt for major but schedulable procedures. Unless these are “trend leaders” in their respective communities, there will not be sufficient numbers to dramatically change American healthcare.
    I’ll know it’s caught on when my state’s Medicaid program begins to outsource sick folks. Until then this is only an interesting trickle of patients.
    But if Cuba ever gets rid of the Castros, there is an opportunity to tour Cuba for affordable healthcare–surplus MDs, literate and talented healthcare workers, all they need is a few modern hospitals….what potential.

  16. “Yeah. Sorry. Free market’s a bitch, and now so are we. How’s it feel?”
    How’s it feel? Your post makes me feel that there are much bigger problems in our public education system than in our medical care system.

  17. Overseas healthcare takes more criticism than it should. It seems like all outside healthcare alternatives are percieved as getting surgery done in a third world country. Other countries have regulations and standards that protect their own citizens. Americans are under the impression that “once you leave America, nothing is safe.”

  18. “If the export of manufacturing jobs and high-tech computer industry jobs outside the US is not a good for America, can export of medical jobs be a good thing?”
    I dunno. Why don’t you ask your peers who won’t pay for decent IT help and instead sit and moan about how when they call Dell it’s someone from the other side of the planet?
    How about everyone who won’t pay the extra $5-10 it would cost to make sneakers here in the US?
    Yeah. Sorry. Free market’s a bitch, and now so are we. How’s it feel?

  19. “Who can argue with this type of competitition as being a positive catalyst to move the U.S. health care system beyond 55% compliance with evidence based guidelines (McGlynn, NEJM)?”
    Well, I wouldn’t argue, but a few questions do occur –
    What is the compliance rate of non-US physicians?
    My physician tells me she won’t reduce her outrageous fees – but that her compliance rate with evidence based guidelines (McGlynn, NEJM) is 95%. Does this mean I should decide to stay in the US for my operation?
    Is the effect of competition only a positive catalyst for compliance with medical evidence guidelines? If the export of manufacturing jobs and high-tech computer industry jobs outside the US is not a good for America, can export of medical jobs be a good thing?

  20. I remember a physician colleague from Intel telling me a few years ago that the most advanced digital hospital he had ever seen was located in SE Asia.
    The implication: as the medical tourism model evolves, I believe a point of differentiation will be superior quality. Let me be clear — the pitch will be “you’ll have less chance of infection and medical error by going overseas.”
    Who can argue with this type of competitition as being a positive catalyst to move the U.S. health care system beyond 55% compliance with evidence based guidelines (McGlynn, NEJM)?

  21. We keep hearing from some docs about how they feel (the solution) patients should be able to negotiate directly with the doc. So here is how it goes, “Doc, I can get this by-pass done in India for 1/3 your cost.” I would like to negotiate a better price.” Industry is all for exporting jobs but never in favor of allowing workers to export profits. I think as this picks up it will weigh in on some solution.

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