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My adventures in medical tourism

210 points by solutionyogi 11y ago

solutionyogi 11y ago
I am originally from India and came to the US 10 years ago. I still can't believe that you can not call up a doctor/clinic/hospital in US and get a price quote for something routine. Chris's experience is representative of what one can expect from the Indian health care system. If you are a working, middle class person, the free market health care works extremely well.
- itg 11y ago
  Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high. Here's another example: https://www.washingtonpost.com/business/economy/new-machine-could-one-day-replace-anesthesiologists/2015/05/11/92e8a42c-f424-11e4-b2f3-af5479e6bbdd_story.html https://www.washingtonpost.com/business/economy/new-machine-... "Anesthesiologists tried to stop Sedasys. They lobbied against it for years, arguing no machine could possibly replicate their skills or handle an emergency if something went wrong. Putting someone to sleep is an art, they said. Too little sedation, and the patient feels pain. Too much, and the patient dies. Anesthesiology requires four years of training after medical school, meaning careers might not launch until the doctors are in their 30s. It’s one reason the profession’s median salary is $277,000 a year, according to research firm Payscale."
  - jjoonathan 11y ago
    Before we start squabbling over whether the fault lies with the AMA in particular (this topic has come up before) let me propose that instead we discuss the more general and more relevant claim "the USA overtrains its doctors, creating needless scarcity."
    - fluxquanta 11y ago
      >"the USA overtrains its doctors, creating needless scarcity." What about the increase in physicians assistants and nurse practitioners, who seem to be taking over in the scene of less serious, more routine healthcare?
  - HarryHirsch 11y ago
    the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low On the other hand, wages in IT suffer from an overabundance of indentured H1-B labourers, held on the very short leash of the US immigration system. This should demonstrate the importance of union representation, even at the high end of the qualification scale.
  - pkaye 11y ago
    I read another article a long while back on how cardiologists used to be paid considerable amounts for their skills in open heart surgery. Then later non-evasive techniques were developed and some of them were not happy because it all became more routine that heroic skills were no longer needed. There is always some degree of thinking what is best for yourself instead of your patient.
  - Symmetry 11y ago
    Other notable problems with our medical system would be the RBRVS[1] and Nixon's scheme to limit hospital competition[2]. [1]https://en.wikipedia.org/wiki/Resource-based_relative_value_scale https://en.wikipedia.org/wiki/Resource-based_relative_value_... [2]https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need
    - HarryHirsch 11y ago
      Other people would think that fixed reimbursement rates are a feature - it's what they do in my country to hold down costs, and it works well. You can ask to be paid beyond published rates, but you better have a good case when you present the bill to the insurance company. As far as overbuilding hospitals goes, you'd think that physicians and administrators will try to fill those beds at any cost, cost that is billed to patients and the taxpayer. Hospital overcapacity is not like airline overcapacity.
      - squozzer 11y ago
        The Roemer Effect has never been proven, as no country has ever had the luxury of too many hospital beds. It's based on a certain plausible logic - similar to saying welfare makes people lazy - but no one has ever presented evidence to support either.
        HarryHirsch 11y ago
        Looking through Pubmed (!) you find many papers that are in favour of the Roemer Effect.
  - chimeracoder 11y ago
    > Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high. The AMA is a common scapegoat, except that the AMA has literally nothing to do with the number of of doctors supply-side. You're probably thinking of the AAMC, which has nothing to do with the AMA, and is responsible for the number of medical students who graduate each year from the US. Except the AAMC has very deliberately and openly increased the number of medical student slots each year for over a decade, specifically with this goal in mind. But even this is a moot point, because the number of people gradating with MDs is not the bottleneck - the problem is that doctors can't practice medicine until they complete a residency program. We graduate more medical students every year than we have residency slots available, so increasing the number of graduates even further will have no effect. Increasing the number of residency slots is up to Medicare, because Medicare funds residency programs nationwide.
    - jessaustin 11y ago
      Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations? What numbers are we talking about?
      - chimeracoder 11y ago
        > What numbers are we talking about? In 2015 there were 41,000+ applicants for ~30,000 residency positions[0]. I don't have the 2015 numbers for medical schools, but in 2014, there were 18,000 graduates in the US[1]. Increasing the number of medical school graduates in the US would mean that a larger percentage of residency slots are taken by people who went to school in the US but not the total number of residents. Ironically, this would actually be a bad thing cost-wise, since foreign medical schools are usually cheaper and students carry a lower debt load[2]. > Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations? Yes. You are likely to see them take jobs in industry - e.g. at a pharmaceutical or insurance company, but on the business side, since they're not licensed to practice. (Nor are they even qualified - medical school teaches essential knowledge for doctors, but they receive basically no training on actual clinical practice. All of that happens during residency). It's worth noting that not all doctors want to practice medicine - for example, people in an MD/PhD program often go into research, and that's a good thing. But if we're talking about increasing the supply of practicing physicians, increasing the number of medical school applicants in the US makes literally zero difference. [0] http://www.nrmp.org/press-release-2015-residency-match-largest-on-record-with-more-than-41000-applicants-vying-for-over-30000-residency-positions-in-4756-programs/ http://www.nrmp.org/press-release-2015-residency-match-large... [1] https://www.aamc.org/download/321532/data/factstable27-2.pdf https://www.aamc.org/download/321532/data/factstable27-2.pdf [2] These aren't necessarily "foreign" students either; it's quite common for people in the US to go to medical school in the Caribbean and then come back for their residency.
  - knughit 11y ago
    $277K/yr doesn't sound too bad, compared to lawyers and finance folks and business VPs. That's not why healthcare costs so much. Even if you booked 1 anesthesiologist for a whole day long massively intensive surgery, that's only about $2k of your cost
  - Omniusaspirer 11y ago
    This comment is not only factually wrong (It's not the AMA) but misleading as well. The typical medical student today leaves med school $250k in debt at 8% interest then spends years in a residency where they make $50-60k working 80+ hours per week in a likely high cost of living area. If they started schooling immediately after high school they probably won't actually make that 270k (median, so many starting out are lower) until they're 30+ years old. Contrast that to a completely mediocre web dev who can pull 100k+ at 21 putting in 40-50 hours a week and do you really still think physicians are overpaid? Keep in mind the majority end up in family or internal medicine working 60+ hours a week for ~$175k/yr. Going to medical school is a massive financial risk with an incredibly uncertain future. If you want a human punching bag then turn your gaze towards hospital administrators, pharmaceutical executives, and exploitative vendors. The actual hospital employees are just as much victims of the healthcare shit show as members of the public are.
- atom-morgan 11y ago
  Exactly. Imagine how much of a hassle car repairs would be if your car insurance company handled an oil change or a tire balance/rotation.
  - lbhnact 11y ago
    Imagine how much a hassle car repairs would be if cars were a staggeringly complex biological system where parts could not be replaced figuring out what was wrong was difficult and all work had to be done in while it was driving down the road and it was really easy for you to die if a mistake was made and other people had to pay for it.
    - kangman 11y ago
      That sounds like a modern car to me. sans biological
    - jerf 11y ago
      Are Indian humans made out of simpler parts, such that it's OK for them to have free market health care whereas it doesn't work for us?
      - s73v3r 11y ago
        No, it's that they don't care about people not being able to get care, whereas we at least try to care about it.
        jerf 11y ago
        That ahem sort of racist snark would make a lot more sense if we weren't having this discussion in the context of a system that appears to be providing wildly cheaper service. My more subtle point is that when we are discussing an existing free-market based medical system, you can not just trot out all the standard arguments about why the US should not go free market, because they are all based on a discussion of a change in how we structure the system. Here we (appear to) have a free-market system, so, one must validate all the slurs actually apply before just flinging them at the existing system. If free-market health is so guaranteed to be so utterly disastrous, instead of flinging quasi-racist slurs at the Indians, why don't you actually go find the guaranteed-disasters in progress? Ought to be pretty easy if it's even one-tenth as bad as everyone always claims in the US context. (Though I'll warn you in advance I'm going to account for the situation on the ground; if the doctor's office in a far-flung village with a per-capita income of 50$/year isn't up to US standards, I'm not going to award you many points. India is not a wealthy country. Only the major medical centers are really that interesting. It's also generally invalid to complain about a government not providing services when they simply do not have the wherewithal to be providing them to everybody yet.)
- pc86 11y ago
  In addition to what itg said, another is that with various insurers the doctors and even the billing people do not actually know what you'll pay. They know what the service costs them to perform (irrelevant to what is charged to the consumer), they know what they're going to bill the insurer (a grossly inflated number that is a big cause of these massive 6-figure bills you see to uninsured folks), but they have no idea what the insurer will actually reimburse them, so they honestly can't tell you. It's a broken system and there's no excuse for it, but at least in the US it is not because they're being intentionally obtuse.
  - secabeen 11y ago
    Many doctors don't even know what they'll bill, as it's different per-insurer, etc. Their back-office staff certainly can look it up, but docs don't know the numbers.
  - r00fus 11y ago
    I went through this a few years back trying to get enough FSA to cover my portion of my daughter's long awaited eye operation. It was insane that I couldn't even be given an exact figure for my portion of the bill to plan for FSA - it's like it's all negotiated at time of operation or after the fact. Now some of that is that if a complication occurs, there will be additional cost, but I was just asking for a baseline, and all they could give me were guesses.
    - pc86 11y ago
      Disclaimer: It has been many years since I was involved in this professionally, pre-ACA. It may have changed since then. Depending on the arrangement with the insurer, and what the recovery period was like for that type of operation, nobody in the office probably had any idea (and I bet their guesses were pretty far apart, too). Some medication used in recovery is very expensive and can add five-figure variances if someone doesn't respond well to the procedure or is in an abnormal amount of pain. And as you mentioned any complications can double the cost in an instant. From the insurer side, they will decide after they receive the care provider's bill what they're covering and for how much. They may decide she only need five hydrocodone, not eight, so there's (3 * $n) out of your pocket (I am not googling the cost of hydrocodone at work :)). What's more is this "justification" is rarely given to the care providers. The insurer is billed $50,000, they pay $47,000 and that's that. The cynic in me wants to say it's so they don't actually have to justify partial payment, but who knows.
- lbhnact 11y ago
  >I still can't believe that you can not call up a doctor/clinic/hospital in US and get a price quote for something routine You can. Routine, profitable procedures are not hard to arrange in the US. I have personally worked in a clinic where the exact experience described in this post happens every day. >If you are a working, middle class person, the free market health care works extremely well. It's pretty easy in most places in the world to get people to do something that makes them money, like the discectomy discussed here. Managing a system where the poor and the unlucky get care is a little tougher. The US does it lousily, but so does most of the rest of the world. India doesn't do it at all. edit:copy error
  - mikeg8 11y ago
    > You can. Routine, profitable procedures are not hard to arrange in the US. I have personally worked in a clinic where the exact experience described in this post happens every day. For the majority, this is simply not the case. I'm sure there are exceptions as our country is very large, but most people's experience would be very similar to the OPs. I'd suggest reading Healing of America by T.R. Reed if you're interested in the working of US compared to other systems.
  - hospes 11y ago
    For vast majority of the procedures and surgeries you cannot get any quote. I tried to get quote for the standard procedure (that they have performed 100s of times) via phone and in person in Dr's office in 4 different hospitals. All of them told me that they do not know the price, since it depends on what my insurance will cover. They said that they need to do evaluation, schedule the procedure, submit paperwork to the insurance company and then I can get the quote, which is crazy, because to schedule the procedure you need to go through pretty expensive evaluation process. Basically just to know the price you may need to spend couple thousand dollars. This happened to most of the people that I know that needed some kind of quote from the hospital. The clinic you have worked was an exception.
- Vivtek 11y ago
  Ha. Back when our son was having regular lab exams, we were in the States. When we asked Bloomington Hospital for a price for one lab exam, the receptionist asked us, "Why? Don't you want the best for your child?" Yeah, lady, that includes not giving you all our money without asking how much you'll be taking.
- crusso 11y ago
  We have too many middle-men in US healthcare. They obscure costs and prices while preventing individuals from getting more involved with their own healthcare decisions. Rather than a one-size-fits-all approach to healthcare through single payer or other subsidies, my fondest wish for government intervention would be for laws that force doctors and hospitals to provide price and likely outcome information to the general public. Give healthcare consumers the data they need to make informed decisions and the ensuing competition could drive down prices while improving outcomes.
  - maxxxxx 11y ago
    That would be my first step for health reform: Require publication of prices and outcomes. Also: Don't allow charging of one price to one group of people (uninsured) and 25% of that price for another group (insurers). One price for all. Maybe allow for 10% discount but not the huge discounts insurers get.
- s73v3r 11y ago
  "If you are a working, middle class person, the free market health care works extremely well." And if you're not?
- xixi77 11y ago
  You actually often can (or at least, could -- not sure how Obamacare might have changed this) -- you need to state that you are uninsured; you may very well get a lower price for your routine than you would have to pay out of pocket with insurance.
- vadym909 11y ago
  Yes- my friend goes to India and does his annual checkups/ dental checkups and fillings for a few hundred rupees which is cheaper than the deductible of his dental insurance here. Last time he had heart pain and went to a top heart specialty clinic and his bill was $11 to get checked out.
jkot 11y ago
My wife had some complications after pregnancy. UK and Ireland has GP referral system, where single doctor coordinates all specialists. In theory it is good system. But our GP ignored basic symptoms and pushed bullshit like "depression" or "have you tried acupuncture?". We paid each GP visit, even for saying hi and collecting results, it was obvious GP was just pushing for more visits. This was going on for several months.. Eventually we visited doctor in Athens, the whole thing was diagnosed and solved in weeks. Solution was $2 pill and routine surgery. I really recommend to anyone with some 'mysterious' health issues to visit REAL doctors.
- richardwhiuk 11y ago
  Hold on, you paid for a GP in the UK? That's not how the system works....
  - jkot 11y ago
    This was Ireland.
    - pault 11y ago
      You might be surprised at how many Americans think Ireland is part of the UK. Source: I live in a hostel. Edit: for extra fun, ask them what country Amsterdam is in.
      - jkot 11y ago
        I would not be so harsh, my initial comment is a bit misleading. And most Europeans do not know the difference between Washington and Washington D.C. :-)
        jacquesm 11y ago
        > And most Europeans do not know the difference between Washington and Washington D.C. :-) Is that so?
- 11y ago
kra34 11y ago
Your treatment in the US would have involved something like 5 doctors, $100,000 billing (probably not payments since those things are only vaguely related) and 2+ years of your time.
anilgulecha 11y ago
My wife is a Dentist in Bangalore, India, and it's amazing what I hear. Basically Cost(Flight to india + treatment cost) < Cost(Treatment in US). The more you think about it, the more crazy it seems on multiple levels. Edit, typed < instead of >.
- kangman 11y ago
  you mean < ?
- CapitalistCartr 11y ago
  Are you sure you mean greater than there?
- cpursley 11y ago
  My wife and I have all our dental work completed in Russia. Not only is it a fraction of the cost, its a no-nonsense experience. An initial consultation in the US costs about as much as the actual dental work performed overseas. It's madness.
  - vkhorikov 11y ago
    What city in Russia? Moscow? Also, shouldn't the cost of the flight eat up the difference?
- vinceguidry 11y ago
  I went to get dental work done in Medellin, Colombia. Two whitening treatments, perhaps a dozen fillings. My Atlanta dentist wanted to do an inlay on one of my teeth. I'd already had two done that year and just couldn't afford to have them keep working on my teeth. When I got to Medellin, my dentist did not want to do the inlay, said it was too invasive and that he would rather fill it. It cost less to fly to Medellin, get all my work knocked out, than it would have for just the one inlay. And I absolutely believe that my Colombian dentist, who spoke English quite well, did better work than the Atlanta guy did. My teeth look better than they have in years. I will never again have significant medical procedures done in the US.
tahoeskibum 11y ago
One thing I've never understood about the US system is why do the doctors charge more for paying cash e.g. $200 for a visit, whereas insurance reimburses them less than half e.g. $80. In everything else e.g. car repairs, the cash price is always lower than insurance covered price. Any ideas why this is so?
- harryh 11y ago
  Insurers negotiate a volume discount.
  - chvid 11y ago
    But not for car repairs?
    - harryh 11y ago
      I guess not. Which does seem a little weird now that I think about it. Not sure why cars would be different.
      - secabeen 11y ago
        Because the law allows you to go to any mechanic to get your car fixed, and they can't negotiate with every mechanic in the market. Most auto insurers have "approved" repair shops, and if you go to one of those, the rates can be cheaper than cash.
        harryh 11y ago
        Ah, that makes total sense. Thanks!
    - blakeyrat 11y ago
      I don't know about your auto insurance company, but mine has "preferred shops" and I presume the reason they are preferred is because they have negotiated some form of discount.
clamprecht 11y ago
I should mention that Paul Buchheit wants to fund the Uber of medical tourism: https://twitter.com/paultoo/status/566379518261088258 https://twitter.com/paultoo/status/566379518261088258 The tweet: "I want to fund the 'Uber' of medical tourism Needs 5 star service, simplicity and safety Let me know if you apply - http://www.ycombinator.com/apply/" http://www.ycombinator.com/apply/" It really has to happen. Health care in the US is just fucked, and everyone knows it.
- endymi0n 11y ago
  Well, the "Uber" business model is actually pretty hard to do in an industry as heavily regulated as medicine (and honestly it's a difference between getting into an unrated driver's car or putting yourself under the knife of an unrated developing country's doctor)... Then again, our friends at Medigo seem to do great service in this direction so far and have just raised a series A ( https://www.crunchbase.com/organization/medigo#/entity https://www.crunchbase.com/organization/medigo#/entity ), the competition seems to be heating up in this space and honestly, I can't think of anything to truly "disrupt" this industry, as the margins are pretty well known, the market is reasonably mature and the order volume is very low.
  - LunaSea 11y ago
    Just do it like Uber, it's illegal in most places but hey if you "disrupt" the market it's alright.
  - deleted 11y ago
    [deleted]
  - dalore 11y ago
    Wouldn't the "Uber" business model mean they are rated? Bad doctors would not get 5 stars and then get dropped. Vs the current state of affairs where the doctors aren't rated at all. If people were going to travel for medical tourism anywhere wouldn't you want to go to a doctor that has been rated 5 stars vs one that hasn't? Bearing in mind they all have qualifications.
- 11y ago
deleted 11y ago
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Dove 11y ago
Cash friendly places are getting more prevalent in the US, but you have to look for them. For example, one of the hospitals in my area publishes this (very sane) price list: http://swedishhospital.com/patient-financial/?page_name=pricing http://swedishhospital.com/patient-financial/?page_name=pric... I go to them. :) There are urgent care centers that are the less-crazy version of ERs, and a lot of primary care stuff can be done self pay. While I have access to insurance through my work, I vastly prefer the quality of the self pay system. You do need to do some research in advance, but there are some pretty cool innovations out there, and services you just can't get via the insurance system. http://theselfpaypatient.com/ http://theselfpaypatient.com/ is a good resource.
- chiph 11y ago
  Be careful when picking an urgent-care center. Some are now for-profit emergency rooms. They can treat a much broader set of maladies & injuries than an urgent-care, but they're priced accordingly. http://www.kvue.com/story/news/investigations/defenders/2015/11/16/buyer-beware/75871654/ http://www.kvue.com/story/news/investigations/defenders/2015...
cryoshon 11y ago
Yep. Medical tourism exists when the cost of local healthcare is inflated by profit-seeking to flatly unaffordable levels, resulting in grotesque health outcomes and extreme behaviors such as traveling thousands of miles or committing crimes in order to end up in prison for care. I would like to coin a term for this kind of disturbing extreme behavior incentivized by extreme distortion of society: fever spasms. It sounds better in German, so: fieberkrämpfe. Out of pocket price of standard blood panel lab in the USA with a follow up phone call if something is wrong, with insurance: $1500. There is no ability to estimate even vaguely what the price will be beforehand, and the bill may take a month to arrive in the mail. Your insurance agency will fight you at every turn for all but the most mundane routine procedures. There will be a billing error somewhere, and it will be to your detriment. They may refer you to collections if you do not pay the incorrect amount while disputing the charges, as happened to my girlfriend. Face time with the doctor is probably minimal, and you will be stressed by the doctor's attempts to hurry you out the door and probably forget to ask important questions. Out of pocket price of extended blood panel lab plus two hours of doctor face to face analysis without insurance in Argentina: $50 USD, and the doctor will speak perfect English. Smartly, the doctor arranges the items on the blood panel before you visit him in the first place. No in-depth discussion of your health can begin before the doctor cannily takes your medical history via a very casual schmooze-sesh which plays out more like old friends catching up. You leave the office relaxed, understanding your health action-items. Where do you think I'm going to go when I need serious treatment? The US medical system is a failure and an international joke.
- ashark 11y ago
  > There will be a billing error somewhere, and it will be to your detriment. They may refer you to collections if you do not pay the incorrect amount while disputing the charges, as happened to my girlfriend. Yep. Can confirm: US hospitals and other care providers are total d-bags when it comes to billing. It doesn't help that for anything remotely complicated you end up receiving 2-3 different bills from each of 5-6 different entities (the hospital, a couple of doctors or departments in the hospital, a couple of labs, a GP for your checkups afterward, et c.), only one of which from each will actually be the one you need to pay. It can easily take most of a year to sort all the crap out, especially if you have any kind of dispute with insurance or billing error from the providers (the bigger the procedure, the closer the probability of this approaches 100%). Makes for a totally stress-free recovery. eye roll It's like it's designed to screw up people's credit, even when they're trying to pay what they owe.
pimlottc 11y ago
Nice piece, although it's a bit misleading to call this "medical tourism" as the author was living in India at the time. Not that it discounts his experience but I'm sure his local connections and familiarity made it easier than it would be for the average American coming it from abroad.
- jacquesm 11y ago
  It says he went back specifically to have the surgery.
  - yummyfajitas 11y ago
    Well, sort of. I would have gone back anyway (I had a girlfriend in Pune, as the pictures sort of hint at, and no reason to be in the US), but my return trip would have been slower and passed through more interesting places. The OP is absolutely right that it would have been more difficult for me if I knew nothing whatsoever about India. However, I probably could have paid a couple of thousand USD more and OnP (the hospital I stayed at) would handle things for me. I know they have a medical tourism office, albeit catering primarily to gulf residents.
    - jacquesm 11y ago
      Good to see you on the other side of this. Any surgery is risky and if your troubles are gone that's fantastic news. Are you still in touch with the people there for check-ups or is it done for good?
      - yummyfajitas 11y ago
        I hope it's done for good, but being 6'6" means that there is always risk of further injury. No point in a checkup - no pain = no problem. I'm not deadlifting anymore, however.
        ahh 11y ago
        FWIW deadlifting definitely helped, not hurt, after my back injury. (Admittedly, I hurt it deadlifting with poor form, but fixing the form and strengthening my back with it was the single biggest contributor to getting better.) MMV, of course.
hvmonk 11y ago
My understanding is doctors in US are trained to scare you about every possible negative outcomes. I find visiting a doctor here is much much more stressful than doing it in India. For a simple chest pain, doctors here would tell you 145566 possible scenarios that may happen with your body, and wouldn't confirm any unless he sees a lab test. And then, a tide of lab tests would start, which will cripple you financially, and emotionally because all you are thinking is which test would be +ve, which -ve; diving on internet where people usually blog about their -ve experiences. Usually, it could be just a muscular pain, etc, which become so irrelevant as you are undergoing all these lab exams. I don't want to blame the doctors here as such, because that's how they are trained here. I guess it boils down to this robust "suing infrastructure" here, that if you missed out a rare symptom with a patient, he will sue you and finish your career. One thing which I couldn't understand is why in a developed country, lab tests are so expensive. An Xray, costs about $100; similar thing costs about Rs 80 (equivalent to $1.25). Shouldn't they be cheaper here, given there are gizmos for everything, and all electronics items are much cheaper here than India. I think these costs are all artificial. I think a mix of both approaches (insurance + free market) would better.
- chimeracoder 11y ago
  > One thing which I couldn't understand is why in a developed country, lab tests are so expensive. An Xray, costs about $100; similar thing costs about Rs 80 (equivalent to $1.25). Many lab tests - though not all - are effectively commoditized. There is little difference in quality, and the requisite supplies are widely available at low costs. X-rays have been used for medical purposes for literally over 100 years, and it's not very difficult to train someone to take an x-ray properly using modern equipment. (Actually interpreting the results of a test is a different matter). For tests which fall under these categories, it will always be more expensive to obtain them in the US than in India, because the cost-of-living in the US is much higher, and paying people to actually perform the tests dominates the costs of the test itself. There's a little more to it than that, but that's the general idea.
SimpleXYZ 11y ago
Socialized medicine or a pure capitalistic system would both be preferable to the current system in the US. Right now it's the worst of both worlds.
- arethuza 11y ago
  Even here in the UK - where we do have a socialist health care system there is still the option of going private. The only option you don't get if you are a normal tax payer is opting out of paying for the state funded healthcare - which is fine as far as I am concerned.
  - laurencerowe 11y ago
    The US spends almost exactly the same proportion of GDP on public healthcare as the UK (~7.3%) but because the system is so horribly wasteful it gets much less for its money. (Much of healthcare spending is on the old who are covered by public Medicare because private insurance would be unaffordable.) UK: 8.8% of GDP total spending, of which 83.3% public = 7.33%. http://www.ons.gov.uk/ons/rel/psa/expenditure-on-healthcare-in-the-uk/2013/sty-expenditure-on-healthcare--2013.html http://www.ons.gov.uk/ons/rel/psa/expenditure-on-healthcare-... US: 15.2% of GDP total spending of which 48% ($3,426/$7,146 per capita) public = 7.28% https://en.wikipedia.org/wiki/Health_care_in_the_United_States https://en.wikipedia.org/wiki/Health_care_in_the_United_Stat... Edit: The 2014 figures are even worse. 17.5% of GDP total spending of which 28% federal and 17% state and local = 7.88% of GDP public expenditure. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html https://www.cms.gov/research-statistics-data-and-systems/sta...
    - yummyfajitas 11y ago
      India: 4%. http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
      - arethuza 11y ago
JamesBarney 11y ago
It's true that healthcare is terrible in the U.S. if you don't have health insurance, but he overstates his case. Chris compares a 1 in a 1000 nightmare scenario to his very average experience. A $112,000 error happens in the U.S. but is rare. Typically the type of surgery he mentions costs between $20,000-$50,000. Or 50-100% of a the U.S. gdp per capita. This is smaller than in India where the cost of his surgery was 130% of the Indian gdp per capita. And the issues with rounding errors has to do with the large amount of health insurance in the U.S. not necessarily free market vs. regulation. When the majority of consumption in a market is driven by enterprise customers, the pricing can become strange and very unfriendly to individuals. [0]https://pricinghealthcare.com/prices/IowaCityASC/spine-back https://pricinghealthcare.com/prices/IowaCityASC/spine-back [1]http://www.backsurgerycost.com/how-much-does-a-discectomy-cost/ http://www.backsurgerycost.com/how-much-does-a-discectomy-co...
- yummyfajitas 11y ago
  It's very true that I don't know what average costs are, in either country. The only prices I know are the price at the place I went (one of the top facilities in the region) and a few nearby hospitals. Several were significantly cheaper and if I earned in INR I'd probably have gone to one of them. But I figured that given how much I enjoy walking, why not just spend $700 more to go to the best guy?
- clamprecht 11y ago
  Take a look at http://reddit.com/r/personalfinance http://reddit.com/r/personalfinance for a few weeks and you will see that there really is a problem.
- FireBeyond 11y ago
  Not three years ago, with "comprehensive" insurance, I paid $7000 for a kidney stone, with a full total approaching $50-60K. For a kidney stone. I had to have two surgical procedures, admittedly - they went in to remove the stone, found long-standing infection, closed up and catheterized. A week of antibiotics later I had it shocked. But still... $60K for a kidney stone.
bambax 11y ago
His symptoms sound very similar to the ones described in the book "The mindbody prescription" by John Sarno. I would very strongly recommend reading that book (which will set you back a whopping $10) before undergoing any back surgery. (I'm not a doctor, this is not medical advice, YMMV and all that. Still. If you suffer from chronic back pain, or carpal syndrome, read the book.)
- collyw 11y ago
  Bizzare being downvoted for suggesting trying a non invasive, cheap procedure before opting for fairly serious surgery. Amazon's reviews give it 4.5 stars. I assume its something similar to Thomas Hanna's Somantics from the name and Amazon description, which would be something I would recommend people give a try before going under the knife.
MistahKoala 11y ago
I wish there was a site like NomadList, but for medical tourism. I'm up for going further afield for treatment, but the lack of information and good local knowledge makes it riskier than I'd like.
squozzer 11y ago
Discussion of cost-effective alternatives is almost pointless now that we have the ACA, which is effectively a transfer of wealth from individuals to insurance companies for the sole privilege of breathing. Oops, forgot at include dying also.
diebir 11y ago
This guy is either an idiot or tries to sell something. More like both. He goes around self treating a serious spine condition, trying to find a doc to inject steroids for cash (which is treating the symptoms, not the root cause). Then he goes for a surgery in some third world place "because it's cheap"; a surgery on his spine no less, where he may or may not ever walk again if something goes wrong. Then, he touts a quick recovery, he being, from what he looks like, about 30 years old. Give me a friggin break. I am not "buying a surgery for cash" for something as critical as my spine. Or knees. Or appendectomy. Or anything else.
- iamthepieman 11y ago
  What are you buying it with then? Good will, bitcoins, large assets or perhaps something else? I think I may be misunderstanding you. Did you mean that you aren't going to base a major health care purchase on cost alone? That certainly makes sense but it also makes sense to me that cost is indeed a factor even if its not as important to you as it is to the OP.
- yummyfajitas 11y ago
  What did I "self treat"? My doctor in India recommended the steroid injection in order to enable me to travel and a first world doctor provided the service. Treating symptoms well enough so that I can travel was the only purpose - the discectomy is what actually solved the problem. If you want to spend extra money on a non-Indian doctor living in America, have fun. I don't plan to do the same - I've generally found care in India to be equal or superior to care in the US. I'm not sure what you think I'm selling. I did name drop the doctor/hospital where I went, but they've paid me nothing and probably have no idea I wrote this post.
- icelancer 11y ago
  >I am not "buying a surgery for cash" for something as critical as my spine. Or knees. Or appendectomy. Or anything else. That's fine. But I might want to. Have you considered this?
- Gustomaximus 11y ago
  > Then he goes for a surgery in some third world place "because it's cheap" You missed the point of the article, which is to not attribute price to quality. Also being so dismissive of poorer countries as having reasonable doctor/facilities smacks of ignorance and exactly what this article is challenging.
geomark 11y ago
My own experience in Thailand is similar to the author's in India: see a doctor on short notice, prices quoted in advance, short wait time for surgery, prices low enough to pay out-of-pocket. The icing on the cake is how friendly and warm the medical care is. My biggest fear when I visit the US is that I will get sick or injured and be subject to that awful system. I lived in the US most of my life, had excellent insurance, and had routinely poor experiences with healthcare.
BryantD 11y ago
I'd recommend doing some more reading on the health care system in India. I believe that it worked really well for the poster; my initial research seems to indicate that there's a huge difference between the health care you can get in urban areas of India and the health care you can get if you're poor and rural. It's easy to build a health care system that works for people with money. The infant mortality rate in India was 38 per 1,000 in 2015. That's really not good.
- lbhnact 11y ago
  Thanks for saying this is more friendly terms that I did. What's also interesting, is that the US is likely a large net 'exporter' of medical tourism. I currently work with hospitals that are rapidly developing large businesses in medical tourism, because for all our needless systemic problems, people trust that, if you have the cash, you can find a good doctor.
  - aesoprock 11y ago
    Why are you so butturt? :^)
- largote 11y ago
  They do have good quality private care which a lot of people in India cannot afford but most people from developed countries could.
- aesoprock 11y ago
  Nowadays every doctor that is required by law(started in assam I think) to go to poor and rural areas and serve there for a minimum of one year. Things are getting way better than one thinks, there is a sense of socialistic way of doing things along with good old capitalism. Rural health missions are sponsored by the government and nurses and doctors are well paid(as per Indian standards).
- FraaJad 11y ago
  yeah, yeah, yeah... when someone visit the US for tourism, they don't go to Alabama and Mississippi. They go to the big apple, las vegas and disney world. When you are applying "Free market principles", you go to the place that maximizes your enjoyment/treatment per $$ spent.
grecy 11y ago
My brother broke his leg horribly in Australia when he was 17. It was the worst break they'd ever seen at the hospital. Ambulance ride, first surgery. Helicopter ride, second surgery, a month in hospital and third surgery and then another month or so in hospital to ween him off the morphine he had become addicted to, and to get walking again. Of course, there was never a bill.
- NeutronBoy 11y ago
  Similar when I got kidney stones here (Aus). Emergency dept, 3 night stay, drugs, multiple x-rays, CT scan, 3 followup CT scans over 3 months, etc. No bill in sight. I realise that I pay for it through my taxes, but I'm ok with knowing if something happens I don't have to cough up thousands of dollars.
  - grecy 11y ago
    I happen to be in the US right now, and last night had a Christmas dinner with people going elsewhere tomorrow. All 10 people spent at least an hour talking about health insurance, "Doughnut holes", the VA, and lots of other things related to the abysmal health system in the US. It occurred to me I've never heard such a conversation in Australia, but it's simply automatically part of life that you get good care.
xacaxulu 11y ago
Having traveled a lot for work, I've had the good fortune to have received care in South Africa, dental work in Serbia and a number of regular treatments in Mexico. I'm a born and raised US citizen though I also have an EU passport. Any day of the week I'll sit on a plane for a few hours and pay less for much better care in another country. Healthcare is a racket here. Better believe when retirement comes I'm nowhere near the USA.
veritas213 11y ago
Cant really speak about orthopedic issues but have had some experience when my partner had cosmetic surgery abroad. Cosmetic surgery makes up a significant chunk of treatments and is much more of art than science. There is no way I would ever risk having surgery anywhere before i knowing all the facts. My partner had a face and neck lift from a "reputable" doctor in Los angeles and honestly looks worse afterward than he did before. About 5 years he became painfully aware that he needed it done again so he went to a well-regarded surgeon in Bangkok that really improved his appearance and cost about half as much. http://www.thaimedicalvacation.com http://www.thaimedicalvacation.com One interesting thing about her experience was that he was told by the doctor in Thailand that he would not be able to offer a surgical facelift since he already had one 5 years earlier. It was very interesting to see doctors saying no rather than risking poor results with multiple surgeries. A person like Joan Rivers is a good example of what can happen when you have way too many surgeries. Overall though my opinion is that for rare or esoteric conditions, there is no place on earth better than the US. However for common elective or nonelective surgeries, going abroad may not be a bad idea.
sillyhealthcare 11y ago
This post is unrealistic in medicine, and really only works for less serious/elective care issues, not primary medicine, or where doctor and location choice actually matters. As a starter: I'm woman with an extremely strong family history of breast cancer before age 50. Standard clinical guidelines is to start doing heavy monitoring 5-10 years before the youngest person in the family tree was affected, since usually cases get progressively younger start dates. Since one of the people was around age 32, I'm under the age of 30 and I go for mammograms, ultrasounds, and MRIs every year as if I were a cancer patient already. Mammograms, ultrasounds, CAT Scans, MRIs, (any form of medical imaging radiography) are actually a perfect example of how the market internationally could be more efficient, but it turns out that's impossible. At its core we're basically talking about photographs, something facebook manages to serve from location a to person b that is nowhere near location a every day. Why couldn't I go to any imaging place in the US, and have my images sent to the lowest cost provider somewhere in india to be read and interpreted by a radiologist, and then have the results sent back to me. Unlike Chris, I don't even have to meet my doctor, all I have to do is send him images. It turns out that medically this is blatantly difficult if not impossible to do. The reasons are 2 fold 1) It turns out that age and variations in how and why the machines that used, as well as technician speciality, matters a ton in image quality. http://www.kevinmd.com/blog/2010/09/mri-places-good-quality-machines-obsolete.html http://www.kevinmd.com/blog/2010/09/mri-places-good-quality-... As a patient, I have no idea if the price I am being quoted is reflected of image quality or price inflation (and this is before being read) 2)Quality of the radiology report is highly dependent on the MD reading the images. This has been well studied since the early 2000s (one of the latest examples being here: http://www.ncbi.nlm.nih.gov/pubmed/23737538 http://www.ncbi.nlm.nih.gov/pubmed/23737538 ) At under the age of 50 with dense breasts, I'm significantly more likely to have imaging misread if I went into a community imaging location, even if they had top notch equipment, because the radiologists do not have enough volume of high risk cases to make sure I am not falling into false positives/recall on a regular basis - which would mean even more imaging costs. In order to effectively export my images, I would have to find a way to duplicate part of the specialized cancer wing I go to. Cost savings actually would be minimal - I'd be running more tests, seeing more doctors, and probably have a delayed diagnosis if/when my expected inevitable happens (which means more expensive drugs, longer treatment times, ect) And while my example is specific to me, many people have similar sorts of conditions where treatment location, equipment used, and people involved have higher initial costs but lower lifetime costs for all sorts of conditions. Pretty much any semi-serious disease falls into this category. I'm game for better ways of paying (insurance does cover this, because as I said, lower lifetime costs to them by paying for preventive care). I experiment with things like telemedicine - I use a compounding pharmacy and Specialized RN over the internet to manage acne that refuses to go away. I'd totally go to the Caribbean for teeth whitening or LASIK. None of these things need regular, serious followup, or run risks of painful drawn out deaths/longer painful medical care with much higher costs if done very incorrectly on a regular basis. Medical tourism isn't the answer - understanding what these services are in relationship to risk is.

210 points by solutionyogi 11y ago

I am originally from India and came to the US 10 years ago. I still can't believe that you can not call up a doctor/clinic/hospital in US and get a price quote for something routine. Chris's experience is representative of what one can expect from the Indian health care system. If you are a working, middle class person, the free market health care works extremely well.

itg 11y ago
Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high. Here's another example: https://www.washingtonpost.com/business/economy/new-machine-could-one-day-replace-anesthesiologists/2015/05/11/92e8a42c-f424-11e4-b2f3-af5479e6bbdd_story.html https://www.washingtonpost.com/business/economy/new-machine-... "Anesthesiologists tried to stop Sedasys. They lobbied against it for years, arguing no machine could possibly replicate their skills or handle an emergency if something went wrong. Putting someone to sleep is an art, they said. Too little sedation, and the patient feels pain. Too much, and the patient dies. Anesthesiology requires four years of training after medical school, meaning careers might not launch until the doctors are in their 30s. It’s one reason the profession’s median salary is $277,000 a year, according to research firm Payscale."
- jjoonathan 11y ago
  Before we start squabbling over whether the fault lies with the AMA in particular (this topic has come up before) let me propose that instead we discuss the more general and more relevant claim "the USA overtrains its doctors, creating needless scarcity."
  - fluxquanta 11y ago
    >"the USA overtrains its doctors, creating needless scarcity." What about the increase in physicians assistants and nurse practitioners, who seem to be taking over in the scene of less serious, more routine healthcare?
- HarryHirsch 11y ago
  the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low On the other hand, wages in IT suffer from an overabundance of indentured H1-B labourers, held on the very short leash of the US immigration system. This should demonstrate the importance of union representation, even at the high end of the qualification scale.
- pkaye 11y ago
  I read another article a long while back on how cardiologists used to be paid considerable amounts for their skills in open heart surgery. Then later non-evasive techniques were developed and some of them were not happy because it all became more routine that heroic skills were no longer needed. There is always some degree of thinking what is best for yourself instead of your patient.
- Symmetry 11y ago
  Other notable problems with our medical system would be the RBRVS[1] and Nixon's scheme to limit hospital competition[2]. [1]https://en.wikipedia.org/wiki/Resource-based_relative_value_scale https://en.wikipedia.org/wiki/Resource-based_relative_value_... [2]https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need
  - HarryHirsch 11y ago
    Other people would think that fixed reimbursement rates are a feature - it's what they do in my country to hold down costs, and it works well. You can ask to be paid beyond published rates, but you better have a good case when you present the bill to the insurance company. As far as overbuilding hospitals goes, you'd think that physicians and administrators will try to fill those beds at any cost, cost that is billed to patients and the taxpayer. Hospital overcapacity is not like airline overcapacity.
    - squozzer 11y ago
      The Roemer Effect has never been proven, as no country has ever had the luxury of too many hospital beds. It's based on a certain plausible logic - similar to saying welfare makes people lazy - but no one has ever presented evidence to support either.
      - HarryHirsch 11y ago
        Looking through Pubmed (!) you find many papers that are in favour of the Roemer Effect.
- chimeracoder 11y ago
  > Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high. The AMA is a common scapegoat, except that the AMA has literally nothing to do with the number of of doctors supply-side. You're probably thinking of the AAMC, which has nothing to do with the AMA, and is responsible for the number of medical students who graduate each year from the US. Except the AAMC has very deliberately and openly increased the number of medical student slots each year for over a decade, specifically with this goal in mind. But even this is a moot point, because the number of people gradating with MDs is not the bottleneck - the problem is that doctors can't practice medicine until they complete a residency program. We graduate more medical students every year than we have residency slots available, so increasing the number of graduates even further will have no effect. Increasing the number of residency slots is up to Medicare, because Medicare funds residency programs nationwide.
  - jessaustin 11y ago
    Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations? What numbers are we talking about?
    - chimeracoder 11y ago
      > What numbers are we talking about? In 2015 there were 41,000+ applicants for ~30,000 residency positions[0]. I don't have the 2015 numbers for medical schools, but in 2014, there were 18,000 graduates in the US[1]. Increasing the number of medical school graduates in the US would mean that a larger percentage of residency slots are taken by people who went to school in the US but not the total number of residents. Ironically, this would actually be a bad thing cost-wise, since foreign medical schools are usually cheaper and students carry a lower debt load[2]. > Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations? Yes. You are likely to see them take jobs in industry - e.g. at a pharmaceutical or insurance company, but on the business side, since they're not licensed to practice. (Nor are they even qualified - medical school teaches essential knowledge for doctors, but they receive basically no training on actual clinical practice. All of that happens during residency). It's worth noting that not all doctors want to practice medicine - for example, people in an MD/PhD program often go into research, and that's a good thing. But if we're talking about increasing the supply of practicing physicians, increasing the number of medical school applicants in the US makes literally zero difference. [0] http://www.nrmp.org/press-release-2015-residency-match-largest-on-record-with-more-than-41000-applicants-vying-for-over-30000-residency-positions-in-4756-programs/ http://www.nrmp.org/press-release-2015-residency-match-large... [1] https://www.aamc.org/download/321532/data/factstable27-2.pdf https://www.aamc.org/download/321532/data/factstable27-2.pdf [2] These aren't necessarily "foreign" students either; it's quite common for people in the US to go to medical school in the Caribbean and then come back for their residency.
- knughit 11y ago
  $277K/yr doesn't sound too bad, compared to lawyers and finance folks and business VPs. That's not why healthcare costs so much. Even if you booked 1 anesthesiologist for a whole day long massively intensive surgery, that's only about $2k of your cost
- Omniusaspirer 11y ago
  This comment is not only factually wrong (It's not the AMA) but misleading as well. The typical medical student today leaves med school $250k in debt at 8% interest then spends years in a residency where they make $50-60k working 80+ hours per week in a likely high cost of living area. If they started schooling immediately after high school they probably won't actually make that 270k (median, so many starting out are lower) until they're 30+ years old. Contrast that to a completely mediocre web dev who can pull 100k+ at 21 putting in 40-50 hours a week and do you really still think physicians are overpaid? Keep in mind the majority end up in family or internal medicine working 60+ hours a week for ~$175k/yr. Going to medical school is a massive financial risk with an incredibly uncertain future. If you want a human punching bag then turn your gaze towards hospital administrators, pharmaceutical executives, and exploitative vendors. The actual hospital employees are just as much victims of the healthcare shit show as members of the public are.
atom-morgan 11y ago
Exactly. Imagine how much of a hassle car repairs would be if your car insurance company handled an oil change or a tire balance/rotation.
- lbhnact 11y ago
  Imagine how much a hassle car repairs would be if cars were a staggeringly complex biological system where parts could not be replaced figuring out what was wrong was difficult and all work had to be done in while it was driving down the road and it was really easy for you to die if a mistake was made and other people had to pay for it.
  - kangman 11y ago
    That sounds like a modern car to me. sans biological
  - jerf 11y ago
    Are Indian humans made out of simpler parts, such that it's OK for them to have free market health care whereas it doesn't work for us?
    - s73v3r 11y ago
      No, it's that they don't care about people not being able to get care, whereas we at least try to care about it.
      - jerf 11y ago
        That ahem sort of racist snark would make a lot more sense if we weren't having this discussion in the context of a system that appears to be providing wildly cheaper service. My more subtle point is that when we are discussing an existing free-market based medical system, you can not just trot out all the standard arguments about why the US should not go free market, because they are all based on a discussion of a change in how we structure the system. Here we (appear to) have a free-market system, so, one must validate all the slurs actually apply before just flinging them at the existing system. If free-market health is so guaranteed to be so utterly disastrous, instead of flinging quasi-racist slurs at the Indians, why don't you actually go find the guaranteed-disasters in progress? Ought to be pretty easy if it's even one-tenth as bad as everyone always claims in the US context. (Though I'll warn you in advance I'm going to account for the situation on the ground; if the doctor's office in a far-flung village with a per-capita income of 50$/year isn't up to US standards, I'm not going to award you many points. India is not a wealthy country. Only the major medical centers are really that interesting. It's also generally invalid to complain about a government not providing services when they simply do not have the wherewithal to be providing them to everybody yet.)
pc86 11y ago
In addition to what itg said, another is that with various insurers the doctors and even the billing people do not actually know what you'll pay. They know what the service costs them to perform (irrelevant to what is charged to the consumer), they know what they're going to bill the insurer (a grossly inflated number that is a big cause of these massive 6-figure bills you see to uninsured folks), but they have no idea what the insurer will actually reimburse them, so they honestly can't tell you. It's a broken system and there's no excuse for it, but at least in the US it is not because they're being intentionally obtuse.
- secabeen 11y ago
  Many doctors don't even know what they'll bill, as it's different per-insurer, etc. Their back-office staff certainly can look it up, but docs don't know the numbers.
- r00fus 11y ago
  I went through this a few years back trying to get enough FSA to cover my portion of my daughter's long awaited eye operation. It was insane that I couldn't even be given an exact figure for my portion of the bill to plan for FSA - it's like it's all negotiated at time of operation or after the fact. Now some of that is that if a complication occurs, there will be additional cost, but I was just asking for a baseline, and all they could give me were guesses.
  - pc86 11y ago
    Disclaimer: It has been many years since I was involved in this professionally, pre-ACA. It may have changed since then. Depending on the arrangement with the insurer, and what the recovery period was like for that type of operation, nobody in the office probably had any idea (and I bet their guesses were pretty far apart, too). Some medication used in recovery is very expensive and can add five-figure variances if someone doesn't respond well to the procedure or is in an abnormal amount of pain. And as you mentioned any complications can double the cost in an instant. From the insurer side, they will decide after they receive the care provider's bill what they're covering and for how much. They may decide she only need five hydrocodone, not eight, so there's (3 * $n) out of your pocket (I am not googling the cost of hydrocodone at work :)). What's more is this "justification" is rarely given to the care providers. The insurer is billed $50,000, they pay $47,000 and that's that. The cynic in me wants to say it's so they don't actually have to justify partial payment, but who knows.
lbhnact 11y ago
>I still can't believe that you can not call up a doctor/clinic/hospital in US and get a price quote for something routine You can. Routine, profitable procedures are not hard to arrange in the US. I have personally worked in a clinic where the exact experience described in this post happens every day. >If you are a working, middle class person, the free market health care works extremely well. It's pretty easy in most places in the world to get people to do something that makes them money, like the discectomy discussed here. Managing a system where the poor and the unlucky get care is a little tougher. The US does it lousily, but so does most of the rest of the world. India doesn't do it at all. edit:copy error
- mikeg8 11y ago
  > You can. Routine, profitable procedures are not hard to arrange in the US. I have personally worked in a clinic where the exact experience described in this post happens every day. For the majority, this is simply not the case. I'm sure there are exceptions as our country is very large, but most people's experience would be very similar to the OPs. I'd suggest reading Healing of America by T.R. Reed if you're interested in the working of US compared to other systems.
- hospes 11y ago
  For vast majority of the procedures and surgeries you cannot get any quote. I tried to get quote for the standard procedure (that they have performed 100s of times) via phone and in person in Dr's office in 4 different hospitals. All of them told me that they do not know the price, since it depends on what my insurance will cover. They said that they need to do evaluation, schedule the procedure, submit paperwork to the insurance company and then I can get the quote, which is crazy, because to schedule the procedure you need to go through pretty expensive evaluation process. Basically just to know the price you may need to spend couple thousand dollars. This happened to most of the people that I know that needed some kind of quote from the hospital. The clinic you have worked was an exception.
Vivtek 11y ago
Ha. Back when our son was having regular lab exams, we were in the States. When we asked Bloomington Hospital for a price for one lab exam, the receptionist asked us, "Why? Don't you want the best for your child?" Yeah, lady, that includes not giving you all our money without asking how much you'll be taking.
crusso 11y ago
We have too many middle-men in US healthcare. They obscure costs and prices while preventing individuals from getting more involved with their own healthcare decisions. Rather than a one-size-fits-all approach to healthcare through single payer or other subsidies, my fondest wish for government intervention would be for laws that force doctors and hospitals to provide price and likely outcome information to the general public. Give healthcare consumers the data they need to make informed decisions and the ensuing competition could drive down prices while improving outcomes.
- maxxxxx 11y ago
  That would be my first step for health reform: Require publication of prices and outcomes. Also: Don't allow charging of one price to one group of people (uninsured) and 25% of that price for another group (insurers). One price for all. Maybe allow for 10% discount but not the huge discounts insurers get.
s73v3r 11y ago
"If you are a working, middle class person, the free market health care works extremely well." And if you're not?
xixi77 11y ago
You actually often can (or at least, could -- not sure how Obamacare might have changed this) -- you need to state that you are uninsured; you may very well get a lower price for your routine than you would have to pay out of pocket with insurance.
vadym909 11y ago
Yes- my friend goes to India and does his annual checkups/ dental checkups and fillings for a few hundred rupees which is cheaper than the deductible of his dental insurance here. Last time he had heart pain and went to a top heart specialty clinic and his bill was $11 to get checked out.

jkot 11y ago

My wife had some complications after pregnancy. UK and Ireland has GP referral system, where single doctor coordinates all specialists. In theory it is good system. But our GP ignored basic symptoms and pushed bullshit like "depression" or "have you tried acupuncture?". We paid each GP visit, even for saying hi and collecting results, it was obvious GP was just pushing for more visits. This was going on for several months.. Eventually we visited doctor in Athens, the whole thing was diagnosed and solved in weeks. Solution was $2 pill and routine surgery. I really recommend to anyone with some 'mysterious' health issues to visit REAL doctors.

richardwhiuk 11y ago
Hold on, you paid for a GP in the UK? That's not how the system works....
- jkot 11y ago
  This was Ireland.
  - pault 11y ago
    You might be surprised at how many Americans think Ireland is part of the UK. Source: I live in a hostel. Edit: for extra fun, ask them what country Amsterdam is in.
    - jkot 11y ago
      I would not be so harsh, my initial comment is a bit misleading. And most Europeans do not know the difference between Washington and Washington D.C. :-)
      - jacquesm 11y ago
        > And most Europeans do not know the difference between Washington and Washington D.C. :-) Is that so?
11y ago

kra34 11y ago

Your treatment in the US would have involved something like 5 doctors, $100,000 billing (probably not payments since those things are only vaguely related) and 2+ years of your time.

anilgulecha 11y ago

My wife is a Dentist in Bangalore, India, and it's amazing what I hear. Basically Cost(Flight to india + treatment cost) < Cost(Treatment in US). The more you think about it, the more crazy it seems on multiple levels. Edit, typed < instead of >.

kangman 11y ago
you mean < ?
CapitalistCartr 11y ago
Are you sure you mean greater than there?
cpursley 11y ago
My wife and I have all our dental work completed in Russia. Not only is it a fraction of the cost, its a no-nonsense experience. An initial consultation in the US costs about as much as the actual dental work performed overseas. It's madness.
- vkhorikov 11y ago
  What city in Russia? Moscow? Also, shouldn't the cost of the flight eat up the difference?
vinceguidry 11y ago
I went to get dental work done in Medellin, Colombia. Two whitening treatments, perhaps a dozen fillings. My Atlanta dentist wanted to do an inlay on one of my teeth. I'd already had two done that year and just couldn't afford to have them keep working on my teeth. When I got to Medellin, my dentist did not want to do the inlay, said it was too invasive and that he would rather fill it. It cost less to fly to Medellin, get all my work knocked out, than it would have for just the one inlay. And I absolutely believe that my Colombian dentist, who spoke English quite well, did better work than the Atlanta guy did. My teeth look better than they have in years. I will never again have significant medical procedures done in the US.

tahoeskibum 11y ago

One thing I've never understood about the US system is why do the doctors charge more for paying cash e.g. $200 for a visit, whereas insurance reimburses them less than half e.g. $80. In everything else e.g. car repairs, the cash price is always lower than insurance covered price. Any ideas why this is so?

harryh 11y ago
Insurers negotiate a volume discount.
- chvid 11y ago
  But not for car repairs?
  - harryh 11y ago
    I guess not. Which does seem a little weird now that I think about it. Not sure why cars would be different.
    - secabeen 11y ago
      Because the law allows you to go to any mechanic to get your car fixed, and they can't negotiate with every mechanic in the market. Most auto insurers have "approved" repair shops, and if you go to one of those, the rates can be cheaper than cash.
      - harryh 11y ago
        Ah, that makes total sense. Thanks!
  - blakeyrat 11y ago
    I don't know about your auto insurance company, but mine has "preferred shops" and I presume the reason they are preferred is because they have negotiated some form of discount.

clamprecht 11y ago

I should mention that Paul Buchheit wants to fund the Uber of medical tourism: https://twitter.com/paultoo/status/566379518261088258 https://twitter.com/paultoo/status/566379518261088258 The tweet: "I want to fund the 'Uber' of medical tourism Needs 5 star service, simplicity and safety Let me know if you apply - http://www.ycombinator.com/apply/" http://www.ycombinator.com/apply/" It really has to happen. Health care in the US is just fucked, and everyone knows it.

endymi0n 11y ago
Well, the "Uber" business model is actually pretty hard to do in an industry as heavily regulated as medicine (and honestly it's a difference between getting into an unrated driver's car or putting yourself under the knife of an unrated developing country's doctor)... Then again, our friends at Medigo seem to do great service in this direction so far and have just raised a series A ( https://www.crunchbase.com/organization/medigo#/entity https://www.crunchbase.com/organization/medigo#/entity ), the competition seems to be heating up in this space and honestly, I can't think of anything to truly "disrupt" this industry, as the margins are pretty well known, the market is reasonably mature and the order volume is very low.
- LunaSea 11y ago
  Just do it like Uber, it's illegal in most places but hey if you "disrupt" the market it's alright.
- deleted 11y ago
  [deleted]
- dalore 11y ago
  Wouldn't the "Uber" business model mean they are rated? Bad doctors would not get 5 stars and then get dropped. Vs the current state of affairs where the doctors aren't rated at all. If people were going to travel for medical tourism anywhere wouldn't you want to go to a doctor that has been rated 5 stars vs one that hasn't? Bearing in mind they all have qualifications.
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Dove 11y ago

Cash friendly places are getting more prevalent in the US, but you have to look for them. For example, one of the hospitals in my area publishes this (very sane) price list: http://swedishhospital.com/patient-financial/?page_name=pricing http://swedishhospital.com/patient-financial/?page_name=pric... I go to them. :) There are urgent care centers that are the less-crazy version of ERs, and a lot of primary care stuff can be done self pay. While I have access to insurance through my work, I vastly prefer the quality of the self pay system. You do need to do some research in advance, but there are some pretty cool innovations out there, and services you just can't get via the insurance system. http://theselfpaypatient.com/ http://theselfpaypatient.com/ is a good resource.

chiph 11y ago
Be careful when picking an urgent-care center. Some are now for-profit emergency rooms. They can treat a much broader set of maladies & injuries than an urgent-care, but they're priced accordingly. http://www.kvue.com/story/news/investigations/defenders/2015/11/16/buyer-beware/75871654/ http://www.kvue.com/story/news/investigations/defenders/2015...

cryoshon 11y ago

Yep. Medical tourism exists when the cost of local healthcare is inflated by profit-seeking to flatly unaffordable levels, resulting in grotesque health outcomes and extreme behaviors such as traveling thousands of miles or committing crimes in order to end up in prison for care. I would like to coin a term for this kind of disturbing extreme behavior incentivized by extreme distortion of society: fever spasms. It sounds better in German, so: fieberkrämpfe. Out of pocket price of standard blood panel lab in the USA with a follow up phone call if something is wrong, with insurance: $1500. There is no ability to estimate even vaguely what the price will be beforehand, and the bill may take a month to arrive in the mail. Your insurance agency will fight you at every turn for all but the most mundane routine procedures. There will be a billing error somewhere, and it will be to your detriment. They may refer you to collections if you do not pay the incorrect amount while disputing the charges, as happened to my girlfriend. Face time with the doctor is probably minimal, and you will be stressed by the doctor's attempts to hurry you out the door and probably forget to ask important questions. Out of pocket price of extended blood panel lab plus two hours of doctor face to face analysis without insurance in Argentina: $50 USD, and the doctor will speak perfect English. Smartly, the doctor arranges the items on the blood panel before you visit him in the first place. No in-depth discussion of your health can begin before the doctor cannily takes your medical history via a very casual schmooze-sesh which plays out more like old friends catching up. You leave the office relaxed, understanding your health action-items. Where do you think I'm going to go when I need serious treatment? The US medical system is a failure and an international joke.

ashark 11y ago
> There will be a billing error somewhere, and it will be to your detriment. They may refer you to collections if you do not pay the incorrect amount while disputing the charges, as happened to my girlfriend. Yep. Can confirm: US hospitals and other care providers are total d-bags when it comes to billing. It doesn't help that for anything remotely complicated you end up receiving 2-3 different bills from each of 5-6 different entities (the hospital, a couple of doctors or departments in the hospital, a couple of labs, a GP for your checkups afterward, et c.), only one of which from each will actually be the one you need to pay. It can easily take most of a year to sort all the crap out, especially if you have any kind of dispute with insurance or billing error from the providers (the bigger the procedure, the closer the probability of this approaches 100%). Makes for a totally stress-free recovery. eye roll It's like it's designed to screw up people's credit, even when they're trying to pay what they owe.

pimlottc 11y ago

Nice piece, although it's a bit misleading to call this "medical tourism" as the author was living in India at the time. Not that it discounts his experience but I'm sure his local connections and familiarity made it easier than it would be for the average American coming it from abroad.

jacquesm 11y ago
It says he went back specifically to have the surgery.
- yummyfajitas 11y ago
  Well, sort of. I would have gone back anyway (I had a girlfriend in Pune, as the pictures sort of hint at, and no reason to be in the US), but my return trip would have been slower and passed through more interesting places. The OP is absolutely right that it would have been more difficult for me if I knew nothing whatsoever about India. However, I probably could have paid a couple of thousand USD more and OnP (the hospital I stayed at) would handle things for me. I know they have a medical tourism office, albeit catering primarily to gulf residents.
  - jacquesm 11y ago
    Good to see you on the other side of this. Any surgery is risky and if your troubles are gone that's fantastic news. Are you still in touch with the people there for check-ups or is it done for good?
    - yummyfajitas 11y ago
      I hope it's done for good, but being 6'6" means that there is always risk of further injury. No point in a checkup - no pain = no problem. I'm not deadlifting anymore, however.
      - ahh 11y ago
        FWIW deadlifting definitely helped, not hurt, after my back injury. (Admittedly, I hurt it deadlifting with poor form, but fixing the form and strengthening my back with it was the single biggest contributor to getting better.) MMV, of course.

hvmonk 11y ago

My understanding is doctors in US are trained to scare you about every possible negative outcomes. I find visiting a doctor here is much much more stressful than doing it in India. For a simple chest pain, doctors here would tell you 145566 possible scenarios that may happen with your body, and wouldn't confirm any unless he sees a lab test. And then, a tide of lab tests would start, which will cripple you financially, and emotionally because all you are thinking is which test would be +ve, which -ve; diving on internet where people usually blog about their -ve experiences. Usually, it could be just a muscular pain, etc, which become so irrelevant as you are undergoing all these lab exams. I don't want to blame the doctors here as such, because that's how they are trained here. I guess it boils down to this robust "suing infrastructure" here, that if you missed out a rare symptom with a patient, he will sue you and finish your career. One thing which I couldn't understand is why in a developed country, lab tests are so expensive. An Xray, costs about $100; similar thing costs about Rs 80 (equivalent to $1.25). Shouldn't they be cheaper here, given there are gizmos for everything, and all electronics items are much cheaper here than India. I think these costs are all artificial. I think a mix of both approaches (insurance + free market) would better.

chimeracoder 11y ago
> One thing which I couldn't understand is why in a developed country, lab tests are so expensive. An Xray, costs about $100; similar thing costs about Rs 80 (equivalent to $1.25). Many lab tests - though not all - are effectively commoditized. There is little difference in quality, and the requisite supplies are widely available at low costs. X-rays have been used for medical purposes for literally over 100 years, and it's not very difficult to train someone to take an x-ray properly using modern equipment. (Actually interpreting the results of a test is a different matter). For tests which fall under these categories, it will always be more expensive to obtain them in the US than in India, because the cost-of-living in the US is much higher, and paying people to actually perform the tests dominates the costs of the test itself. There's a little more to it than that, but that's the general idea.

SimpleXYZ 11y ago

Socialized medicine or a pure capitalistic system would both be preferable to the current system in the US. Right now it's the worst of both worlds.

arethuza 11y ago
Even here in the UK - where we do have a socialist health care system there is still the option of going private. The only option you don't get if you are a normal tax payer is opting out of paying for the state funded healthcare - which is fine as far as I am concerned.
- laurencerowe 11y ago
  The US spends almost exactly the same proportion of GDP on public healthcare as the UK (~7.3%) but because the system is so horribly wasteful it gets much less for its money. (Much of healthcare spending is on the old who are covered by public Medicare because private insurance would be unaffordable.) UK: 8.8% of GDP total spending, of which 83.3% public = 7.33%. http://www.ons.gov.uk/ons/rel/psa/expenditure-on-healthcare-in-the-uk/2013/sty-expenditure-on-healthcare--2013.html http://www.ons.gov.uk/ons/rel/psa/expenditure-on-healthcare-... US: 15.2% of GDP total spending of which 48% ($3,426/$7,146 per capita) public = 7.28% https://en.wikipedia.org/wiki/Health_care_in_the_United_States https://en.wikipedia.org/wiki/Health_care_in_the_United_Stat... Edit: The 2014 figures are even worse. 17.5% of GDP total spending of which 28% federal and 17% state and local = 7.88% of GDP public expenditure. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html https://www.cms.gov/research-statistics-data-and-systems/sta...
  - yummyfajitas 11y ago
    India: 4%. http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
    - arethuza 11y ago

JamesBarney 11y ago

It's true that healthcare is terrible in the U.S. if you don't have health insurance, but he overstates his case. Chris compares a 1 in a 1000 nightmare scenario to his very average experience. A $112,000 error happens in the U.S. but is rare. Typically the type of surgery he mentions costs between $20,000-$50,000. Or 50-100% of a the U.S. gdp per capita. This is smaller than in India where the cost of his surgery was 130% of the Indian gdp per capita. And the issues with rounding errors has to do with the large amount of health insurance in the U.S. not necessarily free market vs. regulation. When the majority of consumption in a market is driven by enterprise customers, the pricing can become strange and very unfriendly to individuals. [0]https://pricinghealthcare.com/prices/IowaCityASC/spine-back https://pricinghealthcare.com/prices/IowaCityASC/spine-back [1]http://www.backsurgerycost.com/how-much-does-a-discectomy-cost/ http://www.backsurgerycost.com/how-much-does-a-discectomy-co...

yummyfajitas 11y ago
It's very true that I don't know what average costs are, in either country. The only prices I know are the price at the place I went (one of the top facilities in the region) and a few nearby hospitals. Several were significantly cheaper and if I earned in INR I'd probably have gone to one of them. But I figured that given how much I enjoy walking, why not just spend $700 more to go to the best guy?
clamprecht 11y ago
Take a look at http://reddit.com/r/personalfinance http://reddit.com/r/personalfinance for a few weeks and you will see that there really is a problem.
FireBeyond 11y ago
Not three years ago, with "comprehensive" insurance, I paid $7000 for a kidney stone, with a full total approaching $50-60K. For a kidney stone. I had to have two surgical procedures, admittedly - they went in to remove the stone, found long-standing infection, closed up and catheterized. A week of antibiotics later I had it shocked. But still... $60K for a kidney stone.

bambax 11y ago

His symptoms sound very similar to the ones described in the book "The mindbody prescription" by John Sarno. I would very strongly recommend reading that book (which will set you back a whopping $10) before undergoing any back surgery. (I'm not a doctor, this is not medical advice, YMMV and all that. Still. If you suffer from chronic back pain, or carpal syndrome, read the book.)

collyw 11y ago
Bizzare being downvoted for suggesting trying a non invasive, cheap procedure before opting for fairly serious surgery. Amazon's reviews give it 4.5 stars. I assume its something similar to Thomas Hanna's Somantics from the name and Amazon description, which would be something I would recommend people give a try before going under the knife.

MistahKoala 11y ago

I wish there was a site like NomadList, but for medical tourism. I'm up for going further afield for treatment, but the lack of information and good local knowledge makes it riskier than I'd like.

squozzer 11y ago

Discussion of cost-effective alternatives is almost pointless now that we have the ACA, which is effectively a transfer of wealth from individuals to insurance companies for the sole privilege of breathing. Oops, forgot at include dying also.

diebir 11y ago

This guy is either an idiot or tries to sell something. More like both. He goes around self treating a serious spine condition, trying to find a doc to inject steroids for cash (which is treating the symptoms, not the root cause). Then he goes for a surgery in some third world place "because it's cheap"; a surgery on his spine no less, where he may or may not ever walk again if something goes wrong. Then, he touts a quick recovery, he being, from what he looks like, about 30 years old. Give me a friggin break. I am not "buying a surgery for cash" for something as critical as my spine. Or knees. Or appendectomy. Or anything else.

iamthepieman 11y ago
What are you buying it with then? Good will, bitcoins, large assets or perhaps something else? I think I may be misunderstanding you. Did you mean that you aren't going to base a major health care purchase on cost alone? That certainly makes sense but it also makes sense to me that cost is indeed a factor even if its not as important to you as it is to the OP.
yummyfajitas 11y ago
What did I "self treat"? My doctor in India recommended the steroid injection in order to enable me to travel and a first world doctor provided the service. Treating symptoms well enough so that I can travel was the only purpose - the discectomy is what actually solved the problem. If you want to spend extra money on a non-Indian doctor living in America, have fun. I don't plan to do the same - I've generally found care in India to be equal or superior to care in the US. I'm not sure what you think I'm selling. I did name drop the doctor/hospital where I went, but they've paid me nothing and probably have no idea I wrote this post.
icelancer 11y ago
>I am not "buying a surgery for cash" for something as critical as my spine. Or knees. Or appendectomy. Or anything else. That's fine. But I might want to. Have you considered this?
Gustomaximus 11y ago
> Then he goes for a surgery in some third world place "because it's cheap" You missed the point of the article, which is to not attribute price to quality. Also being so dismissive of poorer countries as having reasonable doctor/facilities smacks of ignorance and exactly what this article is challenging.

geomark 11y ago

My own experience in Thailand is similar to the author's in India: see a doctor on short notice, prices quoted in advance, short wait time for surgery, prices low enough to pay out-of-pocket. The icing on the cake is how friendly and warm the medical care is. My biggest fear when I visit the US is that I will get sick or injured and be subject to that awful system. I lived in the US most of my life, had excellent insurance, and had routinely poor experiences with healthcare.

BryantD 11y ago

I'd recommend doing some more reading on the health care system in India. I believe that it worked really well for the poster; my initial research seems to indicate that there's a huge difference between the health care you can get in urban areas of India and the health care you can get if you're poor and rural. It's easy to build a health care system that works for people with money. The infant mortality rate in India was 38 per 1,000 in 2015. That's really not good.

lbhnact 11y ago
Thanks for saying this is more friendly terms that I did. What's also interesting, is that the US is likely a large net 'exporter' of medical tourism. I currently work with hospitals that are rapidly developing large businesses in medical tourism, because for all our needless systemic problems, people trust that, if you have the cash, you can find a good doctor.
- aesoprock 11y ago
  Why are you so butturt? :^)
largote 11y ago
They do have good quality private care which a lot of people in India cannot afford but most people from developed countries could.
aesoprock 11y ago
Nowadays every doctor that is required by law(started in assam I think) to go to poor and rural areas and serve there for a minimum of one year. Things are getting way better than one thinks, there is a sense of socialistic way of doing things along with good old capitalism. Rural health missions are sponsored by the government and nurses and doctors are well paid(as per Indian standards).
FraaJad 11y ago
yeah, yeah, yeah... when someone visit the US for tourism, they don't go to Alabama and Mississippi. They go to the big apple, las vegas and disney world. When you are applying "Free market principles", you go to the place that maximizes your enjoyment/treatment per $$ spent.

grecy 11y ago

My brother broke his leg horribly in Australia when he was 17. It was the worst break they'd ever seen at the hospital. Ambulance ride, first surgery. Helicopter ride, second surgery, a month in hospital and third surgery and then another month or so in hospital to ween him off the morphine he had become addicted to, and to get walking again. Of course, there was never a bill.

NeutronBoy 11y ago
Similar when I got kidney stones here (Aus). Emergency dept, 3 night stay, drugs, multiple x-rays, CT scan, 3 followup CT scans over 3 months, etc. No bill in sight. I realise that I pay for it through my taxes, but I'm ok with knowing if something happens I don't have to cough up thousands of dollars.
- grecy 11y ago
  I happen to be in the US right now, and last night had a Christmas dinner with people going elsewhere tomorrow. All 10 people spent at least an hour talking about health insurance, "Doughnut holes", the VA, and lots of other things related to the abysmal health system in the US. It occurred to me I've never heard such a conversation in Australia, but it's simply automatically part of life that you get good care.

xacaxulu 11y ago

Having traveled a lot for work, I've had the good fortune to have received care in South Africa, dental work in Serbia and a number of regular treatments in Mexico. I'm a born and raised US citizen though I also have an EU passport. Any day of the week I'll sit on a plane for a few hours and pay less for much better care in another country. Healthcare is a racket here. Better believe when retirement comes I'm nowhere near the USA.

veritas213 11y ago

Cant really speak about orthopedic issues but have had some experience when my partner had cosmetic surgery abroad. Cosmetic surgery makes up a significant chunk of treatments and is much more of art than science. There is no way I would ever risk having surgery anywhere before i knowing all the facts. My partner had a face and neck lift from a "reputable" doctor in Los angeles and honestly looks worse afterward than he did before. About 5 years he became painfully aware that he needed it done again so he went to a well-regarded surgeon in Bangkok that really improved his appearance and cost about half as much. http://www.thaimedicalvacation.com http://www.thaimedicalvacation.com One interesting thing about her experience was that he was told by the doctor in Thailand that he would not be able to offer a surgical facelift since he already had one 5 years earlier. It was very interesting to see doctors saying no rather than risking poor results with multiple surgeries. A person like Joan Rivers is a good example of what can happen when you have way too many surgeries. Overall though my opinion is that for rare or esoteric conditions, there is no place on earth better than the US. However for common elective or nonelective surgeries, going abroad may not be a bad idea.

sillyhealthcare 11y ago

This post is unrealistic in medicine, and really only works for less serious/elective care issues, not primary medicine, or where doctor and location choice actually matters. As a starter: I'm woman with an extremely strong family history of breast cancer before age 50. Standard clinical guidelines is to start doing heavy monitoring 5-10 years before the youngest person in the family tree was affected, since usually cases get progressively younger start dates. Since one of the people was around age 32, I'm under the age of 30 and I go for mammograms, ultrasounds, and MRIs every year as if I were a cancer patient already. Mammograms, ultrasounds, CAT Scans, MRIs, (any form of medical imaging radiography) are actually a perfect example of how the market internationally could be more efficient, but it turns out that's impossible. At its core we're basically talking about photographs, something facebook manages to serve from location a to person b that is nowhere near location a every day. Why couldn't I go to any imaging place in the US, and have my images sent to the lowest cost provider somewhere in india to be read and interpreted by a radiologist, and then have the results sent back to me. Unlike Chris, I don't even have to meet my doctor, all I have to do is send him images. It turns out that medically this is blatantly difficult if not impossible to do. The reasons are 2 fold 1) It turns out that age and variations in how and why the machines that used, as well as technician speciality, matters a ton in image quality. http://www.kevinmd.com/blog/2010/09/mri-places-good-quality-machines-obsolete.html http://www.kevinmd.com/blog/2010/09/mri-places-good-quality-... As a patient, I have no idea if the price I am being quoted is reflected of image quality or price inflation (and this is before being read) 2)Quality of the radiology report is highly dependent on the MD reading the images. This has been well studied since the early 2000s (one of the latest examples being here: http://www.ncbi.nlm.nih.gov/pubmed/23737538 http://www.ncbi.nlm.nih.gov/pubmed/23737538 ) At under the age of 50 with dense breasts, I'm significantly more likely to have imaging misread if I went into a community imaging location, even if they had top notch equipment, because the radiologists do not have enough volume of high risk cases to make sure I am not falling into false positives/recall on a regular basis - which would mean even more imaging costs. In order to effectively export my images, I would have to find a way to duplicate part of the specialized cancer wing I go to. Cost savings actually would be minimal - I'd be running more tests, seeing more doctors, and probably have a delayed diagnosis if/when my expected inevitable happens (which means more expensive drugs, longer treatment times, ect) And while my example is specific to me, many people have similar sorts of conditions where treatment location, equipment used, and people involved have higher initial costs but lower lifetime costs for all sorts of conditions. Pretty much any semi-serious disease falls into this category. I'm game for better ways of paying (insurance does cover this, because as I said, lower lifetime costs to them by paying for preventive care). I experiment with things like telemedicine - I use a compounding pharmacy and Specialized RN over the internet to manage acne that refuses to go away. I'd totally go to the Caribbean for teeth whitening or LASIK. None of these things need regular, serious followup, or run risks of painful drawn out deaths/longer painful medical care with much higher costs if done very incorrectly on a regular basis. Medical tourism isn't the answer - understanding what these services are in relationship to risk is.