4 ms·

> Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (goin

by csydas 10y ago

> Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...). This part gets me a lot as well, and having experienced other pay-for healthcare systems, it's extremely frustrating remembering just how much I would pay in the US even when I had fair insurance through my employer. Getting a simple biopsy done on my leg resulted in a $250 upfront new patient fee, $2300 for the biopsy, then an additional $400 for lab fees some months later. Aside from the new patient fee, I had no idea or indication about any of the other fees until a bill arrived in the mail, despite asking and persisting about it throughout the visit, and since I had to take time off of work to get an appointment, I was at a loss as to how to "make a stand" to get such information. Compared to where I've been abroad where it's been an upfront fee for walk-in visits. Appointments were needed, but it was a day or two in advance. And when I got insurance through my workplace, it was equally simple.

theoneone 10y ago
So 3000$ for a biopsy: ticket to Greece and back to USA : let's say 1000€. Biopsy procedure if it's ultrasound guided around 300€. Lab fee for examining the biopsy:around 200€ max, maybe less. Hotel room for 2-4 days in Thessaloniki 120€-150€ in a decent hotel. Total:1500€ or even less. All these can be done by highly and well educate medical doctors, treatment in private clinics is very good(since you are paying in cash you always get vip treatment) and o course you can enjoy a good vacation. I always said that medical tourism is the future
- surgeryres 10y ago
  So are you going to fly back when the biopsy is positive for your surgery or chemotherapy?
  - cmdrfred 10y ago
    Chemo is often every week or month for a period of time, but the surgery is probably a one off. I'd go for it if I was able.
    - mhneu 10y ago
      If you need cancer surgery and you want the best you do the opposite-- fly to the US. E.g. MD Anderson has many patients come from all over the world for surgery.
      - cmdrfred 10y ago
        I doubt I can afford the best, an extra 100k or two for a few percentage point increase in outcome isn't a deal I'd make personally.
    - surgeryres 10y ago
      Surgery might be a "one-off", but cancer surgery can be brutal. People with cancer who need surgery are often nutritionally depleted and surgery takes a big toll. Recovery time in the hospital could be weeks. Rehab, getting you back to where you can wipe your own ass and feed yourself, can take months. It's not like you would just fly in, get cut and fly back in a week. You would have to set up some kind of support system for yourself there, which would be very expensive.
- samirillian 10y ago
  Obviously, the problem with this strategy is uncertainty. Part of the point of healthcare is that other people worry about it so you don't have to. Better the Byzantine, inefficient healthcare system you know than a system you don't know at all. That said, I consider myself lucky to have been in Japan when my lung collapsed. The surgery itself was $80!
  - greggman 10y ago
    I love that japanese medical care is mostly inexpensive compared to the USA but at least 1/2 the doctors and dentists I've visited here over the last 20 years were complete quacks and would not be qualified to practice in he USA. No training to certification is required to be a nurse here. And, if you need special treatments like surgery it's common wisdom you should do your research on your own to find a good doctor a and then pay a several thousand dollar bribe to see them. (of course thats still cheaper than the USA for the same treatment)
- csydas 10y ago
  I would strongly agree, especially since it's already happening in the US for those who can afford the travel time, which is probably the biggest damning factor for most people. My last job was a good job, but it was University work so it paid pittance. Likewise, with such terrible sick leave/vacation policies, it's very hard for such a strategy to really work for many Americans. Even those at my company that had been there for 10+ years only got 16 days vacation a year - my job abroad has 28 days a year standard, with the requirement that one bout of it must be at least 2 weeks in duration. It's way easier to plan a vacation around a medical procedure when you have a month to plan around it. Even when you make a steady livable income, it's really crappy to have to go to the doctor in the US.
- mhneu 10y ago
  It's already mostly the other way around. If you have cancer and can afford it you come to the US for surgery and chemo consults because the best treatment is here. That's partially because of the money made in US by drug and device makers. But it's mostly because of US government funds spent on research, and because of the US university system with its medical research that attracts minds from all over the world.
foobarian 10y ago
I had a similar experience for a minor hand surgery. The thing is, when I called the insurance company (or was it the billing dept at the hospital? I don't remember) they went like, "oh, that's wrong" and like magic $5000 in bills disappeared. How many people just pay without asking? How many people don't care because it's the insurance co covering the bill? The whole system just seems rife with inefficiency.
- falcolas 10y ago
  My parents actually had a doctor's office say "why do you care, insurance is covering it", and the insurance company say "we'll get it fixed, but you realize you won't get anything in return". Yeah, the system is deeply busted.
  - mhneu 10y ago
    Lack of price transparency is a huge, huge problem. Without price transparency you can't have a market system -- America already has a socialist health care system because no one can price shop.
    - m-j-fox 10y ago
      http://www.pamf.org/forpatients/pamf-health-care-costs-and-charges.html http://www.pamf.org/forpatients/pamf-health-care-costs-and-c... Your Better Health Care organizations do publish prices. The outfit across the street from PAMF does not publish prices and as you could guess, they end up being at least 10 times higher. For everything.
    - majormajor 10y ago
      Price transparency isn't that useful without outcome transparency. Outcome transparency without thought about capacity leads to other issues: the best don't have enough time to serve everyone. We need to figure out how to improve the baseline rather than improve the top-end, which is what things are currently focused on (if my insurance has no problem with me going to a more expensive, highly-regarded provider, why won't I try to get in there?). How is a "market" supposed to work for life-saving surgery? I would be very interested in how much money is wasted on wrong treatments, unnecessary tests, fixing mistakes like disease transfer in hospitals, versus just paying the best doctors and surgeons for their time.

by csydas 10y ago

theoneone 10y ago

So 3000$ for a biopsy: ticket to Greece and back to USA : let's say 1000€. Biopsy procedure if it's ultrasound guided around 300€. Lab fee for examining the biopsy:around 200€ max, maybe less. Hotel room for 2-4 days in Thessaloniki 120€-150€ in a decent hotel. Total:1500€ or even less. All these can be done by highly and well educate medical doctors, treatment in private clinics is very good(since you are paying in cash you always get vip treatment) and o course you can enjoy a good vacation. I always said that medical tourism is the future

surgeryres 10y ago
So are you going to fly back when the biopsy is positive for your surgery or chemotherapy?
- cmdrfred 10y ago
  Chemo is often every week or month for a period of time, but the surgery is probably a one off. I'd go for it if I was able.
  - mhneu 10y ago
    If you need cancer surgery and you want the best you do the opposite-- fly to the US. E.g. MD Anderson has many patients come from all over the world for surgery.
    - cmdrfred 10y ago
      I doubt I can afford the best, an extra 100k or two for a few percentage point increase in outcome isn't a deal I'd make personally.
  - surgeryres 10y ago
    Surgery might be a "one-off", but cancer surgery can be brutal. People with cancer who need surgery are often nutritionally depleted and surgery takes a big toll. Recovery time in the hospital could be weeks. Rehab, getting you back to where you can wipe your own ass and feed yourself, can take months. It's not like you would just fly in, get cut and fly back in a week. You would have to set up some kind of support system for yourself there, which would be very expensive.
samirillian 10y ago
Obviously, the problem with this strategy is uncertainty. Part of the point of healthcare is that other people worry about it so you don't have to. Better the Byzantine, inefficient healthcare system you know than a system you don't know at all. That said, I consider myself lucky to have been in Japan when my lung collapsed. The surgery itself was $80!
- greggman 10y ago
  I love that japanese medical care is mostly inexpensive compared to the USA but at least 1/2 the doctors and dentists I've visited here over the last 20 years were complete quacks and would not be qualified to practice in he USA. No training to certification is required to be a nurse here. And, if you need special treatments like surgery it's common wisdom you should do your research on your own to find a good doctor a and then pay a several thousand dollar bribe to see them. (of course thats still cheaper than the USA for the same treatment)
csydas 10y ago
I would strongly agree, especially since it's already happening in the US for those who can afford the travel time, which is probably the biggest damning factor for most people. My last job was a good job, but it was University work so it paid pittance. Likewise, with such terrible sick leave/vacation policies, it's very hard for such a strategy to really work for many Americans. Even those at my company that had been there for 10+ years only got 16 days vacation a year - my job abroad has 28 days a year standard, with the requirement that one bout of it must be at least 2 weeks in duration. It's way easier to plan a vacation around a medical procedure when you have a month to plan around it. Even when you make a steady livable income, it's really crappy to have to go to the doctor in the US.
mhneu 10y ago
It's already mostly the other way around. If you have cancer and can afford it you come to the US for surgery and chemo consults because the best treatment is here. That's partially because of the money made in US by drug and device makers. But it's mostly because of US government funds spent on research, and because of the US university system with its medical research that attracts minds from all over the world.

foobarian 10y ago

I had a similar experience for a minor hand surgery. The thing is, when I called the insurance company (or was it the billing dept at the hospital? I don't remember) they went like, "oh, that's wrong" and like magic $5000 in bills disappeared. How many people just pay without asking? How many people don't care because it's the insurance co covering the bill? The whole system just seems rife with inefficiency.

falcolas 10y ago
My parents actually had a doctor's office say "why do you care, insurance is covering it", and the insurance company say "we'll get it fixed, but you realize you won't get anything in return". Yeah, the system is deeply busted.
- mhneu 10y ago
  Lack of price transparency is a huge, huge problem. Without price transparency you can't have a market system -- America already has a socialist health care system because no one can price shop.
  - m-j-fox 10y ago
    http://www.pamf.org/forpatients/pamf-health-care-costs-and-charges.html http://www.pamf.org/forpatients/pamf-health-care-costs-and-c... Your Better Health Care organizations do publish prices. The outfit across the street from PAMF does not publish prices and as you could guess, they end up being at least 10 times higher. For everything.
  - majormajor 10y ago
    Price transparency isn't that useful without outcome transparency. Outcome transparency without thought about capacity leads to other issues: the best don't have enough time to serve everyone. We need to figure out how to improve the baseline rather than improve the top-end, which is what things are currently focused on (if my insurance has no problem with me going to a more expensive, highly-regarded provider, why won't I try to get in there?). How is a "market" supposed to work for life-saving surgery? I would be very interested in how much money is wasted on wrong treatments, unnecessary tests, fixing mistakes like disease transfer in hospitals, versus just paying the best doctors and surgeons for their time.