5 ms·

This is absolutely shocking to me. Had my ACL replaced in the UK privately about 8 years ago (no health insurance, paid out of pocket). Total cost was £3000 (+

by dbuxton 13y ago

This is absolutely shocking to me. Had my ACL replaced in the UK privately about 8 years ago (no health insurance, paid out of pocket). Total cost was £3000 (+ £600 for initial scan). I could have got it done for free on the NHS but it would have messed up my term time at university. Like the OP I had meniscal tearing too so more or less directly comparable. (Although obviously 8 years is probably a long time in medical devices so worth bearing in mind). To put in perspective, that is approximate the same total cost (~$5000) as just _one_ of the pieces of equipment ("Cannula Fast Fix CVD") that the OP lists. It's one thing if doctors are more expensive because they have to carry higher insurance charges to protect against negligence lawsuits, etc, but that the equipment alone is multiple times the cost seems crazy. Mental.

apendleton 13y ago
We hear about medical tourism from the US to India, Thailand, etc., but with these kinds of price discrepancies between the US and UK private practices, I wonder why there aren't more Americans who go to the UK for surgery?
- twoodfin 13y ago
  The fraction of patients without insurance but with enough cash and motivation to fly to the UK purely to seek savings on medical treatment has got to be fairly tiny. My impression is that medical tourism from the U.S. is not typically for cost savings, but rather because particular procedures are either completely unavailable (experimental stem cell treatments) or could require long wait times (liver transplants). I'd love some data on this. Wikipedia's rather poorly written article suggests MT is more popular from countries with socialized systems in order to reduce wait time, but I'm skeptical.
  - apendleton 13y ago
    Were we looking at the same Wikipedia article? Its first sentence is "Medical tourism (MT) is patient movement from highly developed nations to other areas of the world for medical care, usually to find treatment at a lower cost." Later: "[I]n the US, the main reason is cheaper prices abroad." And while I agree that it's not especially well-written, it does provide some hints as to why even insured people might like to go: elective cosmetic surgery, elective orthopedic procedures that may not be necessary but may improve quality of life (knee replacements, etc.), or reproductive procedures like IVF, all of which may not be covered by insurance.
  - defen 13y ago
    > The fraction of patients without insurance but with enough cash and motivation to fly to the UK purely to seek savings on medical treatment has got to be fairly tiny. Well, if my options are to spend 60 grand on an ACL repair in the U.S., or significantly less than that on a first-class ticket to London, some serious fun, and an ACL repair...I know which one I would choose.
    - rogerbinns 13y ago
      Those weren't your options. As with most things health related in the US, someone else was paying (the "insurer" in this case). Given the choice between you paying $2,400 in the US (and the insurer paying an amount you don't see or care about), or you going to the UK and paying 3,000GBP plus accommodation and tickets, I'll bet you pick the former. It is in the insurer's interest for you to go somewhere cheaper as it saves them (not you) money. There are various press articles about this happening such as this 2009 article http://usatoday30.usatoday.com/news/health/2009-08-22-medical-tourism_N.htm?csp=34 http://usatoday30.usatoday.com/news/health/2009-08-22-medica...
      - kriro 13y ago
        If the insurance company pays the remainder i.e. >60k why don't they offer you this deal: - No out of pocket cost - Free all expenses paid one week trip to England with your surgery Would cost them the 3k pounds+2.5k$ of your share+maybe another 3k for a good trip..<10k total compared to 60k I take it they simply can't get that 3k pounds deal as an insurance company.
        woobar 13y ago
        Insurance company will not pay >60K. It will be <10K. Typical insurance pays around 80%, patient 20% of the 'negotiated rates'.
- larrys 13y ago
  "I wonder why there aren't more Americans who go to the UK for surgery?" Potential issues with follow up care as one drawback.
- dragonwriter 13y ago
  > I wonder why there aren't more Americans who go to the UK for surgery? Because a sizable share of the Americans who could afford even the UK surgery prices plus travel and accommodations to/in the UK also have health insurance which covers the procedure in the US, and makes it cheaper for the patient to have the procedure done in the US even if the total cost is more expensive.
old-gregg 13y ago
Similar to my experiences as well. I once compared the price of a knee MRI scan across several countries by calling folks I knew. This is why I was dumbfounded by the call for "innovation" in medical industry at the end of the post. There's plenty of innovation is going on, it's the corruption and extortion we're looking at here: $60K were simply extorted from a person in pain. It's a legislation+law enforcement issue.
- ry0ohki 13y ago
  >$60K were simply extorted from a person in pain. Or more specifically from all of us. The author only paid $2400. The whole system is designed to be opaque and non-competitive so they can just bill insurance companies for whatever. I wonder what it would have cost if he said he was paying in cash (hint: a lot less).
  - ohazi 13y ago
    You'd think that it should be "a lot less" for someone paying cash, but this is almost never the case (in the U.S., anyway). Insurers can threaten to remove a hospital from their network if the prices get too high. The hospital doesn't want to risk losing the large stream of sick/injured patients from the insurer, and usually couldn't care less about one person deciding to have surgery else for reasons of cost (edit: see last paragraph). Individuals paying cash (and individuals without insurance) are generally stuck with the "sticker" price for care (higher than what private insurers pay, and significantly higher than what medicare pays (medicare basically gets to "declare" what they're willing to pay for a given procedure and hospitals generally have to go along with it or they'll lose some/all federal funding)). It's usually very difficult to renegotiate the sticker price without an insurance provider or the government working on your behalf. If it's a time sensitive or life threatening procedure, you'll often have other more pressing action items than haggling over the price. It's even harder to negotiate after the fact, since hospitals make you sign away whatever bargaining rights you may have had before they'll agree to treat you. [edit] Finally, hospitals generate the bulk of their revenue from insured patients. They can and do quote higher prices to uninsured patients, but the fact remains that this is a fairly risky patient pool for the hospital, since many of these patients will sign whatever they need to sign in order to get treatment, despite being completely unable to pay the (relatively huge) prices quoted. Hospitals have incentives to keep this pool as small as possible, and occasionally resort to extreme measures (legal or otherwise) to get rid of these patients [1]. Though the hospitals often aren't able to collect the full price from many of these patients, you would be naive to believe that they won't send collections agencies after you and utterly ruin your credit rating if you find yourself unable to pay. [1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646410/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646410/
chudi 13y ago
I got my ACL replaced in Argentina and the cost including rehab was about U$S 3000 having one of the best insurance companies (about 120 U$S a month). If I wanted to use the public care, it could probably cost almost nothing. It always amazed me that in the US the health of a person is not a right and if you get hurt doing anything you have to pay huge fees.
- pyre 13y ago
  That's because in Libertarian Utopia everyone of importance will be independently wealthy, and those who aren't, deserve to be trampled by the others. /sarcasm
  - jacoblyles 13y ago
    Libertarians have been complaining about the USA's complicated health bureaucracy for decades. Hell, they've written dozens of books about it. It doesn't take a genius to find perverse incentives in US medical pricing schemes. But don't let me get in the way of your 30 seconds of hate...
    - pyre 13y ago
      I've met plenty of people whose political views on health care were along the lines of: Person 1: "You should pay for your own care" Person 2: "What if you are poor and can't?" Person 1: "Sucks to be you." With the possible addendum of: Person 1: "But charity organizations will cover the costs for those that can't pay, because then I can choose of my own will to put money towards the cause." Person 2: "What if not enough people donate?" Person 1: "Well, it sucks to be poor." [I'll note that "sucks to be you" as an answer could probably be translated as, "I have not thought out my position that far, and I don't like you challenging my views, so I'll give you a short and curt answer."]
      - rexreed 13y ago
        Can the issue of who pays for healthcare be adequately separated from the issue of its cost? I think so -- given how wide the disparity in health COSTS (put aside the payer) are between not only countries, but even counties in the US [1]. It would be great if we can talk about the origin of these health costs without getting entangled into who should be paying them. But maybe that's an impossible task. The Libertarian-in-Chief Ron Paul himself a Physician who claims that the exhorbitant costs in health care are a more recent phenomenon. He quotes how much his costs were to do house-visits (remarkably small), and compares that with the ballooning in costs more recently. While one can argue that Libertarianism is a Utopic view, the rapidly escalating prices of healthcare are not something that is espoused by Libertarian philosophy. I.e. Low health costs and individual responsibility for health paying are not incompatible. Then again, neither are low health costs and universal health coverage. Right now, we have the worst of both worlds: high health costs and individual responsibility for payment. [1] http://big.assets.huffingtonpost.com/hospital-procedure-costs-map-2.png http://big.assets.huffingtonpost.com/hospital-procedure-cost...
danielweber 13y ago
We don't really have any price signals for the vast majority of our health care system, when in reality only a tiny minority of it is hard to price (emergency care is hard to price).
deleted 13y ago
[deleted]
rayiner 13y ago
Medical liability costs are about $55 billion in the U.S., or about 2.4% of overall costs: http://www.hsph.harvard.edu/news/press-releases/medical-liability-costs-us http://www.hsph.harvard.edu/news/press-releases/medical-liab.... There are debates about how much "defensive medicine" adds to the cost, but those aren't all that relevant here since the costs presented are exclusive of additional tests, etc.
- dclowd9901 13y ago
  Overall costs: 2.291 Trillion $7,638 per person per year. That just can't be right. I and 90% of the people I know haven't made a significant trip to the dr or hospital in years. Where the fuck is that money going?
  - rayiner 13y ago
    Sick people, rather than people who are not sick, are responsible for the majority of healthcare spending: News at 7. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028 (Table 3). 80% of your lifetime healthcare expenditures will be after age 40.
    - dclowd9901 13y ago
      Incredible! Even more important, I suspect nowadays, most people live more years after 40 than before. Maybe a goal should be figuring out ways we can push back that age.
  - dragonwriter 13y ago
    > $7,638 per person per year. That just can't be right. I and 90% of the people I know haven't made a significant trip to the dr or hospital in years. Where the fuck is that money going? Even if the people you know were somehow a representative sample, that's not all that surprising. A significant health event can easily cost orders of magnitude more than $7,638, so even if 90% didn't have one in a period of several years, the average cost could still easily be $7,638 per person per year.
  - 13y ago

by dbuxton 13y ago

apendleton 13y ago

We hear about medical tourism from the US to India, Thailand, etc., but with these kinds of price discrepancies between the US and UK private practices, I wonder why there aren't more Americans who go to the UK for surgery?

twoodfin 13y ago
The fraction of patients without insurance but with enough cash and motivation to fly to the UK purely to seek savings on medical treatment has got to be fairly tiny. My impression is that medical tourism from the U.S. is not typically for cost savings, but rather because particular procedures are either completely unavailable (experimental stem cell treatments) or could require long wait times (liver transplants). I'd love some data on this. Wikipedia's rather poorly written article suggests MT is more popular from countries with socialized systems in order to reduce wait time, but I'm skeptical.
- apendleton 13y ago
  Were we looking at the same Wikipedia article? Its first sentence is "Medical tourism (MT) is patient movement from highly developed nations to other areas of the world for medical care, usually to find treatment at a lower cost." Later: "[I]n the US, the main reason is cheaper prices abroad." And while I agree that it's not especially well-written, it does provide some hints as to why even insured people might like to go: elective cosmetic surgery, elective orthopedic procedures that may not be necessary but may improve quality of life (knee replacements, etc.), or reproductive procedures like IVF, all of which may not be covered by insurance.
- defen 13y ago
  > The fraction of patients without insurance but with enough cash and motivation to fly to the UK purely to seek savings on medical treatment has got to be fairly tiny. Well, if my options are to spend 60 grand on an ACL repair in the U.S., or significantly less than that on a first-class ticket to London, some serious fun, and an ACL repair...I know which one I would choose.
  - rogerbinns 13y ago
    Those weren't your options. As with most things health related in the US, someone else was paying (the "insurer" in this case). Given the choice between you paying $2,400 in the US (and the insurer paying an amount you don't see or care about), or you going to the UK and paying 3,000GBP plus accommodation and tickets, I'll bet you pick the former. It is in the insurer's interest for you to go somewhere cheaper as it saves them (not you) money. There are various press articles about this happening such as this 2009 article http://usatoday30.usatoday.com/news/health/2009-08-22-medical-tourism_N.htm?csp=34 http://usatoday30.usatoday.com/news/health/2009-08-22-medica...
    - kriro 13y ago
      If the insurance company pays the remainder i.e. >60k why don't they offer you this deal: - No out of pocket cost - Free all expenses paid one week trip to England with your surgery Would cost them the 3k pounds+2.5k$ of your share+maybe another 3k for a good trip..<10k total compared to 60k I take it they simply can't get that 3k pounds deal as an insurance company.
      - woobar 13y ago
        Insurance company will not pay >60K. It will be <10K. Typical insurance pays around 80%, patient 20% of the 'negotiated rates'.
larrys 13y ago
"I wonder why there aren't more Americans who go to the UK for surgery?" Potential issues with follow up care as one drawback.
dragonwriter 13y ago
> I wonder why there aren't more Americans who go to the UK for surgery? Because a sizable share of the Americans who could afford even the UK surgery prices plus travel and accommodations to/in the UK also have health insurance which covers the procedure in the US, and makes it cheaper for the patient to have the procedure done in the US even if the total cost is more expensive.

old-gregg 13y ago

Similar to my experiences as well. I once compared the price of a knee MRI scan across several countries by calling folks I knew. This is why I was dumbfounded by the call for "innovation" in medical industry at the end of the post. There's plenty of innovation is going on, it's the corruption and extortion we're looking at here: $60K were simply extorted from a person in pain. It's a legislation+law enforcement issue.

ry0ohki 13y ago
>$60K were simply extorted from a person in pain. Or more specifically from all of us. The author only paid $2400. The whole system is designed to be opaque and non-competitive so they can just bill insurance companies for whatever. I wonder what it would have cost if he said he was paying in cash (hint: a lot less).
- ohazi 13y ago
  You'd think that it should be "a lot less" for someone paying cash, but this is almost never the case (in the U.S., anyway). Insurers can threaten to remove a hospital from their network if the prices get too high. The hospital doesn't want to risk losing the large stream of sick/injured patients from the insurer, and usually couldn't care less about one person deciding to have surgery else for reasons of cost (edit: see last paragraph). Individuals paying cash (and individuals without insurance) are generally stuck with the "sticker" price for care (higher than what private insurers pay, and significantly higher than what medicare pays (medicare basically gets to "declare" what they're willing to pay for a given procedure and hospitals generally have to go along with it or they'll lose some/all federal funding)). It's usually very difficult to renegotiate the sticker price without an insurance provider or the government working on your behalf. If it's a time sensitive or life threatening procedure, you'll often have other more pressing action items than haggling over the price. It's even harder to negotiate after the fact, since hospitals make you sign away whatever bargaining rights you may have had before they'll agree to treat you. [edit] Finally, hospitals generate the bulk of their revenue from insured patients. They can and do quote higher prices to uninsured patients, but the fact remains that this is a fairly risky patient pool for the hospital, since many of these patients will sign whatever they need to sign in order to get treatment, despite being completely unable to pay the (relatively huge) prices quoted. Hospitals have incentives to keep this pool as small as possible, and occasionally resort to extreme measures (legal or otherwise) to get rid of these patients [1]. Though the hospitals often aren't able to collect the full price from many of these patients, you would be naive to believe that they won't send collections agencies after you and utterly ruin your credit rating if you find yourself unable to pay. [1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646410/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646410/

chudi 13y ago

I got my ACL replaced in Argentina and the cost including rehab was about U$S 3000 having one of the best insurance companies (about 120 U$S a month). If I wanted to use the public care, it could probably cost almost nothing. It always amazed me that in the US the health of a person is not a right and if you get hurt doing anything you have to pay huge fees.

pyre 13y ago
That's because in Libertarian Utopia everyone of importance will be independently wealthy, and those who aren't, deserve to be trampled by the others. /sarcasm
- jacoblyles 13y ago
  Libertarians have been complaining about the USA's complicated health bureaucracy for decades. Hell, they've written dozens of books about it. It doesn't take a genius to find perverse incentives in US medical pricing schemes. But don't let me get in the way of your 30 seconds of hate...
  - pyre 13y ago
    I've met plenty of people whose political views on health care were along the lines of: Person 1: "You should pay for your own care" Person 2: "What if you are poor and can't?" Person 1: "Sucks to be you." With the possible addendum of: Person 1: "But charity organizations will cover the costs for those that can't pay, because then I can choose of my own will to put money towards the cause." Person 2: "What if not enough people donate?" Person 1: "Well, it sucks to be poor." [I'll note that "sucks to be you" as an answer could probably be translated as, "I have not thought out my position that far, and I don't like you challenging my views, so I'll give you a short and curt answer."]
    - rexreed 13y ago
      Can the issue of who pays for healthcare be adequately separated from the issue of its cost? I think so -- given how wide the disparity in health COSTS (put aside the payer) are between not only countries, but even counties in the US [1]. It would be great if we can talk about the origin of these health costs without getting entangled into who should be paying them. But maybe that's an impossible task. The Libertarian-in-Chief Ron Paul himself a Physician who claims that the exhorbitant costs in health care are a more recent phenomenon. He quotes how much his costs were to do house-visits (remarkably small), and compares that with the ballooning in costs more recently. While one can argue that Libertarianism is a Utopic view, the rapidly escalating prices of healthcare are not something that is espoused by Libertarian philosophy. I.e. Low health costs and individual responsibility for health paying are not incompatible. Then again, neither are low health costs and universal health coverage. Right now, we have the worst of both worlds: high health costs and individual responsibility for payment. [1] http://big.assets.huffingtonpost.com/hospital-procedure-costs-map-2.png http://big.assets.huffingtonpost.com/hospital-procedure-cost...

danielweber 13y ago

We don't really have any price signals for the vast majority of our health care system, when in reality only a tiny minority of it is hard to price (emergency care is hard to price).

deleted 13y ago

[deleted]

rayiner 13y ago

Medical liability costs are about $55 billion in the U.S., or about 2.4% of overall costs: http://www.hsph.harvard.edu/news/press-releases/medical-liability-costs-us http://www.hsph.harvard.edu/news/press-releases/medical-liab.... There are debates about how much "defensive medicine" adds to the cost, but those aren't all that relevant here since the costs presented are exclusive of additional tests, etc.

dclowd9901 13y ago
Overall costs: 2.291 Trillion $7,638 per person per year. That just can't be right. I and 90% of the people I know haven't made a significant trip to the dr or hospital in years. Where the fuck is that money going?
- rayiner 13y ago
  Sick people, rather than people who are not sick, are responsible for the majority of healthcare spending: News at 7. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028 (Table 3). 80% of your lifetime healthcare expenditures will be after age 40.
  - dclowd9901 13y ago
    Incredible! Even more important, I suspect nowadays, most people live more years after 40 than before. Maybe a goal should be figuring out ways we can push back that age.
- dragonwriter 13y ago
  > $7,638 per person per year. That just can't be right. I and 90% of the people I know haven't made a significant trip to the dr or hospital in years. Where the fuck is that money going? Even if the people you know were somehow a representative sample, that's not all that surprising. A significant health event can easily cost orders of magnitude more than $7,638, so even if 90% didn't have one in a period of several years, the average cost could still easily be $7,638 per person per year.
- 13y ago