8 ms·

Polish clinics: Another kind of health tourism (2013)

87 points by cturner 13y ago

wozniacki 13y ago
Without implying too much other than what can be directly inferred from this line Private health care is sold as a luxury for the affluent and usually only covers hospital treatment, not primary care—that is, visits to a doctor. I'd like to reiterate that this is where the American model of healthcare delivery is headed. The Affordable Care Act just made this abundantly inevitable. We will soon have a tiered system - if it already isn't here - where the wealthy shall be catered to by doctors and health professionals, who have completely removed themselves from the insurance model and thus only serve in a Direct-Pay model. The best surgeons and experts will exclusively cater in a on-demand model, flying down to multiple locations a day to offer their premium services to wealthy clients. Concierge medicine is already here. [1] Even with things like Telemedicine and Remote surgery, I don't see why the doctors will behave any differently in how they choose to split their precious hours. [1] http://en.wikipedia.org/wiki/Concierge_medicine http://en.wikipedia.org/wiki/Concierge_medicine http://stanfordhospital.org/clinicsmedServices/clinics/primaryCare/conciergeMedicine/ http://stanfordhospital.org/clinicsmedServices/clinics/prima...
- vidarh 13y ago
  In the UK, while there are some that provide only direct-pay services, most of the private healthcare is operated by, or contracted by, large private insurance companies, that offers quite cheap "add-on" insurance offered as perks by companies, or which you can buy separately. Most of the private health-care offerings are also deeply incestuous with the NHS. Large part of the surgeons are NHS surgeons that offer additional services on their own time. Many of the surgeries happens in NHS facilities that make excess capacity available to help offset operating costs, and so on. Additional private cover in the UK is well within reach for most people that are not that far below a median salary.
  - fidotron 13y ago
    Private stuff in the UK is also reasonably common in employment contracts for anyone above middle manager level, since you effectively get the same treatment as the NHS for the reasons mentioned, but with a much shorter waiting period, so companies can get their employees back to work faster.
    - guard-of-terra 13y ago
      "anyone above middle manager level" That meaning top management? :) I guess it's some UK thing but I expected "middle manager" to be something pretty exclusive with not many people above. And this is where it loses relevancy to many people on HN. Maybe you call shop clerks middle managers or something.
- mjn 13y ago
  > We will soon have a tiered system - if it already isn't here That has indeed been the case in the U.S. for years. The three most common health-insurance structures, EPOs, PPOs, and HMOs, each have very specific lists of doctors who accept "in-network" coverage (they differ largely on the terms by which you can pay out of pocket to go "out of network"). How big those lists are and what kinds of doctors they include is pretty noticeably correlated with price: the cheapest insurances don't get you access to a wide range of top-quality "in-network" doctors. And there are a handful of boutique clinics and surgeons who don't take any packages at all. (There's an additional negative impact of this "networks" system in that companies seem to change networks semi-regularly as they renegotiate packages, and people change networks when they change jobs, which interrupts continuity of care.) Where I live now (Denmark) the whole system is just run publicly, except for a handful of elective things (non-reconstructive plastic surgery, etc.), which are allowed to be done in private practice since they aren't properly considered part of the healthcare system. That removes the possibility of any tiering among "regular" care, and somewhat simplifies bureaucracy (plus, kids can keep the same doctor throughout their childhood, not having to switch every few years). I wouldn't actually mind a multi-tiered system, though, as long as the "free" tier can maintain sufficient quality. I particularly don't mind differences in amenities (if people are willing to pay a lot to go to boutique hospitals that have luxurious private suites, like some of the medical-tourism-oriented hospitals in Jordan offer, that's fine). Tiering does have potentially bad consequences for the quality of the free tier, but to me those consequences are what matter more than the tiering itself, i.e. if System A provides everyone level-7 quality healthcare, while System B provides everyone level-8 quality healthcare and those who pay extra level-9, I'd prefer System B despite its inequality, due to the higher absolute standard of its generally-available care. In terms of your worry of doctors dropping out of the insurance system to make higher incomes, I think that is something to watch out for, although afaict the big monetary lure currently isn't to keep the same general profession but go out-of-network, but rather to leave "regular" healthcare entirely and go to super-premium boutique stuff like plastic surgery, IVF treatments, sports medicine, etc., which is where the real "superstar doctor" money is. Some of this may be because it's harder to become a superstar doctor in areas like cancer treatment without being at a top research hospital, and research hospitals tend to see themselves as having a public-service (rather than income-maximization) mission, which impacts their policy decisions. If necessary the government could also probably lean on those kinds of hospitals (places like M.D. Anderson, Johns Hopkins, etc.) by adding strings to NIH funding.
- asveikau 13y ago
  You would have to be somewhat out of touch to think we haven't had a tiered system in the US since long before the ACA. The fact that people can talk about "good insurance" and "bad insurance" where the deciding factor is how good of a job you have - and still keep a straight face - is pretty telling.
  - e40 13y ago
    You would have to be somewhat out of touch to think we haven't had a tiered system in the US since long before the ACA. Yeah, but that interferes with the narrative, that the ACA is responsible for everything bad that's happening in the US. It is appalling to me how much is blamed on the ACA.
    - msandford 13y ago
      If you really want to figure it out you have to go back to WWII when wage controls were implemented. Employers had little way to compete for talent so for some reason the IRS said that various benefits like health insurance weren't taxable. Now your insurance changes with your job, rather than by your decision. Imagine how often car insurance companies would try and deny claims and generally be shitty if their customers were locked in and couldn't switch unless they changed jobs. I think that's one of the biggest problems with healthcare right now. The employer is the "customer" not the employees, so fuck 'em!
      - mjn 13y ago
        That was part of the initial motivation for tying insurance to employment, but the main reason it's persisted is that it's a way of solving the adverse-selection problem. If you let individuals choose when to buy insurance, on average people buy it when they need it and risk going without when they don't. But if you insure a company's whole workforce at once, with individual employees not being able to opt out, you have a risk pool not specifically selected for high-risk patients. This is also a reason group coverage typically has a minimum size for coverage, because small companies still have the adverse-selection problem— founders more worried about their health are more likely to buy their company group insurance than those who think their health is fine. But once a company reaches a certain size, those individual factors get less important since everything's averaged over a large mandatory-coverage pool.
- gress 13y ago
  How can one opt for this 'direct pay' model when the ACA mandates insurance?
lucaspiller 13y ago
> More simply want better customer service than British GPs tend to provide, with their brief consultations and frustrating systems for booking appointments I can definitely sympathise with this, although it isn't a UK wide problem. My local surgery (in a remote part of the country) consists of a couple of GPs who both know me personally and making an appointment involves a quick phone call (and chat to the receptionist who I also know personally). When I was living in London it was completely different, getting an appointment involved phoning up the surgery the morning you wanted an appointment and hopping somebody hadn't done so before hand so they had space. There was no way to book an appointment in advance. It was easier to go to an NHS walk in centre, wait for a few hours, see a nurse, and have them refer me to A&E to see a doctor if need be.
- d0 13y ago
  Very true - this is still the case now. The added an "Urgent Care Centre" to our local hospital to absorb people coming in because their GP was overbooked. They're really good though to the point people just go down there straight away rather than going to their doctor. You can get in and out within an hour with a prescription handed over to you with no prior appointment. Ultimately, the GP should disappear and more of these centres tied to the hospitals should appear. They are more than walk-in-centres as well at which they are sometimes limited to what they can prescribe. Our local walk-in-centre can't even prescribe antibiotics or provide any help to anyone under the age of 3.
  - dublinclontarf 13y ago
    I have to book appointments with my GP a week in advance unless it's urgent. Last time I visited I was told to get a blood test, I had to book that a week in advance as well.
    - d0 13y ago
      At the UCC in our local hospital, we get same-day blood work and imaging done and a call back from a doctor when the results come back in. Screw the GP's week lead time. It's about time we stopped funding their mismanagement if you ask me. (Disclaimer: I spent a lot of time in my life working at GP's as well and they are inefficient and incompetent as a rule to say the least).
deleted 13y ago
[deleted]
_random_ 13y ago
You have a better chance of getting free liposuction then e.g. a modern medicine for your flu-related complications: "Just take some ibuprofen".
deleted 13y ago
[deleted]
altero 13y ago
UK health care is disgrace. Patients dying by starvation in hospitals corridors. Waiting period for some operations is months. Even simple xray took 6 hours of waiting at emergency. My polish friends in case of problems head to airport, not British hospital (insurance would cover it). Also SS wolfs are on hunt and it is serious risk to bring children to UK doctor. GP broke hand to Slovak baby during vaccination, parents took it to hospital, where doctors called social services. Couple had to run from country to keep baby. Also France with exceent health system is just few kilometers away.
- lafar6502 13y ago
  Public health system in Poland has same problems as its UK counterpart. It's free, but public hospitals and clinics have notorious problems with service limits, wait times, financing, care level etc. But at the same time qualifications of doctors and other medical staff are quite high so they somehow make up for the shortcomings of the system (however, the long wait problem is unsolvable). I hope medical tourism improves the situation a bit by stimulating growth of non-public specialized clinics.
  - jedrek 13y ago
    Insolvable? Charge 5zl per visit and watch wait times improve as the number old people who come in for socializing as much as medical care plummets.
    - lafar6502 13y ago
      Don't think so. I'm not talking about grannies spending a day socializing in the waiting room, but rather about people waiting for months or years for treatment, surgeries or transplants. Currently public healthcare logically assumes that many procedures will become unnecessary if you wait long enough.
  - gedrap 13y ago
    Don't know about Poland but back in Lithuania solving that by a little bribe was a common way around, judging from what I've heard. Once I had to get off the dentists (private not public) chair because someone came in and gave a 'bribe' of... $8 (20LTL).
wslh 13y ago
I can add Argentina as a good location, where there are many excellent doctors and very good clinics. If you are looking for international "karma" many of them publish in top journals.
b0rsuk 13y ago
For Polish doctors it's also a chance to work for tolerable wages, escape paperwork and underfunded hospitals. In Poland, a doctor is a subcategory of bureaucrat who is primarily concerned with health and occasionally glances at you over a pile of papers.

87 points by cturner 13y ago

Without implying too much other than what can be directly inferred from this line Private health care is sold as a luxury for the affluent and usually only covers hospital treatment, not primary care—that is, visits to a doctor. I'd like to reiterate that this is where the American model of healthcare delivery is headed. The Affordable Care Act just made this abundantly inevitable. We will soon have a tiered system - if it already isn't here - where the wealthy shall be catered to by doctors and health professionals, who have completely removed themselves from the insurance model and thus only serve in a Direct-Pay model. The best surgeons and experts will exclusively cater in a on-demand model, flying down to multiple locations a day to offer their premium services to wealthy clients. Concierge medicine is already here. [1] Even with things like Telemedicine and Remote surgery, I don't see why the doctors will behave any differently in how they choose to split their precious hours. [1] http://en.wikipedia.org/wiki/Concierge_medicine http://en.wikipedia.org/wiki/Concierge_medicine http://stanfordhospital.org/clinicsmedServices/clinics/primaryCare/conciergeMedicine/ http://stanfordhospital.org/clinicsmedServices/clinics/prima...

vidarh 13y ago
In the UK, while there are some that provide only direct-pay services, most of the private healthcare is operated by, or contracted by, large private insurance companies, that offers quite cheap "add-on" insurance offered as perks by companies, or which you can buy separately. Most of the private health-care offerings are also deeply incestuous with the NHS. Large part of the surgeons are NHS surgeons that offer additional services on their own time. Many of the surgeries happens in NHS facilities that make excess capacity available to help offset operating costs, and so on. Additional private cover in the UK is well within reach for most people that are not that far below a median salary.
- fidotron 13y ago
  Private stuff in the UK is also reasonably common in employment contracts for anyone above middle manager level, since you effectively get the same treatment as the NHS for the reasons mentioned, but with a much shorter waiting period, so companies can get their employees back to work faster.
  - guard-of-terra 13y ago
    "anyone above middle manager level" That meaning top management? :) I guess it's some UK thing but I expected "middle manager" to be something pretty exclusive with not many people above. And this is where it loses relevancy to many people on HN. Maybe you call shop clerks middle managers or something.
mjn 13y ago
> We will soon have a tiered system - if it already isn't here That has indeed been the case in the U.S. for years. The three most common health-insurance structures, EPOs, PPOs, and HMOs, each have very specific lists of doctors who accept "in-network" coverage (they differ largely on the terms by which you can pay out of pocket to go "out of network"). How big those lists are and what kinds of doctors they include is pretty noticeably correlated with price: the cheapest insurances don't get you access to a wide range of top-quality "in-network" doctors. And there are a handful of boutique clinics and surgeons who don't take any packages at all. (There's an additional negative impact of this "networks" system in that companies seem to change networks semi-regularly as they renegotiate packages, and people change networks when they change jobs, which interrupts continuity of care.) Where I live now (Denmark) the whole system is just run publicly, except for a handful of elective things (non-reconstructive plastic surgery, etc.), which are allowed to be done in private practice since they aren't properly considered part of the healthcare system. That removes the possibility of any tiering among "regular" care, and somewhat simplifies bureaucracy (plus, kids can keep the same doctor throughout their childhood, not having to switch every few years). I wouldn't actually mind a multi-tiered system, though, as long as the "free" tier can maintain sufficient quality. I particularly don't mind differences in amenities (if people are willing to pay a lot to go to boutique hospitals that have luxurious private suites, like some of the medical-tourism-oriented hospitals in Jordan offer, that's fine). Tiering does have potentially bad consequences for the quality of the free tier, but to me those consequences are what matter more than the tiering itself, i.e. if System A provides everyone level-7 quality healthcare, while System B provides everyone level-8 quality healthcare and those who pay extra level-9, I'd prefer System B despite its inequality, due to the higher absolute standard of its generally-available care. In terms of your worry of doctors dropping out of the insurance system to make higher incomes, I think that is something to watch out for, although afaict the big monetary lure currently isn't to keep the same general profession but go out-of-network, but rather to leave "regular" healthcare entirely and go to super-premium boutique stuff like plastic surgery, IVF treatments, sports medicine, etc., which is where the real "superstar doctor" money is. Some of this may be because it's harder to become a superstar doctor in areas like cancer treatment without being at a top research hospital, and research hospitals tend to see themselves as having a public-service (rather than income-maximization) mission, which impacts their policy decisions. If necessary the government could also probably lean on those kinds of hospitals (places like M.D. Anderson, Johns Hopkins, etc.) by adding strings to NIH funding.
asveikau 13y ago
You would have to be somewhat out of touch to think we haven't had a tiered system in the US since long before the ACA. The fact that people can talk about "good insurance" and "bad insurance" where the deciding factor is how good of a job you have - and still keep a straight face - is pretty telling.
- e40 13y ago
  You would have to be somewhat out of touch to think we haven't had a tiered system in the US since long before the ACA. Yeah, but that interferes with the narrative, that the ACA is responsible for everything bad that's happening in the US. It is appalling to me how much is blamed on the ACA.
  - msandford 13y ago
    If you really want to figure it out you have to go back to WWII when wage controls were implemented. Employers had little way to compete for talent so for some reason the IRS said that various benefits like health insurance weren't taxable. Now your insurance changes with your job, rather than by your decision. Imagine how often car insurance companies would try and deny claims and generally be shitty if their customers were locked in and couldn't switch unless they changed jobs. I think that's one of the biggest problems with healthcare right now. The employer is the "customer" not the employees, so fuck 'em!
    - mjn 13y ago
      That was part of the initial motivation for tying insurance to employment, but the main reason it's persisted is that it's a way of solving the adverse-selection problem. If you let individuals choose when to buy insurance, on average people buy it when they need it and risk going without when they don't. But if you insure a company's whole workforce at once, with individual employees not being able to opt out, you have a risk pool not specifically selected for high-risk patients. This is also a reason group coverage typically has a minimum size for coverage, because small companies still have the adverse-selection problem— founders more worried about their health are more likely to buy their company group insurance than those who think their health is fine. But once a company reaches a certain size, those individual factors get less important since everything's averaged over a large mandatory-coverage pool.
gress 13y ago
How can one opt for this 'direct pay' model when the ACA mandates insurance?

lucaspiller 13y ago

> More simply want better customer service than British GPs tend to provide, with their brief consultations and frustrating systems for booking appointments I can definitely sympathise with this, although it isn't a UK wide problem. My local surgery (in a remote part of the country) consists of a couple of GPs who both know me personally and making an appointment involves a quick phone call (and chat to the receptionist who I also know personally). When I was living in London it was completely different, getting an appointment involved phoning up the surgery the morning you wanted an appointment and hopping somebody hadn't done so before hand so they had space. There was no way to book an appointment in advance. It was easier to go to an NHS walk in centre, wait for a few hours, see a nurse, and have them refer me to A&E to see a doctor if need be.

d0 13y ago
Very true - this is still the case now. The added an "Urgent Care Centre" to our local hospital to absorb people coming in because their GP was overbooked. They're really good though to the point people just go down there straight away rather than going to their doctor. You can get in and out within an hour with a prescription handed over to you with no prior appointment. Ultimately, the GP should disappear and more of these centres tied to the hospitals should appear. They are more than walk-in-centres as well at which they are sometimes limited to what they can prescribe. Our local walk-in-centre can't even prescribe antibiotics or provide any help to anyone under the age of 3.
- dublinclontarf 13y ago
  I have to book appointments with my GP a week in advance unless it's urgent. Last time I visited I was told to get a blood test, I had to book that a week in advance as well.
  - d0 13y ago
    At the UCC in our local hospital, we get same-day blood work and imaging done and a call back from a doctor when the results come back in. Screw the GP's week lead time. It's about time we stopped funding their mismanagement if you ask me. (Disclaimer: I spent a lot of time in my life working at GP's as well and they are inefficient and incompetent as a rule to say the least).

deleted 13y ago

[deleted]

_random_ 13y ago

You have a better chance of getting free liposuction then e.g. a modern medicine for your flu-related complications: "Just take some ibuprofen".

deleted 13y ago

[deleted]

altero 13y ago

UK health care is disgrace. Patients dying by starvation in hospitals corridors. Waiting period for some operations is months. Even simple xray took 6 hours of waiting at emergency. My polish friends in case of problems head to airport, not British hospital (insurance would cover it). Also SS wolfs are on hunt and it is serious risk to bring children to UK doctor. GP broke hand to Slovak baby during vaccination, parents took it to hospital, where doctors called social services. Couple had to run from country to keep baby. Also France with exceent health system is just few kilometers away.

lafar6502 13y ago
Public health system in Poland has same problems as its UK counterpart. It's free, but public hospitals and clinics have notorious problems with service limits, wait times, financing, care level etc. But at the same time qualifications of doctors and other medical staff are quite high so they somehow make up for the shortcomings of the system (however, the long wait problem is unsolvable). I hope medical tourism improves the situation a bit by stimulating growth of non-public specialized clinics.
- jedrek 13y ago
  Insolvable? Charge 5zl per visit and watch wait times improve as the number old people who come in for socializing as much as medical care plummets.
  - lafar6502 13y ago
    Don't think so. I'm not talking about grannies spending a day socializing in the waiting room, but rather about people waiting for months or years for treatment, surgeries or transplants. Currently public healthcare logically assumes that many procedures will become unnecessary if you wait long enough.
- gedrap 13y ago
  Don't know about Poland but back in Lithuania solving that by a little bribe was a common way around, judging from what I've heard. Once I had to get off the dentists (private not public) chair because someone came in and gave a 'bribe' of... $8 (20LTL).

wslh 13y ago

I can add Argentina as a good location, where there are many excellent doctors and very good clinics. If you are looking for international "karma" many of them publish in top journals.

b0rsuk 13y ago

For Polish doctors it's also a chance to work for tolerable wages, escape paperwork and underfunded hospitals. In Poland, a doctor is a subcategory of bureaucrat who is primarily concerned with health and occasionally glances at you over a pile of papers.