Why put up with expensive, run-of-the-mill health care at home when you can be treated just as well abroad?
ROBIN COOK knows how to spot the latest scare in medicine. Mr Cook, a Harvard-trained doctor, is author of over a dozen medical thrillers, including “Coma” and “Outbreak”, which have anticipated pandemics, anthrax attacks and the black market in organs. “Foreign Body”, published this month, is about the next big thing: medical tourism.
Central to the plot is the story of Maria Hernandez, a working-class American woman who travels to Delhi to get a hip replacement she could not afford back home. Alas, she and other medical tourists die in mysterious cir stances. Contrast Ms Hernandez’s fate with that of another American health tourist, Robin Steele. Mr Steele, a real patient, recently went to India’s Wockhardt hospital chain for a heart operation. Not only is he in fine shape, but he also enjoyed a holiday afterwards and saved several thousand dollars to boot.
Mrs Hernandez’s tragedy may sell books, but Mr Steele’s good health is more typical. The future of health care, long one of the most local of all businesses, promises to be increasingly global. Over the next few years the world is likely to see a lot more investment, medical staff and patients crossing borders—bringing economic benefits and greater access to care as they do so. Even a modest surge in global medical tourism could prove a powerful catalyst for government bureaucracies and sclerotic American health-maintenance organisations to think afresh about what they do. It may even introduce compe ion to private health care in America and elsewhere.
Globalisation is not new to medicine. The outsourcing of record-keeping and the remote transcription of doctors’ notes and X-ray analysis are becoming common. Jagdish Bhagwati, an economist at Columbia University, thinks that the offshoring of, for instance, customer service and claims-processing could save America alone $70 billion-75 billion a year. In recent years leading American hospitals such as the Mayo Clinic and Johns Hopkins have set up offshoots in the Middle East and Asia.
Some wealthy patients have always travelled for fancy medical care. Denis Cortese, head of the Mayo Clinic, in rural Minnesota, observes that “we have been global for a hundred years.” A few years ago Britons fed up with waiting for elective surgery started heading overseas to get joints replaced or cosmetic surgery—sometimes at government expense. Recently, shorter queues in the National Health Service and restrictions on reimbursements have undermined this trend.
However, globe-trotting patients only ever occupied a niche. What is getting people excited today is the promise of a boom in mass medical tourism, as a much bigger group of middle-class Americans prepares to take the plunge. A report published last month by Deloitte, a consultancy, predicts that the number of Americans travelling abroad for treatment will soar from 750,000 last year to 6m by 2010 and reach 10m by 2012 (see chart). Its authors reckon that this exodus will be worth $21 billion a year to developing countries in four years’ time. Europe’s state-funded systems still give patients every reason to stay at home, but even there, private patients may start to travel more as it becomes cheaper and easier to get treated abroad.
Pills and pils
Asian hospital chains stand to be the biggest winners, as their rising stars, such as Singapore’s Parkway Health, look for foreign patients. Thailand’s modern Bumrungrad hospital in Bangkok already sees tens of thousands of Americans a year. It has just opened a new extension, designed to handle 6,000 foreign patients, which it claims makes it the world’s biggest private clinic. The surge of American patients flocking to India’s Wockhardt hospitals has convinced Vishal Bali, the chain’s boss, that medical travel is now “truly reaching an inflection point.”
Not everyone is as gushing. Paul Mango, the chief author of a report by McKinsey, a management consultancy, disputes wild-eyed claims that millions of patients are already travelling abroad. Yet even he predicts that the future for medical travel is bright, and that in the long run it may even “largely dispel the idea that health care is a purely local service.”
Regina Herzlinger, of Harvard Business School, broadly agrees: “The medical travel market is a bit over-hyped today, but economics dictates why it will become huge over time: if a supplier has very high prices and erratic quality, it creates an opening for nimbler rivals.” That supplier is America’s health-care system, a $2.4 trillion colossus in desperate need of reform.
This prospect of an American-led boom in global medical travel raises two questions. Why is it happening now? And what will be the effect on the health-care systems of poor and rich countries?
Impatients
Until recently, few Americans went abroad for medical treatment. Over the past decade, however, that has begun to change. Americans seeking medical care are increasingly making trips far from home, often at their own expense—not just short hops to Caracas for a nip and tuck or dashes across the frontera for cheap Mexican pills. As Mr Steele’s testimonial suggests, they are now travelling across the world for knee and heart surgery, hysterectomies and shoulder angioplasties.
One motive is to save money. America’s health inflation has consistently outpaced economic growth, making it the most expensive health market in the world. The average price at good facilities abroad for a range of common medical procedures is, by Deloitte’s reckoning, barely 15% of the price a patient would have to pay in the United States (see table).
But costs have long been much higher in America than in poor countries, so this alone does not explain the new exodus. Two other factors are now at work. One is that the quality at the best hospitals in Asia and Latin America is now at least as good as it is at many hospitals in rich countries. The second, more worrying, factor is that America’s already imperfect insurance safety net is fraying.
Over 45m Americans are uninsured, and many millions more are severely underinsured. Such people may find it cheaper to fly abroad and pay for an operation out of their own pockets than to find the money for deductibles or “co-payments” charged for the same procedure at home. Arnold Milstein of Mercer, a consultancy, calls them America’s “medical refugees”.
Big business may soon join this wave. Epstein, Becker & Green, an American law firm, says that in the past year big employers have become interested in promoting medical travel among the employees they insure. Many are struggling to cope with soaring health costs and some, they report, are willing to take radical steps to save money.
Hannaford, a grocery chain based in New England, now offers its 27,000 employees the option of getting a number of medical procedures done in Singapore rather than America—at a saving to the employee of $2,500-3,000 in co-payments and deductibles. Blue Ridge Paper Products, a firm in North Carolina that makes milk cartons, also offered employees the option of medical travel, but a backlash from a union has put a stop to the plan. Despite that setback, the general rise in corporate interest is such that in June the American Medical Association, the chief lobbying group for the country’s doctors, issued (surprisingly supportive) guidelines for foreign medical travel.
That has emboldened insurance firms, which had thus far been cautious. A few are beginning to offer voluntary “global medical travel” options on their corporate plans. According to the industry watchers at Epstein Becker, other insurers fear that they may be at a disadvantage if they do not offer such schemes.
Overcoming initial scepticism, Aetna, a giant American insurer, has this year launched a pilot scheme in partnership with Singaporean hospitals. Charles Cutler of Aetna notes that the savings for his firm are not as great as they may be for some others, since it gets volume discounts from American hospitals thanks to its size. Therefore travel abroad for Aetna’s clients makes sense only for procedures costing $20,000 or more, which might include heart surgery. But he remains bullish, observing that quality at the best foreign facilities can be much better than at the average American hospital, thanks to greater transparency and better information technology. He thinks this is inspired by the Asian hospitals’ need to market to a sceptical foreign audience.
David Boucher of Blue Cross and Blue Shield of South Carolina, another big health insurer, at first doubted the quality of care abroad. So he visited Thailand’s Bumrungrad hospital a couple of years ago to see for himself. He recalls sipping coffee at the Starbucks in the hospital’s lobby and thinking that “this is not a straw-village clinic with rusty scalpels!” He has persuaded his firm to let him run a division, called Companion Global Healthcare, to pursue this “blue ocean” opportunity.
Mr Boucher says his division’s customers, mostly manufacturers and other firms with margins that are squeezed by global compe ion, are keen to experiment with an idea that he reckons could easily replace 5-8% of a company’s health spending with cheaper options; in time, he reckons that share may rise to a fifth. Medical travel may be unfamiliar to individual patients, but he points out that thinking globally is nothing new to his corporate clients: “They may be based in Columbia, South Carolina, but they have compe ors and customers in Colombia, South America, as well as in South Africa and in Asia.”
Curtis Schroeder, boss of Bumrungrad, thinks the search for value will push people in his direction: “After all, we’re selling Cadillacs at Chevy prices,” he says. He has good reason to beam: some 33,000 Americans came to his outfit last year alone.
............
Ok, it goes on for quite a bit longer. If you want to read the whole thing, here is the link:
http://www.economist.com/business/di...ry_id=11919622
I swear to God that if this thread gets no comments or views, I am going to make up some inflammatory, fake thread le and re-post it.
I guess we would rather sling mud and call each other re s than actually talk like adults, not that I am much better at times.
Regardign Mr. Steele and his successful hip replacement.
Where was that procedure conceived and invented? Where were the techniques fine-tuned so that it is now a routine procedure, with fantastic results? How many different surgical techniques is that answer the same for? Is that answer a coincidence?
If it is not, and the U.S. follows the model set by the rest of the world, (the world that gets to take advantage of our advances); where will those advances come from?
I can't wait until enough politicians get bribed that we'll have laws on the book making medical tourism illegal... the same way it's already illegal for an individual to import prescription drugs.
History
The earliest recorded attempts at hip replacement (Gluck T, 1891), which were carried out in Germany, used ivory to replace the femoral head (the ball on the femur).[1]
In 1960 a Burmese orthopaedic surgeon, Dr. San Baw (29 June 1922—7 December 1984), pioneered the use of ivory hip prostheses to replace ununited fractures of the neck of femur ("hip bones"), when he first used an ivory prosthesis to replace the fractured hip bone of an 83 year old Burmese Buddhist nun, Daw Punya.[2] This was done while Dr. San Baw was the chief of orthopaedic surgery at Mandalay General Hospital in Mandalay, Burma. Dr. San Baw used over 300 ivory hip replacements from the 1960s to 1980s. He presented a paper en led "Ivory hip replacements for ununited fractures of the neck of femur" at the conference of the British Orthopaedic Association held in London in September 1969. An 88% success rate was discerned in that Dr. San Baw's patients ranging from the ages of 24 to 87 were able to walk, squat, ride a bicycle and play football a few weeks after their fractured hip bones were replaced with ivory prostheses. Ivory may have been used because it was cheaper than metal at that time in Burma and also was thought to have good biomechanical properties including "biological bonding" of ivory with the human tissues nearby. An extract from Dr San Baw's paper, which he presented at the British Orthopaedic Association's Conference in 1969, is published in Journal of Bone and Joint Surgery (British edition), February 1970. With modern hip replacement surgery, one can expect to walk, using crutches for support or even just a cane for balance, within a week.
Modern process
The modern artificial joint owes much to the work of John Charnley at Wrightington Hospital; his work in the field of tribology resulted in a design that completely replaced the other designs by the 1970s. Charnley's design consisted of three parts—
a metal (originally stainless steel) femoral component,
a teflon acetabular component which was replaced by Ultra High Molecular Weight Polyethylene or UHMWPE in 1962, both of which were fixed to the bone using
PMMA (acrylic) bone cement,and/or screws.
The replacement joint, which was known as the Low Friction Arthroplasty, was lubricated with synovial fluid. The small femoral head (7/8" (22.2mm)) was chosen for its decreased wear rate; however, this has relatively poor stability (the larger the head of a replacement the less likely it is to dislocate, but the more wear debris produced due to the increased surface area). For over two decades, the Charnley Low Friction Arthroplasty design was the most used system in the world, far surpassing the other available options (like McKee and Ring). Recently the use of a polished tapered cemented hip replacement (like Exeter) and uncemented hip replacements have become more popular. Once an uncommon operation, hip replacement is now common, even among active athletes including racecar drivers Bobby Labonte and Dale Jarrett. Prince (musician) has also undergone hip replacement.
-----
1) Germany
2) Burma
3) England
Do you actually research this stuff before posting?
no I don't research; if I did I couldn't get owned like that. Off the top of my head.
I actually still go to my dentist in Argentina whenever I head over there for preventive care. I'm yet to find a good dentist here in the US that's not a money grubber. It's like you can't go to a dentist here without having at least one visit to have x-rays done, and at least 2 or 3 sessions.
I was in Argentina last month, and visited my guy. Had a checkup and dental cleanup. It cost me 60 pesos (U$S20) for everything. This is out of pocket, without insurance. Last time I went to see a dentist here in the US, he was charging U$S 100 per cavity fix, not including the office visit.
It's all good.
I do understand what you mean by R&D... But I think that's more applicable to drugs or high end surgery.
The reality is that 3rd world countries still can't do certain procedures that require incredibly high tech. That's still being done in the US, and you have to pay handsomely for it.
But outpatient stuff, or procedures that have become mainstream (like bypass surgery or hip replacement), it's mind-boggling the price difference.
One of the major factors have to do with the cost of insurance for doctors/practices over here. It really drives prices up a lot. It's part of living in a litigious society.
There is also the administrative cost involved in billing and tracking all of the insurance plans, as to what is paid, how much, and when, uses a lot of labor.
I do understand what you mean by R&D... But I think that's more applicable to drugs or high end surgery.
The reality is that 3rd world countries still can't do certain procedures that require incredibly high tech. That's still being done in the US, and you have to pay handsomely for it.
But outpatient stuff, or procedures that have become mainstream (like bypass surgery or hip replacement), it's mind-boggling the price difference.
One of the major factors have to do with the cost of insurance for doctors/practices over here. It really drives prices up a lot. It's part of living in a litigious society.
Administrative costs have been identified several years running as one of the primary drivers of increases by the Price Waterhouse Cooper whitepaper that studies the components of increases every year.
Some of the problems that plague medical tourism cause that as well.
Who do you hold accountable if the drugs are contaminated, diluted or poor quality?
Things as simple as the timing mechanisms for drugs can vary greatly.
If you have some time-release method for a drug that you are supposed to take twice a day, but the time-release, inactive ingredient portion of the drug is one of the corners that is cut, then you get all of the medicine flooding into your system in the course of 2 hours instead of 12, then it wears off, and you are without the benefit of that drug for 4-6 hours until your next pill.
Little things like that can make a big difference in quality of medicines, and are VERY hard to control when the factory is overseas.
Mexican medical maquiladoras! I am all for it. A round of margaritas after surgery.
Joking aside, that would transform the American medical system to truly being free-market. I don't know what you would call the current system but until doctors are advertising their charges and Motel 6 operates a hospital chain what we have here does not seem to be very free-market.
Heh, a lot of them take a vacation in the host country after the surgery.
I could very much see this being done in Cuba if the stupid sanctions were lifted.
Doctors are one of Cuba's main exports.
You know, this begs a question I've thought a lot about lately. The cost of healthcare is very high, and growing; but so is the number of jobs healthcare accounts for. You make it a lot more efficient; you do so by, frankly, eliminating steps in the process; eliminating jobs. Could that be why Obama is shying away from calling for single payor, govt. healthcare?
Admin cost is a wretched joke. See all those paper files. Its the only industry I know of so dependent on paper. Hear them moaning about the cost of converting to electronic storage, it's because efficiency is a non-issue when you get to constantly pass operating costs along to the payers (which aren't the same as the end-user) so they muddle along burning money with their inefficient systems.
Insurance companies and government agencies should refuse to pay on anything that is not sent in an electronic format.
, my car's service history is in an electronic form.
Medical tourism by US tourists is huge business.
of course it is trashed by US docs and dentists, but US medical care kills 100K/year due to medical errors, so whining about botched medical work overseas is dishonest.
Medicare overhead is about 3%, commercial health insurance overhead is 20% - 30%, which is why McLame wants to kill medicare/medicaid and force people into for-profit medical care.
similarly, Social Security o/h is about 1%, but what would privatized for-profit s/s o/h be? minimum 7%.
An interesting bit on 3% Not a source for the statistic, but an interesting analysis.
http://www.thehealthcareblog.com/the..._the_thre.html
I would guess the ultimate source for that stems from an analysis of the Medicare budget.
The most interesting thing brought up by the above blog is that Medicare tends to get people who are really sick, and require expensive treatment. This skews the costs a bit downwards, as sick people cost a lot compared to the amount of money spent on administrative overhead.
http://www.pnhp.org/news/2008/septem...eforall_wh.php
Another interesting article from the Physicians for a National Health Car Program.
The “One-Size-Fits-All” Objection Falls Apart
Ironically, Medicare-for-All and other “single-payer” plans are frequently disparaged as “one-size-fits-all” programs, as if that were undesirable. Yet we all need the same protection in the event of illness or injury, and many of us want that for everyone else as well. Indeed, the most exemplary rule of all time is to “do unto others as you would have them do unto you.” That “one-size-fits-all” rule is hard to beat. In fact, by pooling all existing contributions from all plan sponsors and participants, existing varying contribution rates would be perpetuated. That way, premiums and contributions would not be one-sized after all. And those rates could share in Medicare- for-All’s savings.
Tends to get people who are really sick...absolutely; those over 65. It is not hyperbole that we will all "spend" over half of our lifetime supply of healthcare dollars in the last year of our lives as doctors and hospitals try heroically to save our asses from a lifetime of hard livin (well, some of that was hyperbole).
Anyway, as the baby-boomer leave the private work place, and enter the public; Medicare is going to tank even harder...but, since retirement accouts are currently getting pummeled by the stock market tank; many bber's won't be able to retire, and will stay on the private rolls, thus exacerbating the problems on THAT side.
A truism in the industry, "Your Claims are going to be your claims". They are also going to be the most significant portion of healthcare dollars spent. So public, or private, we are ALL going to have a lot more dollars spent on healthcare over the next 20 or so years, and their ain't a damned thing we can do about it. The boomers (not paragons of good health) are JUST NOW starting to get diagnosed with the REALLY expensive . 15 years ago they started getting limp s, and we got VIAGRA; now their getting to the next stage, and we're gonna get saddled with that, as well. You wonder what it's gonna be? Just watch the evening news, and note the drug commercials (about 60% of ALL the commercials), and that'll give you a pretty good indication.
I did read an article a while back that said that said the MIC and the health care industry have become major drivers of the US economy.
pre-emptive killing and self-inflicted disease, not exactly what the Founding Fathers hand in mind for USA, no?
Now add in that financial wheeling and dealing (producing nothing) has exploded to about 20% of the economy, and you get a really perverse picture.
When docs realize that all "succesfull" govt. payor systems get that way, in large part, by strictly controlling what doctors can charge for their services, you will see a HUGE backlash from the AMA.
BIG difference between the MIC and healthcare, although both consume a similar size of GDP, is the number of jobs provided. Not even close. Healthcare is much greater.
Indeed.
Limiting the fees doctors can charge is one of the things that helps keep costs down in places like Germany or Japan.
Doctors might actually have to be a bit more cost-efficient. GASP!
Gonna start calling you "Spock".
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