Archive for health care reform
How far would you go for medical treatment?
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No, not how far you’d go in the Denzel Washington/John Q/hold-a-hospital-hostage sense. In the get-on-a-plane-toward-care sense.
Medical tourism has seen an exponential rise with patients in the US as health care costs and the number of uninsured patients have risen over the last 15 years. In a TIME magazine piece in 2006, Curtis Schroeder, CEO of Bumrungrad Hospital in Bangkok – somehow, I don’t think he’s Thai – said that in 2005 their census of US patients rose 30% (to 55,000).
That trend has continued, even with the advent of “health care reform” – health insurance reform, really – since health care costs have continued their hockey-stick rise, with no end in sight, for two decades.
50 years ago, patients from across the globe saw health care in the US as the holy grail. Now, US patients are traveling to Costa Rica, Thailand, Mexico, New Zealand, even Cuba to get access to high-quality, low-cost care.
US companies have started to explore medical tourism, and some are offering incentives to their employees – incentives including getting to pocket some of the savings gained from traveling abroad for treatment. Not enough, however, to make medical tourism a healthy industry here in the US of A.
An August 2011 article in Workforce Management includes a story about a nurse in Louisiana (irony is our favorite thing here at Mighty Casey Media) who traveled to Costa Rica a few years ago for dental work, including oral surgery. She paid $2,700 out of pocket for what would have cost her $10,000 at home, with her employer covering $1,500 of her care expenses. Her net cost for the procedures was $1,200, plus her travel expenses – which travel was negotiated and arranged by a broker, Companion Global Health Care Inc.
I’m sure that, even after travel expenses, her savings were still solidly in the thousands of dollars.
So why aren’t more US companies encouraging their employees to take advantage of medical tourism? According to the CEO of Companion Global, David Boucher – who certainly has a dog in this fight, and who is quoted in the Workforce Management article linked above – the rising costs of health care make the health-tourism choice a no-brainer. He says that their customers are seeing a 2- or 3-to-1 return on investment for medical tourism, and patients – their customers employees – are very satisfied with the quality of their care.
However, according to Joe Marlowe, senior VP of health and productivity at the risk-management and HR consulting firm Aon Hewitt who’s also quoted in the WM story, employers are risk-averse, particularly at the idea of making themselves liable for medical care far from home that turns out badly for the patient.
What do you think? Would you travel 8,000 miles for a knee replacement, or 3,000 for chemotherapy, to save a significant amount of money and still receive high-quality care? Or would you want to be closer to your support system – family, friends – while receiving care?
I would most certainly travel to Bangkok or San Jose for a knee replacement. Not sure about oncology, since that follow-up can be so long-term.
You? I really would like to know.
That’s my story, and I’m stickin’ to it …
The Sad Story About Joint Replacement (in the US, at least)
Posted by: | CommentsA hip or knee replacement can offer people with chronic joint pain the chance to return to an active life. The potential promise of being pain-free, in some cases after decades of restricted movement, is a powerful incentive to arthritis sufferers around the world.
I know from direct observation that not all joint replacements result in the patient returning to the dance floor, or the jogging track, or even the walking path. My dad had a hip replacement in 1996 that inserted the wrong appliance, leading to 18 dislocations in the ensuing three years. The issue was finally resolved with yet another surgery, paid for by Medicare and my father’s supplemental insurance. This was a doctor error, not an appliance failure.
Imagine my surprise this past Saturday (April 3, 2010) at this piece in the New York Times, revealing that almost all manufacturers of artificial joints offer no warranty whatsoever to US consumers who wind up with defective products surgically strapped on to their skeletal structure. The dodge is facilitated by the way device manufacturers sell the implants: to the hospital, not to the patient.
The skids on that dodge are further greased by the consulting fees paid to many surgeons by implant makers, giving those surgeons little impetus to bite the hand that feeds them.
Here’s a chart for the visual learners:
US device manufacturers who sell artificial joints overseas offer warranties in the countries outside the US where their implants are used. Why not here? One reason could be our tort-crazy system. Got a consumer complaint? Don’t try to work it out directly – hire a lawyer and sue the bastards.
That does not, however, excuse the failure of medical device makers to offer any kind of warranty on their products. And it’s not excuse for their expectation that we – taxpayers (Medicare and Medicaid), insurers, and patients – foot the bill for their lousy manufacturing processes.
This is another example of why we need what I call “real health care reform” in the US: fully-informed consumers (patients) communicating fully and frankly with health care providers (doctors, hospitals, device manufacturers). Price and outcome disclosures at the outset of every interaction. Both sides held to account on compliance with best practices.
Wow – what a revolution that would be.
That’s my story, and I’m stickin’ to it.
Got comments? Brickbats? Kudos? I welcome all. Bring it on.
A Modest Proposal (on U.S. Health Insurance)
Posted by: | CommentsThis is a guest post by Hank Keiser, an accounting and hay-farming expert (don’t laugh, you need both in the farming biz today), who has a great idea on how to resolve two thorny issues with one bold stroke.
If you will give me 5 minutes of your life, I will give you a health care plan that will work.
When U.S. taxpayers bailed out AIG, we got 80% of the stock in return. We own the corporation. Why not make it work in the best interests of the shareholders?
AIG is licensed to sell insurance, through its subsidiaries, in all 50 states. Why not sell health insurance that covers pre-existing conditions, is not employer dependent, and does not drop you (or jack your rates) if you need to use it?
Isn’t that what just about everybody wants? Wasn’t that the original intent of Mr. Obama’s plan, before it got turned into a Christmas tree by the Senate?
Doesn’t this cut the legs out from the opposition’s arguments? After all, this is not a tax-driven, big-government piece of legislation.
It has zero negative impact on the deficit, is provided by a corporation, not a government agency, and requires absolutely no legislation to enact.
In fact, it’s pure (if there is such a thing) capitalism at work – without the greed factor.
AIG doesn’t have to pay dividends, so it can plow any operating profits back into the business. It doesn’t have to pay bloated salaries, bonuses, or country club fees. It will operate with a lower overhead, hence it can charge less. Much less.
You start off by moving the management of Medicare to AIG, then all Federal government employee health insurace, then state and local government employee insurance, and finally private group and individual health insurance, all under the umbrella of a corporation. A corporation owned by the taxpayers, providing a competitive product in the marketplace. A corporation that would manage the insurance of maybe 200+ million people. That’s a pretty big pool to spread the risk.
There is a huge political upside to this – it doesn’t have to be legislated. It doesn’t care if you are a citizen or not. If you want a plan that restricts coverage for abortions, there will be other providers out there who will compete for your business.
And it is bullet proof – no bank, no financier, no corporation, no tea-bagger can scream socialism, because it is not socialism. Nobody on Wall Street turned down TARP money when it was offered, none of AIG’s creditors lost a penny in the settlements they received.
Oh, we promised not to interfere with AIG’s management when we bailed it out? Too bad, promises are broken every day on Wall Street. If you can dish it out, then you can learn to take it.
Who loses? WellPoint, Cynergy, et al. And Joe Lieberman – he loses big. Real big.
No one is saying WellPoint and the rest can’t offer health insurance that is better than this plan. After all, they aren’t being legislated out of business.
They are just going to confront honest, open competition for the first time from a publicly chartered corporation that we had stuffed down our throats because it failed to price risk correctly.
I lost my health insurance the other day – and I'm not going to look for it.
I have reason to be very glad this didn't happen last year, given the cancer-for-Christmas gift I received at my mammogram last December.
Now that I'm in the self-pay column, I called the imaging practice where my next mammogram will take place to ask what the cost would be.
I have seen Explanation of Benefits (EOB) statements from my insurer – when I had one! – that listed the above-the-line cost as $600 to $1,000. Then there was the 'negotiated discount', and the other horse-trading hand signals that brought the cost down to around $350, which the insurer then paid the doctor.
Every EOB I've ever seen had this sort of dance on it – high initial cost, the insurer does a 'look what a great deal we got for you!' discount jig, and hey-presto, the final price is reduced by 50%-or-more.
So, when I called the imaging center, I was bracing myself for sticker shock.
I did get sticker shock, but in the other direction – a screening mammogram is $135, a diagnostic mammogram runs $120-$180, and ultrasound, if necessary, adds another $75.
Meaning the worst-case cost scenario is….$255.
Mention health care in any circle, and you'll hear cries about costs spiraling out of control, of doctors who lose money seeing HMO patients, of hospitals taking it in the shorts on equipment and supply costs, of patients paying $200 for an aspirin (I guess that's 'cause a nurse delivered it in a little paper cup?), of that last week of dad's life when his hospital bill hit $100K.
Here's a question – could it just be because of managed care that costs have managed to careen out of control?
I'm old enough to remember that, back inna day, you went to the doctor and paid for your visit on the way out.
If you had a prescription, to went to the pharmacy and got it filled…and paid for it.
Needed lab work? You went to the lab, and paid the bill when it arrived.
You had insurance coverage against the day – which you hoped to avoid – when you'd have to go into the hospital.
Here's a suggestion for Tom Daschle, and the incoming Obama health care team: you don't need to invent a new system. Just go old-school, and add technology to it. Give consumers control not just over their care, but its cost.
When you're in the exam room with your doctor, thanks to managed care that's you, your doctor, and fifty people you can't see involved in decisions about your medical care.
That's fifty people who all want their 'taste', who add their cost – for administration, for oversight, for just taking up space in the transaction – to the cost of the actual visit.
That's the first way to attack cost – admit that the Great and Powerful Oz, the whole 'managed care' monolith, is really just a venal clerk behind a curtain who's inserted himself into the medical care system.
Putting patients back in control of their own medical care – really – would not just help control costs, but it might also drive actual patient ownership of their health. Now there's an idea.
So here's a suggestion – kill managed care. And don't have a funeral.
That's my story, and I'm stickin' to it…
