Obamacare

Medical Tourism on The Grow

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A few weeks back, Reason.tv discussed Canadians coming to the U.S. for operations that would take forever to get in the Great White North.

Reason contributing editor and San Francisco Chronicle journo Carolyn Lochhead has a fascinating piece on American medical tourists who go elsewhere for much cheaper and equally good care:

Deloitte Consulting estimated that 560,000 U.S. residents went abroad for care last year. The firm thinks that number will rise to 1.6 million by 2012, with patients getting discounts of up to 90 percent on procedures from liver transplants to hip resurfacing.

Uninsured patients…make up the bulk of those now venturing abroad. But big insurers have started pilot projects, and a reinsurer for businesses, Swiss Re, is now offering overseas coverage. A Northern California casino and a Maine supermarket chain now offer the option to employees….

Here's a story that lays clear the benefits:

Former Mill Valley resident John Freeman, 61, now living in Reno, needed a coronary bypass. He had dropped his catastrophic insurance coverage because the $320 monthly premium was eroding his retirement savings and the $5,000 deductible left him with big bills.

Facing a $100,000-plus operation, he thought he had two choices: "submit or die."

A friend pointed him to a third: World Med Assist of Concord, which lined him up with a heart surgeon in Turkey. The all-inclusive cost: $18,000. He had the surgery last spring and "unreservedly" recommends the care.

U.S. doctors refused to give him a price. "They would almost be proud of it," Freeman said. "They would say, 'That's not my department, I do operations. I don't have any idea how much anything costs.' Even the nurse would get mad at me and say, 'You want me to connect you with the billing department?'"

Lochhead includes this list of comparable prices:

Heart bypass: $8,500 in India; in the U.S., $144,000

Liver transplant: $75,000 in Latin America; in the U.S., up to $315,000

Dental implant: $1,000 in Costa Rica; in the U.S., $2,000-$10,000

Face-lift: $4,000 in Singapore; in the U.S., $15,000

Knee replacement: $10,650 in Mexico; in the U.S., $50,000

She also interviews Keith Smith, an Oklahoma City, Oklahoma, M.D. who was in our "True Tale of Canadian Health Care" vid:

Cochlear implants that can bring hearing to a deaf baby cost about $25,000. But Smith said hospitals mark up the device to $75,000 and then charge $25,000 for the 90-minute surgery. He charges no markup and $8,800 for the operation.

OK City may not be as exotic as Kuala Lumpur, but posting his prices online has allowed Smith to compete with faraway destinations.

Read the whole Lochhead piece to get a sense of how markets in health care could work. And then watch Smith in the vid below:

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  1. A key draw for overseas care is transparency – in price and quality – and U.S. providers’ lack of transparency.

    Let me be clear. This is unacceptable.

  2. Heart bypass: $8,500 in India; in the U.S., $144,000

    I am willing to pay the difference for being in a modern operating room instead of a tent.

    1. That’s probably the excuse they’ll use to ban people from going to foreign countries for medical care in a few years. “For your safety.”

      1. I would say don’t give them any ideas, but that one is probably already in the hopper.

        1. Has anyone finished reading the 2400page bill yet? I’m sure we just haven’t gotten to that chapter.

    2. I’d love to have had a tent like this to stay in when I was in the Boy Scouts:

      http://www.medicalindia-touris…..spital.jpg

    3. They have very current medical suites.

      Here’s a hint, if you don’t like Hindus working on you, don’t go to a US hospital either.

      1. Religion is not the issue. Just being able to smell India through the television is the issue.

        1. “”Just being able to smell India through the television is the issue.””

          Life might be easier if you don’t make up bullshit to hate.

        2. u b idjit

        3. You stupid, bigoted ass.

          1. You left out racist. I didn’t vote for Obama either.

    4. Both are assumptions, and operations in a tent are just silly exaggeration.

    5. You’re willing to pay the difference yourself directly or through risk-priced insurance, or you’re willing to make other people pay for the difference through taxes and other compulsory payments?

    6. Apparently John thinks this is how heart surgery is performed in Indian.

    7. You’ve obviously never been in India or had medical care there. FYI, the changes are excellent that your diagnostician outsources his MRI and CAT scans to world class diagnosticians in Mumbai and sticks you for a handsome profit for doing so.

  3. Thislady should have gone somewhere else. Your morning outrage courtesy of me.

    1. I forgot to add my apologies for the threadjack.

    2. FTA: An angry mayor (Bloomberg) said Monday most emergency workers care greatly and that the above incidents appear to be isolated events.

      You scooped Radley. He should apologize to us for his isolated-incident-radar not picking this one up.

  4. U.S. doctors refused to give him a price. “They would almost be proud of it,” Freeman said. “They would say, ‘That’s not my department, I do operations. I don’t have any idea how much anything costs.’

    What are the chances that, deep in the bowels of the new “health care bill” there lurks a provision making it illegal for hospitals to either compete on price, or publish any sort of standard list of prices?

    1. I’d say the chances are pretty high, P.

      “Standard list of prices” — what a concept. IANAphysician, but it would seem that, given no “complications”, at least *ballpark* estimation for many procedures would be straightforward.

  5. I am willing to pay the difference for being in a modern operating room instead of a tent.

    Ooh, clever.

    And- as we all know, nobody EVER dies in an American hospital due to preventable infections or old-fashioned incompetence.

    1. Just a wild guess that fewer people now have those problems than they did under Civil War conditions.

      1. And those surgeons tents of the 19th century were cleaner than medieval barbershops/leacheries. Not sure what the point is?

  6. U.S. doctors refused to give him a price.

    Forcing U.S. medical providers to post their prices. A regulation that even a libertarian could love.

    1. Forcing
      Giving the option for U.S. medical providers to post their prices. A regulation that even a libertarian could love.

      FTFY.

      1. Are you claiming they don’t have that option already?

        1. Not so much the option but the incentive.

          The cartelization and regulation as well the market distortions caused by third party payers create a number of perverse incentives.

          One of these appears to be a complete lack of competition.

          1. Yes, there are non-coercive ways of encouraging health-care providers to act in a more price competitive fashion.

            But if you’re going to regulate the system, forcing the broadcast of pricing is certainly an improvement upon most other regulations on the books.

  7. new titanium hip $1000.00
    green fees $15,000.00
    alimony $100,000.00
    Lexus for new girlfriend $80,000.00

    Jees man being a doctor is expensive

    1. You forgot a few things:

      Massive school debt
      huge malpractice premiums
      office and staff overhead
      writedown of losses from accepting Medicare

      once that’s done I think you’ll find most doctors these days are nitbthr Scrooge mcducks everyone thinks they are.

      1. Nibthr. Awesome new word, nonetheless I meant not the.

  8. I know more than one autobody shop that gives one price for cash deals then goes to “the book” for insurance claims which are ALWAYS much higher… go figure
    hmm I wonder if it’s the same for medical procedures?

    1. lots of people tend to not feel guilty about about ripping off insurance companies cause those bastards are crooks anyways…

      1. You are not ripping off the insurance companies when you do that stuff though. The insurance big wigs are going to get their money one way or the other. Your so called “ripping off” the insurance companies ends up only hurting other customers. This does not mean i like big insurance.

        When you pay for something out of pocket it is always cheaper than what the insurance companies fork out.

        1. Not necessarily. The insurance companies negotiate fees for just about every procedure code a doctor can use. What has happened is that over time, doctors have raised their prices so the negotiated fees are considered a discount to the insurer.

          Problem is, many doctors will still charge the inflated high price to the customer, rather than give them a rate as low as the insurance company is paying. Some will negotiate with a cash customer, but most will not. If they have a full waiting room, there is not much incentive for them to give you a break.

    2. With medical, there is usually a contracted rate that insurance company will pay. Which is usually less than the provider rate. My last doctor charged over $300 for a visit, my insurance company paid him $139.

      For the autobody shop, he is allowed, to charge the book rate, and there is nothing wrong with giving a discount for cash.

      1. Sorry I took for granted people realize that what insurance companies pay out … they need to more than recoup via premiums, in order to remain profitable… I was pointing out the disconnect when people, both service provider and recipient, have when the service is provided if they don’t pay attention to the actual cost…

        1. They have no clue. I doubt most would know what an EOB is.

    3. It normally is.

  9. i like the story about the libertarian writer who travels to france for his health care needs.

  10. I don’t know how bad or good India’s hospitals are, but there are strange practices that haven’t caught on even in more developed parts of Asia.

    About ten years ago, I visited a freind in a hospital in a big city in Korea. They allowed smoking in the ER waiting area. Also the water cooler had a single steel cup that everyone shared.

  11. I waiting for someone to get screwed up due to errors, and crying to the high heavens when they can’t sue for their injury.

  12. This seems to me to be a libertarian society opportunity.
    A version of an open question by statist is: how do you know in a libertarian society that doctors aren’t going to ignore best practices (as enforced by our current regulation and licensing) and injure or kill you?
    I don’t know necessarily what the best answer is. But, the usual solution is to have private accreditation ala UL or Consumer Reports. So, a partial solution would be to have a rating system to compare the medical facilities in a different country, at the state level as well as the facility level. This probably exists in some fashion, even if not comprehensive, though a more visible expression of it would be a boost to libertarian theory.
    (btw, don’t look to me, I don’t like to travel)

  13. In asia dental implants are about $100 each. I am currently in vietnam contemplating exactly this. Western trained doctors, just get one over age 40. They teach the younger ones in country, but have their own practices on the side.

    My question is, since I live overseas, must I buy this new mandated insurance? Hard to see how I get my monies worth..

  14. My question is, since I live overseas, must I buy this new mandated insurance?

    Of course. Under the social(ist) model of insurance, you aren’t buying it to cover your own needs as much as you are contributing to services provided by others.

    1. Insurance is based in socialism. Pay into a common pool for those who need, and if you need, your rates may go up.

  15. The video is right on. The Surgery Center is a great place. I had a hernia repair operation at there about 2 years ago. They actually called me that morning (my appointment was for 12 but there had been an ice storm) and asked if I wanted to come in early.

    I was there around 10:30 and on my way home by 2:00 and the overall cost was about a third what I had been originally quoted by the doctor.

    It was nearly pain free both physically and financially. I would highly recommend them.

    Of course, if the government has it’s way they may soon be out of business.

  16. This is a great solution for non-emergency procedures. However, if you are uninsured and need emergency hospitalization or surgery, get ready to be ripped off and forced into bankruptcy here in the good ole USA.

    Is it realistic to expect someone lying in an ambulance to haggle over prices with doctors and hospitals?

  17. Kad?k?y Florence Nightingale Hospital provides services in all specialties with its inpatient and outpatient, diagnosis, treatment and emergency service facilities and fully-equipped polyclinics.

  18. Anadolu Hospital Turkey is representing high quality medical care in Gebze, not too far from Istanbul.

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