I’ve enjoyed hearing the healthy debate over Michael Moore’s newest movie, Sicko, and the discussions it has spawned. Fact is, not many of us have experienced healthcare in another country and when we do, it’s the healthcare an American experiences, not necessarily what a citizen of that country experiences. I don’t believe all Cubans experience the portrayed hospital. I don’t believe the experiences some U.S. patients experience in other countries are typical.
Last summer, just about this time, I was a medical consultant for a “medical tourism” company who has since gone out of business from a lack of start up funds. The premise was there is quality healthcare in other places that are more affordable than U.S. healthcare.
This is true.
There is.
BUT, there are significant differences and even more significant reasons why.
I had the opportunity to visit JCI, (Joint Commission International), approved hospitals in India, Singapore, and China. JCI certification is by the same Joint Commission folks who drive your local hospitals crazy to make sure they pass muster. The vast majority of hospitals in the world cannot claim JCI certification, although the criteria are less stringent overseas than what your local hospitals must do to receive JCHO certification. There are, however, other standards and certifications, but it is my impression that the JCI standards are the toughest to achieve. I also discovered some of the JCI accredited hospitals I visited look at JCI accreditation as THE GOAL. The good ones look at JCI accreditation as a milestone on the path to continued excellence. THAT is a profound difference and spells the difference between achieving JCI certification to increase business vs. achieving certification because it’s simply the right thing to do for patients.
Overall, India was clearly the bargain. In India, I found hospitals that could get you a heart operation for a mere $18,000 that would cost $200,000.00 in the U.S. Singapore facilities were excellent, but not as much of a bargain. The China facility was most like a small U.S. hospital, and therefore had limited services, but somewhat cheaper than U.S. pricing. Because I had an opportunity to personally visit with hospitals, physicians, and administrators, I know who I’d send my family to… but when you’re balancing “bargain” pricing with “quality,” you’d better know what you’re doing. In some hospitals, I woudn’t hesitate to refer. Others, I’d avoid. But that’s from an insider’s perspective. I interviewed American patients at all these hospitals and without exception, even at the hospitals I would not immediately recommend, they had very positive experiences.
The facilities were modern, some a bit worn but clean, and efficient. Most were not fancy. Air conditioning in some were limited to rooms, but not public areas, nursing stations, and corriders. Overall, these hospitals paid more attention to sterile procedures than we do in the US. And in the good hospitals, even the good ones that were, “worn,” I’d feel comfortable sending patients. BUT, the option of finding the right hospital, right doctor, and right expertise abroad can be daunting. And here’s the real bottom line that we can all learn from, whether regarding healthcare in or out of the U.S.
- YOU GET WHAT YOU PAY FOR.
- COST OF LIVING DIFFERENCES DETERMINE “BARGAINS.”
Getting what you pay for… The only person I could find to tell me this information was one of my drivers in India. Briefly, from the “man in the street” perspective, there are two types of hospitals in India. Public and Private. I’ll relate the conversation, you make your own inferences:
Me: “Let’s say you have appendicitis. Your stomach hurts. What do you do.”
Driver:”Go to hospital, (he named the hospital he drives for).”
Me: “How about a public hospital.”
Driver: “NO… private hospital!”
Me: “Let’s say you had to go to a public hospital.”
Driver: “NO, PRIVATE HOSPITAL!!!”
(After a bit of discussion he explained that he would never go to a public hospital because of quality concerns, sanitary conditions, etc., and because he had “insurance,” he would go to a private hospital. So I asked him to assume that he had no insurance, and HAD to go to a public hospital.)
Me: “So now you have appendicitis at a public hospital. What happens.”
Driver: “Have operation.”
Me: “How do you pay for it? Does the government pay for it?”
Driver: “I pay.”
Me: “What if you have no money?”
Driver: “No operation.”
Me: “Do you know what appendicitis is?”
Driver: “Yes.”
Me: “If you don’t have an operation you will die.”
Driver: (shrugs), “Then I die.”
If you don’t pay for it, you don’t get it. If you want first class treatment, you pay for first class. If you want economy, you pay for economy. If you don’t pay, you don’t get and do the best you can. U.S. hospitals are phasing out double rooms… most “progressive hospitals” are moving to all private rooms. India has private rooms. There are also doubles, quadruples, octets, and wards. VERY LARGE WARDS. You get what you pay for. If you can’t pay, you don’t get. Do all Americans need private rooms in the U.S.? The cost of a room in a hospital being built in the U.S. in the us is close to a Million Dollars today. In India, it’s a small fraction of that number… that brings us to the second point.
Cost of living… In India, a typical, well trained, good, competent and caring physician in a successful practice may make $2,000 a month. A Coke costs a few cents. Medical “insurance” was laugh-out-loud cheap. Everything I could think of buying that was not imported from another country, out of tourist areas, was easily a fantastic bargain. Name me physician in the U.S. who makes $2,000 a month and I’ll show you an intern! But a yearly income of $24,000.00 allows an Indian physician a great middle class living just like most physicians can afford in the U.S. There are differences in life-styles to be sure, BUT, for the most part, because of the COST OF LIVING differences between our countries, India is a “bargain” for Americans who have cash, and choose to travel.
There are other factors. The Indian physicians I met were literally terrified of litigious Americans. They KNOW American patients have a propensity to sue… often because they had U.S. training and practices in their own background. They simply don’t have that problem to the degree we do in India. Yes, in India you can sue for MALPRACTICE, but Malpractice as a doctor might define it, NOT a jackleg, dime-a-dozen, ambulance chasing, U.S. plantiff’s attorney’s definition. Ooooohhhh…. let me tell you what I really think!!!!! Indian doctors were exceedingly courteous to the American patients I spoke to but one-on-one with doctors I personally met allowed me to chat with some nice docs and some s.o.b.’s as well. (Just like in the U.S.). Nursing was plentiful in India. Most floor nurses were R.N. equilavents and the nurse to patient ratios did put U.S. hospitals to shame. BUT the relative cost of these nurses, coupled with the cost of living differences, was significantly less than the U.S. There is no nursing shortage in India… in fact many nurses emmigrate to other countries, like the U.S. because jobs are hard to come by in India. Nursing and Medical professions are declining in the U.S. but rising in India. The education requirements and exuberance for learning, behavior, and excellence is a rising star in India. I can’t always say the same thing for the U.S.
We have a lot of uninsured and under insured in our country. But I know when a patient presented to my hospital’s ER with presumed appendicitis, I, or whichever surgeon on call, got out of bed and took out the appendix, without regard to payer status. We have a high cost of living in the U.S. compared to many countries. And often many folks do get something they don’t personally pay for in the U.S.
See Sicko. But don’t expect what you see to be %100 accurate. A movie, even a ‘documentary,’ has entertainment value. And how much “fact” would you expect to get for the time in a movie? If people are really that interested in “fixing” healthcare, they would talk to many people, YOUR DOCTORS INCLUDED, read lots of books, articles, proposed legislative bills. Ask questions. Ask why in the arguably most technologically sophistocated “healthcare delivery system” on the face of the planet doctors, nurses and other healthcare professionals are leaving their professions. Why applicant numbers to medical schools have been declining. Why physicians are paid less and are expected to see more patients. Why the first in line to say “this sucks!” aren’t always patients… they’re doctors!
Don’t expect Sicko to provide the answers. But it may give you some questions. Ask the questions, find a version of the “truth” that seems balanced and demand solutions to what ails U.S. healthcare. “You get what you pay for” doesn’t just mean dollars. It means a commitment of time and energy and perhaps even acknowledging that the American way to get a “bargain” out of healthcare really means that someone else should be paying for our healthcare. If we don’t take the time to go beyond the 20 second sound bites and really look at the role of insurers, government, patients, and providers, we won’t ever see substantive change. It might mean quitting smoking. Losing weight. And shouldering the cost of providing healthcare ourselves outside of an employers healthcare policy.
Do I want coverage for the uninsured? Sure!!! I’m a doctor. I like to be paid for my work. The way it currently is, when I treat a patient, in an emergency, I often won’t get paid. Elective surgery for me is always a risk for a patient without insurance. My office policy was to ask for 1/2 up front and then work out a payment plan for months to follow. Typically, I’d get the 1/2 and never get another dime. And the patients who did make regular payments, were often matched with equal deductions so they ended up with a 25% discount. (But, according to the laws governing Medicare, if Medicare found out I only was charging a fraction of what I charged Medicare patients to my uninsured, I’d be in hot water!)
But if you give something away, people will take advantage of you. “Free healthcare” results in many instances of abuse. Of overuse. People need to pay something for healthcare, the same way they pay a grocery store for food.
Cause if you’re not paying for something, you’re not getting much.
Post a Comment