So much has been said about the need to reduce healthcare costs in the U.S., whether or not tort reform will work, fraudulent insurance billing, and on and on. I was listening to the radio today and heard a fellow from Los Angeles interviewed about his experience getting some dental work done. It reminded me of some other medical situations and it made me wonder whether there's room for these ideas in the whole healthcare reform, cost reduction effort.

The fellow I heard interviewed related the story of getting estimates for a complicated dental procedure from two different dentists in the LA area. The range of the estimates was from $35,000 to $39,000. His further research lead him to a well-qualified dental center in Tijuana, Mexico, no more than a 2 block walk from the border station. He said he got his dental work done there for a fee of $3,900. The work was done by a dentist and her assistant who were both educated in the U.S.--at the USC and UCLA medical centers. Both the dentist and nurse spoke perfect English, without any Spanish accent. He described the offices as spotless and equipped with equipment as modern as any he had ever seen. The offices held many dentists and dental surgeons and specialists and all seemed similarly equipped. He observed that the clientele were almost exclusively Americans. He reported that the dental work he had done was perfect and he couldn't be happier with the results.

I was reminded of other news reports I have seen on huge hospitals located in Indonesia, staffed with American-educated and trained doctors and nurses and which perform even the most advanced surgeries at a fraction of the cost of the same procedures in U.S. hospitals. One report showed a patient getting as hip transplant. She had her own personal nurse for the days she was in the hospital in a private room, and her rehab was performed at nearby facility that had all the features of a top-of-the-line resort--beaches, pools, massage therapists, rehab specialists, fine restaurants, gourmet dining, the works. A week of post-op rehab was included in the already low price of the surgery. The report said that this hospital--it was in Bangkok, I believe--was already bigger than any U.S. hospital, and growing!

If excellent medical and dental care is available outside the U.S., provided by U.S.-educated and trained doctors and dentists, in facilities comparable to anything in this country, all for a fraction of the cost here, should we integrate such care into our own healthcare system? It would likely be far cheaper if Medicare and our private insurance companies simply paid for a plane ticket to the foreign hospitals and went on to pay the significantly lower fee. There is reportedly very little defensive medicine practiced in these foreign hospitals because foreign patients are precluded from litigating against the foreign medical personnel and hospitals. But yet the results being reported are equal to if not better than being achieved here in the U.S. It sounds like costs would go down dramatically and the quality of care might even be an improvement over that available here.

Maybe Congress should be talking about the equivalent of a "healthcare NAFTA". Maybe not even Congress. Other than Medicare, which is government-controlled, why not the private insurers simply steering patients from the U.S. to treatment in foreign countries?

Anything wrong with this picture? It works in many, many other industries where high quality products and services can be provided at lower cost outside the U.S. Cars, trucks, electronics, airplanes, building materials, tools, even telephone customer service are more efficiently manufactured or provided by foreign suppliers. It's not like it's a new concept. If the costs of healthcare and drugs here in the U.S. continue to escalate at unsustainable rates, we may be headed in the direction of foreign-provided healthcare anyway.

Why not healthcare? It sounds like it could be an excellent idea which would make the care of U.S. citizens affordable again. And maybe even improve the quality of care and the resultant health of the population.

Can anyone make an argument on why this is a bad idea? Or if anyone thinks it is a bad idea, then how can we provide the same high quality healthcare at lower costs here at home? The free market seems to be telling us that our healthcare, like many other products and services we use, is headed offshore.

Why not prescription drugs?
Also available MUCH cheaper in other countries, just across the borders into Canada or Mexico, if you don't feel like heading to Europe or Asia.

Recently I saw a rerun of the TV series "Boston Legal" (it is humorous!) which one of the fictional cases involved an HMO which would only pay for a specific procedure if the patient flew to India for it (Cost was 1/5th the US cost). Well, the patient went there and died on the table. That led to all sorts of other problems for the surviving family who could not afford to be in India with the patient at the time of treatment.

Since we could never get the industrial NAFTA to work as proposed, a medical NAFTA is as rough. As with the fictional TV case, I can't imagine a government program (or government influenced one) which demanded a person from Kansas City, Denver, Charlotte or The Villages to go to Facility #358 in Durango or Facility #223 in Hermosillo (or even know in where in Mexico these places are) for treatment of anything.

Medical tourism has been around for quite a while. There are several interesting websites on it, and a few companies make quite a lot of money on it. The biggest customers are folk from countries with national care programs who seek options other than wait forever or were denied as not-economically-worth-the-cost.

For those living near the border and willing to drive an hour or two to save money by being treated where there is no recourse for malpractice, that's "risk management" at its ultimate. It's an option, but scary when mandatory.

Originally Posted by kayakernc

why not prescription drugs?
Also available much cheaper in other countries, just across the borders into canada or mexico, if you don't feel like heading to europe or asia.

www.canadapharmacy.com

Originally Posted by SteveZ

...I can't imagine a government program (or government influenced one) which demanded a person from Kansas City, Denver, Charlotte or The Villages to go to Facility #358 in Durango or Facility #223 in Hermosillo (or even know in where in Mexico these places are) for treatment of anything....Medical tourism has been around for quite a while...The biggest customers are folk from countries with national care programs who seek options...

I don't believe our government would ever mandate such a thing. But I think there's a reasonably good chance that if no reforms are put in place that truly "bend the cost curve" for American healthcare, that the simple law of supply and demand--the free market--will drive Americans to this solution. It would only be for major procedures, but if people get to the point where they can no longer afford health insurance, and the "private pay" option is totally unaffordable, I can certainly see people with needs to treat life-threatening or quality-of-life maladies heading to foreign countries for cheaper treatment.

The key words above are "...if no reforms are put in place that truly bend the cost curve..." As has been said so many times before, if our elected representatives leave the public interest wanting once again, and if we keep sending the same people back to Washington again and again...we'll deserve what we get.

I've heard reports of this before, but I have to question how this can be. For it to be that much cheaper, the cost structure must be cheaper. First, if the equipment is as modern as that of a US dental/medical practice, it must cost the same - hence no savings there. With respect to labor costs, I assume there may be some savings, but I wonder about that as well. If the doctors are US trained, I assume that they also have the ability to get a green card to practice in the US since we also have a shortage of trained medical people. Are these people willingly choosing to work for a small fraction of what they could make in the US? Perhaps it's my no-free-lunch cynicism, but doesn't seem to add up.

a

Originally Posted by NJblue

I've heard reports of this before, but I have to question how this can be. For it to be that much cheaper, the cost structure must be cheaper. First, if the equipment is as modern as that of a US dental/medical practice, it must cost the same - hence no savings there. With respect to labor costs, I assume there may be some savings, but I wonder about that as well. If the doctors are US trained, I assume that they also have the ability to get a green card to practice in the US since we also have a shortage of trained medical people. Are these people willingly choosing to work for a small fraction of what they could make in the US? Perhaps it's my no-free-lunch cynicism, but doesn't seem to add up.

There is no doubt that medical tourism has proved profitable and highly competitive with the US medical establishment. But there are risks and massive inconveniences.

I'm sure that sooner or later there will be a health care insurer which will offer reduced costs, but with a proviso that certain procedures, if deemed medically necessary, may only be paid if the insured uses a particular out-of-US medical facility. From a business standpoint, the potential is there, but the emotional stress (and ancillary costs) on the patient and family will be enormous.

I have noticed more and more lately the ads from lawyers and law firms regarding various meds and procedures and numbers to call if you have "been injured", etc. and "that you may be entitled to compensation.....". Just how big a factor is this in the spiraling health care costs? Also, the drug ads to "ask your doctor if XX might be right for you? Shouldn't your doctor already know what's right for you? TV ads are not cheap and don't we all end up paying for them by way of pass-thru costs?

Originally Posted by Villages Kahuna

So much has been said about the need to reduce healthcare costs in the U.S., whether or not tort reform will work, fraudulent insurance billing, and on and on. I was listening to the radio today and heard a fellow from Los Angeles interviewed about his experience getting some dental work done. It reminded me of some other medical situations and it made me wonder whether there's room for these ideas in the whole healthcare reform, cost reduction effort.

The fellow I heard interviewed related the story of getting estimates for a complicated dental procedure from two different dentists in the LA area. The range of the estimates was from $35,000 to $39,000. His further research lead him to a well-qualified dental center in Tijuana, Mexico, no more than a 2 block walk from the border station. He said he got his dental work done there for a fee of $3,900. The work was done by a dentist and her assistant who were both educated in the U.S.--at the USC and UCLA medical centers. Both the dentist and nurse spoke perfect English, without any Spanish accent. He described the offices as spotless and equipped with equipment as modern as any he had ever seen. The offices held many dentists and dental surgeons and specialists and all seemed similarly equipped. He observed that the clientele were almost exclusively Americans. He reported that the dental work he had done was perfect and he couldn't be happier with the results.

I was reminded of other news reports I have seen on huge hospitals located in Indonesia, staffed with American-educated and trained doctors and nurses and which perform even the most advanced surgeries at a fraction of the cost of the same procedures in U.S. hospitals. One report showed a patient getting as hip transplant. She had her own personal nurse for the days she was in the hospital in a private room, and her rehab was performed at nearby facility that had all the features of a top-of-the-line resort--beaches, pools, massage therapists, rehab specialists, fine restaurants, gourmet dining, the works. A week of post-op rehab was included in the already low price of the surgery. The report said that this hospital--it was in Bangkok, I believe--was already bigger than any U.S. hospital, and growing!

If excellent medical and dental care is available outside the U.S., provided by U.S.-educated and trained doctors and dentists, in facilities comparable to anything in this country, all for a fraction of the cost here, should we integrate such care into our own healthcare system? It would likely be far cheaper if Medicare and our private insurance companies simply paid for a plane ticket to the foreign hospitals and went on to pay the significantly lower fee. There is reportedly very little defensive medicine practiced in these foreign hospitals because foreign patients are precluded from litigating against the foreign medical personnel and hospitals. But yet the results being reported are equal to if not better than being achieved here in the U.S. It sounds like costs would go down dramatically and the quality of care might even be an improvement over that available here.

Maybe Congress should be talking about the equivalent of a "healthcare NAFTA". Maybe not even Congress. Other than Medicare, which is government-controlled, why not the private insurers simply steering patients from the U.S. to treatment in foreign countries?

Anything wrong with this picture? It works in many, many other industries where high quality products and services can be provided at lower cost outside the U.S. Cars, trucks, electronics, airplanes, building materials, tools, even telephone customer service are more efficiently manufactured or provided by foreign suppliers. It's not like it's a new concept. If the costs of healthcare and drugs here in the U.S. continue to escalate at unsustainable rates, we may be headed in the direction of foreign-provided healthcare anyway.

Why not healthcare? It sounds like it could be an excellent idea which would make the care of U.S. citizens affordable again. And maybe even improve the quality of care and the resultant health of the population.

Can anyone make an argument on why this is a bad idea? Or if anyone thinks it is a bad idea, then how can we provide the same high quality healthcare at lower costs here at home? The free market seems to be telling us that our healthcare, like many other products and services we use, is headed offshore.

There has been "medical NAFTA" for a long time now. Usually it has been the other way around, with people coming from other countries, some that have a national health care system that doesn't work for them, and others that came for our superior health care.

Fortunately, or unfortunately depending on if one is isolationist or not, our life experience has evolved into a more global experience, due to the shrinking world of communication and commerce. We are now able to scan the globe for goods and services that we want. We are now only one of many countries where quality health care is available. The risks and protections of our system are not universally applicable, unfortunately, and this has to be considered when buying goods or services outside our own country.

If we want or need health care that is either cheaper, faster or better in another country, we have the opportunity do so, but as always "buyer beware". You may not like the results and will have no or little recourse in resolving a legal dispute.

A government style NAFTA for health care, with it's inherent bureaucracy and costs, is not a good option.

Originally Posted by gnu

There has been "medical NAFTA" for a long time now. Usually it has been the other way around, with people coming from other countries, some that have a national health care system that doesn't work for them, and others that came for our superior health care....If we want or need health care that is either cheaper, faster or better in another country, we have the opportunity do so, but as always "buyer beware". You may not like the results and will have no or little recourse in resolving a legal dispute.

Originally Posted by NJblue

...If the doctors are US trained, I assume that they also have the ability to get a green card to practice in the US since we also have a shortage of trained medical people. Are these people willingly choosing to work for a small fraction of what they could make in the US? Perhaps it's my no-free-lunch cynicism, but doesn't seem to add up.

Here's an excerpt from one of the many, many websites featuring "medical tourism"...

The majority of foreign doctors trained in the US or Western Europe are under various foreign government programs that require they return at the completion of their education and serve the public for a period of several years; approximately 8-12 years in Thailand, for example. Most stay after their indentured labor expires, however, both for the desire to stay in their home country and because apart from the monetary incentive, being a physician in the United States is not a particularly enticing position. By staying in their home country, these physicians will receive far more respect for their position than they would in the United States, work fewer hours with less stress, and not have to worry about the frivolous litigation that plagues US doctors. Further, while by US standards they are paid less, by local standards they are very well to do and their lifestyles are as comfortable in their native countries as they would be in the US.

Interestingly, several of the websites indicate that U.S. insurance companies will indeed pay for medical and dental procedures performed in foreign hospitals. In fact, one article said they are "thrilled" to do so because of the lesser expense to them. They forewarn that the biggest problem is for the patient to obtain the proper documentation from the foreign hospital to document their claim. Several foreign hospitals have begun to offer the same insurance claim filing services as are available in the U.S. Some are much farther ahead in this regard than others. Bumrungrad Hospital in Thailand is widely noted as one of the most frequently used hospital by foreign medical tourists. They admitted over 400,000 foreign patients in 2008. They are reported to be at the forefront of seamlessly providing patients from all countries both superior medical care as well as interfacing with insurers worldwide. Bumrungrad has over 900 doctors on it's staff, with 200 of them being U.S. board certified. Bumrungrad is noted worldwide for being possibly the most technologically advanced hospital in the world, both in diagnostic and surgical facilities and also in patient-centered information technology.

Check out the website on Bumrungrad Hospital... http://www.bumrungrad.com/

Bumrungrad provides a slick webpage to estimate the cost of various procedures commonly provided at the hospital. That website is at...http://www.bumrungrad.com/realcost/index.aspx

I looked up a few surgical procedures that some of us might be familiar with. One needs to review exactly what's included in these costs, but I found that the actual period of hospitalization is much longer than is commonly paid for by Medicare or U.S. insurance companies. As an example, in the U.S. patients are typically discharged after three days after a total hip replacement. At Bumrungrad in Thailand, the hospital stay is typically 6-7 days. Some of the costs that we might be familiar with are as follows. These numbers include the total cost of the procedure, hospital bill, doctor's fee and all supplies. These are median cost averages, with 50% of th the procedures costing more and 50% less than this amount...

• Total hip replacement $13,349
• Total knee replacement $10,959
• Colonoscopy $691
• Coronary Angiogram $2,275

I can tell you from personal experience as well as with family members, that these median costs are a fraction of what they are in the U.S. With a couple of the procedures noted above, the average costs are only 20-25% of the costs in big U.S. hospitals.

These comments relate mostly to the big hospital in Bangkok. But just a little research shows that the development of hospitals and medical facilities around the world designed to cater to foreign patients, particularly U.S. citizens, is extensive and growing rapidly.

Can you picture a health insurer telling an insured that the insurer will pay for a knee replacement. All the insured (who lives in Ocala) has to do is: 1) get a ride to Orlando Airport; 2) take a coach seat on a flight to Los Angeles (6 hours airtime - change planes in Dallas); 3) Wait at LAX (3-6 hour layover) 4) Take a coach seat on a flight to Bangkok (16 hours airtime - change planes in Taipei or Seoul); 5) get to hotel (1-2 hours driving time from Suvarnabhumi Airport); 6) stay at local hotel (1-2 days waiting procedure); 7) have the procedure; 8) stay at hotel (unknown time for medical travel release); and reverse the travel direction while wheelchair-bound.

Meanwhile, the same procedure can be done at Ocala, Leesburg, Gainesville, Orlando and Tampa hospitals - close to home, family and rehab facilities.

What a deal!

Originally Posted by SteveZ

...What a deal!

I agree that the difficult procedure for getting a surgery like a knee replacement is as tough as described. But having close experience in a family that has had multiple joint replacements, if one couldn't afford the health insurance to pay for the procedure here close to home, yet could afford the deeply discounted cost as a medical tourist, I guarantee that the travails of travel to Bangkok would be well worth the improvement in life quality that results from a new knee joint.

Originally Posted by Villages Kahuna

I agree that the difficult procedure for getting a surgery like a knee replacement is as tough as described. But having close experience in a family that has had multiple joint replacements, if one couldn't afford the health insurance to pay for the procedure here close to home, yet could afford the deeply discounted cost as a medical tourist, I guarantee that the travails of travel to Bangkok would be well worth the improvement in life quality that results from a new knee joint.

I don't disagree. You do what you need to do for your family and yourself.

If someone wants a reduced-fee health care insurance plan that relies on 'medical tourism' for expensive procedures and an insurer wants to provide such a plan, that is a personal choice. Like most things in life, there are cost trade-offs, and convenience is the first factor.