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Old Nov 04, 2006, 11:05 PM
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3rd world healthcare...starting to look really good

Businesses may move health care overseas

By MALCOLM FOSTER and MARGIE MASON, Associated Press Writers


NEW DELHI, India - Businesses and insurance companies are starting to eye the potential savings of outsourcing health care from the world's richest country to the developing world.

"It's just one of the many ways in which our world is flattening," said Arnold Milstein, chief physician at New York-based Mercer Health & Benefits, who's researching the feasibility of outsourcing medical care for three Fortune 500 corporations. "Many companies see it as a natural extension of the competition they've faced in other aspects of their business."

With an estimated 45 million uninsured Americans, some 500,000 trekked overseas last year for medical treatment, according to the National Coalition on Health Care. Asian hospitals in Thailand, India and Singapore have long been swarmed by medical tourists looking for tummy tucks and face lifts, but many glitzy, marble-floored facilities are now gaining reputations for big-ticket procedures including heart surgery, knee and back operations.

Some American hospitals already rely on places like India for X-ray readings and other diagnostics, while also importing foreign doctors and nurses. But the U.S. health care industry has been largely immune to overseas competition just one reason behind soaring costs.

Premiums for employer-sponsored health coverage have surged 87 percent over the past six years, according to the Kaiser Family Foundation, putting a huge burden on both companies and employees. Family health coverage now runs about $11,500 annually, with workers themselves forking out nearly $3,000.

But just as shipping U.S. manufacturing to China and call centers to India initially created loud opposition, some critics are already preparing to fight any possible mass exodus of Americans packing their bags to go under the knife overseas.

In September, Canton, N.C.-based Blue Ridge Paper Products Inc., was set to send one of its employees to India for a gall bladder operation. Carl Garrett would have been the first U.S. employee sent abroad for medical care through an employer-sponsored pilot program, which would have allowed him to share the company's savings.

Shortly before Garrett was set to leave, the United Steelworkers, America's largest union, pulled the plug.

"We don't want to expose our members to the risks associated with providing health care in the Third World," said Stan Johnson, a union spokesman. "This is perceived to be voluntary, but voluntary programs tend to lead to mandatory programs."

Blue Ridge ultimately scrapped its plan for union members, but several other U.S. businesses and insurance companies are starting to explore the option of exporting patients.

"I get the impression that they're all waiting for someone else to take the first step," said Jason Yap, director of health care service for the Tourism Board in Singapore, another major medical tourism destination. "They're all interested in doing the homework now so they can move ahead when the time comes."

United Group Programs, a Boca Raton, Fla.-based company that sells self-insurance policies to small businesses, is already offering a plan that sends patients to Bumrungrad International hospital in Bangkok, Thailand. UGP says the plan will save employers more than 50 percent on major medical costs and slash employees' out-of-pocket expenses to zero.

Blue Shield of California and Health Net of California also both offer lower-cost policies allowing members to seek medical care in Mexico.

In June, David Boucher, an assistant vice president at BlueCross BlueShield of South Carolina, traveled to Bangkok for a close-up look at Bumrungrad. The Thai hospital began heavily recruiting overseas patients after the 1997 Asian financial crisis. It drew 400,000 foreigners last year including 55,000 Americans.

"I was thoroughly impressed," Boucher said. "We're taking a serious look at this as an alternative" for the health plan's 1.5 million members.

In addition, West Virginia lawmaker Ray Canterbury plans to propose legislation next year that would give government employees the option of traveling abroad for necessary procedures, which could save the state up to $2 million annually. He wants to offer incentives, including extra sick leave and 20 percent of the cash saved by going abroad allowing workers to actually make money on the deal.

Dodie Gilmore is a rodeo barrel-racing champion who runs a 180-acre ranch in Oklahoma when she's not bouncing across back roads selling farms. Gilmore is a spry 60-year-old who loves the outdoors, but when she could no longer straddle her faithful horse, River, she knew it was time for a new hip.

But how could she afford it? As an independent contractor for a small Coldwell Banker real estate franchise in Durant, Okla., she knew her privately purchased health plan would never pay up to $40,000 for the operation.

So she asked her boss about traveling to India where hip resurfacing alone would cost just $7,000. He not only gave her his blessing but offered to foot the bill, minus travel and hotels making Gilmore one of the very first Americans sent overseas for surgery by an employer.

"The doctors were wonderful," Gilmore said days after being discharged, sipping coffee at a New Delhi roadside cafe with her sister, Carol, who was along for whole trip. "The overall care was pretty darn good."

More and more patients like Gilmore who had never held a passport or even tasted Indian food before her trip are returning home and spreading the word about an alternative to America's ailing health system.

Gilmore's boss, Martin VanMeter, who owns a Coldwell Banker office with about 24 workers, wasn't obligated to pay anything toward the hip surgery. But he sees his employees as family, and if they're too hurt or sick to work, no one benefits.

"I've invested so much money in them," he said by telephone. "All she's got to do is make one transaction for us, and we've got our money back."

But even with the growing momentum, big questions must be asked by anyone considering treatment abroad.

Despite the five-star facades of some hospitals fountains, white marble floors, even a Starbucks and McDonald's inside Bumrungrad's lobby the comfort of having a major surgery near home with family at the bedside is a far cry from the experience in the developing world, where culture shock alone can be stressful.

Pollution, poverty and insane traffic are all part of the experience when visiting hospitals like the Indian-owned Max Healthcare facilities in New Delhi, where it's not uncommon to see people urinating along roadsides. Jet lag, traveler's diarrhea and strange foods also can be coupled with the unpredictable, such as September's bloodless military coup in Thailand, which ultimately had little impact on daily life.

Language and cultural barriers also can make communication with doctors and nurses frustrating for some Americans, who are used to being direct with their physicians, often peppering them with tough questions and expecting straightforward answers.

Some Asian cultures also rely more on hints and subtleties to communicate, and doctors in some countries are regarded as authority figures who often aren't questioned. Follow-up care back in the U.S. also can be an issue for some patients.

"There are a lot of risks," said Rick Wade, a senior vice president at the American Hospital Association. "What happens if something goes wrong?"

In countries like Thailand and India, medical malpractice claims are rare and multimillion dollar awards are nonexistent.

"If there's a mistake, we fix it," said Curtis Schroeder, an American who is group CEO of Bumrungrad hospital, which requires all doctors to carry malpractice insurance. "But the idea of suing for multimillions of dollars for damages is not going to be something you can do outside the U.S."

In February, Joshua Goldberg, a 23-year-old American who was traveling in Thailand, died at Bumrungrad after seeking care for a leg injury. His father, James Goldberg, has set up a Web site alleging the hospital administered a deadly drug cocktail to a patient with a history of substance abuse.

Bumrungrad insists the care given was appropriate. Thai authorities are investigating the case, as is standard with all unexpected hospital deaths. No conclusions have been reached.

"What I'm dedicated to doing is to try to alert people to at least do their homework and consider very carefully what they're getting into. Why is this such a good deal?" Goldberg said by telephone. "You might not walk away. That's what happened to my son."

It's ultimately up to patients themselves to investigate hospitals and physicians before considering surgery abroad. The Internet is loaded with resources that range from doctor bios to patient blogs, detailing the positives and negatives.

As the phenomenon grows, more countries are trying to get in on the action. The Philippines began a campaign this year aimed at attracting Filipinos living abroad and Asians within the region. Packages offering city tours, day spas and even golf have been combined with health checkups and cosmetic surgery.

Some experts predict greater access to options like these will eventually drive more people to take control of their own health care.

Medical tourism facilitators like California-based PlanetHospital are banking on it, already working to make the journey less stressful for patients traveling abroad by arranging everything from visas and airport pickup to sightseeing.

Many doctors working in facilities catering to medical tourists are trained abroad, often in the U.S. or Europe. About 100 foreign hospitals have been approved by the international arm of the Chicago-based Joint Commission on Accreditation of Healthcare Organizations, which also accredits American hospitals.

Six countries in Asia have accredited facilities, including Bangkok's Bumrungrad; five in India, with three belonging to the Apollo Hospital group; and 11 in Singapore.

The Max Super Speciality Hospital where Gilmore had her surgery on Oct. 10, is working to become accredited, but she said she felt comfortable from the very beginning. Even if her boss had refused to pay for the surgery, she said she likely would have made the two-day flight on her own because her insurance would never have paid to fix the pre-existing condition.

"It's either that, or do it in the States for $28,000 to $40,000," she said. In the U.S. do you not sign forms? They're not responsible. The risk of it didn't really weigh on me."

In addition to saving thousands the three-week trip totaled about $12,000, including the surgery, travel and lodging for two and a tour of the Taj Mahal she also underwent a new technique just approved this year in the U.S.

Instead of total hip replacement, which limits mobility and requires the top of the femur to be cut off and a long shaft inserted, hip resurfacing uses only a small ball-and-socket device that enables patients to maintain their flexibility for activities like yoga, praying or even racing horses.

Gilmore's Indian physician, Dr. S.K.S. Marya, chief surgeon at the Max Institute of Orthopedics & Joint Replacement, has performed some 150 hip resurfacing operations over the past two years. About one American comes to him for the surgery each week, and Gilmore is just the latest in a growing number of satisfied patients who plan to keep their passports renewed.

"Every day I feel better. I can get around on one crutch now," said Gilmore, who plans to be back in the saddle within six months and out selling ranches soon after returning home. "I don't have near the pain. I can already move my leg a lot more than I could before. I can actually go up the stairs without pain, that's something I couldn't do before."
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Old Nov 04, 2006, 11:15 PM
Deletedfor proving Nauga wrong
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Old news.

Due to the added costs in our medical system due to exorbinant malpractice awards, resulting in huge malpractice insurance cost, it can be MUCH cheaper to get a medical proceedure done in another country.

this doesn't help the people who need emerency surgery, such as an appendectomy. But it can be enough of a savings when having a major sirgery done that some companies will PAY THE AIRFARE for the patient AND SPOUSE for the trip, and pay them part of the rest of the difference in cost for the proceedure.

It now costs almost $500 to go to the local ER and get 2 stitches in a cut here in the US. $250 to $300 if you can get into the local doctor's office for the 2 stitches....

**********

Again... this is old news. Some insurance companies have been sending people overseas for proceedures for 5 years now.
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Old Nov 04, 2006, 11:30 PM
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Due to the added costs in our medical system due to exorbinant malpractice awards, resulting in huge malpractice insurance cost, it can be MUCH cheaper to get a medical proceedure done in another country.
roflmao
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Old Nov 04, 2006, 11:40 PM
Deletedfor proving Nauga wrong
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I'm glad the truth amuses you
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Old Nov 04, 2006, 11:47 PM
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I'm glad the truth amuses you
Sorry...you are sadly mistaken...it is the ability of some people to accept the idiotic as truth that amuses me.

Malpractice awards have almost no practical effect on healthcare costs in America.

If all malpractice suits were made illegal tomorrow...and all doctors could kill at will...healthcare would still be more expensive next year than this year....because the annual inflation of American healthcare costs is about 3 times the maximum estimate of costs caused by malpractice.
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Old Nov 05, 2006, 12:03 AM
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So when are you moving to India, BA?
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Old Nov 05, 2006, 12:11 AM
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Iwanna look out BA is trying to beat your pastie Queen title.

Just a heads up man.
Don't let him do it.
Bill

I don't think he has a chance but I just thought I'd warn you.
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Old Nov 05, 2006, 12:19 AM
Build/Fly/Crash/Repeat
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Originally Posted by badaltitude
...healthcare would still be more expensive next year than this year....because the annual inflation of American healthcare costs is about 3 times the maximum estimate of costs caused by malpractice.
What's your proposed solution?
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Old Nov 05, 2006, 12:24 AM
Go get them Meg!
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Originally Posted by CoastalFlyer
What's your proposed solution?

The best solution would be to make fluctuations in the bond market illegal.
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Old Nov 05, 2006, 12:29 AM
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What's your proposed solution?
Simple.

Remove the profit motive. That's where the extra costs come from...and it also causes millions of hard working middle class Americans to be denied access basic healthcare.

Single payer.

Take a look at successful (and much cheaper)healthcare systems worldwide...the answer is inescapable.
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Old Nov 05, 2006, 12:34 AM
Go get them Meg!
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By all means, "Take a look at successful (and much cheaper)healthcare systems worldwide".
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Old Nov 05, 2006, 12:54 AM
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Originally Posted by badaltitude
Simple.

Remove the profit motive. That's where the extra costs come from...and it also causes millions of hard working middle class Americans to be denied access basic healthcare.

Single payer.

Take a look at successful (and much cheaper)healthcare systems worldwide...the answer is inescapable.
So you then, go to work and expect no profit?
'Course your mantra is of "one free from work" and therein you require everyone else to pay more in taxes to support you. (and your free medical care desire)
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Old Nov 05, 2006, 07:57 AM
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http://groups.google.com/group/rec.t...184d1644ee79ea
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Old Nov 05, 2006, 08:27 AM
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There's a point that I totally agree with.
But many will not support for fear of privacy.
Bill
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Old Nov 05, 2006, 08:50 AM
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Jeremy Paxman on the BBC did a fascinating comparative survey of various British systems (including the National Health Service, Education, Transport and the Prison System) and contrasted them with alternative systems from around the world...

the findings were interesting to say the least. The NHS was compared to the Cuban State system which runs on a tiny fraction of the the budget and equipment that the NHS has at its disposal + yet by almost all measures Cubans are healthier and longer lived than Britons.

Needles to say, being a poor country Cubans have a far healtier diet than Britons since they cant afford all of the sweets sodas and junk food that proves so fatal to our health and well being

big bird
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