Medical Tourism for U.S. Proletariat

[Spartan_Warrior]

For those of us in the U.S. with expensive and ineffective private health insurance (so, all of us)... anyone have any experience with medical tourism? Any particularly good countries/facilities for U.S. citizens to undergo expensive procedures at a reasonable, non-life destroying rate? Particularly for lazy folks like me who speak only English and a negligible amount of Spanish, Latin, and C++.

I've heard Thailand is good?

[RealPerson]

I have some personal experience with health care in other more - or less- developed countries. The quality varies a lot between facilities and providers, even in more developed countries. The variation is greater than in the US, but even here there is variation between facilities and doctors.

You would need to do some research before committing to a provider. I am not sure how to do that. The things I worry about are the critical steps taken by lower paid staff. For example, it is difficult to control infection risk between patients. Yes the doctors play their role, but what the staff does with instruments and treatment surfaces is at least as important. Are you sure that the needles are trown away after one use? Are vials of injectables thrown away after a single use? How well are these people trained and are they given the extensive necessary resources to accomplish this task? I don't know how you find that out, unless you have knowledge and can observe from the inside.

[almostthere]

I have used medical services in at least six countries, from very third world to London. Anything in a major city in the second world will be just fine. Many hospitals will have a English language or foreigner unit that will coordinate your visit.

It also depends on what you want done. I'd do basic dental services in any country on the planet. Basic surgery or child birth, second world is fine (Mexico, South America, most of Asia, Eastern Europe). I'd do more advanced things myself, but I have seen enough to know that your first world biases are just that biases. Once you have done it a couple times you will never have expensive medical work done again in the States.

[Ego]

I have personal experience with Bangkok (Bumrungrad Hospital). The were fabulous for an eye infection and travel vaccination clinic. When we were there about ten years ago the nurses all looked like models and wore the traditional nurses uniform from the fifties. Mrs. Ego says I get sick every time we go to Bangkok in hopes of having to go to the hospital.

There is also a great outpatient clinic in Kathmandu across from the British Embassy where I had a few X-rays after a fall. They cater to the expat/embassy community but their prices were good and service was incredibly fast. I walked in, saw a doctor, got x-rayed, and got the results within an hour.

I had a crown replaced in Morocco a few months ago by a French trained dentist for US$40. He commented on the high quality of my other crown which he assumed was done in the US. It was actually done in India.

I'm not sure I would have major surgery in India but I wouldn't hesitate in Thailand and in most major cities in Latin America.

[RealPerson]

I think you can have an excellent outcome of care in many places.

Here is an example of what I worry about. A very respected, properly trained, with apparent proper infection control procedures oral surgery office in New Mexico had a significant heptatitis C outbreak. The CDC got involved because it was a mystery how this could happen. The CDC used genetic sequencing to verify that all the patients were contaminated from the same source. They were. A detailed analysis of the infection control procedures in the office showed no apparent deficiencies. Ultimately, the outbreak was traced to a handpiece that a staff member had not been properly cleaning and sterilizing. Trace amounts of hepatitis C virus from an infected patients were lodged in the handpiece and had contaminated several other patients. This stuff happens. Hepatitis C, although now finally treatable, is a very serious disease with an incredibly expensive treatment cost. The virus is very stable and highly contagious. As a patient, you would not know about this problem until you get tested for some reason. You may be very pleased with the outcome of your medical (or dental) procedure, but ctach a serious communicable disease without knowing it. Just some food for thought. This situation in New Mexico took the most sophisticated infectious disease agency in the world a lot of effort to figure it out. I feel quite confident that such a level of infection control procedures and investigation of problems would not be available in most places in the world. Just some food for thought.

[luxagraf]

the most sophisticated infectious disease agency in the world a lot of effort to figure it out.

haha. good one.

And FWIW, I had a very similar experience to Ego's at the same hospital in Bangkok. When I first got there I honestly thought some kind of very sophisticated joke was being played on me. But I got get service and care.

[RealPerson]

the most sophisticated infectious disease agency in the world a lot of effort to figure it out.

haha. good one.

I don't get the humor. I know of no other infectious disease institution that has a higher level of expertise. Please elaborate if you do. I am very curious to hear if you know of one.

I can understand that your experience in Bangkok was a good one. My daughter was treated in the same hospital, and our experience was good also. I am not an America-centric -rest-of-the-world-is-inferior fanatic. I just know the infection control procedures in different psarts of the world and in different types of facilities. Some problems are invisible to the patient but have serious consequences later on.

[The Old Man]

Thailand comes highly recommended.

[Scrubby]

I recommend trying to find some hard data about results before selecting. I know Thailand is popular because of their very welcoming staff, but their survival rate and chance of complications for serious operations were significantly worse than most western countries when I checked a few years ago.

[bad_LNIP]

Malaysia openly advertises for Medical Tourism. The Philippines is a good place as well I hear. Good, trained doctors, cheap health care. If you are in the US, there should be plenty of good doctors between Mexico, Ecuador, Costa Rica, Panama, and Argentina. Like with anything, you need to do your homework and check on things, get referrals, etc...

They say 500k in people visit Malaysia for health care per year so they must be doing something right.

http://www.mm2h.com/malaysia-healthcare.php

[luxagraf]

the most sophisticated infectious disease agency in the world a lot of effort to figure it out.

haha. good one.

I don't get the humor. I know of no other infectious disease institution that has a higher level of expertise. Please elaborate if you do. I am very curious to hear if you know of one.

Oh I'm not saying anyone is doing better (I have no idea) I just find "sophisticated" and "government agency" in the same sentence inherently funny. I'm sure the CDC has their good people and their bad ones, like any employer, but I don't think they're going to have any effect on how safe your medical care is in the U.S. My understanding of the process is that if the CDC shows up it's because you're already dead/exposed.

[RealPerson]

Oh I'm not saying anyone is doing better (I have no idea) I just find "sophisticated" and "government agency" in the same sentence inherently funny. I'm sure the CDC has their good people and their bad ones, like any employer, but I don't think they're going to have any effect on how safe your medical care is in the U.S. My understanding of the process is that if the CDC shows up it's because you're already dead/exposed.

I totally get that. And you are correct that CDC is typically involved after the fact. They do have incredible resources to discover stuff that is difficult to figure out. The lessons learned from unusual cases (remember the Florida dentist who infected patients with HIV in the early 90s) do benefit patients overall, because the standard of care is improved based on such findings.

Countries where you have no legal recourse if things go wrong can do away with defensive medicine. That cuts cost dramatically. Some type of tort reform will be needed here in the US if we want to keep costs under control. So much is done in health care that does not benefit patient care. It is red tape, protective action from lawsuits, incredibly expensive pharamceuticals and a very expensive system of interventional medicine. It all adds up to a ridiculous price tag. The US has a very high tech medical system that can save lives, but the value proposition is severely compromised because the cost is so excessive. For many routine procedures, overseas care is very satisfactory and much cheaper. You just have to do your homework.

[Ego]

I agree about Hep C / HIV concerns. I'm also vigilant when getting a haircut. The moment I see them going for the straight razor I stop them.

When we need to find a provider we generally ask the expats and then look for online reviews. It's amazing how Yelp, Trip Advisor and google reviews can do what their governments can't by acting as a crowd sourced governing body. Fair or not, these providers often recognize that a few bad reviews can turn off the tap of lucrative foreign patients. The dentists I've used are sensitive to the fears of international patients and go out of their way to show that they are using instruments that have autoclaved and sealed.

[FRx]

I realize you are asking about medical care in other countries but I can tell you that if you are willing to pay cash (which you would be doing in other countries) then you are most likely going to be paying the same price here.

Here is some bad analogies but if you have auto insurance and got rear ended you can take your car to a facility that will charge this shit out of your insurance and fix the bumper with all the bells and whistles. Your insurance might go up and you will pay your deductible. If you take that same care to a reputable auto body s/he will fix it for you for sometimes less than your deductible.

If you need a gallbladder removed you can pay your copay with some insurances which may only be $150 to have it done. But you will pay $25 for you doctor visit, $100 for the ultrasound. $30 for your medications (before and after the surgery). $50 to see the surgeon for a pre-surgical consult and then 2-3 follow up visits. $50-200 for blood work. And if you are above age 50 the anesthesiologist may want to see you as well before agreeing to put you under which may then involve more blood work, routine chest xray, EKG. You will have some other unnecessary visits that healthcare providers are used to doing mostly to bill and also to prevent complications which may result in law suits/complaints.

If you had some abdominal pains that you researched and thought to be due to gallstones then you could see a private general surgeon in his/her office and they may charge you $100 for the office visit, do a bedside ultrasound for no charge, confirm that it's gallstones. You and the surgeon would then agree on a flat fee for the surgery anywhere from $500-1000 and s/he may even agree to see you in their clinic one time for follow up. This will require you to be proactive, do research, talk to others, look up that physician and plan out and anticipate and potential complications which all isn't hard to do with the information that's available these days.

In summary I doubt you would pay much less in other countries for the same procedure. Though granted, the whole process would be easier and more streamlined for you.

[fiby41]

Currently Thailand is the most popular country for medical tourism followed by India.

Here is a tongue in cheek video on the subject interspersed with anecdotes and $s saved figures,

Starts at about 3:20
https://youtu.be/qs_gYUVO_0k

[thrifty++]

Personally I am uncomfortable with undertaking medical treatment where there is no recourse to legal action. No way to protect yourself if things go wrong. Mind you in NZ it is very hard to sue a doctor because the govt is liable for all medical misadventure, except maybe a complaint to the medical council to tell the doctor off. But at least you get all your losses paid by the govt. I always thought if I go to Thailand and get something done which goes wrong and causes me to be unable to earn any income I will be in deep shit.

[Chad]

Personally I am uncomfortable with undertaking medical treatment where there is no recourse to legal action. No way to protect yourself if things go wrong. Mind you in NZ it is very hard to sue a doctor because the govt is liable for all medical misadventure, except maybe a complaint to the medical council to tell the doctor off. But at least you get all your losses paid by the govt. I always thought if I go to Thailand and get something done which goes wrong and causes me to be unable to earn any income I will be in deep shit.

Aren't you in deep shit either way? It's unlikely that something that prevents you from earning an income allows you to live long. Of course, there are certain specific conditions that could, but overall it's basically a march toward death if it doesn't work.

[thrifty++]

No I don't think so. I think there are loads of things which could go wrong which could prevent you working but which dont kill you. Eg back issues. Contraction of a disease. damage affecting the limb of the hand you use. Things affecting the lower limbs. Could be countless things. Also loss of income is not the only thing which you can seek damages or compensation for.

[Chad]

My point exactly. Money isn't fixing you.

[thrifty++]

Personally I would find it much more reassuring though to know there is recourse to obtain financial assistance to ease that worry while everything else is going on.