I have of course heard of the rise in medical tourism, wherein people who are seeking medical treatment travel outside of their home country to recieve said treatment, most often because of the high cost within the home country. India is a very popular destination of medical tourists, and after our experience yesterday, I understand why.
Eric had been complaining for a day or so that his little finger on his right hand was hurting him. It was a bit swollen and a bit red so we applied a topical antibiotic to the cut and covered it with a Band-Aid. This continued until yesterday around noon when he called from work and asked if my friend Mamta, a M.D., might be able to look at it. I thought that he was being a little bit of a drama queen since it looked okay when we left for work just a couple of hours earlier, but I thought that Mamta and I would humor him. When we met up, it was obvious that something was really wrong because his finger had swollen to a huge and disgusting size and looked like a sausage about to pop its casing. We decided that we should go immediately to the hospital to get this looked at because it was so gross and Eric was in alot of pain. We set of to the nicest looking hospital that we could think of since none of us had ever really been in a hospital in Bangalore (Mamta has only been in Bangalore for 10 months or so). We knew that this hospital would be much more expensive than the typical hospital, but we didn't want to mess around just trying to save a few bucks. Little did we know that we had nothing to worry about.
When we arrived at the hospital we promptly filled out a brief registration form; name, birthdate, address, the typical stuff. It was so nice to not have to sit for forever filling out all of the insurance paperwork and all of the other crap that has to be done at US hospitals. We waited maybe five to ten minutes before we saw that surgeon who diagnosed the problem, and then waited maybe another five minutes before the procedure was started (they numbed his finger with a local anestetic and then made an incision to drain the fluid, and dressed it). He was done in about another ten minutes. We then took the prescriptions and the paperwork to the cashier to pay. I was hoping that it would be under 8000 rupees, which is about $200. I am not sure what the equivalent procedure would cost in the US, but when I dislocated my shoulder I am positive that we ended up paying at least a couple hundred bucks, and that was in addition to the pleasure of having been made to sit in a freezing ER for two hours with a shoulder out of socket before actually receiving any treatment. I was absolutely shocked when the total cost was 1772 Rs ($43.59). This price INCLUDES the cost of the prescriptions (a one week course of antibiotics and three days worth of pain killers). And also remember, NO INSURANCE. That is the actual cost, no strings attached. My god, my jaw just about hit the floor. I am still in a state of shock. And the other factor that makes the cost even more shocking is that the hospital that we were at is actually NICER than any hospital that I have ever been to in the US, so imagine what the cost would have been at a more typical Indian hospital; probably $30 tops. I thought that I would just include that price breakdown that was included on our bill for those that are interested.
Registration Fee-100 Rs ($2.46)
Antibiotic-806.74 Rs ($19.84)
Pain Killer-71.65 Rs ($1.76)
Surgical Blade-3.26 Rs ($0.08)
10CC Syringe-7 Rs ($0.17)
Sterile Gloves-33 Rs ($0.81)
Consultation Charge-250 Rs ($6.15)
Doctor Charges-500 Rs ($12.30)
So if any of you are needing any medical procedure and are looking for a bargain, please consider visiting us in India. We were so pleased with our experience, we are looking forward to our next injury.
Thursday, May 31, 2007
Reverse Sticker Shock
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13 comments:
You were ripped off on that surgical blade. I've never spent more than a nickel for one here.
What was wrong with your finger? I told you to stop carrying those little "treasures" home that you find roadside, you don't know where that stuff came from. Just kidding.
Hmm....I just had surgery 6 weeks ago and it ran about $10K (total cost, not my cost!), how much are tickets to India? Maybe I should have researched a little first and flown to India for a Wal-Mart priced surgery. Trouble is, just like you said Suzi, when you need to have something done, cost isn't usually the first thing that pops into your head, you just want it done and done right!
So Jeff, you finally decided to go ahead with the breast enhancement I guess? Hopefully Sandy is happy with the final result... Seriously, I hope that you are recovering well. I suppose that you are partially right in that you and I did not worry about the cost of health care before having a procedure done. Unfortunately, I think that the reality is that not all Americans have that luxury. The insurance and health care industries have inflated prices to such a degree that it is sadly prohibitory for a large section of the population, and thus health care is often sought as a last resort, and usually too late. I think that it is a sad commentary on the state of our health care system that when we receive our bill, we do not bat an eye at a $20 charge for sterile gloves or $10 for a Band-aid, let alone question the underlying cause for these outrageous inflations.
I agree with the low costs in India for medical bills, but they are really ai'nt low for Indian public. Rs.1772 is a real high cost for someone who is making just Rs. 10,000/month and has couple of kids and a wife to support, that too just to get a finger fixed...
One more aspect of this: A 5 year old living in india has leukemia. He needs a bone marrow transplant to get better. There are no bone marrow registries in India, no bone marrow transplant doc and facilites. Only option he has is, to go to some other country for treatment. Cost for that is almost impossible to afford for some one working in India with a normal salary. On the other hand, in US, one can recieve such treatments in a normal hopital setting. At least parents donot have to worry about basic infrastructure being in place for a child/adult to get treatment.
Overall...things are not always the way they look at first..there are always other aspects, which outweigh the advantages and disadvantages.
I think the cost of US medical treatment is high due to high standard of medicine, numerous regulation to project the patients, reseach, quality and security that comes from knowing that every thing possible is being done for one to get better...and usually cost is not an issue with Insurance...and even if it is expansive, it is still better than dying or living with terrible diseases due to lack of treatment...
There is one more thing involves high cost in USA.....People Sue or ask for compensation, Insurance lobby and lot other things.
Wow, you make some outstanding points in your argument. People in this country are quick to condemn our health care industry as being too expensive and demand nationalization, but I fear this would be the death knell for our system and it would greatly reduce the overall quality. If the treatment you receive is substandard, who cares if it is affordable to everyone?
Some people say Canada and France have perfect health care industries, but I have also heard accounts that this is not very close to the truth. Despite not having universal health coverage, this country still spends more per capita on health insurance than they do in Canada. So something does seem to be awry, and you touched on it by talking about malpractice insurance and other such issues in this country.
I have always felt that you get what you pay for, and that our health care industry is still the best in the world. This does not justify the entire cost inflation of the industry, but it does rationalize a large amount of the escalating costs in my humble opinion. If our health care industry is not as good as I think it is, than my logic is fatally flawed I guess. There does seem to be a disconnect somewhere, but I certainly do not feel that more government is the answer.
The little child I was talking, who had leukemia, has passed. It is such a loss, which could be prevented...
I am sorry to hear that the child has passed.
To Anonymous,
There are about three hospitals that I found in India that do Bone Marrow Transplants so your statement about there being no BMT doctors and facilities is false. India lacking a Bone Marrow Registry is true but a little odd. The current National Bone Marrow Registry is a network of hospitals in the US and various countries that happen to have socialized medicine. So India should be able to at least start their own registry if there is a pressing need for marrow. India has more than twice the population compared to the combined total populations of the US and international countries which contribute to the National registry. If a registry in India doesn’t exist then it is not because there is a lack of donors.
Your example of the guy not being able to “just get a finger fixed” because it costs 1772rs and he only makes 10000rs per month is ridiculous. You obviously must not realize that having an infected finger that is left untreated can turn into a really serious problem where you lose the finger or even worse. This wasn’t a trivial problem. Having a finger swell up to twice its size and turn albino white because it is filled with puss is a little alarming especially since I am dark skinned. Also having the constant waves of nausea from the pain wasn’t pleasant.
It also shows you know nothing about the current problems that people in the US face with health care costs. So let’s take your guy and move him to the US. He gets a job making twice the federal minimum wage and takes home $1140 a month after taxes. He is still uninsured, still has a wife and the same two children. Now he has to go the ER to as you put it “just to get a finger fixed.” Now I do not have the actual cost for this SURGICAL procedure for the finger but I do have the cost for a NON-SURGICAL repositioning of a dislocated shoulder that is definitely cheaper. The cost for this would be $1120. Now that only includes the doctor’s fee and the ER visit. Any pain medication needed would be a separate cost. Now this guy would need to spend an entire month's salary to get the shoulder (or finger) corrected.
People in the US may have access to the best medical care in the world, but what good is that if you can’t afford it. One of the problems people face in the US face is that the health care system discourages preventative medicine and early detection of problems. People do not want to go to a doctor for “just a finger” because it costs too much. So they could just ignore the finger or ailment and wait to see if it gets better on its own. However, they may run the risk of it becoming worse and needing a more expensive procedure than they would have needed originally to correct the problem. Maybe this is a case of the grass seeming greener in India, which is ironic since there isn’t really that much grass in India. Okay that is the end of my rant.
Jeff, I have to partially disagree with you about the more government thing. Any service that is required for our very survival should be apart of the Commons and as such should be maintained and owned by We the People. I do agree with you that Canada’s healthcare system does suck but what do you expect from the people that brought the world round bacon and poutine. Take that Canada!!!
Here is the page http://dhammo.blogspot.com/2007/02/appeal-for-help.html , which is prepared by the parents of a child, and in the paragraph: 7, it clearly states that there are no hospitals in India that do the MUD (Matched Unrelated Donor)transplants. I am sure these people have done exhaustive search for this treatment in India.
A Registry for bone marrow doesnot exist in India is definately not due to lack of donors...but due to lack of Infrastructure, and some initiative from Govt. That was the point I was trying to make.
Infected finger sure can turn deadly, it is a small procedure from cost perspective...but it is still expansive for average guy there....
I see that people who are not insured, can end up in lots of financial mess...in US, end result is same in India too...
Average people have very little money, even small doc visits and procedure can drown them in debt as well...most of the time, they too prefer to live them, than getting the treatment.
The point is that when some one is dealing with diseases such as cancer, people in India have no options...it is a terrible thing to know that you are dying because there are no options. In US, atleast the treatment is available with insurance...and to the people who can afford...
I would rather buy a very expansive bottle of water, than dying thirsty in desert.
Dear Anonymous,
Sorry, but I had to weigh in on your last comment. I did go to the page that you suggested and did a bit of research and found that the ONLY reason that MUD transplants are not done in India is due to the lack of a registry. As you rightly mention, this is due to a lack of infrastructure or prioritization on India's part. It should be noted that the National Marrow Donor Program (NMDP) in the US is not a government entity, but rather a not-for-profit that operates internationally. If it is a priority that this type of transplantation be available in India, then I feel that it is the responsibility of the people to take the initiative and set up a registry.
There is no question that medical treatment and availability of said treatment is much more advanced in the West in general, and in the US in particular. That has not ever been an element of this conversation. The argument that I have tried to make is that if that treatment is out of the reach of the average citizen because of the high cost, then it hardly matters for that citizen that the treatment is available. You say that you would rather buy an expensive bottle of water than to die of thirst, but I would argue that if you didn't have the money to pay for the water then it really shouldn't matter to you if the water is available or not. Either way you are not getting a drink because you can't pay for the bottle.
Thank you though for including the link to blog which outlines the costs for bone marrow transplants in the West as it further supports the argument that I have been making since my initial post. The cost of a bone marrow transplant in India costs around $25,000, the same transplant in France is $180,000, while in the US the cost balloons to $350,000. I am, of course, not saying that $25,000 is not a lot of money for the average Indian to cough up, but I can also guarantee that $350,000 is also a lot of money for most Americans.
I will try another example to put the relative cost of medical procedures to salary in the US versus that in India. I have recently switched from being paid in rupees for my work as a researcher by the Indian government to being paid in US dollars by the US government. In both cases I was or am making the standard going rate for someone in either country with my expertise in my field. Based on my Indian salary, if I needed a bone marrow transplant here in India, it would take me 4.7 years to pay for it (if I spent none of my salary on anything else). That is a horrible prospect. Now let's look at how long it would take me to pay off the equivalent surgery in the US based on my US salary (which, by US standards, is not too shabby). It would take me over 7 and a half years (7.7 years to be exact) to pay for the same surgery. That is three years more of work to pay for the EXACT SAME SURGERY. That is the point that I have been trying to make; if you compare both Indian and American salaries with Indian and American medical costs it is IMPOSSIBLE to argue that there isn't a fundamental issue with the cost of healthcare in the US.
So I guess that what I am saying is that in the US, the lower and middle class are priced out of even the most basic of health care while the wealthy have available to them the best and most comprehensive health care in the world. In India however, health care is proportionally much more affordable to the lower and middle classes when compared to the US. The upper class in India, who could afford difficult and complicated procedures, do not, unfortunately, have that option. I suppose that I am always rooting for the underdog (and as the majority of the populations of both countries fall in the middle and lower classes), so I am going to maintain that the health care system in India is a better overall system because it addresses the needs of the majority instead of catering to a small minority.
Anonymous,
I am sure the parents aren't idiots and did their due diligence in researching their child's illness. You however need to reread what you wrote originally. You said "There are no bone marrow registries in India, no bone marrow transplant doc and facilities." Sorry but what you said is wrong or at least extremely misleading. There are doctors and facilities in India for MRD (matched related donors) BMTs. However MUD BMTs and MRD BMTs are the same thing! The only difference is from whom the bone marrow is taken - either a sibling or a stranger. The main obstacle for doing a MUD (matched unrelated donor) BMT is actually having a matched unrelated donor. To find an unrelated match a bone marrow registry is used. I had already agreed with you that India does not have a registry. However, it is not because of a lack of infrastructure but a lack of will.
To have or build a registry to do MUD transplants you need donors, and lots of them. Here is the most important part; if you want to increase the likelihood of a match then it helps to have a registry that has people of similar ethnic background. Ethnicity can play a part in increasing the odds of finding a match. Of the millions in the national registry there is only a small percentage that is of South Asian decent. Again this does not preclude a match being found, but it does not help it. The reality is that the odds of finding a match if you are Indian or Asian in all the current registries is about 1 in 28 million. Maybe Piyush would still be alive if the feckless Indian government and the current Indian hospitals that do specialize in MRD transplants actually tried to jump start an Indian Registry so that one day MUD transplants would be available. India does have a lot of potential donors to work with since the population IS over a billion. If India had a registry then MUDs could be done in India and the cost of the procedure would be a great deal less than the $180,000 to $350,000 it would cost to do it in Europe or the US.
About your comment “at least the treatment is available with insurance” shows again that you do not understand the cost or availability of health insurance in America. Getting decent health insurance that is affordable and provides good coverage is difficult unless you have an employer that provides subsidized health insurance or you live in a state that happens to provide subsidized insurance. Those that do not have access to a subsidized insurance plan have to buy directly from the insurance company which can be costly. For example, COBRA insurance can cost a person anywhere from $100 to $700 a month in premiums which is money paid each month just for the privilege of having the insurance plan. When you actual have to use the insurance to cover a procedure there can be high deductibles and limits on what and how much is covered. Also some plans might have rules about not covering any procedure that is a result of a pre-existing condition.
Let me put this in personal terms. I have a good employer based subsidized insurance so the premiums that I pay are extremely low. My plan would arguably pay for 80% of the costs for a Matched Related Donor BMT. The BMT in the US would run about $350,000 so I would only have to come up with $70,000 to cover the remaining costs. Again that does not include all the medicine and any follow-up treatments or visits. Honestly, I would have no clue on how I would pay for the $70,000 of medical expenses and most American’s wouldn’t either. Even with the help of insurance this is still 3 times what it would cost to do a MRD BMT in India. Bottom line is that people in the US can struggle with paying for just the monthly premiums for the medical insurance. Even if they have insurance it is still not a golden ticket to treatment due to the inflated cost of healthcare in the US.
You said, “I would rather buy a very expensive bottle of water, than dying thirsty in desert.” If you can’t afford the water then you would still die thirsty. You are essentially saying that money is irrelevant. If you honestly believe that then you undercut your entire argument of Indians not having options. They can travel to Europe or the US to get the treatment they need since you already made money a non-issue.
Maybe you should reread that blog link you posted and especially paragraph 7 again. The difficulty for Piyush and his family is not really the lack of MUD BMTs in India. The root cause is money. They have the option of going to the US or Europe but they can not afford the procedure. They would experience the SAME problem if India actually had MUD BMTs available but the procedure happened to cost 1.6 Crore Rupees or $350,000. So they could not buy that “very expensive bottle of water” that you quipped about.
Eric's 6 cent surgical blade has started quite an interesting back and forth! I cannot respond to everything, because time simply doesn't allow. But I do want to throw my two cents in (1/3 the cost of a surgical blade in India) as to why free markets have failed our health care system. Well, I don't even consider it to be a free market system. I don't know what you call it. If I want to buy sunglasses I can look on eBay, go to Oakley's website, check out an outlet mall, or even go to Target and make a decision based on what I need and what I want to spend. How many people are able/willing to price check medical procedures? There is zero accountability in our health care industry because they know that people are not going to question the price or simply go somewhere else. I tried to find out what my back surgery was going to cost and nobody even knew! No one at the hospital that is. I was dumbfounded. How can you not know what you charge for something?
I like that you were able to go online and compare prices for the same procedure in three different countries. I especially like that you adjusted the price relative to two different pay scales that you are familiar with. That is what is missing in our system, information. The health care industry controls all the information, the people who need care are completely in the dark as to why something costs as much as it does. Asymmetry of information has caused the cost to spiral out of reach for many people. If the cost of various procedures were well known and publicized both here and abroad, they would be forced to keep their prices in line. If I knew that my surgery cost $15,000 at Mercy, $10,000 at the U of Iowa, $500 in Bangalore, or $1000 of physical therapy to avoid surgery, I would have a serious decision to make. Are the doctors all of comparable skill? Can severely herniated disks permanently heal with physical therapy alone? How much does a ticket to Bangalore cost? But I don't know the answers to those questions, the hospital could only give me a 'ballpark' number, plus or minus a few thousand dollars. In my naivete I originally went to the hospital's website and tried to find out what different things cost!
So I guess I am trying to say that the system is broken not because the government is not involved, but because there is asymmetry of information. In a free market system one party does not possess more information than the other party, so it is not correct to call our health care industry a capitalist system. I have no idea what it is. An oligopoly by insurance companies is probably what you'd have to call it. And I want to throw one more thing out there, Suzi, the hospital never asked me how I was going to pay for my share of the bill. Maybe that was because I had insurance, but the part that I'm responsible for can be paid to the hospital pretty much however I want to pay it. There was no chance they would deny me the surgery if I didn't have the cash on hand for my out of pocket expenses. Like I said, maybe they would have denied me if I didn't have insurance and couldn't prove that I had the money, but they seemed very flexible about payments. Rather than just giving them all of the money now, I am just going to pay them a smaller amount over time. If they allow you to do that (no interest of course), there is no reason why one shouldn't do that. A dollar a year from now will be worth less than a dollar today! Sorry for all the rambling, most of this is just based on my personal experience and I have very little to back anything up, just baseless claims! But it is fun to discuss this with Sicko all over the news here in America. It was great to see you while you were here, glad you had a safe trip back!
The reason I was talking about the insurance to cover the cost of such treatments in US, was that you donot end up paying 20% of $350,000(your portion of cost with mot insurance), there is a indiviual out of pocket max approx 2000-3000 and for family max $5000-6000. That is a very small price for this treatment. That doesnot take 3 years to pay. The child which I originally mentioned, had passed due to cancer, was son of a doctor. A doctor will have a subsidized insurance that will cover most part of the treatement cost for the that child, if a similar case was to happen in US.
But even a doctor (a person with a top income bracket in India) could not get his child the treatment, instead in midest of all the pain and worry that came from that situation, they had to worry about raising such high amounts of money just by public donations.
So here is the money factor comes in....the kind of money that is needed to get this treatment in India is almost impossible to raise. However if a person works in even in a salon, Walmart, or Dominics can get health insurance in US from employer. We are talking about the majority here...if at least one person works in family the whole family gets the health insurance. Well..if some one has a family, and doesnot want to work at all and still wants to get insurance..that is a whole different story...
Does it matter, why they cannot have MUD transplants done in India...the end result is what matters...It could be due to lack of registry, lack of facility..I am sure it will not consol the parents of that child. All they would have wanted was that treatment was available to them in India, even with the cost being abnormally expansive even from Indian standards.. and the child possibly, was still with them.
So it is things come back to the same point: a person who is very well capable of affording things in US, can afford them...however in India, he cannot do it...because they DONOT EXIST (due to reasons like lack of registry, boils down to the same). Amount needed for foreign travel and treatment is not an option...cancer doesnot wait for raising all that money. Only a few top industralist have it in their account ready. Bottom line is loosing a precious child due to LACK of treatment.
Anonymous,
I have put up with your thread hijacking and trolling for long enough.
I am glad you brought up the max out of pocket expense. For my plan I do not think that transplants qualify under the max out of pocket expense but I could be wrong. For the sake of argument let's assume that you are right and it does qualify. My insurance has a huge caveat regarding max out of pocket expenses. It depends on what they deem as being "eligible" costs that go toward the out of pocket max and also whether or not they will cover the procedure in certain cases if they feel like the procedure is unnecessary. Most insurance plans can completely deny coverage for a BMT which would leave the insured to pay the full cost. Or they can limit coverage by deeming parts of the whole BMT process to be not eligible or needed. Either way these loopholes have been easily and repeatedly exercised or exploited by insurance providers. I have had a few medical claims in 2005 that my insurer deemed parts of it not eligible and that did not go toward the out of pocket limit.
Other people have experienced the same things with various insurance companies especially when they tried to file claims for BMTs. Actually there a number of lawsuits settled and pending against insurance companies, of which my insurer is a defendant, trying to get them to cover BMTs even though the plan says that the procedure should be covered.
Not all insurance plans treat BMTs and other transplants as "regular" medical procedures subject to the normal out of pocket expense which you refer to above. Some plans have a separate max out of pocket cost for transplants that can be anywhere from $100,000 to $200,000. There are also plans where there is a max limit that can range anywhere from $20,000 to $200,000 on what the insurance plan will PAY for transplants. Again, how is someone going to pay for the balance if the overall procedure and follow-ups can run $300,000?
You said, "However if a person works in even in a salon, Wal-mart, or Dominics can get health insurance in US from employer."
Yeah, I am sure that Supercuts provides affordable comprehensive health coverage for ALL their employees. Also are you sure you want to bring up Wal-mart in a discussion about healthcare? Places like Wal-mart can purposely limit hours to employees to avoid providing them health insurance. The average Wal-mart employee makes about $8 per hour which equates to $11500 per year after taxes. Assume that the employee chooses the cheapest and most limited Wal-mart plan they still would have to pay about $2600 annually in premiums alone. Also Wal-mart's plans have really high out of pocket expense limits, deductibles and/or coverage gaps that require supplemental insurance to be purchased. As of now only about 44% of Wal-mart's work force is covered under their health plan.
You said, "We are talking about the majority here...if at least one person works in family the whole family gets the health insurance. Well..if some one has a family, and doesnot want to work at all and still wants to get insurance..that is a whole different story..."
Equating the uninsured with those who are lazy and unemployed is ridiculous and insulting. My wife was raised on a farm and her family had no health insurance due to the costs being too high. Farmers like other small business owners struggle with health cost. If you would like to suggest that these people are not hard workers then I challenge you to do their jobs for a day. If you are going make inflammatory statements then I suggest you get your facts straight. As of 2006, there are 20 million uninsured Americans working full time jobs and 6 million uninsured working part-time. You can be the head-of-household and working but not qualify or afford health insurance for your family.
I am not going to even comment AGAIN about the other dreck you mentioned because all of this has become tedious and annoying. I have agreed that certain procedures are not yet a reality in India, but you are so myopic that you refuse to engage in thoughtful discussion about anything else. You are still missing the overall points raised so far but whatever. Being anonymous does not give you a green light to troll.
This thread is officially dead.
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