The outsourcing of health care

Pre-Med & Medical School Pre-Med Topics
1

<p>I seem to recall several former posters on CC who shall remain unnamed who were quite, shall we say, "vocal" that medicine could never be outsourced. Au contraire. According to an article in the latest BW, not only is medical outsourcing occurring, but the insurance industry is actually encouraging its growth as a way to cut costs.</p>

<p>Consider the following quote:</p>

<p>*"Getting covered employees to leave the U.S. won't be that hard, says Edelheit. An insurance company could waive all deductibles and co-pays, offer to cover travel costs for the patient and family members, even throw in a cash incentive, and still save tens of thousands of dollars. After all, a heart procedure that costs $100,000 in the U.S. runs only $10,000 to $20,000 at some of the best private hospitals in Asia. And the quality of care? Foreign hospitals in such arrangements are typically approved by Joint Commission International, part of the same nonprofit organization that accredits American hospitals" *</p>

<p>Outsourcing</a> the Patients</p>

2

<p>sakky, this is already happening in our area. I know locally of one large company that is encouraging surgery in Asia. They are really pushing the ortho procedures like hip replacements. The company (or their insurance) pays the travel, the hotel stay (and for one family member), the cost of the procedure .....plus pay a "bonus" to the employee for going this route. Our friend, who is owner, says many employees have taken this option.</p>

3

<p>You don't have to convince me. Indeed, I have been watching the growth of medical tourism/outsourcing for some time now. </p>

<p>I posted the article in order to convince those who still refuse to believe that such a thing is possible and that medicine is somehow "immune" from outsourcing. It isn't, and people shouldn't think otherwise.</p>

4

<p>Another example of outsourcing healthcare.....at some hospitals during off-peak hours, they have doctors in india read x-rays and other films rather than having an actual radiologist on duty.</p>

5

<p>Also, a lot are having their dictations transcribed over seas...leads to some interesting interpretations of what you dictated when you see them actually typed up...</p>

6

<p>
[quote]
Also, a lot are having their dictations transcribed over seas...leads to some interesting interpretations of what you dictated when you see them actually typed up...

[/quote]
</p>

<p>Interesting that you should say that. The Radiology department here no longer has a dictation transcription service - they use in-house software now. I asked the radiologist I've been shadowing why the department switched, and it turns out that having a radiologist transcribe their notes theirself is faster, cheaper, and more accurate than using a telephone service.</p>

7

<p>
[quote]
I posted the article in order to convince those who still refuse to believe that such a thing is possible and that medicine is somehow "immune" from outsourcing. It isn't, and people shouldn't think otherwise.

[/quote]
</p>

<p>But its still a more risk averse choice than say engineering.</p>

8

<p>student14x,</p>

<p>Why would medicine be more risk adverse? To the degree that insurers incent folks to choose less expensive options, as described above, our medical establishment is out of the picture. </p>

<p>The interesting question in my mind is what liability the insurer might have for bad outcomes? I suspect there are legal liability shields in place for insurers, whether through ERISA or state law, but do not know. Sakky, any idea?</p>

<p>Curious concept - travel to India or China for a TKR. Hope those patients get extra legroom for their return flights...</p>

9

<p>
[quote]
Why would medicine be more risk adverse?

[/quote]
</p>

<p>It is in the sense that if get an MD, then you'll be a doctor. The same can't be guaranteed for those with degrees in engineering.</p>

10

<p>Yeah, the DVT risk must be a nightmare unless you're going to keep them there for six weeks afterwards.</p>

11

<p>
[quote]
Curious concept - travel to India or China for a TKR. Hope those patients get extra legroom for their return flights...

[/quote]
</p>

<p>
[quote]
Yeah, the DVT risk must be a nightmare unless you're going to keep them there for six weeks afterwards.

[/quote]
</p>

<p>I understand this is a facetious topic, but on a serious note, if they were to indeed perform TKR, I would assume that you wouldn't be 'flying coach'. Rather, I assume that you would be flown in some sort of medical air transport: the same way that special-needs patients today are sometimes flown to a particular hospital in the country in order to receive specialized treatment. Outsourcing would simply extend such medical transportation beyond national borders. Given the difference in costs, I strongly suspect that patients with particular surgical needs might be flown to a particular country, receive a procedure, and flown back, and the total costs might still be lower than just having the procedure done in this country. For example, as shown in the article, a heart bypass in Singapore costs 1/7 of what it costs in the US, yet I think few people would dispute that Singapore is a wealthy nation with reasonable health care quality.</p>

12

<p>
[quote]
It is in the sense that if get an MD, then you'll be a doctor. The same can't be guaranteed for those with degrees in engineering.

[/quote]
What? If patients all go overseas, you can sit around and call yourself doctor all day long and it won't matter -- the same way engineers can sit around calling themselves engineers even if nobody wants to hire them. This is nonsensical.</p>

13

<p>
[quote]
The interesting question in my mind is what liability the insurer might have for bad outcomes? I suspect there are legal liability shields in place for insurers, whether through ERISA or state law, but do not know. Sakky, any idea?

[/quote]
</p>

<p>Well, actually, I think this whole topic begs a more fundamental economics question: why exactly is US health care so darn expensive, relative to the rest of the world? For example, like I said, a heart bypass in Singapore costs only 1/7 of the price in the US. So why is Singapore able to deliver health care services at such a low price point, and, more importantly, why can't the US do that? It can't be a matter of low labor costs * per se*, for Singapore is not exactly a cheap country; in fact, Singapore has one of the highest per-capita GDP's in the world. Nor can it be a matter of poor infrastructure or institutions; on the contrary, Singapore has been widely lauded as having one of the best-run business infrastructures and stablest governments in the world. </p>

<p>I personally suspect that egregious waste permeates the US health care system. As a case in point, a friend of mine, who is studying for his PhD in Health Policy, was conducting a field study on how hospital staffers conduct their job. He was called into one of the weekly staff meetings that was lavishly catered with not only some of the best gourmet food he had ever seen in his life, but also top vintage wines (yes, that's right: *wine * was served in a hospital). Granted, this was an after-hours meeting, and only people who had finished their shifts were drinking the wine, but still, my friend found it quite bizarre that a hospital would be serving wine to its staff. In any case, he estimated that there was probably $1500 worth of food and drink (largely the wine, which was quite expensive) served at that meeting. Nor was this an unusual meeting: *such meetings were held every week. * </p>

<p>But - here is the greatest irony of all - what exactly was the agenda of the meeting in question? How the hospital could cut costs (!). Can you believe that? What's wrong with this picture? My friend is going to have a field day writing about this incident in his dissertation.</p>

<p>Now, granted, one might argue that in the grand scheme of things, even weekly meetings like this, however excessive the costs, are not particularly impactful upon the bottom line. For example, $1500 * 52 weeks a year is still only $78k a year which, granted, isn't that much when compared to the rest of the total hospital budget. However, I think what is salient is how the incident demonstrates the cavalier attitude that the hospital staff has towards costs.</p>

14

<p>How about medical outsourcing to Israel:</p>

<p>""Then there are the Americans, who come here because they can get first-rate health care for a fraction of what it would cost them in the U.S. For example, an American with no health insurance would pay $120,000 for bypass surgery in the U.S. At Hadassah the procedure costs $35,000, and that includes all the necessary arrangements, such as airfare, accommodations and food for both patient and family. This means that ultimately, even with all the added expenses, the patient pays less than one-third of what the same operation would cost in the U.S." "</p>

<p>Welcoming</a> the world's ills - Haaretz - Israel News</p>

<p>Or consider Canada:</p>

<p>"uninsured Americans -- estimated at 47 million -- visiting the Canadian clinics will
be able to save "up to 30 to 60 per cent" off U.S. costs....[for a hip replacement in Canada] the cost is $18,000, while in the U.S. the cost is $39,000"</p>

<ul>
<li>Kusch, Larry. "Surgery in Canada Marketed to US Patients". Winnipeg Free Press, 12/06/2007</li>
</ul>

<p>Here's a story about Costa Rice and Singapore. </p>

<p>"For Dianne Cramer, going to Costa Rica a year ago for a hip replacement was a boon. Before the operation,
the Lakeland, Fla., resident was in so much pain, she says, "that I couldn't get out of the car without crying."
At 64, she was too young for Medicare, which starts at age 65. Her husband, who owns an advertising
company, had canceled their insurance because of soaring premiums.
So, through the Internet, Ms. Cramer's son found a medical-tourism agency that provided information about
overseas hospitals, including Hospital CIMA in San Jose. She ended up paying about $14,200 -- including
$10,000 for the doctor's fees and a three-day hospital stay, an additional $2,500 for 10 days at a
rehabilitation facility and $1,700 for round-trip first-class airfare -- compared with the $44,000 she says it
would have cost her for the surgery and hospital stay back home.
"The doctor did a really good job," she says, "and I don't hurt anymore."</p>

<p>Now, some employers are offering overseas options for their workers. Hannaford Bros. Co., a supermarket
chain based in Scarborough, Maine, is one of the first companies in the U.S. to include a foreign hospital in
its network of providers. On Jan. 1, the company added National University Hospital in Singapore -- but to
start, just for hip and knee replacements. The cost for hip replacements is about $10,000 to $15,000,
compared to more than $40,000 in the U.S.</p>

<p>Generally, under the Hannaford health plans, the company pays 80% of an employee's medical costs -- until
the worker reaches an out-of-pocket limit of $2,000 to $3,000. For an employee who goes to Singapore for a
hip replacement, Hannaford will pay the entire medical tab; the worker won't have any out-of-pocket costs. In
addition, the firm will pay for travel costs, including airfare and lodging for the patient and a companion, up to
$10,000.</p>

<p>Free</a> Preview - WSJ.com</p>

15

<p>
[quote]
What? If patients all go overseas, you can sit around and call yourself doctor all day long and it won't matter -- the same way engineers can sit around calling themselves engineers even if nobody wants to hire them

[/quote]
</p>

<p>Thats if all patients go overseas. Really would someone go overseas just to get a checkup? No. What about medical emergencies? You see my point? But with engineering, its possible that most if not all projects get outsourced.</p>

16

<p>I had a friend who went to have a knee replacement done in Thailand, since he'd semi-retired and had no health insurance, this was the only way he could afford it.</p>

<p>According to him, the hospital was more modern than what he's experienced here - (coincidentally or no, he went to have the replacement done to repair the damage of his previous two surgeries here, which left him in constant pain. And, the doctor in Thailand opted against the knee replacement, saying it was unnecessary, and he performed a much more minor, and very successful procedure, which left him pain-free.)</p>

<p>Anyway, he asked his doctor how they could such medical care so cheaply. </p>

<p>First, was that the patients paid in cash, prior to the service. No collections, no deadbeats, no insurance company denials -- and no jacking up the fees for everyone to cover them.</p>

<p>Second - virtually no malpractice lawsuits. The standard for getting an award is very high, you're not going to get a judgment because of negative outcomes, like happens so often here. So, malpractice insurance is far cheaper. </p>

<p>Third, everything is cheaper in Thailand - labor, housing, food, etc.</p>

<p>fwiw, my friend was interviewed in the broadcast part of this story: Vacation</a>, Adventure And Surgery?, Elective Surgeries By World-Class Doctors At Third-World Prices - CBS News</p>

17

<p>Wow. This is a very interesting topic indeed.</p>

<p>I believe that the medical industry isn’t immune to outsourcing. We are living in the Information Technology era and with the advances of almost everything right at the tip of our fingers, almost every industry is affected; whether we like it or not.</p>

<p>Outsourcing isn’t something we should fear. It’s something we can enjoy for it helps in achieving goals faster and economically. It’s time efficient. </p>

<p>Just a thought. :)</p>

18

<p>

</p>

<p>You’re not premed, are you?</p>

<p>I also wonder what will happen if an insurance company forces a patient to go abroad for a procedure and something goes wrong…which is bound to happen…</p>