Wednesday, July 25, 2007

Are You A Good Candidate For Medical Tourism?

Here's a quiz I wrote at the request of my colleague and fellow BCG alum, David Williams who runs This is a site dedicated to international medical travel (also called medical tourism) for Americans.

Many factors go into deciding whether you are a good candidate for going abroad for a particular procedure and a destination you may have in mind. Reducing these into a single quiz runs the risk of over-simplification. The scores and conclusions from it are not a substitute for common sense and are certainly not medical advice. But they can give some idea about your suitability. There's a reason why some choices are not labeled in continuous alphabetical order.

10 Question Quiz:

1. How much traveling have you done?

a. A lot, including to the region where my intended foreign hospital is located
b. Quite a bit by air, though not to my intended medical travel destination
c. Rarely by air, though some by ground (driving, train, etc.) in the US
d. Never / hardly ever

2. How fit are you to travel?

a. My doctor and I foresee no / hardly any problems
c. I am at very low risk, and can further minimize this with precautions
e. My risk is quite low, but much higher than for an average traveler
f. My doctor has advised against air/extended travel under any circumstances

3. What is the treatment and recovery time for the procedure (before you can fly back)?

a. Less than a week for minor procedures, 2 weeks for major ones
b. 7 - 10 days for minor procedures, or 2 - 4 weeks for major ones
c. 10 - 20 days for minor procedures, or 4 - 8 weeks for major ones
d. Over 20 days for minor procedures, or over 8 weeks for major ones

4. What is you financial situation?

a. Very tight. The savings from foreign treatment will save me from bankruptcy
b. So-so. I can just about afford US care but take a large hit to my savings
c. Comfortable. I can easily afford the US care but will welcome savings
d. Very good. Paying for US care is not a problem at all

5. Approximately how much will your intended treatment cost you in the US?

a. More than $50,000
b. $30,000 - $50,000
c. $10,000 - $30,000
d. $4,000 - $10,000 ($2,000 - $10,000 if you're driving distance away)
f. Below $4,000 (below $2,000 if you're driving distance away)

6. Is the added privacy and anonymity of treatment abroad (e.g., cosmetic surgery) important to you?

a. Very important
b. Somewhat important
d. Not a factor
e. Quite the opposite - I strongly prefer lots of friends and family close at hand

7. How much do you expect to save through treatment abroad?
(Consider your out of pocket costs, factoring in your insurance coverage, if any.)

a. Over 75% of the cost AND this works out to over $10,000
b. 50% - 75% of the cost AND/OR this works out to $5,000 - $10,000
c. 30% - 50% of the cost AND/OR this works out to $5,000 - $10,000
d. 15% - 30% of the cost (0% - 30% if your answer to "6" above is "a")
f. Below 15% of the cost (but choose "d" if your answer to "6" above is "a")

8. How much do you value sight-seeing and the experience of going to a new place?

a. Very important - it's one of the reasons I want to go abroad
b. A good side-benefit but my treatment quality is by far my key priority
c. Hardly matters - but if it helps pass the time while recuperating, that's nice
d. I dislike unfamiliar surroundings, and dread going to a new place

9. Are you familiar with the culture and the language spoken in the country you plan to travel to?

a. Very/quite familiar, and most or all of the people there speak my language
b. Not too familiar, but most or all of the people I'll be with speak my language
c. Not familiar, but many people at the hospital and hotel speak my language
d. The doctor and some of my hospital and hotel staff speak my language

10. How internet savvy are you?

a. Excellent at researching through Google (or equivalent), regular email user
b. Use email; occasionally surf the internet
c. Rarely use email or internet
d. I don't use the internet (someone else is helping with this quiz!)


Give yourself 3 points for an "a"; 2 points for a "b"; 1 point for a "c"; zero points for a "d"; minus 3 points for an "e"; and minus 15 points for an "f".

Add your points and rate yourself for the condition and destination that you have in mind:

25 - 30 points: You are an excellent candidate
20 - 24 points: You are likely still a very good candidate
15 - 19 points: You may gain significantly from this option, but weigh it carefully
6 - 14 points: The pros of your medical travel are probably outweighed by the cons
5 points or below: There's no place like home, including for medical care

Sunday, July 22, 2007

Healthy Response To "Sicko"

What most surprised me about "Sicko" was how it was funny and entertaining even as it packed a powerful message. It is doing well at the box office with current revenues of $19M according to Rotten Tomatoes, and as significantly, has been getting very good reviews both from critics as well as from users.

The other notable thing as I mentioned in my earlier post was that contrary to Dr. Sanjay Gupta's and CNN reports it was surprisingly free from any factual errors. I had thought of Michael Moore as a kind of a liberal rabble-rouser who would bend statistics to overstate his case. But he didn't. What he did do of course was to play up that hilarious trip to Guantanamo Bay and Cuba to highlight how Americans without coverage are worse off meeting healthcare needs than the denizens of both those places.

Other countries that he featured certainly have their shortcomings and it is an imperfect world. But they manage to achieve a lot more with their resources, and tellingly, those from Canada or the European countries would never trade their healthcare system for ours.

"Sicko" almost exclusively concentrates on two aspects of US healthcare - the role of private insurers and the pharmaceutical companies. These are responsible for about half the price differential between the US and Europe (where prices are roughly half those in the US.) The other two factors that "Sicko" doesn't mention contribute the same amount to higher US prices. These are malpractice laws and litigation (that leads to defensive medicine and other forms of waste) and artificially induced doctor scarcity that I have talked about earlier.

Still, I can appreciate why Moore stuck to two causes instead of trying to deal with all sources of US healthcare woes. There's only so much you can put into a two hour movie without over-burdening the audience. He did emphasize the high US costs, and didn't want to dilute the basic message of the need for universal coverage.

In short, I highly recommend the movie, whether you watch it in theatres or subsequently on DVD.

Monday, July 16, 2007

Sicko's Critique By Dr. Sanjay Gupta, CNN Is Entirely Misplaced

Funny how a little conflict of interest can show up a person who's so well thought of for years. I've avidly watched Dr. Sanjay Gupta on CNN and affiliated stations, and found him to be very informative, articulate, engaging and interesting. He is all that, but I also ascribed honesty and sincerity to his earnest doctor's persona.

Then I saw Dr. Gupta's 4 minute "fact check" report on "Sicko." Some aspects of the report struck me as strange and unbalanced even the first time. But I paid more attention to it after seeing Sicko creator Michael Moore's outburst on Wolf Blitzer's CNN show, followed by Moore's rebuttal on his website. Subsequently, I saw the Moore-Gupta exchange on Larry King Live, then the actual movie "Sicko," and finally Moore's second rebuttal, this time of Gupta's statements made on Larry King Live.

In these situations you normally expect both sides to be at least partly right. But here's the thing - none of Gupta's substantive corrections or criticisms was valid. Worse, when the facts were starkly laid out in Moore's first rebuttal Gupta only acknowledged one mistake and managed to cover himself on Larry King with his debating skills, glibness, and "running out the clock" in the limited air time.

You can follow the successive links to see the whole story, but here are Gupta's key distortions:

  • He accuses Moore of cherry-picking numbers from several data sources. I can see that Moore used the most authentic sources and the latest data where available, and going to other sources on a sliding scale when the ones higher up on the list did not have the information.
  • Gupta said that Moore "did indeed fudge his numbers." You call it fudging or "cherry-picking" when the numbers you choose are more favorable to the case you're trying to make. In the main example Gupta gave, it was just the opposite. Moore says US healthcare at $7,000 per capita is much more expensive than Cuban healthcare at $251. Gupta says Moore cherry picked and fudged by taking this number of $251 instead of the BBC figure of $229. This is (a) a trivial difference, (b) Moore had picked the more authentic data source, and worst of all (c) the $229 number was making Moore's case even stronger, so he actually gave detractors the benefit of doubt by quoting the higher figure.
  • Gupta quibbled with Moore's statement of US per capita healthcare expenses of nearly $7000 , claiming it was "actually $6,098." Well, Gupta's figures are for 2004, while Moore used the more current 2006 estimates from the US Dept. of Health Services. Gupta made the ridiculous point that the 2006 number was a "forecast." If you haven't noticed, 2006 is already gone, so while it's an estimate that may land up, say, a hundred dollars higher or lower than this estimate, the $7,000 figure is a lot more valid than the $6,098 Gupta touted. I want to ask Gupta, if the US authorities said they were really really sure only about numbers of 30 years ago, would he have espoused using those 1977 numbers for comparison, or the current official estimates?
  • Gupta pointed out that Canada scored lower than the US in wait times to see the doctor. Talk of focusing on a glass being 20% empty. That same source said that New Zealand, UK, Germany and Australia (all with universal coverage) scored higher than the US in this six-nation study.
  • Gupta showed that industry expert Paul Keckley (whose links and Repub affiliations weren't disclosed) dissing the Europeans because 15-20% of people will purchase services outside of the government system. He exaggerates the numbers, but even so this means that 80-85% of the people are happy enough not to look outside the government system, even for any supplemental care.
  • Gupta made a big deal of Cuba at 39th place being behind the US in 37th place in WHO rankings. But the film clearly showed this, and irony of the point being made was clear - even a miserable place like Cuba coming anywhere near the US in healthcare comparisons is a shame.
  • Gupta also deliberately mis-ascribes the claim to Moore that healthcare in the other countries is "free." Anyone can see Moore means that patients don't get billed so they are not inhibited from going to the hospital/doctor. The film spent several minutes addressing the issue and claim about "drowning in taxes" and Gupta wrongly implied that the film glossed over this aspect.

The list goes on. Did Sicko have any notable omissions? Sure it did, and I'll mention them in a subsequent post. But even here, Moore may have wanted to concentrate on the two issues that most bothered him, without the distraction of the other things that are wrong with US healthcare.

The point is, Gupta's original piece unfairly criticized "Sicko" on nearly all counts, and this does not stem from honest mistakes. He seems to have ended up defending his healthcare industry as a partisan while in the garb of an impartial journalist. CNN deserves credit for at least giving Moore's outburst coverage in their subsequent shows, and some additional time on Larry King Live to make his case. But while the casual watcher may be taken in, the errors in Gupta's initial report and his subsequent stance should be clear to those looking at it in some depth.

Dr. Sanjay Gupta may refuse to retract his story and unconditionally apologize. CNN should then do so on his behalf. That'll be the right thing to do, though I doubt it'll happen.

Tuesday, July 10, 2007

Moore Bites CNN Back

I'll talk more about "Sicko" after seeing it, but here was an interesting explosion on Wolf Blitzer's CNN program by Michael Moore yesterday. Moore reacted angrily to Dr. Sanjay Gupta's four minute long fact-check segment on "Sicko" that preceded Moore's interview.

I like Sanjay Gupta and his programs, as well as Wolf Blitzer who I think of as the-man-who-rarely-smiles. But I can see why Moore was angry because at least some (if not all) of Gupta's critique was shoddy and inaccurate.

For example, he needlessly contested Moore's assertion that per capita US healthcare expenditure is $7000 a year saying it is actually $6,098. Even the 2004 figure as reported by OECD is $6,102 and the US Health Department's (HHS) estimates for 2006 exceed $7,000. More seriously, Gupta misquoted the movie as claiming Cuba spent only $25 per capita on healthcare (10% of the actual figure) while Moore fumes that the movie said $251. I just saw Gupta on TV admitting at least to this mistake, while needlessly losing grace by asking why it wasn't $229. (Well, duh, the lower number would just strengthen Moore's claim that Cuban care is much cheaper, so what is Gupta's point?)

As promised by Moore on the CNN program, he posted a strong rebuttal to Gupta's critique on his own website. But even if they've been sloppy, you've got to give CNN credit. They had interviewed Moore live so that his comments and outburst could not be edited, and then have been reporting on the story and the exchange since then on their news channels. Tonight, they've called Moore to Larry King Live for a full interview, with Sanjay Gupta in attendance. This should be interesting.

In a broader context CNN strengthens its centrist credentials with both the left and the right wings complaining that it leans towards the opposite side.

Saturday, July 7, 2007

Two Doctor Stories, And Takeaways

Some doctors are very good and others are not. It pays to pick your doctors carefully, and also to do your own research. This was reinforced when we spent time with Anita's brother Prakash and his family this past July 4th holiday.

During our chats Prakash and his wife Shabnam mentioned two health-related incidents, one relating to Shabnam and the other to their son Rishi that I'd like to share.

Some time back Shabnam developed a recurrent redness in one side of the white of her eye that would last for days. A Costco optometrist advised her to get this checked out by a large and flourishing ophthalmic practice that this Costco store worked with. Over the next year till recently Shabnam went to this practice seven times and was seen by three ophthalmologists. Each of them had a different diagnosis and prescribed a different (costly) treatment. Nothing helped.

Then Prakash who is a business professor with no medical background looked up the internet and found the answer - she has occular rosacea, a common condition for people with acne, and that she now manages with simple home treatment. I typed "redness eye" without quotes in the search box of and it popped up right away.

The other incident relating to their son Rishi was also ophthalmologist related, and more disturbing. Rishi was a few months old when Prakash and Shabnam noticed in the mornings that he'd have excessive mucus in one inner corner of his eye that they'd clean up. On their pediatrician's recommendation they took him to an ophthalmologist. The ophthalmologist diagnosed 9 month old Rishi with a blocked tear duct and urged them to let him immediately operate on Rishi under general anesthesia. He said the procedure becomes more complicated after 12 months of age.

Prakash wanted to double check, and looked up on the internet as it existed then in 1996. He came across a Canadian website with discussions by doctors that said this blocked tear duct problem is common in infants, and frequently resolves by itself. Moreover, the doctors advised against surgery till at least 18 months of age. Prakash and Shabnam never went to that ophthalmologist again, and sure enough, Rishi's problem permanently cleared of its own by his first birthday. His parents are relieved that they didn't blindly go by the doctor's recommendations.

I've myself always relied on strong word of mouth by patients or doctor friends when choosing our doctors. I almost always end up with great doctors and recommend this practice. And as Prakash's stories show, it can help a lot to look up the internet to check on what your doctor says.