France is ranked No. 1 in healthcare by the World Health Organization. Thanks to "Sicko" most people know that the US is ranked No. 37. So the question on my mind during my recent trip to Paris was: can France be a good destination for medical tourists, or is it good just for the French?
The short answer is, France does not look good at least for US medical tourists. Because of its closer proximity it can still serve rich visitors from some other countries, notably the Middle East. From my informal conversations with a lot of the French people I had the same impression that is widely reported in the media - by and large the French are satisfied with their own system even if policy planners are worried about the budgetary gap.
On the last point one thing stood out: almost everyone I talked with said social security paid French healthcare was satisfactory and adequate, but not outstanding. Many said that if cost was no object then they would prefer to go to the American Hospital of Paris. This is a US managed private hospital that does NOT accept the French social security system of payment or reimbursement, and is a favorite among rich Parisians. The reason: it has very attentive staff, ultra clean and somewhat luxurious facilities, and well qualified doctors (many of them working as consultants rather than employees.) I confirmed this in my own tour of the hospital. Rebecca Alliegre who showed me around sounded disappointed when I remarked it was similar to the very good US hospitals I had seen. She said they hope it is better than that. I had actually meant it as a compliment - the top US hospitals are actually great, if hard for patients to get into or afford.
In contrast, I was told the regular French hospitals offer a more pedestrian level of care and attentiveness even if they have the required expertise and equipment. Moreover, none of the hospitals other than the American Hospital has a comprehensive website in English. So online information access to English speaking patients will be a problem, and there may be some spoken language problems for admitted patients as well. For these reasons I'd consider the American Hospital to be the best (perhaps the sole) prospect for US patients.
American Hospital has 180 - 190 beds and is a general surgery hospital. It does all sorts of procedures but none of the "standard" ones popular with medical tourists in very high volume, with the possible exception of angioplasties and corneal transplants.
An aside: I met a very impressive young cardiologist, Dr. Tarragano Francois, who performed 580 out of the 600 angioplasties at American Hospital last year (he does over a thousand in all, the rest being in other facilities.) He mentioned that in France teaching cardiologists (who can train others in angioplasty procedures) need to perform at least 600 angioplasties, and the certification threshold for practising cardiologists is 120 procedures (versus only 75 in the US.) It was also interesting hearing him talk about why he prefers using the latest Xience drug eluting stents manufactured by Abbott Labs, as compared to competing products like Taxus, Cypher and Endeavor. Xience allows better insertion and flows in branch points of arteries, and has a slower and more prolonged delivery of the drug that prevents clots. Very interesting stuff - I wish I had become a doctor.
Back on topic, right since 1956 the American Hospital of Paris is the only JCAHO accredited civilian hospital (not just JCI accredited) outside of the US. It was established way back in 1906 with 19 beds as a way to provide American style and quality care, and originally intended mainly for US expats working in Paris. It has come a way since then, and has upto date equipment, like a 64 slice CT scanner, and a PET scan to be operational next year.
So why is it not suitable for most US medical tourists? The biggest problem is prices. Thanks to a weak dollar, the prices here are about the same as the negotiated prices in US hospitals. My impressions are based on preliminary discussions. Thuy Tien Couty, the Director of Marketing was very cautious about disclosing prices, and she said the list will be available only in mid-November. Other French hospitals are somewhat cheaper, but the differential isn't dramatic, and besides they do not match the service levels of the much cheaper elite hospitals in places like India or Malaysia. Besides, India has super-specialty hospitals with 500+ beds that have deep expertise and quality credentials in almost all the major surgeries sought by medical tourists.
Still, some US patients with private insurance or sufficient means may opt for American Hospital because they would like to enjoy visiting Paris and recuperating here while receiving high quality and attentive care.
Wednesday, October 17, 2007
Friday, September 21, 2007
We Thought Alike - At Least This Time
Funny how my post from yesterday mirrors Paul Krugman's column about healthcare in The New York Times today. He puts things better of course, but touches the same points about (a) Hillary and Edwards plans being the best (as constrained by realism), (b) the Republicans having no meaningful alternative that can deliver, and (c) MittRomney's hypocrisy. So those who don't have access to Krugman's columns that require subscription can simply read my blog.
Jokes aside though, there are two places where my perspective differs from that of Krugman. One is a minor point - he worries that Hillary took so long to announce her detailed plan and says this may portend her reluctance to deliver on it subsequently. I feel the elections are still so far away that she had every right to take her time and study all the issues carefully. So I do not question her determination based on her timing.
The second difference is more pronounced, and is about the effect of malpractice activity on healthcare costs. Krugman, like Michael Moore in "Sicko," is conspicuously silent on this issue of reining in the trial lawyers through malpractice caps and tort reform. On the contrary I view this as one of the biggest problems and contributors to high US healthcare costs.
The left traditionally stands for civil rights and individual protections that then extends to support of lawyers and litigation. Could his anti-Right leanings constrain Krugman from attacking a leftist viewpoint even when this viewpoint is flawed? I hope this isn't the case because I admire his writing style and crisp logic, and enjoy reading his columns.
Jokes aside though, there are two places where my perspective differs from that of Krugman. One is a minor point - he worries that Hillary took so long to announce her detailed plan and says this may portend her reluctance to deliver on it subsequently. I feel the elections are still so far away that she had every right to take her time and study all the issues carefully. So I do not question her determination based on her timing.
The second difference is more pronounced, and is about the effect of malpractice activity on healthcare costs. Krugman, like Michael Moore in "Sicko," is conspicuously silent on this issue of reining in the trial lawyers through malpractice caps and tort reform. On the contrary I view this as one of the biggest problems and contributors to high US healthcare costs.
The left traditionally stands for civil rights and individual protections that then extends to support of lawyers and litigation. Could his anti-Right leanings constrain Krugman from attacking a leftist viewpoint even when this viewpoint is flawed? I hope this isn't the case because I admire his writing style and crisp logic, and enjoy reading his columns.
Thursday, September 20, 2007
So What's Wrong With HillaryCare?
Somehow Hillary Clinton's opponents on the Right have managed to make HillaryCare sound pejorative. But it's Hillary and John Edwards who have come out with healthcare plans that can tackle the biggest issue of the uninsured or underinsured in the US. Hillary's plan has been recently announced and positively addresses the three basic questions that determine if it is meaningful and workable:
(a) Does it commit to ensure everyone has coverage? Any plan that doesn't is insufficient.
(b) Does it require pooling of risk (i.e., are the healthy forced to get coverage and thus pay into the system?) Without pooling the concept of insurance does not work. This is where Obama falls short.
(c) Is it sensibly funded , i.e., doesn't necessarily lead to breaking the bank of public and private resources? This is the toughest challenge for Edwards and Hillary, but their repeal of tax cuts and forcing large employers to pay into the system or cover employees seems that it can do the trick.
The Republican candidates can only answer positively to "c" above, so their plans are hardly worth talking about - they too seem to realize this and try to avoid the subject or fall back on "Beware HillaryCare" slogans.
Hillary has even left a role for private insurers, saying that they can provide the necessary coverage, even to the currently uninsured. That's quite a contrast from the Michael Moore "Sicko" denunciations. Yet her proposals make sense. Private insurers need to make a profit, which imposes a cost on the system, as Michael Moore and economist Paul Krugman rightly point out. But on the other hand, private insurers can offset these factors and earn their keep if they can discharge the payment and reimbursement function more efficiently, and curb fraudulent billing by providers more efficiently than the government. And the "risk pooling" requirement that insurers cannot turn down or charge more from sick applicants or those with pre-existing conditions removes a big source of inefficiency.
Hillary's plan says nothing about some other big factors behind the high healthcare costs - malpractice and litigation fears; drug pricing and doctor shortages. The first of these is the biggest (and the one that Democrats are least likely to address through tort reform) but it is encouraging to see this Businessweek article of April 30th about the vanishing jury trials.
Mitt Romney has been denouncing Hillary's plan which largely incorporates the features of his own Massachusetts State plan. Romney is the ultimate Chameleon candidate - he seems to have reversed himself on nearly every big issue since his quest for the White House. On healthcare I think he would have been better served even during the primaries by sticking to his earlier stance. After all many Republicans too are worried about healthcare and want meaningful solutions. But this may be a moot point as Romney's so far behind the front-runners.
(a) Does it commit to ensure everyone has coverage? Any plan that doesn't is insufficient.
(b) Does it require pooling of risk (i.e., are the healthy forced to get coverage and thus pay into the system?) Without pooling the concept of insurance does not work. This is where Obama falls short.
(c) Is it sensibly funded , i.e., doesn't necessarily lead to breaking the bank of public and private resources? This is the toughest challenge for Edwards and Hillary, but their repeal of tax cuts and forcing large employers to pay into the system or cover employees seems that it can do the trick.
The Republican candidates can only answer positively to "c" above, so their plans are hardly worth talking about - they too seem to realize this and try to avoid the subject or fall back on "Beware HillaryCare" slogans.
Hillary has even left a role for private insurers, saying that they can provide the necessary coverage, even to the currently uninsured. That's quite a contrast from the Michael Moore "Sicko" denunciations. Yet her proposals make sense. Private insurers need to make a profit, which imposes a cost on the system, as Michael Moore and economist Paul Krugman rightly point out. But on the other hand, private insurers can offset these factors and earn their keep if they can discharge the payment and reimbursement function more efficiently, and curb fraudulent billing by providers more efficiently than the government. And the "risk pooling" requirement that insurers cannot turn down or charge more from sick applicants or those with pre-existing conditions removes a big source of inefficiency.
Hillary's plan says nothing about some other big factors behind the high healthcare costs - malpractice and litigation fears; drug pricing and doctor shortages. The first of these is the biggest (and the one that Democrats are least likely to address through tort reform) but it is encouraging to see this Businessweek article of April 30th about the vanishing jury trials.
Mitt Romney has been denouncing Hillary's plan which largely incorporates the features of his own Massachusetts State plan. Romney is the ultimate Chameleon candidate - he seems to have reversed himself on nearly every big issue since his quest for the White House. On healthcare I think he would have been better served even during the primaries by sticking to his earlier stance. After all many Republicans too are worried about healthcare and want meaningful solutions. But this may be a moot point as Romney's so far behind the front-runners.
Friday, August 17, 2007
Bumrungrad: Go Elsewhere For Medical Tourism
My colleague David Williams had asked for my comments on his MedTripInfo website posting about the world's best known medical tourism destination - the Bumrungrad Hospital in Bangkok. Alas, "best known" is certainly not "best choice" as far as I'm concerned. Here are my views that I also posted on David's website:
The best thing about Bumrungrad is its marketing success. The credit goes to its American managers and marketers, who have not only promoted the hospital well in the media, but have also included slick designs and features, streamlined administrative processes and generally made the interface with the foreign patients very user-friendly and reassuring.
Bumrungrad tends to charge well for each of its services, and includes handsome markups for services it arranges through its local service partners. For example their airport "meet and greet" costs $40 and the trip to the hospital costs extra - about twice as much as for a luxury taxi engaged directly at the airport (or six times what an ordinary taxi charges.) But patients may not mind paying all these extras which are complimentary or included in package costs in other international hospitals. Instead, a cause for greater concern are some of their "substance" issues like their quality of treatment.
The Bumrungrad death in Feb. 2006 of the 23 year old American Joshua Goldberg has drawn a lot of attention. This could arguably have happened anywhere, but I too had concerns about the hospital way before that. Joshua's dad has made many allegations against Bumrungrad in his website directed against them, including engaging in a trade for body parts, and sacrificing patients for that purpose. In the absence of any facts to support this I don't set any store by such statements, and attribute them to the rage of a grieving father.
My guess is that Joshua died because of a negative response to one or more of the medications given to him. It's quite possible that negligence was involved and that Bumrungrad management tried to cover up mistakes made, or stonewalled an investigation. On the other hand it may not be the case, but here are the reasons why I am leery of their treatment quality and their practices:
The best thing about Bumrungrad is its marketing success. The credit goes to its American managers and marketers, who have not only promoted the hospital well in the media, but have also included slick designs and features, streamlined administrative processes and generally made the interface with the foreign patients very user-friendly and reassuring.
Bumrungrad tends to charge well for each of its services, and includes handsome markups for services it arranges through its local service partners. For example their airport "meet and greet" costs $40 and the trip to the hospital costs extra - about twice as much as for a luxury taxi engaged directly at the airport (or six times what an ordinary taxi charges.) But patients may not mind paying all these extras which are complimentary or included in package costs in other international hospitals. Instead, a cause for greater concern are some of their "substance" issues like their quality of treatment.
The Bumrungrad death in Feb. 2006 of the 23 year old American Joshua Goldberg has drawn a lot of attention. This could arguably have happened anywhere, but I too had concerns about the hospital way before that. Joshua's dad has made many allegations against Bumrungrad in his website directed against them, including engaging in a trade for body parts, and sacrificing patients for that purpose. In the absence of any facts to support this I don't set any store by such statements, and attribute them to the rage of a grieving father.
My guess is that Joshua died because of a negative response to one or more of the medications given to him. It's quite possible that negligence was involved and that Bumrungrad management tried to cover up mistakes made, or stonewalled an investigation. On the other hand it may not be the case, but here are the reasons why I am leery of their treatment quality and their practices:
- They don't seem to have outstanding doctors, particularly in areas of major surgery. I've read their policy is to hire primarily Thai nationals, which limits their talent pool. The bios of their doctors on their website is suspect as it mentions "fellowships" at US, etc. hospitals without mention of US residency (the US does not allow board certification or practice of medicine without US residency that spans several years.)
- They don't mention how many procedures they perform, especially major orthopedic or cardiac ones. This number is known to be positively correlated to quality. After Joshua's death and the resulting publicity they have changed their website quite a bit, but even earlier I had noticed that their treatment packages were generally for the minor procedures, e.g., angioplasties, with no mention of heart bypasses.
- They feed the media with claims that are clearly false or ridiculously exaggerated, though they are clever enough not to directly state these on their own literature or website. For example, the NY Times, the Pittsburgh Post-Gazette and other major publications quote them as having treated 58,000 Americans a year, of whom 70% come for major surgeries. A back of the envelope calculation shows they are exaggerating such numbers at least fifty-fold. For instance, see Tom Keesling's blog comments
- They don't put out any quality or outcomes data for major procedures, as some top Indian hospitals often do, and US hospitals are now increasingly required to disclose. Coming to think of it and given their declarations of patient volumes, even if Bumrungrad disclosed outcome statistics I wouldn't believe them unless it is independently verified.
- They don't have a pricelist of the standard procedures, unlike other top-tier hospitals popular with international patients. To get prices from Bumrungrad you have to go back and forth with one of their specialists assigned to your case. Their lack of up front estimates and transparent pricing makes me think, well, almost of used car salesmen. Or Bangkok's PatPong bargaining bazaar.
I've seen Bumrungrad from up close in addition to reading about it. I'd not go, or take a friend or loved one there, except if the outward patient experience (the tourism part of medical tourism) is a high priority. And the procedure is relatively simple, with inherently low risk. When I was visiting Bumrungrad their international lounge was a sea of women in black dresses and head scarves. I was told a large proportion of their foreign patients are women from the Middle East who come for nose jobs or other cosmetic treatments.
I worry because Bumrungrad on being exposed is likely to deeply undermine faith in other hospitals, including those in India, that are truly excellent and a better choice for medical tourists. The best outcome for the medical tourism industry would be for Bumrungrad to clean up its act quickly while acknowledging past mistakes, but I doubt this is going to happen with the current management in place.
Friday, August 3, 2007
No Kidding About Coverage
When logic cannot work, try mouthing inane phrases to discredit a sound measure. That's the tactic of choice for our Republican lawmakers and our President once again. The issue at hand is extending and expanding the Children's Health Insurance Program so that it covers children of lower middle class families in addition to poorer children.
The House has passed this Bill 225-204 over vigorous objections by Republicans and threat of veto by President Bush. Their objection is that this would expand "socialized medicine, and Washington-run healthcare." Well, so what? If this form of healthcare works much better than the alternative (and there's every indication that it does) then why should those terms be any grounds for opposition? Two thirds of Americans favor universal coverage, leave alone this more popular issue of covering children.
Interestingly, while 5 Republicans voted for this bill, 10 Democrats opposed it. Those 10 probably caved in to lobbyists or constituent special interests. I'm guessing their opposition arises because of the way this program is financed: by increases in tobacco taxes and cuts in subsidies to the Medicare drug prescription plan.
Paul Krugman wrote a good piece about this today in the New York Times, though it is unfortunately available only to subscribers. Here's the part I particularly liked:
"...The bill is so good that it has Republicans spluttering. “The bill uses children as pawns,” declared Representative Pete Sessions of Texas. Yes, the Democrats are exploiting children — by providing them with health care.
The horror, the horror!
What’s especially encouraging is the way House Democrats were willing to take on the insurance companies. The bill pays for children’s health care in part by cutting subsidies to Medicare Advantage, a privatization scheme that yields big profits for insurers, but that the budget office estimates would cost taxpayers $54 billion in excess payments over the next five years...."
Of course Bush may well veto this, but with all their spin that will probably cost Republicans big in the 2008 elections.
The House has passed this Bill 225-204 over vigorous objections by Republicans and threat of veto by President Bush. Their objection is that this would expand "socialized medicine, and Washington-run healthcare." Well, so what? If this form of healthcare works much better than the alternative (and there's every indication that it does) then why should those terms be any grounds for opposition? Two thirds of Americans favor universal coverage, leave alone this more popular issue of covering children.
Interestingly, while 5 Republicans voted for this bill, 10 Democrats opposed it. Those 10 probably caved in to lobbyists or constituent special interests. I'm guessing their opposition arises because of the way this program is financed: by increases in tobacco taxes and cuts in subsidies to the Medicare drug prescription plan.
Paul Krugman wrote a good piece about this today in the New York Times, though it is unfortunately available only to subscribers. Here's the part I particularly liked:
"...The bill is so good that it has Republicans spluttering. “The bill uses children as pawns,” declared Representative Pete Sessions of Texas. Yes, the Democrats are exploiting children — by providing them with health care.
The horror, the horror!
What’s especially encouraging is the way House Democrats were willing to take on the insurance companies. The bill pays for children’s health care in part by cutting subsidies to Medicare Advantage, a privatization scheme that yields big profits for insurers, but that the budget office estimates would cost taxpayers $54 billion in excess payments over the next five years...."
Of course Bush may well veto this, but with all their spin that will probably cost Republicans big in the 2008 elections.
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 medtripinfo.com. 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!)
---------------------------------------
Scoring:
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
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!)
---------------------------------------
Scoring:
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.
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.
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