Thank you, come again.

June 17, 2006 5:18 PM

The ultimate in outsourcing. Welcome to India, where you can visit the Taj Mahal and get a new knee, all for under $10,000, airfare included. Of course, it's not just for Canadians whose health care system, while free, sometimes necessitates lengthy waits for important surgical procedures. The uninsured in the US and other nations are a potential market as well. And there's potential for medical tourism destinations in the US as well.
posted by greatgefilte (38 comments total)

"First they came for the programmers, but I am not a programmer, so I did not object....."
posted by Afroblanco at 6:04 PM on June 17, 2006

On a serious note, though, what if they screw up, and give you, like, a pignose? What are your chances of being able to sue someone in India? I'm sure doctors in the USA would be a lot cheaper if they didn't have to do things like pay malpractice insurance.
posted by Afroblanco at 6:06 PM on June 17, 2006

Malpractice certainly bumps up the local costs.

This is an interesting development. A friend of mine from India scheduled his dental surgery to correspond to a trip home to visit relatives and friends. He said that it was getting difficult to schedule that stuff now because of so many more people are doing so from everywhere else.

The language in the States towards people seeking healthcare is changing and I think global competition has some influence. For instance, people aren't called patients any more - they're clients. Hospital lobby's are looking more and more like nice hotels.
posted by dog food sugar at 6:15 PM on June 17, 2006

This is nothing new, you can go to many places in Europe too and have operations for less than the cost of the co-pay in the US. My personal choice would be France or Spain and not India but I'm not familiar with the country and if you are I'd imagine this is a serious option.
posted by fshgrl at 6:17 PM on June 17, 2006

I prefer Amsterdam, the BovenIJ ziekenhuis.
posted by nickyskye at 6:26 PM on June 17, 2006

Having recently been seriously injured in Canada, I was shocked to find such a high level of competence and compassion exhibited by each of the doctors and nurses. The health care I received in Canada was exponentially better than any I have recieved in the states. I was admitted on an emergency basis so routine health care may well be a different story.

In general; health care in the US blows. I guess I'm not actually making much of a point here.

I'm not sure patients are looking at the downsides here. Follow up care seems a bit difficult should something go wrong. Based on recent experience, getting on a lengthy plane flight after a hospital stay was about the worst experience one could imagine. Thank God for morphine.
posted by vaportrail at 6:46 PM on June 17, 2006

Re the going to the US for sex selection link:

IVF babies tend to be less healthier than natural babies. I guess this doesn't matter if you demand a particular sex.
posted by MonkeySaltedNuts at 7:05 PM on June 17, 2006

And yet, for all the talk about how the free market would save Americans from evil, no-good, overpaid doctors in the 1980's, HMOs and Big Pharma fight tooth and nail to prevent actual free market reforms like this one, or allowing employers to competitively shop for drugs from dirty, dangerous third-world countries like Canada.

Honestly, this trend doesn't bother me. Obviously, you could get in trouble if you get a quack, but how many thousands of Americans have had serious health complications and/or have died from so called "modern" medical treatment in the US?

That said, there's already a hierarchy of care within the US depending on your income level. I don't see this as a qualitative shift at all, just more choices that require a consumer of healthcare to know as much as possible.
posted by bardic at 7:08 PM on June 17, 2006

Apparently sex-selection is leading to such a girl-shortage in India that the government is paying parents to have girls through this "Apni beti, apna dhan (your daughter, the apple of your eye)" program. Ultrasound for the purpose of sex-selection is already illegal there.
posted by Methylviolet at 7:54 PM on June 17, 2006

My dad and my stepmom live in Mexico, outside Guadalajara.

In Guad (as the expats call it), there is a booming business in discount plastic surgery. Americans, Canadians and others are taking planes south for facelifts and other procedures at 60%-70% of the cost in their home countries.
posted by jason's_planet at 7:55 PM on June 17, 2006

Sorry. That should read "at a 60-70% discount."
posted by jason's_planet at 9:38 PM on June 17, 2006

This was on 60 Minutes last year. Many of these doctors were educated in the US/west to begin with.

Also, according to the WSJ atricle I read a couple months ago, Amish people from the midwest have long been going to Mexico to receive cancer treatment.
posted by b_thinky at 9:39 PM on June 17, 2006

For the ultimate medical outsourcing experience, especially if you're in need of replacement organs or type-matched tissues, head to China, where your organ donor can be type matched to your need, executed on a schedule made known to you in advance for your travel convenience, and where the exchange rate is still highly favorable, and procedure costs are very low.
posted by paulsc at 9:46 PM on June 17, 2006

In general; health care in the US blows.

Here, here.

Honestly, I spend more time consciously avoiding going to the doctor here than actually receiving care. In France, I never hesitated because everything was reimbursed - and you actually conferred with your doctor each time instead of the typical 2 minute "hello" after being screened by the underling. I always tripped out when the secretaries handed me the bill (never much more than 20 euros) and never failed to explain exactly how to get everything fully reimbursed.
Come to think of it, I haven't even met my general practitioner here yet.

The other day I was at the pool and I started talking to a guy - an interesting fellow from NY. After a while I asked him what his profession was he told me that he is a higher-up in a health insurance group - he didn't want to say exactly. We had actually been talking about the (rather poor) quality of life in America so, as health care is one of my peaves, I decided that I'd bust his balls a minute or two. I asked him how it is possible that I pay such a hefty sum for my wife and I each month and see no real benefit - unless something happens like me getting my arm chopped off. I tried to get him to tell me where how the money is distributed.

He just kind of shrugged his shoulders...and said that if the American public was more educated and agressive - "as in Europe" was the comparison he made - that we wouldn't get fucked over so hard. The Europeans organize and cause a lot of political pressure, the Americans just sit back assuming that everything over here is "the best."
posted by pwedza at 10:20 PM on June 17, 2006 [1 favorite]

Maybe I'm just lucky, but my doctors in the States are almost universally great. Overworked and harried? Yeah, sure. But the quality of care I've received, even during short checkups, has been exceptional. Then again, my parents work with the same healthcare provider, so I think they vet who we see based on a bit of inside info.

I asked the boyfriend, who was born in India, if he would personally go back there for medical care, and the gist of his response was that his family didn't come here for nothing, and he doubted whether the standards of care were necessarily up to snuff there.
posted by anjamu at 10:34 PM on June 17, 2006

He just kind of shrugged his shoulders...and said that if the American public was more educated and agressive - "as in Europe" was the comparison he made - that we wouldn't get fucked over so hard. The Europeans organize and cause a lot of political pressure, the Americans just sit back assuming that everything over here is "the best."

I don't think I've ever heard wiser words from an insurance man.
posted by Jimbob at 11:06 PM on June 17, 2006

The language in the States towards people seeking healthcare is changing and I think global competition has some influence. For instance, people aren't called patients any more - they're clients. Hospital lobby's are looking more and more like nice hotels.

So true. My mom, an RN, works at an upscale nursing home. They recently added a new subacute wing, for people who need longer-than-hospital term care, but will eventually be going home (orthopedic and stroke recovery, primarily). Not only does the lobby look like a hotel, the rooms are fancier than the last hotel I stayed at (which was a Marriott!)! Flat screen TVs in all the rooms, fresh flower arrangements everywhere, gourmet meals, and a concierge.

yes, a concierge.

It makes me feel sad, though, because I remember where she worked years ago, in another city. They had mostly medicare (cade?) patients.
The place didn't even have a/c.

More money does buy better care in this country. It's unfortunate that most of the people who actually vote belong to the group that gets hallways filled with roses instead of a sweatbox in July.
posted by Kellydamnit at 11:32 PM on June 17, 2006

I didn't have health insurance until recently. Some years ago, major surgery would have cost me between $28,000 to $50,000 in NYC, so I went to Amsterdam and had surgery there and superb nursing care for a week in hospital for $3000.

A doctor's visit with sonogram in Amsterdam was $35.

In NYC, that would run me, cash, about $150 to $400 to see a doc and $250+ for a sonogram. I could literally fly roundtrip to Amsterdam and see a doc there for a check-up and it would be cheaper than seeing a doc for the same check-up in NYC.

Useful sites for getting medical help in India:
http://www.dfait-maeci.gc.ca/asia/new-delhi/site/health-en.asp

New Delhi was a lovely city when I lived there for 4 years. Some nice and also affordable hotels. Here's an excellent list of hospitals in India (not including Bombay, now called Mumbai)
http://www.doctorndtv.com/hospitals/default.asp?city=Delhi

For any skin condition, I highly recommend
Dr. PN Behl
M Block, Part 1
Greater Kailash , Delhi 110048
Phone: [phone]

Free and low cost health care in NYC via the VillageVoice.

Affordable health insurance in NY.
posted by nickyskye at 11:33 PM on June 17, 2006 [1 favorite]

To those complaining that public health blows in the US, while private healthcare is hotel-like, this is exactly what is happening in India, just that Marriott Hospital New Delhi is much much cheaper than Marriott Hospital New York (to steal Kellydamnit's example).

Fact is, our (ie India's) primary healthcare system plainly sucks; either there's too much political interference in hospital administration, or the hospitals themselves are pork-barrel projects. Which would, for instance, explain why despite all this jazz of medical tourism, some parts of the country have serious public health issues; Alamgarh, UP, for example, is the last place on Earth where polio exists.

Exceptions abound though; Kerala, for example, has a decent primary healthcare system for Asian standards. So much so that Kerala actually has healthcare metrics comparable to western Europe, for example.

What we do very well, though, is tertiary (ie elective) healthcare, both in the public and in the private spheres. Hence this boom in healthcare and drug trials. The story of contemporary India, ladies and gentlemen, whether it is engineering, real estate, cricket, politics or films; dispiriting basics, but some great showing in parts internationally.
posted by the cydonian at 1:03 AM on June 18, 2006

Soon people will be going overseas for things like stem-cell treatments.
posted by T.D. Strange at 1:05 AM on June 18, 2006

When I lived in San Diego, I got all my dentistry work taken care of by a US trained dentist in Tijuana. Half the price and good work too; plus the dental practise didn't try and sell me anything I didn't want.
posted by adamvasco at 5:20 AM on June 18, 2006

The American health care system is great for what it is. Name someone you know who is dying or suffering because of an inability to pay a health care bill. The general level of public health in America is outstanding. We come off as less healthy than some other parts of the world because so many of us choose to get fat, choose to get type 2 diabetes, choose to get lung cancer, or choose to get HIV. The health care establishment doesn't shove that hamburger into your mouth. Reading about the "crises" in health care, you'd think that the streets of America were strewn with the bodies of poor people dying of diseases that, but for the poor people's inability to pay for health insurance, would be easily treated. But our emergency rooms are actually filled with poor people who are not particularly sick, getting free care. Sure the whole health care thing could be better in the U.S.

The the current muddle isn't a "crises." It's just a muddle.
posted by Faze at 8:23 AM on June 18, 2006

#Faze: The American health care system is great ... The general level of public health in America is outstanding. ... because so many of us choose to get fat, choose to get type 2 diabetes, choose to get lung cancer, or choose to get HIV.

So it is just a matter of personal responsibility? Then why do people in England smoke more than those in the USA but have less smoking related disease?
posted by MonkeySaltedNuts at 9:15 AM on June 18, 2006

Name someone you know who is dying or suffering because of an inability to pay a health care bill.

Right this minute? No one. But I waited four years to get a diagnosis for my MS, because the insurance(!) I had at the time wouldn't even pay for a visit to a neurologist, much less any of the diagnostic procedures that would have been needed. I was a student, and on my own, and had no money for any of those things.

When I finally did get the MRI, the radiology practice billed $3141. The insurance company paid $525. And that was counted as payment in full. Had I not had insurance, I would have been liable for the full $3141. Had I not had the insurance, I would never have agreed to the MRI, or to any comparable treatment, as long as I was conscious to refuse.

Do the people driven into bankruptcy by medical bills count as suffering?
posted by dilettante at 9:23 AM on June 18, 2006

Poor people in the US don't get free care in emergency rooms. They have to pay like everyone else -- they just can't. So they rack up hundreds or thousands of dollars on "free" ER visits, which then just end up as charge-offs on their credit reports, or cause them to declare bankruptcy, or which they try to slowly pay back with interest on interest.

Not the same as free.

And definitely a crisis.
posted by Methylviolet at 9:29 AM on June 18, 2006

Name someone you know who is dying or suffering because of an inability to pay a health care bill.

I know multiple people who have been driven into deep debt due to outrageous hospital and medication bills, despite the fact that they pay as much in taxes for medical care as Canadians do. Their bills are on top of that.

I know other people who cannot afford their medications. They have resorted to obtaining these necessities illegally. Drug dealers are starting to carry non-recreational drugs.

Thank god for the black free market (and thank god no members of my family are in this position.) The medical IP/taxation scheme violates natural law and is not long for this world. It's simply unsustainable. The only way it has held together as long as it has is because the alternative to not participating in it is to risk imprisonment.
posted by sonofsamiam at 10:11 AM on June 18, 2006

Faze, What a crock! Blame the person whose 'fault' it is for being human, making bad choices? Oh those lazy, irresponsible idiots for getting sick! They CHOSE to get sick? Not.

People make choices all the time that may endanger their health or safety, jaywalking and getting hit by a car, riding a bike and falling, going up a wobbly ladder, drinking one too many and tripping. They made bad choices for lots of reasons, so now what, leave them on the curb to croak? Yes, people can and may learn to make better choices. Some continue making bad ones. Better not get in a car again because there are plenty of car accidents every year and you know that. It's dangerous. So if you get injured it's YOUR fault. You knew better!

"In 2003 there were 6,328,000 car accidents in the US. There were 2.9 million injuries and 42,643 people were killed in auto accidents."

The original post is about outsourcing for health needs.

"More than 1.8 million New York City residents (nearly one in four) do not have health insurance, according to a 2003 United Hospital Fund report. And nearly one in three adult New Yorkers were unable to get necessary health care when they needed it last year, says the Department of Health. With the least expensive private insurance premiums edging toward $400 per month, the price of a standard doctor's office visit well above $100, and the proliferation of the full-time freelance job, many New Yorkers are taking a wait-and-see approach to sickness: Wait until you're at death's door and then see the bills skyrocket after a pricey visit to the emergency room."

The percentage of the nation’s population without health insurance coverage remained unchanged, at 15.7 percent in 2004.

There are illnesses which do not present as an emergency but may be serious and need medical care. I know many people who suffer because of lack of health care insurance. I was one of them. Broke my ankle, didn't have health care to take care of it, bound the ankle myself. Was in abdominal pain for years. Not enough pain for an emergency ward visit. It was manageable pain. Finally found a job with health insurance, waited the year+ for it to kick in and then went to a doc. Cancer. Had I not had medical insurance I would be bankrupt with the $250,000 cost for surgery, chemo and radiation AND I'd be homeless too because I couldn't pay the rent.

Uninsured friends just endure what they have, eye problems, blood pressure issues, depression, rotting teeth. They get by, just like I did. I live in Hell's Kitchen, NYC and many of my neighbors are from other poorer countries and don't have medical insurance here. When something goes physically wrong they pay out of pocket or just put up with it. Or else they leave the country, like I did for years to get affordable medical care or surgery.
posted by nickyskye at 10:14 AM on June 18, 2006 [1 favorite]

Name someone you know who is dying or suffering because of an inability to pay a health care bill.

(Raises hand). My mother is still paying off a hospital bill from two years ago, when her blood pressure skyrocketed and she was rushed to the ER in an ambulance. She often goes without things she could use to be healthier, like a health club membership or fresh vegetables, to save money. She has insurance, but despite being relatively healthy for her age, the deductibles are punishing, and she can no longer work full time.

Last week, she went to the ER again for what she thought was food poisoning. Turned out to be a kidney infection--she had been having fever for weeks, but wrote it off as hot flashes, and because she has to pay so much on her limited income for every doctor visit, she put off going to the doctor.

She's still battling that infection, and having reactions to the antibiotics that give her intolerable itching and have made her lose 15 pounds. I hope she'll be all right, but who knows? On top of her actual pain is the knowledge that despite working long past retirement to pay off her last round of bills, she's back in debt again.

Oh, and go fuck yourself.
posted by emjaybee at 11:58 AM on June 18, 2006

He just kind of shrugged his shoulders...and said that if the American public was more educated and agressive - "as in Europe" was the comparison he made - that we wouldn't get fucked over so hard.

Amazing statement. Time to start doing something about it.
posted by vaportrail at 12:34 PM on June 18, 2006

Name someone you know who is dying or suffering because of an inability to pay a health care bill.

A good friend of mine is diabetic and can't get health care (he makes good money and works for a unionised industry to boot) and has been hospitalised with diabetic coma 5 times in the last 2 years because something went screwy and they can't get it under control. Type I diabetes, btw so not something he "choose" to get.
posted by fshgrl at 1:25 PM on June 18, 2006

ETA he can't get it under control because he's not under a single doctor's care and doesn't have the ability to pay for the ongoing testing he'd need, despite making well over the median $50K/year around here.

Back when I lived at my old place I knew numerous people in the neighbourhood who were suffering from a lack of pre-natal care and numerous kids who suffer from asthma etc that could be helped by having a regular doctor. This was a blue collar type neighbourhood, too much money for Medicare/ Medicaid, not enough for private insurance.
posted by fshgrl at 1:28 PM on June 18, 2006

Hey, I asked.
posted by Faze at 1:30 PM on June 18, 2006

What's really interesting are the options that differences in currency exchange and systems make. My parents live in Singapore and dad had preventive quadruple bypass surgery in New Delhi at Escorts Medical where a follow up check up with the cardiac specialist costs US$ 6 (Rupees 300) and for his carpal tunnel surgery drove across to Malaysia, where the operation which would have cost Singapore $3000 plus was done for RM 350.

Medical care as an example of globalized free market service buying is an interesting development. I'd be interested to see where it leads.
posted by infini at 3:46 PM on June 18, 2006

Name someone you know who is dying or suffering because of an inability to pay a health care bill.

I've been though bankrupcy because of $30,000 in medical bills.

My ex husband died of an overdose, he had lost his insurance and been out of treatment for six months at the time, after being fairly successful in outpatient care up to that point. And while I wouldn't directly equate that to death by lack of health care, I do think that, had he been in treatment, he'd be around for his 25th birthday tomorrow.
posted by Kellydamnit at 4:57 PM on June 18, 2006

We filed Chapter 13 because of a $18,000 hospital bill. Just a C-section and 2 nights in the hospital, in Austin, Texas. I'm starting to seriously consider getting fake ID and putting down false information next time I have to go to the ER. American hospital costs are a step down below extortion, and I have little regard for their bottom line anymore.
posted by zek at 10:02 PM on June 18, 2006

Here ya go, Faze: Severe psoriasis for several years with no relief until six weeks ago when I got health insurance. Suffering? Okay, here's a partial list: constant and severe itching verging on pain. Constant bleeding, necessitating two layers of clothing at all times and in all weather so as not to freak out the populace. Leaving mounds of flakes anywhere I stood or sat. No social life, certainly no sex life. Depression. Self-medication with alcohol. FACIAL psoriasis, for fuck's sake. Oh, and the infections I get from having open sores, one of which put me in the hosptal overnight for an antibiotic drip. Cost: 5k. My net worth at the time: 1k. My monthly income: unemployment to the tune of maybe USD1200 monthly

Want more? Another hospital wants several thousand for five stitches and an xray.
posted by goofyfoot at 11:52 AM on June 19, 2006

Want more? Another hospital wants several thousand for five stitches and an xray.

The reason doctors/hospitals gouge the walkin uninsured are a) they can, and b) they feel negotiate payments on the insured are less than they deserve so they have to make up the profit elsewhere.

If the uninsured payed what was charged to the insured they wouldn't be caught in such a money sucking trap.
posted by MonkeySaltedNuts at 12:44 PM on June 19, 2006

Hey, but you guys can still say you are better than places like Cambodia.
There you see alot of people missing arms or legs. Most tourists seem to think its from land mines or something like that, but in most cases now its from a vehicle accident.
They cant afford the $1000-up hospital fee for the fractured limb, so the $4 dollar amputation fee looks much more reasonable.
But if you have money you can get decent care.


USA: better healthcare then Cambodia.
posted by Iax at 12:58 PM on June 19, 2006