Health Magazine

Flying the Friendly Skies to Your Doctor's Visit

Posted on the 13 December 2012 by Fadi Bejjani @DrFadiBejjani
Flying the Friendly Skies to your Doctor's VisitMedical Tourism has gained a lot of momentum in the last decade: It started by polish, lituanian or other immigrants returning to their mother land for dental work which we know can be very costly in the US. There is also the South American ladies (Columbians, Brasilians, Ecuadorians, Mexicans, etc.) going back home to undergo cosmetic surgery for cheaper prices. The latter bunch are finding the prices more and more competitive here and the added bonus of better post-op care and especially the ability to sue the doctors to their hearts content. Of course dental and cosmetic can be considered as retail business non-insurance based, where patients shop around for the best price here of abroad.
What has been happening more and more though is patients going abroad for bona fide surgical procedures such as back fusion. First there is the fact that a large number of doctors working in South America (Costa Rica, Panama) and in India are trained in the US then return to work in their countries. Second there is the other fact that private accrediting agencies such as JCAHO and AAAHC have been also active internationally. Indeed many private hospitals in these countries can now claim that status. Third there is the trivial fact that a two-level fusion would cost no more than $15,000 in Costa Rica, all inclusive with the vacation to boot, while it can cost upwards of $200,000 in the US! Looking at all these facts, maybe Medical Tourism is THE remedy for our healthcare costs, what do you think.
The US-trained Costa Rican surgeon is not using plastic screws and plates for this fusion! He is using bona fide titanium hardware, same as the devices used here, so what gives? The truth is that  the same screw that costs the surgicenter or hospital $3000 per unit in the US is bought for close to $300 there. Why? good question. Among 95% of humanity nobody pays as much as we do for medical implants, just like Pharmaceutical drugs (see PharmaEconomics). This $3k screw can end up costing 2-3 times more. Here's how:
There are companies out there called Third Party Billers TPB which build some solid relationships with carriers, commercial but especially auto or WC, whereby they would buy the hardware for you to implant and bill those carriers for it so you (usually private surgical center) do not have to spend that large amount upfront then wait to get paid. That is fine and dandy except I discovered fortuitously once that the third party biller I was using TRIPLED the cost of the device in their bill to the carrier and worse THE CARRIER PAID FOR IT without flinching while beating down our bill.  The net result was that the TPB got paid more than  twice more than our facility got paid, while we did all the work and paid all the related expenses, and they did not even have to meet the patient or do anything beside brokering the deal. Doesn't that baffle you? Only in America! This kind of out-of-balance remuneration is of the same order as the lawyers take in class action suits (see Solicitors blog);
How can we supposedly thrive for social justice when brokers, lawyers and other go-betweens keep getting paid exponentially more than the victims, patients and other interested parties, while doing a lot less work and having a lot less costs and liabilities. There is also the issue of pursuing the highest of Higher Education to end up getting paid half as much as a simple broker. What should you tell your children about that or about working hard?
Maybe the secret to right this wrong is Medical Tourism. Those kinds of disparities do not usually exist abroad where the cost is ALWAYS less no matter how you slice it.
Brokers here or medical tourism abroad "Good Fortune Favors the Bold" (Alexander the Great)

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