Taking up beds? While there may be a shortage of ICU type beds, since hospital planners probably didn't contemplate people electing to come to there hospitals in order to enter their ICUs, my impression is that in the past 25-30 years there has been trepidation in the hospital business that there might be a glut of empty beds (empty bed=no income), hence some hospital closures and many consolidations.
2
I thought this was a very thoughtful article on a difficult ethical issue that has no easy answers.
From the other side of the Atlantic where we have an under resourced but extremely cost effective health care system it raises different ethical questions. We see repeatedly families, often not well off, trying to raise funds for travel to the USA for a non standard treatment not available in Europe because there is no evidence to support its use. This often involves children where understandably parents would grab any avenue of hope. So often the outcome in the USA is the same as was predicted by their physicians here but with an added chapter of stress caused by the travel and expense and often a feeling of being let down .
There is a subtle but vital difference between a hospital or individual physician offering high quality evidence based medical care to those that can pay and the selling of unrealistic hope for commercial gain.
2
This article is about an advanced branch of service export. Instead of mourning the decline of manufacturing, Americans should rejoice in the strength of their service exports. Whether it be entertainment, software, paid education or advanced medical care.
The huge inequalities of medical care in the US have nothing to do with foreigners grapping the beds. It is all about American politics.
Funny thing, when American cars are exported, you don't complain that this is unfair to Americans who might need a new car. When American arms are exported, you don't say that these arms had better stay in America to defend the homeland. You understand that exports contribute to the strength of these industries. Basically, it's the same for service industries that take in foreign patients, students, retirees or tourists.
If ethical problems are involved, it is mainly about consumer protection. Are foreign patients wasting hope and money because they have unrealistic expectations? Should hospitals do more to discourage this? Can hospitals deliver on difficult issues like cross-cultural empathy and understanding? These are quite relevant issues raised by the author.
Like in any business, you'd better make sure you get paid. Some loop-holes might be difficult to close, like the misuse of Emergency Departments by foreign patients described by some readers. But this has little to do with the legitimate business of receiving paying patients from abroad.
5
They are taking up beds AND they are bringing in money.
So much xenophobia reflected in the comments here. Yet few Americans are asking the other side of this question: is it right for Americans to go abroad to get cheaper medicines and treatment? Because that is also an increasingly common practice whether it be for less expensive fertility treatments, getting hepatitis C treatment in India, or yes even kidney transplants. As is often the case American xenophobia takes the form of “they are taking from us” without ever bothering to look at what “we are taking from them”. Even more in today’s ugly climate.
Also what of the gain to the US economy? I ask this as an American citizen white a foreign parent who came here for medical treatment. Tens of thousands of dollars were spent. Not just at the hospital, but also at the hotel, the taxis the restaurants and stores. All of the American businesses only too happy to get revenue.
9
Dr. Leiter,
Does your hospital accommodate "cultural" requests like, "No male doctor should examine my wife", or "I want only male doctors"?
I understand this kind of request is common when patients from certain countries are treated in the West. I wonder how you handle it.
3
@Grevillea: Some American women also prefer female doctors, and why not? Perhaps some American men too - there is evidence that female doctors provide better care.
1
I have seen many people buy travel insurance in their home country who then think their family members are covered for healthcare costs here. These insurance policies do not cover preexisting conditions and the families who brought a family member here do not realize they are liable for the costs of care. It’s an old story, “my father started feeling ill on the flight... “. For example, I’ve seen a son who brought his father (a stroke patient) from India with fresh burr holes in his head who claimed it was new onset! The cost of his father’s care was astronomical. That son spent all of his savings including his savings for his children’s college education and then lost his home. Health care is great here if you have good insurance or you are wealthy, but devastating for those outside those categories. Foreigners who come here need to research the costs before they dive into our financially messed up healthcare system.
6
I wonder if this doctor would have devoted 5 seconds of his time to this issue if the international patients did not have the ability to pay for treatment.
Seriously, the only issue here is whether an international patient with money should take the place of a local patient with money. It’s America and it’s called Wealthcare.
7
Most of the comments appear to focus on the financial aspects of treating a foreign patient who had the resources to pay his bills. The other comments relate to how the Kingdom of Saudi Arabia treats its citizens and foreigners on its soil. Neither of these are the treating doctor's concerns.
The doctor has a well defined scope of work and appear to have discharged it professionally.
The doctor is expected to deliver the same standard of care irrespective of the patient's nationality and ability to pay. The standard of care may not appear to meet the desires and unreasonable expectations of the patient. This situation happenes with local patients too.
The doctor's dilemma was in traversing cultural nuances and communication skills of a foreign patient whose only interaction with the US is in the context of his treatment in a US hospital. Even when the son may be able to speak english his command of the language may not be adequate to have an in-depth and empathic discussion with the caregivers.
The family relationships and a son's obligation to his parents in arab and asian cultures are different from what is the norm in the US. Even when the son knows that there is no effective treatment, he is expected to push for treatment and hospital stay to demonstrate his devotion.
Problems of financing health care for US residents cannot be resolved because of our misplaced ideas of "exceptionalism and individualism". Foerign patients don't matter in this matter.
6
What are the policies of those foreign governments and the local medical establishment regarding American patients entering their country and receiving treatment there?
3
More importantly, why are international patients who require an organ transplant allowed to have on in the Unites States. The whole organ transplant system is funded with tax-payer dollars.
Why are we allowing a foreign national to have an organ paid for with tax-payer dollars? Which will result in the denial of that organ to an American citizen.
Is this at all fair to our fellow citizens?
9
If that is true, that people from abroad can take advantage of the tax-payer funded organ transplant program and receive organs that would in fact otherwise go to Americans, it is troubling, indeed.
It would also be troubling if rich people from here or there are able to buy their way to top of the transplant lists. Having a ton of money does not make one's life more worth saving than the life of someone of more modest means (especially when one considers that people of modest means tend to give a greater percentage of their money to charity than do the wealthy).
2
This article speaks of justice, and it is quite clear that the only way to achieve justice (which we will define as equal medical outcomes for all people) is provide medical care to everyone in the world, regardless of ability to pay.
4
@Middleman MD And just how do you propose that you will pay for all that?
2
Amen. And the saying goes, "Peace starts at home." So, too, perhaps, with health care. Yet under Trumpublicans and Libertarians and the like, only the truly $$ rich in America can be assured of getting excellent and timely care. They are followed, at least by the breadth of insurance coverage, by the indigent who are lucky enough to find out about and keep qualifying for Medicaid, and then at the end, most Americans, who face the choice between affording high-quality comprehensive health insurance and affording co-pays on the one hand, and very literally keeping food in their kids' bellies, a vehicle to get to work, a solid roof over their heads and heat in the house, shoes and clothes and school supplies for little ones, and childcare and elder care for their kin so they can be safe while the adults are working... And that's an awful choice to have make. And one that most people in the civilized world and developed countries aren't forced to make. Because they don't fall for lies of ultra-individualism and denial of life-giving and life-preserving interdependence.
7
@MSW I am all for single payer health care-- As long as it can be proven that my care will be exactly the same as my Senator and his family.
3
We assume other cultures have the same views regarding terminal disease that we do: they do not. Taking home one's family's patriarch, when at death's door from a previously undisclosed cancer offers a perfect example. There are places where families - and doctors - choose not to tell even the patient about such a cancer diagnosis.
As to the question of whether patients who travel internationally to obtain health care represent a cash cow or a system clog, the United States is certainly not the only country asking this question. Medical tourism is a booming business, whether one is going or coming. No matter which way the patients go, it is obvious that the costs of health care in the United States go in one direction only: UP.
5
This is not a case of "greedy" doctors and hospital administrators. Actually, entire cities in America are built around a single, world-class hospital. The hospital may even be the largest employer in the state, also. The financial success of the hospital is every bit as important as the reputation of a university in a small-to-medium-sized town. And foreign patients often make huge gifts, which are used to fund medical research that benefit millions of Americans!
4
Thank you. Dr. Leiter, for a sensitive and balanced article, although it evoked certain comments which were not. Medical services are not a "zero sum game", where X quantity given to one patient diminishes the quantity given another. In the US healthcare system, there is ample unused capacity. The best data suggests that foreign consumers represent a rounding error to most academic medical centers here in the United States - less than 2%. As a healthcare professional involved in international care and medical travel, the global markets in healthcare services have not yet matured sufficiently to address the myriad issues raised by these comments. Be assured that international trade in health and medical services will continue to grow.
8
@Irving Stackpole
"Even when the son may be able to speak english his command of the language may not be adequate to have an in-depth and empathic discussion with the care-givers."
The governements of India and Thailand vigorously promote "medical tourism" to their resperctive countries for non-emergency surgeries.
1
I hate to say it, but I can't help but think of how American hospitals, pressured by their utilization review staff and by insurance companies, will practically force non-rich patients out, sometimes discharging weak and still-I'll or injured folks despite knowing that these people have literally nowhere to go and no one to help care for them (and too often then soon show up in the ED again, or in the morgue). Meanwhile, patients who are not US citizens and have traveled to the US for treatment are, apparently, allowed to stay in the hospital as long as they may feel they need. The story of homeless patients at a major Los Angeles hospital a few years back comes to mind... My guess is that the same patient this author describes would, had he been a US citizen, have been told that since he was dying, there was no reason for him to stay in the hospital and he and his son would have been given the choice to leave within 24 hours or face significant and complicated legal battles, behavior bordering harassment by hospital staff regularly pressuring them to leave, a complicated and confusing legal system, and likely impoverishment since they would be hit with tremendous medical and maybe legal bills for insisting on another day or days of care in the hospital, possibly just so that the son could find a place to stay that the father-patient could access, to get needed supplies, and to arranged, somehow, for help outside of the hospital.
6
@MSW
Your guess regarding end-of-life care might well have been pretty accurate. Once there is no "treatment" that can be reasonably charged to insurance, the patient is transferred to an "appropriate" care situation with "skilled nursing." In other words, sent to a nursing home.
This happened in October to my father-in-law. He was only returned to the hospital when a family member DEMANDED an ambulance be called; his "skilled nurse" ignored his confusion and disoriented weirdness (something he'd not had) while it turned to unconsciousness. Unfortunately, the transfer was too late. His symptoms were the result of soaring fever (not taken by the "skilled nurse") from septic infection. which was followed by two strokes, and death. Too often this is now the American way of death.
The reason for quotes around "skilled nurse"? The person in charge of medical care for my father-in-law, who was newly released from intensive care at a large medical center, was a newly hired nursing assistant who had not even finished the eight-week training course at a for-profit "medical institute" that churned out "certified" graduates in skilled patient care - with a GED or high school diploma and a mere two months.
7
@Elizabeth unfortunately the term "nurse" is used liberally. Clearly that person was not a nurse but a nursing assistant. There are rarely any true nurses in nursing homes, just assistants and LVNs-not a real nurse. You only find them in hospitals usually.
Kind of makes you wonder how gynecologists and other health care providers overseas will feel and function of abortion is prohibited by law in the US. Can you imagine the flood of patients traveling, say, to Ireland to get a fuller range of women's healthcare services? Of course, there's not a chance that the US government would sponsor a poor person to travel abroad for healthcare, let alone for an abortion.
5
@ROI
Ireland does not allow elective abortions beyond 15 weeks gestation, nor do the rest of the European countries.
2
@ebmem
I don't think you are correct about all other places in Europe, though it could depend on what you personally consider "elective" abortion.
My guess is that most people terminating a pregnancy after the 4th month are NOT doing it "electively" -- unless you consider something like not enduring a full term pregnancy, labor, and all the possible pre-, peri, and post-natal complications that could arise while carrying a fetus with just a brain stem but no full brain, or an untreatable and immediately fatal heart defect to be "elective" abortion. I can tell you, from women and men who have gone through such things, it is hardly "elective" in the sense that, for example, getting a face lift or tattoo is.
1
Islam may be a minority religion in the US, but it most definitely is NOT a minority religion in the world at large. Your article does not make this important distinction.
Speaking of the Middle East and Saudi Arabia, one wonders how a Jewish or Zoroastrian or Baha'i or Hindu or Coptic or Sikh or Buddhist or atheist patient would be treated by the Saudi government and dominant culture there. Or a female patient, for that matter -- her mom wouldn't be allowed to take her to the doctor without a male family member's permission. And heaven forbid a Jewish Israeli citizen should ever need medical care that might be available only in Saudi Arabia or Iran or elsewhere where even Americans having an Israeli customs stamp in their passports have been denied entry or otherwise significantly harassed.
Furthermore, why no mention of the fact that every day in America, members of minority religions or ethnicities who are American citizens have their cultural norms and needs ignored or trampled on in the healthcare arena? I have seen and heard of this happen many times, first hand. Especially in non-urban and non-coastal areas, though it happens there, too.
Maybe if the American health care industry first spent needed time, money, effort, and other resources learning about and negotiating the diversity that already exists in the US, our health care providers and systems and laws would save and better serve two populations at once: our neighbors and our visitors.
6
The author left out another huge group of international patients; those that are not wealthy and show up in our Emergency Departments with a stack of papers from a foreign hospital that confirms a cancer diagnosis or some other grim prognosis. These foreigners then expect the American taxpayer to pick up the tab. I work in an ED and see this happen all the time. If they get admitted, they get Emergency Medicaid which covers all the inpatient costs and yes it is paid for by the American taxpayer. They can get outpatient care for free at a city (government funded) hospital such as Bellevue again paid for by the American taxpayer. Yet working class Americans that make too much to qualify for Medicaid but are too poor to afford an Obama care plan get nothing except a huge bill in the mail and possible bankruptcy if they get sick...
45
Not just cancer and other non-contagious but costly-to-treat diseases, but also HIV, drug-resistant TB, and others that put all in contact with them at risk in a widening halo. These people, especially, need treatment -- not just to save their lives, but also to save the lives of countless others who may catch what they've got (and may have caught from yet a different uninsured/untreated person). As you must know, being a medical doctor, that protection of public health is a significant reason why they are granted Medicaid, as it allows healthcare providers to get paid something for the care they provide to those among us who must be treated in order to save everyone else in their circle of contact.
11
@Altered Carbon This is one of the major problems with our healthcare system.
It is analogous to American universities attracting as many children of Chinese oligarchs as possible, because they can pay out-of-state tuition and pour money into the universities' coffers. They are, of course, taking up space that could be used to educate American kids, especially the economically disadvantaged. But hey, money talks.
20
When my father was diagnosed with lymphoma a few years ago, he and my mother were ready to pack-up and go somewhere, anywhere, that he could have the "best possible treatment". It took quite an effort for myself and his Haematologist to convince them that he'd have exactly the same science- and evidence-based treatment here in Australia that he would get anywhere else.
People will push for hope against hope, even when they've been told that there is nothing more that can be done. That's why despicable cancer quacks find an endless procession of dying patients to exploit with their lies - desperate patients.
10
@PeteH
If they lived in America and had Medicaid or an Obamacare insurance plan from the individual markets, any of the American centers of excellence would have been out-of-network for them.
Ted Kennedy had government insurance that paid for him, a resident of Massachusetts or DC to be treated at a North Carolina University research hospital. Had he been a Massachusetts or DC resident with a Romneycare, ObamaCare, Medicaid or Medicare plan without a pricy supplement, he would have had to make do with whatever facilities were in-network for him.
3
@ebmen
Your cynical claims about Medicaid and Obamacare insurance plans are patently false and do damage in being so.
Medicaid is accepted by most hospitals around the country, including almost all of the best. I say almost all because I am aware that the Hospital for Joint Diseases in NYC (I think that was the name) had made the disturbing choice to stop accepting Medicare and, thus, likely Medicaid. That decision made care at its hospital effectively inaccessible to all but those with specific insurance plans or huge private coffers.
Regarding the ACA "Obamacare" PPOs, where we live many of the best hospitals are included among the preferred providers. Many people getting insurance via the ACA markets wouldn't have had any insurance at all were it not for the ACA (including its ban on excluding or charging more to people with preexisting conditions, which is they majority of Americans over the age of 15-35, as insurance companies had been known to deny coverage to people because they had received treatment for acne (preexisting condition!) or gone to see a couple's counselor at some point in their adult lives).
Perhaps the solution to your cynicism is for the US to adopt a Universal Healthcare (not insurance, but actually care) system like that of Canada, Sweden, Great Britain, or any number of other places.
2
Correction - it may have been the Hospital for Special Surgery that stopped accepting Medicare -- NYT will have to double check.
1
I wonder how many of these international patients are men, and how many are women? I have trouble seeing the Saudis paying for any woman, except the most connected, to come here for health care. Additionally, we all know men have a lot more money than women worldwide, so when push comes to shove they'll spend that money on themselves in the end.
7
@cgg
Very good question. Another one is how many of the people sponsored by their governments to travel to USA for medical treatment, or even allowed out of the country at all, are religious or ethnic or sexual minorities in their country of origin/residence? And how do those sponsoring governments perceive and treat people with disabilities (non-medical or not the reason for needing medical treatment abroad -- like a middle-class deaf person needing specialized cancer treatment vs. a middle-class hearing person needing that same treatment?
2
@cgg
Right. And how many of those patients supported by or allowed by their foreign governments to get treatment in the US are ethnic or religious minorities where they live, or LGBTQ or disabled (other than by the condition for which they seek treatment in US)?
2
@Patriot
Another valid question is whether the foreign government actually paid the full bill for the care or if they stiffed the hospital.
3
Dana Farber is located in Boston, yet the article references a hospital in Manhattan. Does Dana Farber have a satellite facility in NYC?
1
@Eugenie
According to the linked bio on the DFCI website, the writer did his residency training at Weill Cornell Medical Center so I'm guessing this is a case he saw back then. Though I'm sure there are plenty of similar patients in Boston.
1
The healthcare industrial complex feasting on gold and not healthcare. If they pay full rates it helps the rest of us but also makes Americans wait longer for care in our institutions. Healthcare like Big Pharma follow the money.
5
If they are paying full rates it helps the rest of us. My recent hospital bill was over $20,000 and my insurance paid far less than $10k.
3
This story is similar to the issue of international students attending public and private universities. They pay full tuition which helps the public university offset reduced funding from the state. However, often they are accepting students who are unprepared to meet the standards of the university, and the university is unprepared to help them with culture shock. Cheating and plagiarism become issues as well. Is it ethical? Is it worth it?
5
Except that going into it, one can pretty well determine how much it will cost to educate a student (not likely to be significantly different from other students in that major), and if they don't pay any additional fees or costs they accrue, they will legally be booted out of the school, have their transcripts and/or diplomas withheld, etc.
With a seriously ill or traumatically injured patient, costs quickly and exponentially increase in the course of a few minutes or hours or days; and it could be considered unethical and, in some circumstances, illegal and endangering to the public to refuse to keep treating a medical patient, whether they pay or not.
3
Let's agree not to pretend that the U.S. medical community is controlled by anything other than profit. Our system is built on a competitive model that finds even the not for profit hospital systems concentrating on their bottom line. Pharmaceutical companies feast on the U.S. market which refuses to control prices for their products. Our healthcare system is unique in the world and in desperate need of an honest assessment. Time and finances will force that on us eventually.
15
@Dennis W
And yet, the wealthy come here for treatment rather than going to Canada or Great Britain.
2
Because if you have money, US healthcare is among the best in the world. They don’t go to Canada because all that money won’t get you to the front of the line there. It will on the USA.
4
@ebmem But they do go to Germany, Belgium, Switzerland for the same quality of care but less outrageously expensive than in the U.S.
1
I have little doubt that some grateful patients make immense financial contributions to the hospitals that care for them. Their largesse may make their care completely worthwhile and even benefit some US hospitals, particularly research hospitals. This angle also deserves some reporting.
1
I'm wondering if international patients also place a financial burden on our system. If they come to our hospitals with severe illness, we certain can't turn them away based on ability to pay. So what is the practice to ensure foreign patients are responsible for using U.S. resources?
6
Good question!
One of our local “nonprofit” hospitals has built a spectacularly luxurious new inpatient building. It looks very much like a big Fortune 500 corporate office.
Given the rising cost of healthcare, and the affordability dilemma, I wonder why these new buildings are so over the top.
For us Americans? Or are they in competition to attract the international wealthy patient?? There is no need for luxury in healthcare. Most especially when our (unaffordable ) insurance premium and taxes are funding these new buildings that then use foreign money to beef up their own bottom line.
9
@Barbara Vilaseca
Under Obamacare, hospitals are scored on customer satisfaction. Thus, gourmet meals, attractive settings and concierge services. Set up a metric and get strange outcomes. You don't want people complaining because they don't like lime Jell-O or hard plastic chairs in the waiting room.
2
@ebmem
Patient satisfaction is determined by answers to a standardized questionnaire that asks about communication with doctors and nurses, responsiveness of the staff, pain management, the cleanliness and environment of the hospital, how well informed the patient was about medications and other discharge related matters, etc. This has nothing to do with the flavor of jello of type of chair in the waiting room.
And Obamacare never included "death panels", either.
I read the other day that a US insurance company was using physicians in India to do billing and transcribing work. India has such a tiny ratio of doctors to population.
In Mexico, us patients go for cheap plastic surgery. In several countries, American patients go for organ transplants.
We have a long way to go before we would ever be on the wrong side of the balance of trade on medical care.
5
Upon my last visit to the dentist, I overheard the medical secretary referring to me as the $1000/year patient to the dentist, while I was waiting on the chair. I suppose this was to let the dentist know that his time with me was going to be well reimbursed. This reinforces the grim fact we already know: in American healthcare, patients, and their needs, are regarded as commodities where value can be extracted.
The author's premise that there is a moral dilemma for the American healthcare system between accepting a rich foreign patient, and turning down an American one is laughable. The rich foreign patient paying the higher price will be accepted every time -- and that money will most likely go to fund the bonus of paid administrators who will be celebrated for raising the hospitals bottom line.
I almost forgot. Depending on how generous they feel, these same administrators might make a small contribution to a charity helping people facing medical bankruptcy.
13
Or she may have thought you had an insurance plan that covered only $1000/yr in dental care, and so her reminder to the dentist may have been a nudge for him to (unethically) treat you differently, perhaps not giving you all the possible treatment options, than patients who have $5,000 or $10,000/yr of coverage. Really, $1,000 doesn't go very far toward dental care where we live. One crown costs much more than that, and two deep cleanings will wipe most or all of that $1,000 away.
5
@Clem I'm guessing the "$1000/year patient" was referring to the annual limit on your dental insurance covered benefits.
4
Very simply, YES. The international patients are taking up bed space that must be used in the care and treatment for local residents who need the service. It is the local residents tax dollars that have helped fund the medical research which has translated into advanced care. And NO ONE can tell me that all the advanced treatments available in the US (and Canada) have been developed from private funding. I have worked in Medical consultancy with "major" pharmaceuticals and I am very aware.
The foreigner, an arrogant Saudi especially, should be treated in their home country. I am a Muslim Arab myself and yet I say emphatically for the Saudi to be left for treatment in their home country because of how these Saudis treat all the foreigners who work in a wide range of services in their own country - including medical doctors whom they disrespect.
26
Last I checked the Hippocratic Oath did not specify nationality.
11
@LTJ
You are right about that Oath. However, these foreigners must seek treatment in their home countries and rather than funding wars to create famines elsewhere their governments should be funding hospitals.
1
In the USA, the Hypocratic oath dies include ‘the ability to pay’
In a lot ways this article proves what I've said for a long time; we do not have a health care system in the United States, we have a wealth care system. If you have the money you can get the care, if not, oh well.
46
@hen3ry True, but even wealth can’t prevent death and this article points out how tricky it can be to help patients and family use that time as meaningfully as possible. Money can’t buy a good end of life. That takes compassion and some planning.
13
@Chieftb
Your comment sums it up well.
Some of these comments are made by people who clearly lack any compassion or humanity. Good thing they aren't physicians.
1
Taking care of a dying patient whose cultural, religious, social and moral values are totally alien to you is asking for trouble. However earnestly you do, the patient and family are likely to end up seeing you as ‘money grabbing ventures’. Not a nice place for a palliative care physician to be in.
4
Sigh....can people stop using the term “healthcare” and instead use “illness care”??!!!
There is not one single bit of “health” that modern medicine is taking responsibility to “care” for-if medicine did “healthcare” we would have clean water, clean energy, Big Pharma oversight, no greedy doctors, greater access to fresh/clean food, etc etc......
There are HUGE profits to be made off illnesses.
15
The author left out that thousands of patients without any insurance or support show up in our emergency rooms from Africa and Asia with advanced cancers which they claim that they suddenly noticed in mid-flight.
30
@SridharC "Thousands," you say? What evidence do you have? Forgive my skepticism, but your choice of words indicates a bit of xenophobia.
7
@SridharC
Do they get treated for free in the Emergency...? My friend from another state (in the US; insurance out of state) had to make an Emergency room visit here in the northeast - and that 1/2 hour visit and a ton of useless meds cost her a few hundred dollars...which she is still paying on a payment plan...are these "thousands of patients" (a caravan we did not know about?) from Africa and Asia enjoying a free ride...? I did not know such a thing existed in the US...
3
@Ananda Yes they get treated for free while in the hospital. Most safety net hospitals will provide for a month of medications supply upon discharge. Medicaid pays for the ER and Inpatient costs. Most US citizens who show up in our emergency rooms on the other hand will get a bill.
4
Why was this imminently terminal patient on a ventilator in the ICU? There was no obligation, medical or ethical, to provide this level of wasteful and futile treatment.
41
@LC
"Obligation?"
Is that what you think medical care by a palliative physician is based on?
1
@LC
Hey, give the family some time to think about what to do next, OK?
God, so many today think they know everything. They don't. They never will.
4
A helpful construct taught to me in a palliative course recently was to think about and talk about the BEST care. It has been helpful for me to ask consultants what they think is the best care. Sometimes the answer is not more CT scans, more lab draws, and more hospitalization. Sometimes the best care is to get safely home with family and good hospice services.
If they can pay, let them stay. Most Cities have plenty of available Hospital beds, and can certainly use the Money. Perhaps a certain percentage of the Money from international patients should be set aside for indigent or uninsured Patients here. Win-Win.
24
Years ago an entire floor of the Cleveland Clinic was reserved entirely for a certain gentleman from Oman. That is not even the real story. He received an organ transplant. The “joke” remains some poor Pakistan 14 year old provided the organ Who knows. But I have always wished an investigation on international patients and their transplant organs was done. I am told they are not on and will never be on an organ donation list.
25
@Tn Towanda
My father was being hospitalized at the Cleveland Clinic then. I remember the elevator doors opening on the floor of the man from Oman and his armed guards standing there at the ready. I think the same family purchased a nearby restaurant so they could have made to order food. The public was allowed to go to the restaurant. The food was great.
It's really hard to get on an organ donation list at the Cleveland Clinic.
5
Yes, I am fairly certain the Cleveland Clinic allotted a floor or section for the ruler of Oman. I am also equally certain a child from a poor nation was used to harvest the organ. The Cleveland Clinic simply asked if the organ had been improperly obtained and happily accepted the confirmation it was not. Truly this topic deserves an investigation by the NYT
4
@Stephanie Wood
Good grief! You aren't "...still technically alive" if your heart is beating because you are hooked up to machines.
It is quite a thing when you realise that all the money in the world will not buy you a cure for an incurable illness. Unfortunately there are many people who do not realise how useless money can be in this situation. The disease stops for no-one and no amount. I wish the son peace - he did all that he could and respected his father's wishes. I just wish they could have done it at home with excellent hospice care.
28
@Kirstine
Very well put, Kirstine. Spot on. I am an Oncologist who has been in this situation many times and couldn't agree more.
10
A careful and insightful look at the great promise and great compromise that is our healthcare system. I most appreciate the focus on the patient experience, the casting of seriously ill patients, even those who may be well-resourced as vulnerable and worthy of not only our compassion at the bedside but administratively as well.
17
Universities seek out international students and charge them 2x-4x the in-state resident tuition. Universities have become dependent on that income and I don't think the foreign students are keeping out local students. It is the same for medical cases.
If one university/hospital does not take them, some other will, and not all students/patients are particular about coming to the USA. They often go to UK or Australia if they don't want to go to the USA (unfriendly policies/behavior towards foreigners). If someone is willing to pay, they should be allowed to come.
15
@AN
This article reminds me of the practice of California Universities encouraging foreign students to help pay for overblown salaries to administrators and high government pensions. It is a common practice, for example foreign students make up 18% of the population at in University of California, Irvine. Our students have a hard time getting intotheir school of choice here even with good high school averages and SATs. Even if foreign students pay more it doesn't make up for the lost opportunities for our own tax paying citizens. I watched a "House Hunters" show on TV where a foreign student's family bought her a $2 million house to be close UCI. Our citizens are not being prepared for the future due to their lack of technical skills and education and healthcare is too expensive for many of our citizens but displacing our own citizens whether in health care or education for foreign money does little remedy this situation. Glad we are providing these services to the highest payer. I guess it is the old greed game. This is a capitalistic country without compassion or help for most other than the few privileged who can be either as a USA citizen or a foreign visitor. But is it still our tax dollars that support these institutes and overpaid "professionals" that earn far more than those same professions in other countries. Funny though that many of our citizens are going to foreign countries to get medical treatment since they cannot afford to pay for it here.
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@Vail
If we reversed Prop 13, there would be more money for schools and we wouldn't need foreign students to generate revenue.
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The choice is not in-state students or international students. Rather, the choice is in-state students (residents whose tuition Is subsidized by the taxpayers in that state) or out-of-state students (Non-residents whether they be international students or students from another state) who hypothetically pay the cost of their education without being subsidized.
Taking up a bed? I doubt the inner city patient on state aid, is making it to MD Anderson, Dana Farber, Sloan Kettering or Cleveland Clinic. Most likely he gets admitted to whatever hospital is closest to home.
If an international patient wants to be an experiment on his own dime, who am into judge? I've known plenty of people who have burned up tons of money for last ditch efforts to buy a few more months/weeks/days that were domestic
I personally would not want to die in the ICU hooked up to all things that go beep. I don't know why the patient in the article did, but if he's paying the whole bill, does it really matter? It's his choice.
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@Ford313
Actually you're wrong. I had an operation and used my Medicaid to pay for all of it at SK. I had a top flight surgeon of my choice and a recovery room and bed that could've been in a first class hotel. Not to mention compassionate and steady care by staff. All paid by MCaid.
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Another patient dying in the ICU on a ventilator because oncology couldn’t say no. Should have been comfort measures only.
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@Guan Mingde I'm not sure who couldn't say no, but I agree ICU is a waste of resources in terminal care and is no place for a terminal cancer patient. Hospice would have been much more appropriate.
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@Guan Mingde
I would guess that you have never had a family member with cancer. Moreover, I would guess that you don't expect to ever have cancer.
At any rate, you have no idea what "should have been."
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It's the exact same situation with our colleges. Are foreign students "taking up a slot" that could go to an in-state or American student, or are they bringing in needed revenue?
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@Madeline Conant
It's not the "exact same situation."
Colleges accept foreign students to encourage international good will and open our doors to cultural interchange.
Some foreign students will obtain advanced degrees and become valuable contributors to our industries whether in research or entrepreneurial businesses.
American students benefit from being exposed to other cultures and thus doors open to opportunities they hadn't thought about before.
This palliative care physician is expressing a far, far more profound question - can American medical expertise provide those of other cultures what is "best" when they are seriously ill and perhaps dying.
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@Mimi
In California, schools accept foreign students to pay the bills.
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I fear that one reason Florida hasn't expanded Medicaid is concern by voters with Medicare that hospitals and medical offices will be flooded with Medicaid patients. There might be concerns in Miami about foreign patients taking up hospital beds, but I haven't spotted stories to that effect in the Miami Herald.
The state legislature, with support from the incoming governor, will be seeking ways to cut health spending. So in a Florida context, if residents are denied hospital care, it's probably for lack of health insurance or alternative financing, not overcrowded medical facilities.
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An exquisitely balanced and sobering essay on the delicate balance between compassion and the "bottom line(s).
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@LIssa Paul
This is not about the bottom line.
The question is balancing excellent medical care which America is renowned for and inherent cultural differences with foreign patients which this compassionate and sensitive physician questions his ability to consider.
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@Mimi
"Are they taking up beds that could be used for vulnerable domestic patients or are they bringing money that could be used toward other programs?"
That's the overview. This is very much about money.
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@cheryl
Did you read the entire article or just the sentence under the headline?
If you read the entire article, you might conclude that it was compassion and humanity, not the bottom line.
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Insightful and very interesting article!
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