Kudos to the executives of Ashley Furniture, Dr. Parisi, Ms. Ferguson, the staff in Cancún and all the others who made this experiment work. This process cannot help everyone, but it shows what can be achieved when thoughtful people are willing to try a new approach.
79
When will American wake up to the fact that we are a decaying society currently led by gang of sociopathic rogues who do’t give a darn about the majority if our citizens:
—life expectancy decreases,
—infant mortality increases,
—the health care system totters,
—the infrastructure further degrades (D+ rated)
—the opioid crisis rages,
—the obesity rate increases (up to 40% of the population)
—mass shootings and the high number of gun murders continue unabated,
—the quality of schools declines,
—massive deficits and debt levels grow,
—obscene levels of inequality continue,
—600,000 + homeless roam the country
—40 million live in poverty ( 1 in 8),
—1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year,
—environmental degradation continues unabated (i.e. more than 19 million Americans have been exposed to contaminated drinking water, according to new data released by the the Northeastern University and the Environmental Working Group).
—The richest 1 percent in the U S own more wealth than the bottom 90%
—The US medium savings account balance is $5200.
—21% of Americans have no savings at all.
155
Had a core needle biopsy done on my breast last spring--$8000! Then, the hospital double billed me for my co-pay for months, despite the insurance company telling them how much my co-pay was. They finally sent me a letter stating the amount, and I took that to the billing office--and still had to battle over it.
65
Dr. Parisi said that the lack of English proficiency among some surgical staff members created “momentary delays"
Or maybe it was Dr. Parisi's lack of Spanish proficiency.
112
Dr. Daniel is a HERO
18
The premise behind having surgery in the U.S.--so one can file suit if less than desired outcomes occur is obscene==and far from realistic. I have had surgeons flat out LIE about what they did to my cervical spine--even on the coding work to the insurance company. The amount of effort to PROVE their errors and the damage done to my body and the fact corrective procedures where done a mere 6 weeks later? A nightmare when he was chief of staff at the largest hospital. Do not allow the ability to sue be the reason for U.S. based procedures. If I have her option--I will do so no doubts.
20
@Koni Royval multiple surgeons lied? Or one unfortunately unscrupulous individual? You used both 'he' and 'their' in your description, and although no one would wish for one to be injured as a part of a medical procedure, I would question a conspiracy by multiple surgeons.
6
Corporate ideology, tactics, and MBA-think have permeated and poisoned U.S. healthcare. The system is the ICU and the prognosis is grim.
36
New tooth in Bangkok = $35.00. Dental Cleaning in Taiwan = $15.00
35
Broken Leg in Austria with steel plate, six screws = $2000. Would be $10,000 in USA.
27
@Suburban Cowboy--Far more than that for a broken arm even 20 years ago! The metal in my neck--was $25,000--no darn way did it cost that much to provide and even with a decent profit margin-should not be charging this.
22
The use of air travel to get patients to experienced surgeons and effective hospitals can actually improve patient care - the logic is that the surgeons are going to perform lots of these surgeries which improves effectiveness. Kaiser's Robert Pear notes there must be a linkage between the EHR at the hospital and the rest of the team that maintains support for a patient over the long term. Maybe NASH does that but it wasn't described.
Big cost issues in US healthcare come from close cooperation between Congress and the Medical supply and delivery system which builds margins for the supply and delivery in response for donations to the Senators and Representatives. These are encoded in legislation and are carefully protected. The profits may be used to do more R&D that is leveraged globally, but the system is a little opaque to check.
The yearly insurance system in the US encourages healthcare to be short term focused, since paying for someones long term health will be another insurers benefit!
The ACA individual mandate was a big part of driving down costs -- of course when the Republican's zeroed that mandate they made the ACA much more popular, but they removed the incentive to limit numbers of treatments.
Doctors in the US are very dedicated in my experience, but they are trapped with a huge debt, and so seek specialties that will help them escape that burden quickly. Too many specialists then reduces the number of operations performed
22
The last time my husband was in the hospital was to be evaluated for hospice care. The room & board charge alone was over $14,000 for 5 days, and the tests cost over $13,000. The entire bill was over $48,000, and he had no treatment whatsoever. If I get sick, I'm going to the Ritz. It will be cheaper, and I'll probably get better care.
87
As an American who has lived in France for many years and fortunately has had to deal with US healthcare rarely during that time, there is something I do not understand in this article.
Why would Ashley Furniture be paying for this surgery? Does not the employee’s health insurance policy pay for it? This does not make sense. Why would it come directly out of the company’s coffers?
I am extremely thankful to be living in France and to know that my health care is being taken care of here with practically no out of pocket expenses and at a very high level of care.
For those interested in medical tourism, I highly recommend coming to France where the costs are low and the care is excellent.
38
@Overseas American healthcare.gov says "Self-Insured Plan
Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract for insurance services such as enrollment, claims processing, and provider networks with a third party administrator, or they can be self-administered.
"
23
Or if the overall costs and claims of an employer prove to be lower than average, the insurer can charge them less in premiums for their employees collectively. The math and the sharing of the lowered cost is easy money for those involved - Insurer, Employer, Patient and Doctor. The losers are the hospital and doctors who are unwilling to participate. Later, if the trend builds, the hospitals will feel the pinch and reduce staff ( and perhaps prices to lure back the overseas service seekers ). Health Econ 101.
10
@Overseas American - ERISA medical plans are common among large corporations. They are administered by an insurance company, which makes it look like insurance, but the company is actually paying all the bills and deciding what medical care the employees can receive.
Back in the 80s, I was responsible for a system where Met Life billed hundreds of big companies for medical costs paid for their employees. Every night Met Life sent us a computer tape (by bicycle messenger!) and we used it to debit the accounts of these large companies and credit Met Life.
11
Well it sure sound convenient for US patients, the caveat is what kind of certifications are these US doctors getting in order to be able to perform surgery in Mexico, that is, Mexican certifications.
I’m a plastic surgeon myself, and as much qualifications and boards I have here in Mexico, I’m pretty sure there’s no way for me to come to the US to establish a practice, let alone operate and leave within 48 hours. So of course it should be up to Mexican health authorities to regulate this new kind of medical tourism, but physicians should be aware that if they are not certified they are breaking the law.
I really hope this doesn’t become a thing, because the only thing it’ll do is raise prices here in Mexico where people struggle to pay their medical bills as it is.
If patients in the US are looking for first class facilities with lower costs and first class doctors they can easily find them in many cities around Mexico, trust me they don’t need to bring their doctors along.
50
I agree there is no necessity to bring in the gringo doc. However, in this early stage and perhaps in some cases, the accompanying doctor helps to generate the business decision. For certain, the Cancun clinic must be licensed and the inbound doctor must have proper permission to perform the procedures. It is an obvious win/win for those mentioned in the article. I would say further as the knowledge and positive reputation broadens , the cost and incentive to go to Mexico WITHOUT a US doctor will be excellent and the US doctors will get priced out too along with the US hospitals.
23
That is a good point, it is not uncommon for US news outlets and even “reality shows” to discredit medical tourism by showcasing cases that went wrong over here. The truth is we do have a problem (especially in plastics) where a lot of non-certified “professionals” offer very cheap procedures. But actually most of the people that come over from the US have a great experience, as not only the cost is lower, but personal attention is on-par or even better than most US hospitals.
So as you say, this could indeed turn out to be something positive if it helps Mexico’s hospitals and health care providers to boost their reputation over the border. I sure hope it does!
23
First in war, last in health care. Make Congress pay what we pay. Elect people who promise to fix and then throw them out, without benefits when they don't produce. Only corporations can fix this problem, because their employees suffer and they are what counts in Washington, not us.
39
I wonder if the US doctor had permission to work in Mexico. They are (properly) cautious about giving such permission.
5
I recently retired to Mexico. Last week I saw a leading dermatologist here to check a mole. He examined it, and did a general skin exam, and luckily everything was fine. He charged me 700 pesos, or about US$35. You usually pay doctors in cash here after appointments, so I handed him two 500 peso notes, and he took out his wallet and gave me 300 pesos in change. That's medical billing in Mexico.
And if you want to know what something will cost, you just ask. And they tell you.
Here in Mexico, expats tend to buy private health insurance (mine costs US$1,800/year) but pay for small things out-of-pocket. My health insurance would cost much more, however, if I wanted a policy that covers me when I visit the U.S.
46
This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. The author is a reporter for Kaiser Health News.
Does this compromise the Times's journalistic independence, printing this co-production written by outsourced staff?
In any event, there is a lot to consider in this article about health care costs in the US. We have serious problems. To most people in other developed nations, our system is a baffling puzzle, our costs absurd. We need to take a step or two toward something fairer for the most of us, with less opaque pricing, and not wait for some solution leapfrog that satisfies everyone at once.
Write your congressional representatives. Tell them what it is about our health care that makes you sick. Vote for changes to our system. Keep pushing. We deserve better.
23
@Harold B. Spooner Kaiser has lots of reporting on NPR as well. These are not opinion pieces, simply reporting.
16
Between the shareholders getting their profits, the CEO's getting their millions of dollar salary and the millions of people employed to do the paperwork on this monstrosity there is no interest in really upsetting this absurd system.
45
Yep, America can export her medical expertise now!
2
Great article!
14
In 25 years of observing American healthcare the biggest change I've seen is a cultural shift. The traditional view was that the patient is a dependent who must be guided and guarded to health. The new culture is that patients are customers who must be offered choices, but are also profit centers to be milked for as many extra fees as can be legally justified.
The biggest driver in this cultural shift is physicians who are seduced by medical consultants, healthcare administrators and commercial actors into thinking about ALL THAT MONEY THAT THEY COULD/SHOULD BE MAKING. Not very subtle . . .
This worked well when local physicians and hospitals had a monopoly on providing services in a given geographic market. It is very interesting to observe how they react when it becomes clear that their own actions have put them into competition with foreign hospitals for the most profitable types of care. A competition that inevitably they will lose.
My view is that "medical tourism" is just a further extension of a healthcare culture of decisions based on cash flow and profit margins rather than focusing on the best medical outcomes with the most efficient expenditure of society's resources.
Knowing nothing about NASH, I can guarantee you as a business man and investor that their business model is focused on the day when they can send Dr. Parisi down to Cancun to do 5-a-day operations with two dozen US patients shipped in at a time. Just think of how much money that'll make!
26
I think medical tourism is great. But one thing not mentioned in this story is pain control. I have a friend who lives in Mexico in the winters. She had a bad fall resulting in multiple severe fractures in her leg. Surgery at the local hospital went fine, but when she was discharged she was not allowed any pain meds stronger than ibuprofen - oxy and other strong meds were made illegal by the government. She was in extreme misery for weeks.
11
@Linda S.
Post op patients here are sent home with nothing, as well. I constantly see ads from Hospital of University of PA that brag about how great it is to send cancer patients home with no pain pills after surgery. I had surgery three times this year, and it was a real battle to get any post op pain meds. Now, the dentist says he gives nothing for root canals, although he used to. The US has bullied the entire world into joining the War on Drugs.
17
According to the article the average cost of knee replacement in the US is $30,000. Subtracting the costs mentioned, hardware, surgeon and 2 nights in the hospital that still leaves $21,100 unaccounted for. Where is that money going? Neither anesthesia nor medications were mentioned... but I am specifically interested in how much the insurance company pockets and how that compares to what NASH charges.
15
The net difference is money not spent by the insurer for the care provided. Just like any other business that can deliver for a lower cost, the margin is theirs to keep.
7
I am a primary care doctor in the US. I am so disgusted by the corruption and dysfunction in our medical "system". I use the quotes, because it is really not a system. It is a disjointed, unintelligible group of interests, all bent on getting theirs wherever possible. Some of the expense of services and supplies in our hospitals is to recoup business losses since hospitals in America are required to provide emergency services to the un-insured (who often are presenting with expensive-to-treat crises, that could have been avoided if we had universal coverage to pay for preventive visits). However, even in my "non-profit" health system, there are layers of administrative executives, who provide no direct care, and are paid WAY better than the boots-on-the-ground providers. There is also no way for the healthcare consumer to price shop for comparable services. When I have to order an MRI for a patient, there is no way I can tell them the cost, and they cannot readily determine the cost at different imaging locations, so there is no competition to drive costs down. A very effective lobby has kept the cost of medications and medical devices (replacement joints, pacemakers, etc.) artificially elevated in the US.
Healthcare-related corporations in the US have tremendous lobbying power to keep in place a regulatory structure that does not encourage competitive pricing. It is my hope that competition from these foreign ventures leads to healthy in-country competition.
147
@Anne Ominous Thank you for your post and for continuing to treat patients. I'm so glad you posted this. All completely true.
27
Thank you for writing this. Not only patients suffer but so do providers. The system is rotten but the vultures still try to squeeze every penny out of it. As an American, living in the so called greatest county in the world (or not) I cannot afford a standard medical procedure here. This is ridiculous. But all the people who voted for Trump won’t even bat an eye to have their surgeries performed in Mexico. I hope the Mexicans will shut this nonsense down ASAP.
18
My parents spent winters in Mexico for more than twenty years. In that time, they or other family members needed medical treatment and, in one case, emergency surgery. All doctors were Mexican and the care and treatment provided was superb. Doctors spent much more time with them than they do here. After surgery, my niece had a nurse assigned to her full time. And the bills were a small fraction of what they are in the US. Granted villages in Mexico do not have such treatment available (but rural areas here also have a dearth of facilities and medical personnel). Oh, and I always filled several of my prescriptions on my trips there-- in one case I paid $5 for a medication for which my copay here is $48 on top of what my insurance covers.
39
Goes to show how utterly broken the "free market" fee for service private insurance based medical industrial complex in the US is.
Interesting that the author is a reporter for Kaiser Health News. I would be willing to bet that the cost of a total knee replacement at Kaiser Permanente (total cost = surgeons fee, anesthesia, OR, hospital stay, pharmacy, labs, imaging) are LESS than what was paid for this patient to go to Cancun to have her surgery. The same would be true of other physician salaried models in the US.
16
@maxcommish
I think Kaiser Health News is a separate entity from Kaiser Permanente Health Corporation. But I do agree this article shows how outrageously expensive the US health system is. It also makes me wonder if medical tourism will do to nurses, techs and other support staff what NAFTA has done to auto workers.
How can people not see that Medicare for all would be a good deal.
22
@hewy - "How can people not see that Medicare for all would be a good deal."
Well, the answer is in the previous sentence. Salaries would have to be cut in half to compete, and those medical workers will put up a very strong resistance.
3
We live half the year in Mexico, and regularly use medical services there, both for the cost and quality. Rarely do we wait for a doctor, unlike the US. Rarely do we have to wait months for an appointment with a specialist, unlike the US. And never do we pay the obscene costs as in the US.
Unfortunately, Medicare neither pays for these services nor reimburses us for our costs.
We (and others) could be saving billions for Medicare if our system permitted paying for services outside the US.
39
To know why American healthcare costs so much, come down to Houston. I live a few minutes away from the TX Medical Center. My neighborhood is filled with executives who work in the for-profit health care industry, ranging from insurance to pharmaceuticals to medical records software sales to ambulance transport, etc. My neighbor's (now) ex-wife is a lobbyist fighting for the status quo, and she owns a vacation home in England, where she loves their NHS.
Sanders and Warren are not popular here.
95
When I broke my toe on a visit to London last year, I went to a local private hospital. I was seen in about 30 minutes, and 45 minutes later, I had had an x-ray, been seen by a doctor, had my foot strapped up and been given instructions on how to strap it myself and how to look after it while it was healing. For all of this, I paid a grand total of £200. I left the hospital thinking that if I’d gone to the ER at New York Presbyterian (where I usually go), I’d have sat there for four hours, then received an x-ray bill for $1,100, a radiologist bill for $350, an ER bill for $500, and a bill for $100 for having my foot strapped up (this last one in particular drives me crazy - if I ever go see my foot doctor about plantar fasciitis or whatever I see the same thing on the bill - I just can’t get my head around there being a separate charge for what should be part of the treatment and covered by the doctor’s fee!). These are not made up numbers, by the way - I’ve had similar things happen in NYC and seen exactly those numbers. When my husband landed in the hospital overnight for a foot infection two years ago that had to be treated with intravenous antibiotics, we saw even bigger numbers. Most doctors here in NYC won’t even see a patient without them first having an x-ray and/or an MRI, each of which is billed at $1,000 and up. The last time a doctor wanted me to do that I decided not to see them and just waited out the pain, simply on principle. And then we wonder about costs!
41
@NYer--While I would not have bothered to even GO to a doctor for a broken toe. Would have strapped it myself--as there is NOTHING much else to do for a broken toe. I have refused more medical tests than most people have had ordered for them. Guess what--no doctor has refused me treatment,nor fallen over dead because I said NO. After some 25+ surgeries including cages and rods in my spine--I do know what tests are worth my time or NOT. A broken toe? Not worth the drive to any doctor--certainly not n ER visit. Those happen when my child's hip was protruding from his skin--the other had compound fracture and a newborn was in a seizure. Even then--I had no problems PAYING monthly my part of the much need services. I do not get free housing,free food-so do not expect FREE medical care.
1
I totally agree with Ms. Ferguson. I just had double knee replacement in Mexico City. The whole Mexican medical team, from head surgeons, anesthesiologist, nurses, etc..., gave me direct and total attention. Top Top quality and I am recovering splendidly.
50
@Kim Were you happy with pain control measures?
4
While wages are less, far less, in Mexico, does that explain the dramatic cost difference? I have substantial hospital experience in an excellent, teaching, not for profit hospital. They are NOT making money, but need government assistance. A detailed study of the reasons for these differences is needed. You can be assured that if this form of tourist medical care takes off, the knee replacement manufacturer will change their cost based on the citizenship of the recipient.
9
Judging by the internationally diverse clientele in the many waiting rooms in the massive Memorial Sloan Kettering Hospital complex on Manhattan's East side, devoted entirely to the treatment of cancers, Asian, Middle Eastern and Eastern European patients are medical tourists, flocking to this venerable beacon of hope in New York.
Either their national health insurance plans are footing the bill, or they are willing to pay out of pocket for the best chance to survive an often deadly diagnosis.
2
@Reed Erskine Or all those people in the waiting rooms are living in the very diverse city that is NYC or the coutry that is the U.S.
37
@Reed Erskine
Yes, Sloan is a world renowned cancer center.
That doesn't mean that people shouldn't travel outside of the USA so that highly qualified professionals can perform surgery on them at a fraction of USA prices.
16
I know the Canadian health care system will pay for treatment in the US if similar care is not available in Canada.
10
American healthcare and health insurance costs are obscene. The last time ANYONE tried to do ANYTHING about it was the ACA. Rather than build on or attempt to fix any of its shortcomings, the Republican party has done absolutely NOTHING. Well, not quite, they have actually made things worse. trump and Repubs have not only NOT come up with something better, things have actually gotten worse.
87
@Chris The ACA, a rehash of Republican plans going back to Nixon, is flawed BY DESIGN
8
Another example of the myth of American Exceptionalism. Yes, the US was a global leader in just about everything after WWII, but that era is gone. Other countries are experiencing, in various degrees, the scientific and technological progress of the late 20th and 21st Centuries, once led by the US and western Europe. It's silly to think the way we do things is always superior, safer and better. Humans all over the globe are creative, adaptive, innovative.
66
Sure. I routinely drive to Mexico for dental work. My then Houston dentist quoted me years ago $4500 for two crowns and a cleaning. It was done in Nuevo Progreso for $690 by an excellent Mexican dentist, and since then all my dental work is done there. Years ago I flew to Spain and spent a week in Marbella -only a day in the hospital- to have kidney stones removed -all for less than my then US insurance policy deductible. Now I'd probably go to Mexico City -it's closer and even cheaper.
37
@Michael Skadden I agree and do the same. Its funny how much prejudice I encounter from people here who assume that if its done in another country the dentist must be unqualified. There are many terrible dentists here in the USA despite their qualifications.
26
Many Americans go to Mexico for procedures that their insurance companies will not cover. Breast reduction surgery, which can substantially improve the patient's quality of life and alleviate a lot of pain and wear and tear on neck and spine is not commonly covered in the US. While you do pay out of pocket for surgery in Mexico it is a fraction of what you would have to pay without insurance in the US. Bariatric surgery, another life-changing and possibly life-saving surgery is also not covered by a lot of US insurance companies. Depending on the procedure you could pay less than $10,000 in Mexico. There are many excellent hospitals that routinely do these surgeries right over the border.
12
Mick Jagger, a UK citizen, recently had heart surgery in NY. He was in the U.S. on tour but could easily have flown back to England for the operation. I wonder why he chose to have it done here?
1
@Eric Fleischer Are you sincerely asking the general NYT readers who likely don't know Mick or his decision making process or are you implying that our health care is better than that in the UK?
As I have said to a friend in big pharma anytime she points out the Canadians that come to the US for medical treatment, it is the wealthy who come for treatment, never or seldom is it the average or poor. Our system is great for those who have the best jobs (and hence health care) or the wealth to pay for it.
57
@Eric Fleischer My guess is because the UK's National Healthcare System paid for it. The NHS will generally approve surgery outside the UK when it is medically necessary. It is also possible with his money he picked up the tab.
29
@rf I think you picked up on the implication. Clearly our healthcare system has a myriad of challenges not the least of which is access, but the finest care money can buy is here in the U.S.
As far as the NYT readers that don't know who Jagger is that's their loss. I'll be in the stands at the Stone's concert in Miami at the end of this month enjoying what may well be their last American show. Rock on.
5
My only question the article quoted Medicare rates for the Dr’s fee. Since this was a private insurance policy not Medicare why go there. I would have liked to know how much his fee would have been here under the private insurance. I’m all for any cost savings for medical services as long as the quality is good.
@Calvin Knight most private insurance companies roughly match their reimbursements to match Medicare rates.
13
@Calvin Knight
Perhaps the sentence directly following the Medicare rate-- "Private insurers often base their reimbursement rates on what Medicare pays."
The word "often" leaves quite a bit of ambiguity, but it's an indication of what surgeons may be typically paid.
10
This is a natural expression of technology transfer - the same thing that is happening in the automotive industry. As our technology has advanced, we have let go of the less expensive models and only build the luxury. However, when our technological lead begins to decrease, we find ourselves with a need to bring back some of those services and to decrease our elevated living standards. Expect more of this.
8
My best French friend and her American husband moved back to France for good, She spent 30 years in The Us, could not afford medical insurances with all the headaches, happy , happy in France, both of them, fully covered and great care, yes folks, we have in France socialist medecine and it’s swell.
78
Necessity is the motherhood of invention and this is what happens when costs become a huge obstacle to care. Not nearly enough emphasis is being placed on containing health care cost increases.
17
@R. Anderson
Even if health care costs are sustained at current levels, it is still unaffordable to most Americans.
25
"Also, having an American doctor meant that if something went wrong, she could file a malpractice suit in the United States, she added."
Therin lies the problem, and one of the biggest driving forces for increased costs. It won't be long before this 'option' becomes as expensive as getting the surgery stateside. If something went wrong, in this meticulously documented endeavor...it clearly wasn't the fault of the surgeon....but why not sue him anyway?
15
@S As a OR nurse with 45 years experience I get sued, or served with a subpoena probably 2 times a year. I am involved with many more patients than the surgeon in any given year, sometimes 5 patients a day. We all get named in your suit. Always. It is the extraction of as much settlement as your lawywers can get. That is why they sue everyone. And you know what, it does not ever matter if wrong was done to you, what MATTERS is how the JURY feels about what happened, and how much they want to award you. Frequently is is cheaper, and less expensive, to just write you a check and settle.
34
@PerAxel I hear you. I'm an Emergency Physician, and am sickened as this being the first thought of the patient, especially while choosing an unproven path with multiple unknowns along the way. My sister is a General Surgeon and has been dragged into frivolous lawsuits against others with what could only be described as a 'carpetbombing legal approach' (later dropped for complete lack of cause) but not after going thru the sleepless nights and second guessing of one's legitimate good work.
12
In 198, I badly needed a hip joint replacement. (I could feel the bones grinding on each other when I sat or stood up.)
My insurance had been cancelled because of a pre-existing condition that I had declared, was accepted, then suddenly disallowed.
I was able to register as a "foreign visitor patient" at the hospital where the surgery was to be performed. (With help from the surgeon, who was chief of arthritic and orthopedic surgery.)
The operation and prosthetic cash prepayment was $20,000. The doctor's fee was $5000. (A discounted rate.) Fortunately, I had the cash.
I am now on Medicare. A recent MRI was billed at $11,000.
So much for health care.
25
This article makes it sound like all there is to a safe and successful surgery is the surgeon and a bed. I'd be curious to know the educational level of the nurses involved. What are these nurses being paid? Do they get meal breaks? What's their patient load? Do they have retirement plans? What's their healthcare coverage look like?
The CEO of Kaiser Permanente makes $16 MILLION a year while unit clerks fight for basic labor rights and benefits.
51
You still have unit clerks at Kaiser in California? Kaiser Colorado continues to lay off staff. Clinic check-ins are done via kiosk. Telemedicine is also a big deal now, you can chat with a doctor on call quicker than you can reach your own doctor. My medicines now come from a Kaiser pharmacy in Downey rather than here in Aurora.
We no longer have the traditional Kaiser HMO any more, either. We pay what is called "co-insurance," which is code for "You're picking up more of the bill." I have to ask now what it's going to cost me to have something done because it's no longer just the co-pay.
I was unaware that Kaiser's CEO makes 16M annually. This makes me quite cross. I've had Kaiser coverage for a majority of my adult life and as I watch the Kaiser model slowly disintegrate, I wonder what it is, exactly, the CEO is doing to earn 16M? Destroying Kaiser like Mitt and his hedge fund did to ToysRUs?
24
@Chloe Jeffreys I was wondering this as well. Do you suppose the cost of hospital staff is included in the per night hospital fee referenced in the hospital? (2k per night in the US, 300.00 per night in Mexico)
6
@Chloe Jeffreys I was wondering this as well. Do you suppose the cost of hospital staff is included in the per night hospital fee referenced in the article? (2k per night in the US, 300.00 per night in Mexico)
2
There is a problem in the US with medical professionals being chosen by the system that makes selections for college based at least partly on their ambition and greed. I know medical students who are viciously jealous of their class position and incurring huge debt and the stress selects for the most ambitious and hard driving capitalists.
If the US government paid for the education of our doctors and surgeons, and if the system selected medical school candidates with an emphasis on public service, we could have a whole system of doctors that were just as good technically, but more motivated and free to heal people, rather than to make money, and everyone would benefit. Greedy doctors could go work on Wall St instead.
Plenty of brilliant students are qualified to be doctors but do not want the rat race part of the profession. The do not want to rep for Big Pharma, sell procedures that are not necessary and fight to earn so they can have a Ferrari. They want to heal people and live simply. We should have far more doctors, and they should be humanists not capitalists.
59
@CK Good point. One reason that universal medical care works in Europe is that Med Schools in Europe are state funded, and graduates are not saddled with six figure debt loads at the beginning of their careers.
Having been a patient in both Europe and the US, my experience has been that European medical practice feels motivated by an egalitarian sense of caring, in contrast to an American system in which doctors are an elite class in a system that emphasizes speed, efficiency, and the bottom line. If money is "the root of all evil", America may well be the tree sprung from that root.
36
@CK
There is a program to help those interested in primary care pay for primary care health professional school. Don't do it unless you want to sign onto a contract that can be changed at any time by the government, without any input from recipients on these changes
40 years ago I went to medical school on a National Health Service scholarship. The deal was tuition, full room and board for 4 years, commitment to go into a primary care field and work in ANY federally designated healthcare shortage area for 4 years. It is now a 2:1 payback. The goal was to have physicians stay in these areas once they finished their obligatory time. Halfway through school, rules changed. no longer got money for room and board but still had same time requirements. After I finished my residency in Internal medicine, started looking for job in the Tri State area (yes there are medically under served areas within 2 hours of NYC). But they had changed the rules again, tried to send me, a Jewish person who keeps kosher, to northwest Mississippi! 2 classmates in the program, both of whom had spent their entire lives in cities (1 didn't even drive) , willing to work in "ghetto" public clinics, were told that as trained family practice physicians, they could only go to rural areas. We refused these assignments, Had to pay back what was paid to us, x 3 at 18% interest rate at time
Some recipients sued, others tried declaring bankruptcy because of crippling burden. didn't work.
10
@CK. I don’t know your background to make that kind of sweeping statement, but as a physician who does not drive a Ferrari, your characterization seems to be a gross misrepresentation. Absolute ignorance on your part to suggest that making “big bucks” is the major motivating factor to go through 8 years of higher education followed by between 3 and 10 years of specialty specific training in order to work 60-80 hours a week to make an average salary of $300K! Unfortunately, the high cost of education and secondary debt has driven many idealists away from primary care fields (peds, family practice) where salaries may be half that and the need is great- that’s where better subsidized medical education may make a difference, but I can assure you that the majority of my colleagues are in this field for the right reasons! Those without a true interest and desire to learn and serve rarely survive the rigor of training.
12
A fellow I knew had been treated for a coronary artery blockage, and knew what his insurance company paid for the procedure, minus the device used to expand the artery's narrowing.
6 months later he needed his license renewed so he could return to flying commercially, and at the time, he was told that he could apply but without a repeat angiogram it was unlikely he'd be given his second class license. Since this wasn't medically necessary, his insurance wouldn't pay for the return-to-work procedure. He approached the very hospital which had treated him initially, and offered to pay cash in the amount the insurance company paid for initially. The hospital, and three others, refused, wanting almost double since he was a private pay service. The logic behind this befuddles me, since it was cash on the barrel-head with no aging account through billing.
He told me he was back to flying, and I asked if he was able to get the insurance to cover his test, and he said no his morals were higher than trying to get them to pay when it really wasn't medically necessary. Instead he flew to the Philippines, had an American trained cardiologist do the test, stayed in a nice but not opulent hotel and hospital room, then flew back home all costs were less than even just the cath. Go figure.
55
I wish there was insurance that would give you the option to travel for treatment abroad in exchange for lower deductibles or other incentives.
30
As a Mexican currently in Virginia for graduate school, I’m a bit irritated by the unattended bias of the expectation of proficiency of physicians in Mexico. Even as it is a solid move to have a Mayo Clinic surgeon operating down in Mexico, it’s kind of absurd that there’s no mention that all patients having surgery in the US would most likely not have a surgeon from the most elite institution. More importantly, regardless of the mention of the Mexican doctor’s training stint in the US, I would not be surprised if doctors in countries with more straightforward healthcare systems were actually more proficient in performing medical procedures compared to their US counterparts, given that the foreign doctors actually spend their time ATTENDING patients and are relatively unencumbered and frustratingly bogged down by the never ending middleman grifter required paperwork that healthcare providers as a whole have to deal with in the US.
196
@Enrique My physician took his kids to an Egyptian pediatrician, saying her clinical experience made her a first rate diagnostic doctor. He said “she has seen everything” and was not able to rely on all the testing U.S. doctors such as himself had available.
20
@Enrique
I needed to see a doctor when I was staying in a town outside of Mexico City. I not only got great care--his prescribed treatment cleared up my problem the next day--but I was treated with such compassion and simplicity. There was no receptionist, no medical assistant: the doctor came in, took my vitals, talked with me, showed real concern, collected the $10 for the visit--and then, because he didn't have any more patients and was leaving for the day, gave me a ride home. I often think that all the "efficiency" built into the US health care system makes me feel like I'm being moved along an assembly line. Yes, we need Medicare for all, and we also need to remember that patients are human beings who respond to care and compassion.
31
How about insurance covering physical therapy early so there is less need for surgery?
7
@Cynthia Card Physical therapy does not actually stop arthritis in its tracks. How I wish it did!
23
This is great! At last credible competition to the monopolistic US conglomerates.
And if people think US hospital care is risk free, think again.
43
You are so right...my husband died from sepsis. He had two blood infections and one was a hospital superbug which was vancomycin resistant. He had a gastroscopy less than two weeks before he died.
21
I am so sorry for your loss. I can't imagine your grief and even the sense of betrayal you might feel.
But if Americans think seeking care in a foreign country with even more rampant antibiotic overuse than the US is going to be an answer to Superbugs then I'm afraid there are heart-shattering surprises ahead.
I predict the NYT will very soon be reporting about what happens to those Americans who end up in foreign countries with complications like the ones that your husband suffered. I'm very curious what responsibility insurance companies will take then?
This article is so irresponsible. The author makes it sound like there's a magical oasis of cheap healthcare in Mexico just waiting for us to exploit when what there really is is cheap Mexican healthcare labor to exploit.
How much are the nurses being paid? What about kitchen staff, unit clerks, OR techs, lab techs, etc? These used to be good jobs in America with pensions, paid vacations, and a liveable wage. Kids today are leveraging their entire futures to buy an education into these industries.
WE NEED TO ADDRESS CORPORATE GREED-- such as the greed of this woman's insurance company that shaved money from American workers in order to send this American to Mexico for her healthcare.
What we shouldn't do is allow the insurance industry to bribe us into outsourcing yet another middle-class category of jobs while risking American lives at hospitals that aren't being regulated to American standards.
4
@Alta Hanlon I am sorry for your loss.
6
Why does the same implant cost only $3,500 in Galenia, cost $8,000 in the U.S. The lack of price competition and opacity is ruining medical care in the U.S.
58
Similar to pharmaceutical differentials. Priced to the local market.
8
There are certainly inefficiencies and questionable profit-motives in the US healthcare system. However, if we want hospitals to remain open to treat trauma victims after a mass shooting, as they did at University Medical Center in El Paso (https://www.nytimes.com/2019/08/09/health/el-paso-hospital.html), we need to ensure that these hospitals are financially viable. One of the ways that hospitals remain viable is by using profits from more-profitable elective procedures (arthroplasty) to fund the 24-7 operation of trauma centers, cath labs, and emergency departments, so that they are available to everyone in the event of a true emergency. A private hospital in a foreign country is not of much use a person having a heart attack in Wisconsin in the middle of the night.
13
Compensation for hospital administrators and CEOs have soared, that's where the high costs go.
40
All my Japanese friends go back to Japan for big stuff. Healthcare in this country is up the creek.
36
Perhaps Mexico should build a wall to keep out all those Americans coming in and hogging all their medical procedures.
The irony of Americans going to Mexico because they cannot afford adequate medical coverage in the US is laughable (if it wasn’t so painful).
One wonders who these medical “tourists”
vote for.
You can’t make this stuff up.
170
@Other Why would they build a wall to keep out people who are coking in to GIVE them money? Money that helps fund equipment that they can use for their own citizens.
8
Why would we build a wall to keep out people who want to pick our fruit and vegetables, clean our houses, mow our lawns, cook our meals, care for our elderly parents?
25
@ Holly No it takes care and resources away from the people who live there.
3
“Dr. Parisi said that the lack of English proficiency among some surgical staff members created “momentary delays,” but that the bilingual surgical assistant helped.”
And, if something doesn’t go as planned? Those “momentary delays” could have led to a disaster.
14
I would emphasis the point that the surgeon's compenation was much higher than the US standard yet the savings relative to a surgery in the US was substantial. The out of control healthcare costs have little to do with practicing doctor compensation and much more to do with the structure and inefficiency of a huge for profit industry.
93
How many high risk patients have been approved for this process and what do the medical professionals define as high risk. That and traveling and staying alone for the 10 days post-op would be concerns.
5
My brother is a prestigious heart surgeon in Mexico, when he read this article, he told me that Dr. Parisi should have had a license to practice medicine and perform surgery in Mexico, if he didn’t, it was an illegal procedure.
Only those medical professionals who have been accredited by the government body that regulates professional licenses “cedula profesional” and have gone through the requirements, like spending at least a year in a rural area doing “social service” and have a work visa in Mexico can perform legally in the country..
It would be interesting to know how Dr. Parisi complied with the requirements.
47
@Oscar B
it's a great question; there is a loophole the article does not mention. NASH has in fact built a an American ward on the fifth floor of the Galenia Hospital and got JCI accreditation. So technically they operate as a US facility.
(and a Canadian too).
I still question why flying a US doctor rather than having one on staff.
25
@Oscar B
Maybe this needs repeating… It’s Mexico.
4
@Lee Zehrer
Perhaps, however, I would’ve expected better from the American Dr. if what he did was indeed ilegal...
1
I lived in San Diego for a large part of my life, and developed uterine fibroids for which I needed an operation. Also lost my health insurance at work a bit before. Using medical tourism I had the operation across the border in Tijuana at a lovely hospital called Hospital Angeles. I had my own private Suite, and a wonderful experience as operations go. Would do it again. Our system is so toxic and convoluted here. I wish more people knew about the options out of country.
73
A couple of years back I was visiting Medellin Colombia when I started experiencing excruciating abdominal pain. I went to the ER at Clinica Medellin where they told me I had a gallbladder stone that needed an immediate operation as my life was at risk.
They rushed me to the OR where a team removed a stone the size of a walnut. I spent a night at a really nice hospital room and I was discharged the next day.
Total cost for the procedure including the room, all medications and consultations was under $1,500.
82
Taiwan has one of the best and most reasonably priced universal healthcare systems in the world. I have seen it in action, up close. Patients don’t wait, get quality care at cheap prices, if at all. It serves 24 million people and runs a budget surplus.
In a recent recent article:
“Taiwan’s healthcare system has been ranked the best out of 89 countries surveyed, according to the Health Care Index compiled by CEOWORLD Magazine, an online business magazine and news site.
The index measures the overall quality of healthcare systems, including healthcare infrastructure, competencies of healthcare professionals, cost and availability of quality medicine, the magazine said.”
When I come back to the U.S., I just shake my head in dismay and at the waste, fraud, abuse and inefficiencies in our healthcare system.
88
That’s my experience too. ER, EKG, blood test, X-rays and doctor exam for a broken rib = $200 without any paperwork whatsoever.
8
Wonderful anecdote, obviously meant to expand on the narrative of US health care being broken. Major surgery involves a team of nurses, anesthesiologists, rehab, perhaps infection disease docs, etc., not just a peripatetic surgeon. How is their quality assured? And will the patient be flying back to Mexico is a problem arises? Second, where are the actual outcome data for this hospital and this approach to medical tourism, and why didn’t the Times produce such data? Are we going to seek to change medical practice based on opinions unencumbered by any actual facts?
22
@LTJ You asked the most important questions. The reporter and his editors need to answer questions about short and long term outcomes for this hospital and all patients in these medical tourism plans. The patients are probably highly selected for low risk but still bad things happen in all facilities and with all surgeons. Reporting 100% outcomes does not occur in the US but should. Demanding outcomes for surgical and medical procedures and treatments has long been the "third rail" of American medicine. Advocating mandatory true outcomes reporting has never been good for a successful career in medicine or in hospital administration.
7
@LTJ Chill out, its knee replacement surgery not a quadruple bypass.
What actual facts do you have to support your opinion that the US healthcare system isn't broken? Because I have plenty to show that it is.
Highest cost system in the world but not the best outcomes. Highest maternal mortality rate in the developed world. Tens of thousands of bankruptcies per year due to medical debt. And no small number of deaths due to inability to afford care.
"This article is terrible because it doesn't answer all the questions one could possibly ask on the subject" is a pretty dumb rebuttal.
12
@LTJ, it's Mexico, they don't have to keep records as well have to.
1
We visited Kiev and my husband had a great cleaning and root canal at a gorgeous, new dental facility. We received a Cd of his X-Rays. The U. S. System is a disgrace and the world knows it.
47
Imagine 10 years from now doctors protesting like auto workers. Demanding that people buy local, and that their jobs are being stolen by Mexicans. Why can't we just fix the system we have here. Why can't we know the cost of a procedure before it happens? I personally don't mind medical travel, but it shouldn't have to exist in the first place.
57
Why is the same medical device in Mexico less than half the price than in the United States?
American hospitals are expensive because they offer free care to indigent including illegal aliens and subsidized the care by increasing costs to insured Americans.
But don't worry, soon we will have free unlimited health care for all Americans, legal and illegal immigrants and tourists. No one will have to do this anymore..
9
@ Michael Green - you make a good point in hospitals here having high costs because of the indigent, but seem to be focussed on the immigrant as a major source of that cost. In my own family (born here all) many have had procedures covered by hospitals because we were not insured. My brother just had a cardio stay covered, tens of thousands of dollars. In the 80s, just out of college, I had brain surgery and associated 4 week stay covered by the hospital (that was before coverage up to 26 year olds on your parents). Many other examples in my family. So I would ask: how much of these indigent costs to our medical systems are the result of immigrants, legal or illegal? Do you know?
32
@Michael Green
Indigent people get served in hospitals in other countries and the drugs and devices are still cheaper.
46
@Michael Green : a quick web search turns up a paper from the RAND corporation that states that “The Public Spends Little to Provide Health Care for Undocumented Immigrants”, around 1.5% of total costs. So, not really.
https://www.rand.org/pubs/research_briefs/RB9230/index1.html
38
US hospitals charge astronomical rates, but the care in some hospitals is unbelievably substandard. I wouldn't have a problem traveling to a foreign country for surgery. That being said it's better to keep yourself healthy and stay as far away from doctors as possible. you play Russian roulette every time you enter one of these places.
38
@kerri That's why I have put off elective foot and back surgeries. My husband died from a hospital acquired infection. I have heard of so many other people getting infections at the hospital too, so naturally this makes me keep putting it off.
13
This is a risky proposition. What happens if there’s a surgical complication, like a heart attack or a post-operative infection? Are there other medical specialists available to deal with this? How about post-operative follow up. Usually, patients after a knee replacement, are seen by the orthopedist in follow up to assess the outcome and healing response. How is this done once the patient leaves Cancun?
Personally, I would not recommend that a patient have a total joint replacement done in Cancun.
Caveat Emptor.
8
@Charles Believe it or not, there are very good medical professionals in Mexico. Mexicans have surgery every day there and live to tell the tale. Why are Americans so resistant to the fact that other countries can provide excellent medical care?
24
@Charles the patient stated quite clearly if something went wrong she would be suing the surgeon. Because....why not?
3
Reading these comments, we all have to get together, and storm Congress, pool our resources, create ads and buy ad time and tell our stories. These nightmare insurance companies have to be toppled like Saddam’s statue. The time is now.
39
Someone in Mexico was denied care or had it postponed so that an American could get care in that country. The US is offloading its own health care deficencies on a country with single payer. Not a pretty sight.
11
@Person
Not the case. The surgery took place at a private hospital in Cancun. The care available from the public health system is widely considered to be substandard, and anyone living here that can afford it receives care at private hospitals. She was a paying customer just like everyone else.
51
@Aaron The point remains that Americans flooding other countries to access good and affordable care DOES take resources and care away from the people who live there, and who are paying into the overall system benefiting all doctors. Health care in most countries should be deemed a resource for citizens and residents first. Sorry not a fan of medical tourism - you should fix your own health care problems in the US, and not offload patients on countries that have functioning systems. Basically it's patient dumping. "A paying customer like anyone else" precisely sums up everything that is wrong with the US approach to healthcare. The procedure in Mexico was cheaper because the entire system is not predicated on the greed of wringing every drop of profit out of every patient and prescription. Thus, this woman was benefiting from the Mexican health care system, as a medical tourist.
12
@Person Aaron is correct. I live in Mexico for half the year. The private system and the public system are 2 separate entities. There is not a single American or Canadian in San Miguel de Allende that would go to a public hospital. If these doctors weren't making substantially more at private hospitals, they would pack up and move to another country.
13
I wish there was some way to get total numbers of people going outside the country to get medical treatment. I think we would be surprised.
30
“Dr. Parisi said that the lack of English proficiency among some surgical staff members created “momentary delays,” but that the bilingual surgical assistant helped.”
Maybe Dr Parsi should take Spanish lessons... after all he is operating in Mexico.
50
@Liliana Munguía
He lives in Wisconsin.
1
I know right!!
1
Let’s hope Mexico doesn’t have their version of ICE raid their hospitals to keep out sick United States Citizens.
56
I’d do this in a heartbeat, until the absolutely ridiculous US system changes its ways- or has them changed for it.
I already buy my asthma medicine from Turkey for $55/mo instead of $428/mo stateside (either way it doesn’t apply to my $7000 deductible on my $2700/mo plan).
Sorry, US, you are absurd to cling to your abusive medical system. Having grown up with the NHS, I’m just shocked that Americans are such suckers.
277
American hospitals... running a profitable business is the first priority, providing healthcare is the second.
71
Not second. It’s not even considered.
21
The author of this article neglects to mention an important issue: Does Dr. Parisi have a license to practice medicine in Mexico? If not, and not otherwise authorized, he risks arrest and prosecution in Mexico, just as a Mexican physician might if practicing medicine in the USA.
12
Good point. The doctor is taking major risks for being a renegade traveling surgeon.
4
I am quite confident he is doing this legally, otherwise why would he and NASH and Galenia allow themselves to be featured in Sunday NYT ?
6
A friend had an MI in Florida -- doctors prescribed stents.
His insurer chartered a medevac jet with flight crew, a physician, a nurse, and patient's wife -- to fly him home to Canada for the surgery.
That should tell you something.
50
@alan auerbach
He was obviously a private pay patient and was not returning for care from the national health care system.
3
Wrong. No such thing in Canada. He was treated by the public system. It’s just that it was much less costly for his insurance to fly him back home for treatment than to pay for it in the US.
39
@Salamander “His insurance” being Canada’s National Health Insurance???
2
My father needed eye surgery years ago which his insurance would not cover. After numerous unsuccessful calls, lengthy talks, we got nowhere with his insurance. I was furious because my parents worked so hard at their jobs, paying for healthcare only to be denied when it was needed the most! The system is so broken from the way medical school is structured, to its cost, limited residencies, to healthcare institutions to health insurances and the litigations. Shameful!!
So I worked the phones to find the best eye surgeon in one of the best hospitals in Mexico. My father and mother flew to Mexico, he had his eye surgery and spent an additional 2 weeks vacationing. It has been 15 years since then. Healthy eyesight, healthy outlook and my dad is still working at 72.
So our family has become part of medical tourism for items not covered by our insurance or items which may bankrupt us if done in the US, last surgery someone else in my family had a hand surgery, my aunt. Her Mexican doctor had completed a fellowship in orthopedic surgeryat UCLA. She had that surgery 7 years ago. Her hand is healthy and pain free, and she's not stressing about health care bills.
109
@A
Funny, America provided that education to that doctor. Oh and for the record, you and I probably paid a good chunk of that residency. What about the foreign doctors who don’t complete fabulous residencies. Caveat emptor.
5
And how do you know that? Facts please.
10
The system is going to eat itself alive and I will happily zip off to wherever to have the work done. There are many things I will tolerate in this country (well not as many as there used to be) but being driven to bankruptcy over healthcare is not one of them. It's a giant scam.
53
Every person, including surgeons, respond to incentives. As a surgeon myself, I question what motivates this well trained and presumably busy orthopedic surgeon to fly all the way to Mexico and endure whatever licensure and logistical hassles just to do a couple of procedures. My guess is that this surgeon is being heavily incentivized to do so - either directly from the medical tourism company, or his primary employer. He places his patient in the awkward debacle of handling a post-operative complication in the early post op period, since he has already blown out of town. His local covering surgeon ‘fixer’ is left holding the bag. All in all, it’s a sad commentary on the bloated, teetering and unbalanced medical care system that we have in the USA
109
@Scott Sattler MD he got paid $2700 for a one hour surgery. Definitely not worth the flight time for just one procedure, so I don't doubt that there was probably some additional compensation somewhere in this instance but if he could knock out five or so in a day as the model scales there's no extra incentive needed.
Even easier if they pull in doctors from Miami, Houston, or Dallas.
14
@Scott Sattler MD Maybe the Hippocratic Oath is alive and well in this particular surgeon's locus of control instead of the bottom line.
8
The doctors in these countries are well trained. The difference is they do not owe $350,000 in school loans to be educated and trained. They do not have the same ‘accident chasing lawyer system’ we have here, so malpractice is affordable. Therefore, they can charge 70% less than we do here.
My Father had a root canal (start to finish, with an extra visit for a mold modification) for a total of $250 in Greece. Two years later, with a routine cleaning and Xrays here in the States, he is still doing well and his dental exam looked good.
60
@a
The level of training varies greatly. Dentistry is not surgery.
Classes are much bigger, fewer instructors and many have never touched a cadaver. Hospital training is not as good. Europe is mostly good and some Asian and AU/NZ but I would be wary and look for USA board certified docs out of the country.
5
@a Had emergency root canal two days ago. Excellent care, $2,400. Greece would have been nice...
8
I traveled to Mexico to get a root canal and a crown. Took two visits. Cost 1/2 of U.S. price. Had some great Mexican food between the root canal and the cast for the crown. And a cerveza to boot. Haven't had a problem with said tooth since and that was about four years ago. Via Mexico.
42
The doctor got $2700 on his OFF DAY. I'm assuming airfare and hotel free. This guy is probably working 3-4 days a week max. I guess you can argue that he could have made the same money in Wisconsin if wanted to work on his day off.
12
During a wonderful holiday in Belgrad Serbia, my family and I are having extraordinarily excellent dental work done at 33% of the cost in Canada. All educated Serbs speak perfectly competent and accent-free English.
26
We are on the verge of a bloated heathcare "system" collapsing in on itself. Consolidation into massive hospital systems, medical practices bought up and owned by the same massive hospital systems, patients who feel "processed" by doctors glued to computer screens. It's just a matter of time till the whole mess implodes. So much of what passes as "healthcare" in our country is 1) do more procedures = make more money 2) do more tests = make more money. It's not good healthcare. It's simply a money-making machine.
68
As an isolated case, yes, the amount earned is higher. However a surgeon operates on more than one person at a session usually, since this is an elective procedure. So in the time the surgeon flew to and from Mexico to earn 2700 he could have earned more than that by staying in the US, probably 3 to 4000 per hour.
How much a doctor earns depends. Private insurers pay more, but Medicare provides more patients. The median take home pay is 450,000.
If he is on the Mayo Clinic staff, he is on salary, so it is the insurer and the clinic that are directing care and making the bigger share. What is cheaper is the personnel supporting this surgeon's work.
8
@Donald Green
Every reimbursement is different. Under Medicare docs get paid less than a vet for a dog hip replacement. My orthopedic surgeon husband finally threw in the towel.
9
Maybe the surgeon did multiple procedures while in Mexico. Or he has equity in the medical tourism company, and accepts lower pay today for a long term payoff. Who knows? ...or maybe he cares about the financial well being of his patients and wants to provide a lower cost option
5
@Donald Green I think your argument is weak. Orthopedists are top earners in this country. My point was different. This orthopedist, if in private practice, could have earned more at home. The doctor is also supporting a system in Mexico where hospital personnel are underpaid, hence the bigger bucks to him and the patient. At 450,000 dollars this is in the top 1% income bracket. The analogy to dog hip surgery falls flat, since the amount of training and skill is comparable. The difference is what insurance or lack thereof will pay. The latter is what needs fixing.
6
A friend of mine, who lives in France, had a friend to stay over from the US. About two days into the stay, the "curtain came down" in one of her eyes. My friend took her to his local general practitioner who saw her immediately. He took one look in the eye, diagnosed a severely detached retina and within two hours she was seeing (what turned out to be) one of the leading eye specialists in Europe (never mind France). He spoke perfect English, confirmed the diagnosis and recommended surgery the following day. She, of course, did not know who he was and phoned her specialist in the US. He knew the French doctor well and, having reassured her that she was in excellent hands, pointed out that she had no choice anyway as she wouldn't be allowed to fly period, never mind back to the US.
The operation was a success, she had an extra 14 days in France staying my friends house both for necessary aftercare and healing (including two more appointments with the specialist) and was pronounced ready to fly.
The bill? As a private, non-subsidised foreign patient, with two days in hospital? 1680 euros + about 200 euros for the original GP appointment and aftercare. The "hotel" was free :-) At that time she was paying $950/month for her US insurance plan. She didn't bother to claim as it was less than her excess.
Come to France, see the sights, go to Paris (if you must) and have reasonably priced surgery while you're there.
151
@Dirk
My brother in AU had a similar situation but with bad outcome. A partial tear six months without a referral to a real ophthalmologist result in a full tear, very dicey surgical repair and a year of allowing scar tissue to build before a new lense could be placed. One year with vision in only one eye. He could hardly do any work.
The national health service almost blinded him in that eye.
Good for simple stuff, these services offer very little sophisticated care.
2
Hey Dirk, how do I contact you for the free hotel? I have about a month’s worth of knee rehab to do as soon as ski season is over next spring. Maybe we can coordinate around the Tour de France.
4
@Dirk France has one of the best health care delivery systems in the world. A friend visiting Paris took a nasty fall and got a severe cut on the palm of her right hand. Went to a GP recommended by the hotel and by that afternoon was seeing a surgeon who specialized in traumatic injuries to the hand. He did the necessary outpatient surgery and she paid less than a thousand dollars for everything.
18
Would a doctor's malpractice insurance honor a surgery he performs in a different country? Does he know anything about the staff in the OR, including the anaesthesiologist? If the doctor is travelling to Mexico on his days off to perform more surgeries and earn more money, is fatigue a factor for his U.S. patients (and the surgeries in Mexico) since he is not getting as much rest? Seems the U.S. should be able to improve healthcare management and avoid all the shortcomings of travelling out of country for surgery if we ever get our act together and get rid of private insurance.
18
Wow, very interesting. I am curious about the comment around the lack of English proficiency among some surgical staff members. In an emergency situation this would be critical. Surely they need a more comprehensive approach beyond a bilingual surgical assistant. Am I overreacting?
15
Take out the profit motive; reduce middle management; clean up the insurance industry and everyone needs to realize physicians are human.
28
But there are high costs & profits built into it all - from the education of our doctors & medical professionals (debt of $300k - not to mention residencies during which they can’t even get decent sleep), to the cost of drugs(yeah you, & I & everyone helps pay for the ads & all),& medical devices - where does it end?
1
This is great - the globalization of healthcare. Many people have thought the American service industries of healthcare and education would never be exported overseas but here we see it. Of course I can see the handwriting on the wall - at some point Trump is going to cry about how the elitists are exporting American healthcare jobs and will try to put a tariff on it somehow.
My guess is that at some point these overseas clinics are going to wise up to the cash cow they have with America and start charging a lot more for their services.
6
U.S. Medical Costs versus outcomes are drastically out of balance with the rest of the world. US Hospitals and Drug and Med Device manufacturers have also been gouging US patients for years. Alternatives like this, while not the large scale solution, will continue to grow until the US Health Care system is brought back into balance with the rest of the world.
39
I had a serious knee laceration repaired by an on call plastic surgeon in a local Orange County ER. The physician assistant recommended the plastic surgeon due to the nature of the injury.
He arrived shortly thereafter and I was required to sign paperwork agreeing to pay the undisclosed charges for the work. I spoke to multiple hospital representatives who couldn’t tell me what my costs would be. The hospital was in network but it was unclear who else was in network or contract.
The surgery was performed bedside in the ER and it took about two hours.
The plastic surgeon charged my insurance company $75,000! My insurance company, Blue Shield, paid it as an out of network charge leaving me with a $65,000 bill which the doctor’s billing department aggressively pursued. After much heartache Blue Shield agreed to pay at the in network rate which left me with only $10,000 out of pocket expenses. Probably about what the doctor should’ve charged originally.
The hospital’s undisclosed fee structured and their contracts with doctors are terribly complex and confusing. The plastic surgeon’s exorbitant fees were at a minimum excessive and borderline unethical. The hospital received complaints but patients were understandably hesitant to actively complain in fear of compromising their followup care.
Our system is completely broken.
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The American College of Surgeons and the Joint Commission of Hospital Accreditation are two entities who are very interested in such financial sculduggery. The hospital does not want you complaining to them. So get the hospital to get the doctor to forgive the $10,000 or get a lawyer to sue for a court to declare the doctor has been paid enough. Easy case.
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@Tracy:Lack of transparency,consider legal action.
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The Great American Healthcare Rip-Off strikes again.
Congress and the President should resign for healthcare extortion crimes against American humanity.
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What did Dr. Rios, the physical therapist, and the nurses get paid?
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Another example of the incredibly ineffective and wasteful USA medical system. I routinely get my dental work done when I’m abroad in Asia for work. The costs are just a small fraction of the costs in the USA often with better technology and facilities at the high end clinics.
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Very interesting to read. This is a win win situation for the Doctor and patient, loser bring American hospitals. India is very popular for medical tourism. Plenty of patients come from all over the world to get all kinds of operations done efficiently based on their ailments relatively at cheaper rates. Moreover with the amount thus saved get to see a number of places in India.
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America has been colonized from within, by not only every single entity involved in healthcare, but by every other corporation. Another reason to have Medicare for All!
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My brother needed extensive dental work done, with multiple tooth extractions and replacements. He was consistently quoted over 40K in Austin. He ended up going to India to get the work done. Total cost $12k, including three round trip flights and 9 nights at a high end hotel. We are getting jobbed by the entire medical industry.
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We ought to provide foreign countries with the right to establish
"reservations" inside the United States, much like some states allow Indian tribes to do so in areas off their historical sites. They the can open casinos there.
In this manner, Mexico might open one in Mexico, Missouri and allow United States citizens the ability to get excellent medical care at a much lower price than the United States medical system costs.
Write your congressmen and senators.
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@Matthew O'Brien
Embassies or consulates???
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@Matthew O'Brien
A better idea would be for the Native American tribes to set up clinics on the res instead of casinos.
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@Matthew O'Brien
Maybe the casinos should build surgical suites attached to their hotels.
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You mean it doesn't have to be as expensive as it is in the United States to get health care? Who would have ever thought?
It is so irritating that Republicans in Washington want us to spend more and get less, simply so their friends can make more money.
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@Paul in NJ
A big chunk, around 40% of American healthcare costs, is the seven and eight figure salaries of hospital executives, along with payments made to politically connected sinecures.
Michelle Obama was paid $175,000 per year for a part time gig as "director of outreach" for a Chicago charity hospital after Obama was elected to the Illinois legislature. Her salary was doubled to $350,000 when he was elected to the US Senate for the same part time gig.
Executive pay in the medical charity sector increased after Obamacare was implemented. Democrats love their big business cronies.
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Sources please.
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@ebmem Just a tiny bit of research shows that the claims you site are not true... https://www.factcheck.org/2009/05/michelle-obamas-salary/
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$98,000 to set a broken leg, $257,000 for 7 days in neo-natal care. From the hospitals to pharma, it is so broken and so focused on profit that this type of thing makes sense!!!
Private insurance is socialism with a profit center - "from each by their ability to each by their need (they decide what is needed)" - This system simply eats itself alive.
A single payer with elected officials would be so much better...
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When battling my private insurer Anthem Blue Cross over a completely denied anesthesia payment following my colonoscopy, I offered to pay the doctor the in network amount which Anthem refused to pay as medically unnecessary. Rather than reveal the exact amount, Anthem wrote back that it bases its physician reimbursements for over 8000 procedures codes at the Medicare rate + 15-20% extra. (That's IF the doctor gets paid at all!) I still have the letter. So you see, private insurance payments = socialist payments + a 20% tip MAX, if paid at all. Private health insurance is highway robbery.
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@xzr56 Looking at your statement carefully, what you are really saying is that it is the doctors who are committing highway robbery, b/c it is they who are charging you the exorbitant amount, while the insurance company is reducing the amount they will be paid to the Medicare rate plus 15-20%.
Doctors and hospitals already have the Medicare rates taken into account, as they must accept the contract amount that the insurance company offers from any insurance company they contract with.
For example, I had a hysterectomy, bladder sling, and related support procedures done under Blue Cross private insurance, spent 4 days in hospital, and the bill was $55k. Blue Cross paid $5.5k which the docs and hospital contracted to accept.
My point, which no one wants to say out loud, is that MDs in the USA can charge exorbitant amounts, but what insurance pays them is what they actually live on.
This contradicts the narrative that doctors and hospitals would go broke under Medicare for All.
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So once this patient, who lives in Mississippi, returns to the USA, and has a complication, and the surgeon is in Wisconsin, does he think a local orthopedist , or for that matter any MD, is going to deal with his complications?
Good luck!
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@skshrews
That’s what Emergency Departments and their staff are for. And referrals for follow-ups.
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There are hospitals even in Mississippi. If issues should arise she’ll be just fine.
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Even if Dr. Parisi made $1,900 more (based on the Medicare schedule which is not applicable to a 56-years old patient),
he spent 14 hours in a plane and used two days of personal time. Cost of opportunity?
Moreover, I am not sure that his US patients, US colleagues and administrators will be thrilled to see him in the US OR the next day.
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The article says this:
“Private insurers often base their reimbursement rates on what Medicare pays.”
A correct statement. Also, a fast orthopedist can crank out several knees in a morning if they are flipping rooms. Around $2900 per hour? Holy cow. Sign me up.
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@Philip
The article does not say Dr. Parisi had the opportunity to do multiple procedures that day; it implies he did only one and we all know this is not a sustainable model. I also disagree with the large brush statement “Private insurers often base their reimbursement rates on what Medicare pays.”
Which is why when Dr. Parisi was still at Mayo, his colleagues were(are) prioritizing commercial insurance patients vs Medicare/Medicaid ones.
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@--Jack
I agree ... geez, jet-lagged much?
I'd hate to the U.S-based (Wisconsin) patient scheduled at 8:30 am for the day after the Cancun flight/surgery/return!
Passing through airports and on various flights, picking up all sorts of whatever's in the air along the way. Hope it's not a big part of his practice during the typical 6-month flu season.
Living in WI, and knowing all about Ashley Furniture -- none of this really surprises me. All about cost-cutting.
That said, this also really highlights how out of whack our 'healthcare' system is.
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This patient was under 65 and did not have Medicare as her health insurance, I assume. Why are they comparing reimbursement rates to what Medicare would have paid?
The Medicare fee schedule for the surgeon, CPT code 27447 is actually about $1500.00 not $900.00.
The big savings in Mexico come from reduced facility fee, reduced anesthesia fee and reduced rehab fee and lower priced drugs.
In the US the fee schedule for the surgeon(what the surgeon actually gets paid by the insurance) is only about 15% of the total cost for everything.
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@Marc A - I thought the same. She was 56, so not on Medicare.
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"Medical Tourism" is a very lucrative bet for many countries, and in most cases, subsidized by their governments (just as any form of tourism is). What's ridiculous to me, is how many Americans feel we have some sort of "pie in the sky" standard of health care, when in fact (and even though up to 7X the average cost), the efficacy of our health care is far below that of many other countries. For example, Costa Rica (where dental procedures are "king") has much better trained and equipped personnel available... and most procedures (at reputable destinations) are done at a rate ~70% less than the same in the US. Moreover, the care is far more personal.
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Coming from a surgical nurse. Wow! Just wow!. I may have to have mine done there. This tells us something doesn't it.....
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While medical care in the Western Hemisphere may be improving, the article mostly points out the range of deficiencies of the US healthcare system. Unfortunately in this scenario, there are the obligatory third-party hands in the pocket.
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I wouldn't be surprised if US doctors that perform these services outside the country aren't penalized in one way or another back home.
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@MarkR
How, exactly?
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Great piece and particularly interesting that the US surgeon is participating. A little tricky with that reimbursement math (3x Medicare rate) at $2700 which is likely just what he would have been paid by private insurance at his home hospital according to my sources with no flying involved. I wish we could know more about what else motivated him to fly down to MX as he apparently didn't stay long enough to enjoy the Cancun sunshine (also certainly he wouldn't have agreed to fly coach for this odyssey?). Something else about the foreign medical experience that he appreciates, perhaps?
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The two principle drivers of the concern regarding serious healthcare reform in this country are costs and hospital/physician reimbursement.
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@Dave Winsor
Maybe he did multiple procedures on that Cancun trip?
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@Dave Winsor Medical school loans would be enough.
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This may also make sense for long term care. I suspect patients in a nursing home would get very similar care in Mexico or other countries and the employees would not have to leave their homes to try to emigrate to the US to be employed. Many immigrants to the US get jobs in nursing homes. I haven't seen a robot designed to do bed baths, showers, feeding, and housekeeping work such as changing bed linens .
Patients with dementia probably could not tell the difference.
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@kw12
actually guadalajara has several nursing homes for seniors ; half the price and twice the care.
definitely my plan, since I do not want anyone visiting me when i’m old and demented
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@pamela even if you did want visitors, I imagine family would be glad to combine it with a Mexican vacation!
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My mother’s hip replacements in Mexico were $5000 cash each, same German implants , a surgeon who does 8 such surgeries a week for the last 20 years, a private clinic with two nurses per patient, private room with all the comforts, medicines, ambulance trip home (local), and two home visits by the same surgeon post op. Just absolutely no comparison to the $50k to $80k cost in Texas with less care. Amazing.
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For many decades the cost of medical care in the US has been rising several times faster than median income. A day of reckoning was inevitable. In the very near future the cost of care will be too high for anyone except the rich. We are already there for the many who still don't have insurance. We can governmentally subsidize the cost for many people for a little while longer however the cost will soon overwhelm the country. What then?
Our unwillingness to address this issue, hard choices and all, ensures an unpleasant, not very distant, future. We will then find ourselves with only the kindness of the big medical corporations to save us.
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What else does anyone need to realize how broken the American healthcare system is? It is incredible to me that it is more cost effective to buy a round trip international flight, hotel stay, and have surgery abroad than it is to have a procedure at a local hospital. Legislators, Insurers, and healthcare administrators in this country should be ashamed of themselves.
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@chris I agree with you but I might be inferring a different lesson. There is a lot of government regulation and federal and state mandates in the US which, as I understand, inflates the cost of healthcare. Since these regulations adversely affect the free market, the patient here circumnavigated the regulations by going abroad while still getting American quality care. American doctors are also able to bypass US regulations and substandard income from Medicare by doing the same thing. This feels like the Amazon or Uber version of healthcare, lowering costs and putting the bloated industries out of business.
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@kevin, no so Kevin. First of, Mexican doctors are just as good or better and they only get paid about a tenth of a similar american doctor, second, there’s no layer of private insurance companies taking their cur, third, there’s very little or no overhead (fancy buildings, receptionists, a nurse for every “procedure”, and on and on. Just the necessary people and equipment), and third there’s no liability insurers taking their cut, plus the same drugs are a tenth the cost. There are just way too many layers here taking their cut due to the private insurance model. In Mexico is either public health systems for the poor or cash for the not so poor.
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There is no real transparency to costs of care here and so so-called government regulations play little or no role in how they are set. It’s really quite arbitrary. Just look at any detailed hospital bill, if you’re allowed.
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