This is a total outlier. The norm in private hospitals (mostly owned by a physician or a group of physicians) is they check first if you have insurance, and how much that’ll pay, and then the tests and procedures are dictated primarily by that. Having good insurance isn’t always better - it may just result in a whole lot more testing. </p>
<p>If you don’t have insurance, you are given a figure, you deposit the cash and the procedure sans frills is done. Government hospitals are a totally different story.</p>
<p>
Friend of ours flies to SA from India with his whole team, does a bunch of elective surgeries and comes back. The locals like having it done there than dealing with the hassles of coming to the US with lots of support staff, and their local facilities have enough money to make them as good as you can get in the west.</p>
<p>As I said, she works in a public hospital. The clientele is poorer, and of course on the whole the conditions are much poorer. However, because she sees so many more cases, (as do the staff around her), the knowledge base is much larger, and the opportunities for innovation are vast.</p>
<p>Many (most) physicians in public hospitals carry on a private practice as well (which is where they make most of their money.) My sister doesn’t, which means her salary as at the same level as a high school teacher. She’s not complaining though - her work is known worldwide, and she gets to lecture at Oxford and Hopkins (when she gets her visas in time.) </p>
<p>The private hospital conditions (in some cases I have personally seen) rival those of the best hospitals here. Not universally true, though.</p>
<p>It may depend on the condition being treated. For example, some conditions are common in south China / Hong Kong / Taiwan but rare in the US, so doctors there are much more familiar with them than doctors in the US, so medical tourism for those conditions is often motivated by that reason (with lower cost being a bonus). In the early days of LASIK, Canada was a common medical tourism destination for that, because it was approved in Canada earlier, so the more experienced LASIK doctors were in Canada compared to the US. On the other hand, some treatments are approved and available in the US but not in Canada, so medical tourism into the US from Canada for those treatments exists.</p>
<p>Here in NY, a number of women go to third world countries for elective procedures , almost all cosmetic for cost reasons. Even with travel and hotel costs, it comes to a lot less. </p>
<p>But the Arabs have special accommodations at a number of major hospitals, so many of them come for their medical treatment. When you have certain life threatening conditions, it’s pretty clear where they come.</p>
<p>ucbalumnus, I think you’re right about it depending on the condition.</p>
<p>I have a dear friend who is a physician. When she had a life-threatening condition, she received her treatment locally. When her husband had a different life-threatening condition, he traveled out-of-state. When I asked her about it, she said that the most effective treatment protocol for her condition was well-researched and agreed upon, and could be carried out by any good physician. Her husband’s condition was more rare, and the state-of-the-art treatment was being carried out by just a couple of doctors elsewhere. So they went where the best treatment was.</p>
<p>I haven’t read all the posts, but my previous internist was one of the first to sign up for this sort of deal - my husband & I were in our early 30s and needed little more from a doctor than an annual physical and 1-2 sick visits/year. I called the office and told them what I thought of their offer to a decade-long client. We moved to a group in the area and can’t be happier - every specialist under the sun and a fabulous Urgent Care facility, etc. (actually one of the doctors in the former group moved to the new group).</p>
<p>One the other hand, the family signed my MIL up for this service a few years ago when her doctor started it, as she has several significant health issues and benefits from it. </p>
<p>IMO, if you keep yourself healthy and have no chronic conditions (ie diabetes), paying for this sort of healthcare is not necessary.</p>
<p>Even those of us with chronic conditions who are able to keep stable and take good care of ourselves may NOT have complicated medical issues. It really is the “frequent flyers” who spend a lot of time bouncing in & out of ER & hospitals who consume a disproportionate amount of healthcare resources. They generally can’t afford concierge services and it may not be offered to them.</p>
<p>It is said that the sickest 10-20% consume 80-90% of healthcare resources.</p>
<p>That may be true of insurance in general. My one and only auto claim was in 1979.</p>
<p>I think that we use up about 10% of our premiums in medical expenses per year at the most and 5% at the least. I know other employees that have had to deal with cancer, major issues with their kids, broken bones, etc. In general, I think that the company population is pretty healthy - we have fitness centers all over the place and there’s peer pressure to get fit when you see everyone else doing the same thing. Basically a virtuous cycle. Now if we could just do that for the whole country.</p>
<p>Yea, H’s workplace tries to encourage fitness & he & several buddies bought some inexpensive exercise equipment that they have installed there. He has been using it. They also used to jog & play tennis but haven’t in years–heat & age have made it less attractive for many of them. They are all pretty fit.</p>
<p>They still do have increasing claims like cancer as their population ages. </p>
<p>We have had a few expensive claim years (needed to get evaluations of complex idiopathic conditions) & do have ongoing Rx that also adds to our claims. Otherwise, we generally pay more in premiums than we get back in benefits. Staying out of ERs and hospitals are very important in keeping claims low. Avoiding cancer & other conditions that require expensive maintenance meds is another way of keeping costs down.</p>
<p>Lifestyle can help with conditions like obesity, type2 diabetes, cardiac, and some others but not ALL conditions, especially those which are idiopathic and/or hereditary and can still be expensive to treat.</p>
<p>I’m new to this discussion. My sister is an RN for a concierge physician. His wife is the one interested in money, and she pushed him into it. She also thought he would have more time with his family. But he is a rare breed, and took his most complicated patients with him. Those very ill patients who couldn’t afford the $1,500, were allowed to go with the new practice. He could take about 30 patients, I believe, who couldn’t pay (they call it scholarship). By the way, he gets 2/3 and the company that sets up the practice gets 1/3. So he makes something under $600,000. He does not have any more time with his family than before. He is on call all the time and must give his patients his private (dedicated to the practice) cell phone number. I know the company was sued several years ago…something about Medicare, and the company won. The $1,500 covers almost everything, including emergency visits by visiting immediate family members of the practice member. Also, they can be seen by another concierge physician when out of town (within the same concierge company). Patients are seen by the physician the day they call or the next day. I don’t know if it’s worth $1,500 but he hasn’t had any trouble keeping up his 600 patient limit. They get around certain restrictions by saying the $1,500 covers the annual physical, which is extensive. I do think the parent company is always thinking of new ways to make money. I know that many couples have had to choose other physicians for one spouse, so the spouse with more health issues can stay with the concierge physician. I feel terrible for the patients who wanted to stay with him but couldn’t afford it (and there were many). I see them all the time because my sister and I are twins and I’m mistaken for her, and constantly stopped, usually at the neighborhood grocery store, and asked about the practice. It’s sad.</p>
<p>You guys have got to get over this fear, drummed into your heads by the AMA for decades. Really. We live in a country where the govt took over in the 60s. People value their healthcare here so much that it’s a point of national identity and pride.</p>
<p>Sure it’s far from perfect, you’ll find its flaws and the most rare but dramatic stories about it make it into the propaganda mill running in the US. </p>
<p>But what I know is my GP is just like the concierge doctor you talk about. She chooses to see a smaller set of patients, we never even have to wait more than 5 minutes to see her and we never feel rushed. My mom who now lives here gets at-home care by a geriatric specialists, among others. We can go to ANY doctor we choose. We never been denied a test or procedure and we never have to wait for permission from anybody. We have also never seen a medical bill. And we don’t have to save to cover our healthcare costs when we are older.</p>
<p>Statistically, we have one of the highest survival rates in the world for most major illnesses, such as breast and ovarian cancer. Our doctors make a lot less (including less that other occupations), but contrary to the fearmongering, we have no shortage of the brightest minds lining up to become doctors here. </p>
<p>In short, we have lived both systems, and with one child who has had to use the healthcare system <em>extensively</em> in both countries, and yet none of us would trade what we get from ‘the govt’ here in Canada for what we had from excellent private insurance in NYC.</p>
<p>Until the US stops spending 75% of the world’s defense budget and funding the IMF, we just don’t have the same kind of money to allocate towards national health care. When we stop being the world’s police force, we may be able to afford the education and health care other countries afford. Unfortunately, in the guns v. butter issue, we got the guns and everyone else spent on other things. </p>
<p>If we make this paradigm switch, which I think we should, we will be able to afford the health care, instead. A good trade off, imho.</p>
<p>Actually, we do spend the same kind of money, if you look at government spending. The US government spends about 6% of the US GDP on medical care. This covers about a quarter of the US population (Medicare, Medicaid, government civilian and military employees). Other rich countries’ governments spend about 6% of their countries’ GDPs on medical care, usually to cover their entire populations.</p>
<p>Private spending on medical care in the US is about 9-10% of US GDP, while other rich countries’ private spending on medical care is about 3-4% of their GDPs.</p>
<p>I just spoke with the director of a non-profit. He’s connected with one of our insurers which covers 20% of the people in our state. They use about 3% of their net toward the community. Of this, 80% is losses from caring for Medicaid patients which they CANNOT cap. The remainder is used for community programs and projects in our state.</p>
<p>80% or more of our state’s Medicaid spending is to folks from Micronesia, many of whom are still suffering awful chronic health issues from the nuclear tests conducted by our federal government and our state is having to shoulder nearly all of this burden, despite repeated ignored requests to have the federal government pay more of these crushing costs.</p>
<p>I count my blessings that to my knowledge, concierge medicine has NOT caught on in our state/island. It IS admittedly hard for people to get docs & all of mine only take referrals from other docs or patients they really like & trust. Their practices are busy and full but somehow they manage to squeeze in urgent cases as needed.</p>
<p>I doubt they are earning as much as they COULD if they wanted to charge each of their patients some premium, like the $1500/year or other amount, but they know they are greatly loved and needed. I do hope they are not a dying breed, as they make all the difference in my world and we need more of them, not fewer!</p>
<p>Unfortunately, HImom, money talks. Obviously it’s financially advantageous to a doctor who’s willing to do it, and it’s a wonderful service for the patient who can afford it. The fact that the rest of us have even fewer doctors (already a scarce resource), and the fact that it overloads non-concierge doctors even more – well, that doesn’t matter much.</p>