The concept is a new one on me and I find it fascinating. The typical context along these lines in past blog posts has been if you move to a foreign country what would you do for medical care. While I have no plans to move anywhere there is something intellectually intriguing about living in New Zealand or Uruguay or the like. So the idea of medical service in another country is fascinating (repeated from above for emphasis).
The countries mentioned in the article were India, Thailand, Singapore and Panama but really far more attention was given to India and Thailand. Without repeating the entire table of examples a heart bypass procedure that Barron's estimates at $70,000-$133,000 in the US would cost $7,000 in India, $22,000 in Thailand, $16,300 in Singapore and $10,500 in Panama.
The article did not really address quality of care in great detail and I do not know about this (anyone who does please comment on it) but in terms of financial consequence this is truly game changing. The motivation of the insurance companies for this is obvious but if this sort of thing could generally put some sort of downward pressure on medical costs or slow down the rate of price inflation then it could be a positive for the insured as well.
It also raises a question about what type of health insurance coverage to have. If you need a hip replacement, your insurance covers it and somehow the insurance company convinces you to go somewhere else then fine but if your insurance wouldn't cover a hip replacement for whatever reason or you do not have insurance at all then going to Singapore and paying $12,000 for the procedure, $2000 for airfare (the low end of the range for two people leaving from Phoenix) and maybe another $5000 for who knows what else adds up to less than $20,000 and becomes very doable even if you have to borrow every single nickel for the trip.
Flying to Panama looks to be close to $700 per person, Barron's says a new hip would be $5500 there so the whole thing might not even be $10,000.
Obviously no one would prefer to go into debt for $19,000, or $10,000, but these are not ruinous amounts for anyone who needs to.
If the care is comparable then living in New Zealand becomes a little easier (15 hour travel time to Singapore) assuming you can find and not have to wait to see a primary care physician. Ditto Uruguay to Panama (coincidentally also about 15 hours travel time).
This is an investable theme. Barron's mentioned five stocks, four of which I was able to find US five letter designators for but it you have any interest you need to verify the symbols are accurate. From Thailand Bumrungrad Hospital (found two symbols, don't know which is correct BUGGF and BUHPF) Dusit Medical Services (again found two symbols, don't know which one is correct BDULF and BDUUF). From Singapore Parkway Holdings (PKWHF and PKWXY, don't know if the ADR symbol is active) and Raffles Medical (RAFLF).
This was the first I've heard of this theme and it is interesting on some level. If this a viable investment theme then it becomes a way to access certain countries via the health care sector and there might even be more stocks and countries than the ones listed. Parkway Holdings has a 0.42% weight in the SPDR International Healthcare ETF (IRY) with none of the other stocks included. The WisdomTree International Health (DBR) doesn't own any of them and neither does the iShares Global Healthcare ETF (IXJ).
If the quality of the healthcare does not stand up then there is diminished utility from a personal finance standpoint but the article implied the motivation in these places for this to work is very strong. For now more learning is required but for now how about exercising more and drinking less soda?
35 comments:
Roger,
Identifying the better facilities and condition of the individual are major considerations.
If you are 40 to 70 and need heart bypass and can be stabilized for the journey - great
If you are 80 to 100 you are likely not traveling if you are ill.
Where have you been?
India Nurtures Business of Surrogate Motherhood
Before this, many people would go overseas for cosmetic surgery because it was cheaper, and doctors in certain regions had more experience. Breast implants in Brazil, nose jobs in Israel or Iran, etc.
anon, great point. anyone i've ever known who needed bypass went to the doctor for a routine checkup and needed the bypass done right away. the comment about being 80-100 is certainly valid too.
s baghaii, maybe I should have known some about this but i didn't.
I had 2 dental implants done in Thailand last year at Thantakit Dental. The cost was less than 50% of what I would have paid here. Service was excellent, highly skilled dentist, excellent facilities. If medical care is as good as dental I would not hesitate to do it over there.
Roger,
Check out the CIA World Factbook.
https://www.cia.gov/library/publications/the-world-factbook/geos/us.html
From life expectancy and infant mortality data where it scores way better than the US, Singapore would be your best choice.
thanks for sharing about your dental experience
as far as Singapore, I have a few acquaintances who live there and based on conversations with them (which admittedly is not much to go on) seems closer to the US which helps overcome irrational biases that people might have (at least it would for me).
An opinion and a small rant. I think one of the primary cost drivers of medical care in the US is litigation; which presumably going overseas for one's health care avoids. That said, I wonder what patient protections are in place in some of these places; probably varies with the location. Wonder if Obama will bring up tort reform in his health care speech. Wonder what the reaction would be from the Trial Lawyers Association (just happens to be a major democrat party contributor) if he does.
Tort reform and the dollar declining by 50% relative to Asian and south American countries over the next 10 years should eliminate the need to go abroad. Of course if you do not invest abroad so that you can afford surgery in the USA in the future you will be out of luck.
We get ads here in Seattle for medical tourism in Vancouver, BC where they are quoting prices 1/3 of some procedures in the US.
forgive my ignorance but if you needed a surgery in the next two weeks could it happen that quickly going to BC?
Yes, we do have two-tiered health care in Canada. There are clinics who have "opted out" of the single payer system and market their services for private payers with little or no wait times. In our community, we regularly have US citizens coming up to deliver their babies as it is significantly cheaper for them to do so even when paying the hospital and doctors directly.
thank you Douglas
Tort reform is more of a red herring than anything else: Total malpractice litigation costs run approximately 2% of medical costs overall; e.g., http://tinyurl.com/lb2gxp
The medical and insurance industry have enormous profits to protect here and rather than lose those would much prefer to continue distracting Americans and their congressional representatives with billions of shiny objects while sending more and more people abroad for services.
Other countries with more cost effective delivery systems -- all the developed countries in essence -- and/or boutique services in third world countries that most of their own citizens could not afford will not be subject to any American malpractice claims naturally which means the business of catering to US medical tourists will prove profitable for some time barring significant reform dealing with the basic problem in the US which still boils down to medical costs rising much faster than wages.
If reform fails I have a private placement offer for medical boutiques abroad on the table that I will seriously consider: A stake could give me some additional benefits beyond the pecuniary too, a definite factor in the equation.
PS: The answer to your question Roger is yes: More shiny objects; waiting times are generally no worse in Canada than in the US (depends on locale and procedure) but usually better for emergencies because ER's in the US are overburdened and so costly that they are more likely to be closed than a new one opened.
Hey we could all move to BC and work in the movie/tv industry. what's a key grip?
If you speak with doctors malpractice insurance concerns affect every medical decision they make leading to excessive testing and needless surgeries.
I know of several people having surgeries for asymmetric anomalies found during examinations. If you look closely almost everything about us is not completely symmetric. In every case these surgeries were not needed, but the doctors needed to make sure due to malpractice concerns. So the distorted litigation costs quoted by many do not even take into account the wasted procedures.
So am I going to drive by my Medical Professional's Local 3243 where their marquee reads "Still got yer job? Keep buyin' foreign medical care!"
There are frequent redundant or unnecessary procedures in the US system but they primarily arise because of insurance and profit structures: (a) the fee-based system -- charges are by procedure not outcome -- means more procedures equals more profit so there is no incentive to curtail and (b) record keeping is a profit center and proprietary so it is scattered leaving physicians with no unified record of previous tests or procedures so they must repeat them. Malpractice probably play into this no doubt, possibly to a significant degree in some specializations (pre-natal and natal care seems to be one), but they do not appear to be a primary driver of US health care costs.
I know of several acquaintences have traveled abroad for either routine or "unique" surgeries, with the blessing of their insurance company so long as it was pre-approved.
I know of no one that has traveled abroad for life-threatening surgeries, except in one instance where they tried some crackpot cacner treatment in Germany.
So be it. Choice is an essential part of successful medical care and living life to the fullest.
Obamacare? No thanks.
T
I believe RW is getting his tort facts from the usual far left liberal "stink tanks". I saw a piece in our Sunday paper on this, quoting BW's tort facts, and it was completely out of the left wing fringe.
I agree 100% that defensive medicine and tort reform are the two largest driving factors in health care costs. Obama won't touch this. His backers are the pro-litigation lobbies.
As a retired physician I think RW has his facts very wrong. Even if you accepted his 2% number you would realize 2% of doctors are having their lives ruined every year, it is hard to escape this during decades of practicing.
All doctors not just prenatal constantly prescribe tests and referrals to defend them selves in case of a unforeseen outcome. You can not show up in court looking like you have not tried. The wasted effort is very large because no one wants to be part of the 2%.
RW - my first thought after reading Roger's post: are the people who get the suggestion of going overseas demanding lower premiums before doing so?
"I agree 100% that defensive medicine and tort reform are the two largest driving factors in health care costs. "
Actually, no. Study after study after study show this isn't the case.
They are factors, perhaps large ones. And believe me, I want tort reform because IMO there are many types of insurance that are out of control. But poor health and poor health maintenance are the biggest issues. Americans do not maintain their health, they wait far too long to get help, and when they want help they go to an emergency room.
It's interesting how relatively simple things can have a big effect on healthcare costs. One study found that if a doctor did a followup call on every prescription he made in order to make sure the patient took ALL the prescribed medication, there were large savings over time due to the lack of recurring health issues.
I doubt that we'll get decent healthcare reform, but I can't really blame Obama for it. I mean, any one of us could probably write a decent healthcare bill once we took the time to do the research. But it would never pass Congress.
As a physician, the physicians I have met from other countries are more content to work for lower salaries. They also seem to be more atuned to medicine than finance. Other countries don't have the complex insurnace system we have here. I have extra staff to sort out these complicated plans.
In the U.S. everyone in the medical chain desires to earn a profit. If I order a lab test, I charge for an office visit and for interpretation of lab results, the lab charges a mark-up fee, some labs use per diem staff which drives up costs. Some physicians are beginning to charge for phone calls.
Can our system operate without the profit motive? If not, we are silly in thinking we can control costs.
In the absence of evidence or links regarding what a "left-wing stink-tank" looks like and whether that differs in any significant respect from a "right-wing stink-tank" I guess I'll have to stink with statistics, in this case mainly from AMA, OMB and CBO (which, last I sniffed, only smelled slightly off); e.g., Congressional Budget Office (CBO) projects that a 30% reduction in malpractice costs would lower health care costs by only about half a percent with a similarly small impact on health insurance premiums.
I know folks have pretty passionate beliefs on this subject but there is also an incredible amount of mythology out there: My own feeling is everyone is entitled to their own opinion but no one is entitled to their own facts ...or their own stats.
Steve, as far as I know those who seek offshore healthcare are pretty much left to their own devices although there are increasing numbers of agencies (sometimes supported by a host government) facilitating the process. I have seen no evidence that the insurance companies cut any breaks on premia but rather clearly they are now: (1) much more likely to approve an offshore procedure and (2) less likely to drop the patient afterward. I suspect it is because it does improve profits by cutting cost and it also provides a 'non-public,' public option to differ criticism; i.e., most of the offshore facilities, even the private ones, are part of some state-subsidized system.
I started investigating this as an investment idea some time ago because it was clear the current health system was bankrupting the country and I knew that some reaction was inevitable no matter which party won. I didn't want to pull the trigger though until I had a better sense of how strong and coherent the national response would be: So far it's looking like even if something is passed it will be too flawed or weak to make a real difference; not a problem for me personally but I confess I'd rather see something better for more people than make more money; I've got enough.
Meant to say "to deflect criticism..." in the 2nd to last para above.
Roger, RW,BillB, and Steve,
I came to Italy and the windfall is that I and my family get free health care. Top notch. Next week we are all going to termal health Spa all for free. When I was in the USA I was paying close to $10,000 a year is health insurance and never got any money back for any medical care. Yes I pay 20% VAT tax and 150% in gas tax, but I have no worries about my escalating medical bills as I get older. I get even medicine. No worry free medical care, for all rich and poor.
Best,
Jeff from Milan Italy
Jeff, free sounds kind of expensive. 20% tax. Yowza, that would add up to more than 10K per year for me.
Good discussion here. Points:
1) Congress is all lawyers, it is hard to see tort reform getting through there. Upton Sinclair: "It is difficult to get a man to understand something when his salary depends upon his not understanding it."
2) If I were the US medical industry strategist, I would ignore medical tourism as long as possible to try to limit mind-share and press coverage. If/when tourism starts to seriously impact the business then I would do everything possible to get horror stories to be covered on the evening news. The news people would slurp up gory photos and emotional family members ;>
3) Maybe there is a market for Personal Health Advisors like financial advisors but their fee structure rewards them for coaching and advising clients to achieve their goals in terms of objective and subjective measures of health. Maybe Roger could start a sister business Your Source Health, and become an expert on medical tourism and the metabolic abominations of soda!
RW can't get enough of himself today.
South Eats Asia is often a destination for medical tourists, since they offer facilities that are on-oar with the US at less than half the price. I agree with Colin- Singapore is a place to consider when you need to get some major medical procedure done.
Roger, I am located in singapore and the costs are huge compared to India [where I am from]. However, singapore ranks high in comfort level and is a also a good tourist destiation [medi+ tourism] so this is a nice choice.
India is good if one is really cash strapped.
This is a fascinating article especially when taking into account the state of health care in the US. I've heard good things about Buenos Aires Partners, www.buenosairespartners.com, regarding medical tourism and Argentina.
I work for a medical tourism company (MedTrava) where we help send Americans overseas for health care. I can vouch for the quality of care; like a previous poster said, many of the doctors in our network used to work in the U.S., but then returned to their native countries abroad to work for lower salaries. Most of them were simply fed up with the complex nature of the U.S. insurance system and they wanted to be able to focus on their passion-medicine.
And in regards to which country is best, you're going to have good and bad in every country, it's just a matter of doing some research and finding out which hospitals are reputable (or you can just have a medical tourism company do the work for you!). The most popular destinations in our network are India and Costa Rica, because they offer some really great doctors and hospitals as well as some of the lowest prices.
Quality of care can usually be verified pretty easily by checking the hospital and surgeons credentials and accreditation. Look for members of the International Society of Quality in Healthcare (ISQua) accrediting bodies such as JCI, Canadian Council on Health Services, Quality Health New Zealand etc. More about this on
http://www.medtral.com/Resources/Hospital-Accreditation/JCI-or-ISQua-Accreditation/default.aspx
Given that New Zealand is an emerging destination for Medical Tourism itself, I find it fascinating that you talk about the need to travel from New Zealand to Singapore to receive treatment if you were an expatriate here.
According to both the WHO and the Commonwealth fund New Zealand healthcare ranks above the USA. I was also at a recent conference where Singapore was boasting that their physicians were trained in New Zealand and Australia. I should point out the the cost of treatment in New Zealand is very similar to that in Singapore with equally good quality of care.... Food for thought, there are other destinations out there as well as Asia and South America.
I have several friends who live in NZ, one ex-pat and the rest kiwi and your comments are inconsistent with what they have said and one article I remember reading a while back. As I understand (understood?) it there are not a lot of doctors and there are issues with having to wait.
Let me just say I would much rather you be correct than me.
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