By Jennifer Bunn, on July 29th, 2008
Medical tourism may be defined as seeking healthcare outside one’s own country. This is becoming more common as people search for affordable healthcare. In the U.S., patients travel to countries that perform the procedure they need for a fraction of the cost of the same procedure done domestically. In Canada, where healthcare is essentially free but where wait times may be unacceptably long, people are choosing to go to places that can perform the necessary procedure on the same day of arrival if desired. Some patients like to kill two birds with one stone and combine surgery with a holiday in an exotic locale.
What are the advantages for patients/consumers? As mentioned, costs may be considerably lower in other countries, allowing patients to combine a holiday with their procedure. Having surgery in another country can also cut down considerably on wait times for those patients who come from countries such as Canada, where wait times for elective surgery may be months. For example, wait time for a hip replacement may be longer than a year in Britain and Canada. In the U.S., restrictions on the patient’s choice of facility, surgeon, and the type of prosthetic used may be factors in patients choosing to receive medical care out-of-country. Additionally, many international hospitals have improved their facilities and standards of care to attract international patients. Many international hospitals have become JCI-accredited, which makes them even more attractive to foreign patients.
What are the disadvantages for patients/consumers? One disadvantage is that patients traveling to foreign countries for healthcare may actually expose themselves to infectious diseases to which their immune system has had no experience in dealing with (i.e. TB, malaria, hepatitis). Also, travel after some surgeries may not be recommended for some time and may be very uncomfortable. Post-operative care may not be to the same standard that some patients are used to, although many foreign hospitals are striving to remedy this.
Other considerations concern legal issues. Patients who are dissatisfied with their surgery results, or who have an adverse outcome, may have little recourse in other countries. Doctors in other countries may not have to adhere to the same insurance and malpractice standards as physicians in countries such as Canada and the U.S. Patients who suffer a poor outcome may have a difficult time finding a doctor in the U.S. who is willing to take on their care.
It seems the trend of medical tourism is here to stay. Patients who are considering receiving their care in a foreign country should thoroughly research the doctor and hospital where they will be receiving their care. They should also research insurance options for themselves before departure. Lastly, choosing a facility that has been JCI-accredited may provide some reassurance that the hospital they have chosen is maintaining basic standards of care.
Reference:
Health News Today, July 10, 2008. Washington Post, Wall Street Journal Examine Issue of Medical Tourism. http://www.medicalnewstoday.com/articles/114520.php.
By Jennifer Bunn, on July 25th, 2008
There has been much written and spoken recently about antibiotic resistant organisms, nosocomial infections, and the rise in the incidence of these. MRSA (Methicillin Resistant Staph Aureus), VRE (Vancomycin Resistant Enterrococcus) and other infections like Clostridium Difficile have been increasing in alarming numbers, leading to rising costs in caring for the patients infected by these “super bugs” and numerous patient deaths. Nosocomial infections account for approximately 20,000 deaths each year, and about 1 in 10 American hospital patients can expect to get a hospital-acquired infection each year.
In hospitals all over the country, patients routinely share rooms with one or more other patients, a practice that is proving deadly. They also share nurses, and all too often there are not enough of them to go around.
Evidence has shown that the number of people infected by these bugs can be greatly diminished in two ways: First, by every patient having their own room with their own bathrooms, and secondly, by having enough nurses available so that uninfected patients are not cared for by nurses who have been caring for infected patients. Additionally, having enough nurses available helps in infection control measures, as nurses are often the ones who implement these measures.
If this is known, why is more not being done? Although the cost of revamping currently existing hospitals to make all the rooms private would be astronomical, so is the cost of caring for the 10% of patients who require extended hospital stays because they contracted a nosocomial infection in the very place that was to help them get well. And we cannot discount the 20,000 deaths caused by these infections each year.
In at least 42 states, efforts are underway to counteract the problem. The American Institute of Architects has called for 100% private rooms as the minimum standard for some units in general hospitals in their document “Guidelines for Design and Construction of Health Care Facilities.”
This is definitely a step in the right direction, and it is likely that the remaining states that have not adopted these guidelines will do so, as people become more aware and concerned about this issue.
Source:
Nicholas Kohler, (2008). Death Traps. Maclean’s. p.40
By Jennifer Bunn, on July 23rd, 2008
The use of electronic medical records has been touted as an enormous economic benefit in terms of cost savings as well as a boon to increasing patient safety. So why aren’t more doctors using them?
Although many doctors employed by larger medical entities are making use of EMRs because the costs of implementing the system are covered, smaller practices with few doctors are unable to afford the $5,000-$50,000 start-up costs, not to mention the approximately $1,000-a-month maintenance fee.
There is also the issue of time lost and decreased productivity during the implementation of the system. It takes a lot of time to enter data on each individual patient into the system. Once the system is fully functional, doctors report that much of their time is still eaten up during clinic visits entering data into the system.
While larger medical centers are willing to pay these costs and train staff to use them, it is just not feasible for smaller practices with fewer resources. Additionally, there is little incentive from the government and insurance companies, although they receive most of the benefit from the use of EMRs.
Another reason for doctors’ worries are that there are many different models of EMRs, some of which are not compatible with each other and are unable to share the very information they were designed for.
So what can be done to encourage smaller practices to purchase an EMR system? Very few doctors report receiving financial subsidies to help mitigate the cost of implementing the system, according to a Texas Medical Association survey. If these systems will save the amount of money that they are predicted to and save as many lives as the companies who make them claim they can do, perhaps the government needs to help smaller practices implement these systems by paying for a substantial amount of the start-up costs.
By Jennifer Bunn, on July 20th, 2008
As the recent campaign for the Democratic nomination has shown, there is always much debate surrounding the issue of delivery of healthcare; specifically, what is the best way to deliver healthcare to citizens in the most cost-efficient manner? The U.S. healthcare system has provoked criticism due to its high cost and the fact that there are approximately 45 million people in the U.S. with no healthcare insurance.
The Canadian healthcare system has been offered up as an example of what Americans can aspire to; yet it has its own share of problems. Although every Canadian is entitled to free healthcare by law, wait times for some procedures and surgeries, as well as a shortage of doctors in some specialties, means that there is an increasing number of Canadians who believe that privatizing Canada’s healthcare system is the answer to the problem.
Is there a happy medium? Why is it that a model of healthcare hasn’t been developed that takes the best of each system and combines these virtues into a healthcare system in which every citizen has equal access to insurance that is affordable?
It has been suggested that the Canadian government should allow privatization of some parts of the healthcare system, such as diagnostic and surgical centers, in order to decrease wait times for some procedures that have excessively long wait times. Most Canadians have balked at this idea and fear that allowing privatization in some areas will lead to a two-tier system. Yet something must be done as the system is foundering.
The U.S. healthcare system is also foundering as many of the nation’s population have no access to healthcare despite living in one of the richest and most powerful nations in the world.
There is no easy answer to the problems of either country. Undeniably, each country will have to continue to look for a cure for their own particular woes. And, although we are allies, it is unlikely that the U.S. and Canada will look to each other for answers to these problems because then we would each have to admit that we have a problem.
By Jennifer Bunn, on July 18th, 2008
Multi-national food chains are cropping up in poor countries, but no one is buying.
It sounds like a good idea in theory. Poor people require cheap food, and giant food chains can provide them. So why aren’t the poor lined up outside the doors to buy the goods?
In developed countries, consumers flock to these chains to buy their groceries at cheaper prices than they might get at the neighborhood store. One would think that the same would be true in poorer countries. It seems this is not the case.
In a study by Bart Minten, a Senior Research Fellow at the New Delhi office of the International Food Policy Research Institute, Minten concludes that even at very low prices, “food prices in the global retail chains are 40-90% higher than those in traditional retail markets.” His study found that shoppers were still not willing to pay the prices of the large global retail chains, instead preferring to do their shopping at the local markets “who operate at very low margins and carry local foods of widely varying quality largely untouched by modern agriculture, both of which would be unacceptable to a multinational company.”
If Minten’s conclusions are correct, multinational food chains will have a hard time enjoying the huge profit margins that they can enjoy in more developed countries. The surge in percentages of food retail that supermarkets have enjoyed in recent years may become a flop in some developing countries. As Minten remarks, “If the chains do survive in poorer countries, they will likely remain exclusively the domain of the middle classes, especially so in the poorest African nations.”
Apart from grocery chains, fast-food chains are also opening across poorer countries. These chains, however, are more cognizant that the average consumer in these countries cannot afford fast food, and deliberately target the middle class.
Although the idea of supplying food cheaply to consumers in poorer countries would seem to be a wonderful idea at first glance, those considering such a move might reconsider.
Source: Rudy Faust, University of Chicago Press Journals http://www.medicalnewstoday.com/articles/112137.php
By Jennifer Bunn, on July 16th, 2008
There has been much debate over the past several years regarding the current nursing shortage. The statistics are grim: the current shortage is projected to double to around 12% by 2010 and to quadruple to 20% by 2015. By 2020, it is expected that the shortage will amount to 800,000 nurses.
One of the suggested solutions to the nursing shortage crisis has been to hire foreign nurses to fill the void. In theory, this makes perfect sense – they need the work and we need the nurses. Foreign nurses often receive a free education in their country of origin and are willing to work for less wages than domestically trained nurses. Why is this a problem?
The law of supply and demand is the basic underpinning of economic theory. When there is a shortage of labor in a market economy, wages increase as employers compete with one another to attract workers. If the shortage persists, wages and other compensations rise until enough workers are attracted by the higher wages and compensation; at this point, equilibrium is reached and supply and demand is balanced.
The practice of hiring foreign nurses to address the crisis may be beneficial in the short term but may worsen the situation in the long term. Foreign nurses willing to work for less pay and benefits falsely lower wages below what they would be in a fair market. Driving down nursing wages will result in nurses leaving the profession to work in other occupations.
In eight National Sample Surveys of the Registered Nurse Population (NSSRN) conducted between 1977 and 2004, a disturbing trend emerged: “According to the 2004 survey, there were an estimated 2,909,467 registered nurses in the United States as of March 2004. Of these, 16.8%, or 489,790, were not employed in nursing. Of those RN’s who were not employed in nursing, many were retired and others had left for family reasons. However, an estimated 209,140 to 241,563 left “for personal career reasons…or reasons connected to the workplace”*.
The NSSRN found that there were several reasons why these nurses chose to leave nursing. Some found that their current position was more rewarding. Others cited better wages, better hours, and concerns about their personal safety as reasons for leaving nursing.
Hiring foreign nurses to address the nursing shortage is not likely to fix the problem. Eventually, foreign nurses will leave nursing for the same reasons that many nurses now leave the profession: low wages, long working hours, and concerns about their personal safety as well as dissatisfaction with working conditions. In the meantime, hiring foreign nurses to fill the gap will only drive down wages and force more domestic nurses out of the profession.
The cure for the nursing shortage may be to address the issues that are leading to job dissatisfaction and to make nursing, as a profession, more attractive to those contemplating nursing as a career.
*Elgie, R. “Politics, Economics, and Nursing Shortages: A Critical Look at United States Government Policies.” Nurs Econ. 2007;25(5):285-292.
By Jennifer Bunn, on July 13th, 2008
It seems that, by 2009, doctors may be able to bill Medicare for electronic consults, a practice that has been discussed in the past but has not been reimbursed by insurers (except in a few remote instances) to date.
Under this new provision, consumers of healthcare will be able to log on to the Internet and consult their doctors from the comfort of their own home, thus saving themselves from lengthy visits to hospitals or busy waiting rooms.
An advantage of this technology, if it should come to pass, is that patients may be able to access a specialist in a more timely and convenient fashion. Also, patients who find it very difficult to travel or mobilize may find this method of care a literal lifesaver.
Physicians may find it easier to monitor their patient’s conditions and prevent complications from occurring if they are able to maintain better contact with them in this manner. And patients in remote areas may have better access to healthcare than they have enjoyed in the past. In fact, remote telehealth has been in use in some areas already.
So what are the potential pitfalls of this practice? The first and biggest area of concern that comes to mind is the measures that will need to be put into place to ensure confidentiality. This will be an important issue, and patients using such a system may have legitimate concerns regarding the security of their personal healthcare information. Secondly, for hospitals that are already having difficulty implementing electronic healthcare records that are very expensive, implementing a system such as this may be too cost-prohibitive. The technology required to capture and store all the data that will be generated by these “visits” will be staggering, not to mention very expensive.
It remains to be seen whether the idea of e-visits will be the wave of the future or simply a great idea that never really took off. Likely what will decide the issue will be the patients who use the system.
By Jennifer Bunn, on July 11th, 2008
The cost of healthcare is always a major concern in the U.S. With approximately 47 million uninsured people and soaring costs, the already-beleaguered healthcare system has been a major topic of debate in this, an election year.
In “Options for Slowing the Growth of Health Care Costs” from the April 2008 issue of the New England Journal of Medicine, the authors present several options that they see as potentially cost-saving. Their “top three” picks that they believe have the greatest potential are capitation, strengthening reviews for new drugs and technology, and electronic health records.
Capitation, in which providers of care are paid a fixed amount of money to provide for the healthcare needs of a patient population, has been tried and found wanting. Providers of care have balked against caps placed on their provision of service, and patients have been dissatisfied with being unable to freely choose their own physicians. Given that it is an unpopular choice for many physicians and patients, an effort to expand capitation to more healthcare sectors will likely be an unpopular choice that will meet much opposition.
The idea of a national oversight committee to provide more effective and stringent reviews for new drugs and technology and which would be required before reimbursement was made is a sound idea in theory. However, as the authors point out, “concern about this approach comes from members of industry, who worry about the possible effects of such reviews on the time and costs associated with getting products to market.” This may be a valid point: tying up new drugs and technologies in bureaucratic red tape might unnecessarily lengthen the time it takes to get them to patients who need them. This could be a drawback if the new products have the potential to save money in the long run in terms of making patients well faster.
The authors believe that use of electronic health records can be a cost-saving strategy. “We believe the greatest cost-reducing effect of electronic health records will result from improved coordination among health-care providers and from decision support that improves clinician’s use of tests and treatments.” The major drawbacks mentioned by the authors in this study are the costs involved in implementing electronic health records into practice and, perhaps more importantly, physician’s potentially negative attitudes towards using computers to tell them how to practice medicine.
The authors suggest several potential cures for what ails the U.S. healthcare system, but will anyone be able to agree on which, if any, methods to use.
By Jennifer Bunn, on July 9th, 2008
At the UN summit in Rome, which ended June 5, the UN’s Food and Agriculture Organization (FOA) appealed to governments to step up to the plate and provide at least $20 billion per year to help feed the world’s hungry.
On the agenda (at least for U.S. Agricultural Secretary Ed Schafer) was promoting the use of genetically modified (GM) foods, but the concept left a bad taste in some people’s mouths.
Europe has been the main holdout to using GM foods. France, who is Europe’s number one producer of agriculture, passed a bill by a single vote to allow GM crops if and when the EU accepts them. Some European farmers are willing to give GM crops a try, as they are seeing the tangible (financial) rewards of GM crops.
Some of the poorest countries who are most in need of food have rejected the use of GM foods as a way to ease the burden of hunger – which angers countries like the U.S. who commonly use GM crops to produce processed foods, oils, and corn syrup.
So why are people so against using a technology that could help end world hunger by producing crops that are drought-resistant, insect and disease resistant, and that yields higher levels of nutrients?
The answer is simple: people are afraid. GM foods have only been in existence for a few years. Although (thus far) there have been no reports of adverse effects, scientists are unable to say with any certainty that there will never be any ill effects from consuming foods produced from GM crops.
The American Medical Association states: “Worldwide, many people are eating GM foods with no overt adverse effects on human health reported in the peer-reviewed scientific literature and according to regulatory agencies.” In their adopted policy as of 2000, the AMA recognizes “the many potential benefits offered by genetically modified crops and foods, does not support a moratorium on planting genetically modified crops, and encourages ongoing research developments in food biotechnology.”
However, they once thought Thalidomide was the answer to the nauseated pregnant woman’s prayer.
By Jennifer Bunn, on July 6th, 2008
A recent poll by the California HealthCare Foundation found that even though a substantial amount of patients use the Internet to obtain their health information, few patients make use of the physician rating sites, and fewer still (2%) used the information available to change their physician. However, this could change as more people become aware of the availability of this “service” and insurers push patients to use them.
The AMA has certainly voiced their reservations about this practice. The push for these types of sites seems to be coming from insurers in tiered networks.
“In such networks, health plan members pay less out of pocket for seeing physicians who meet the insurer’s quality criteria, which doctors generally have criticized as faulty.”
-P. Dolan (http://www.ama-assn.org/amednews/2008/06/23/bil10623.htm)
The author goes on to say,
“Much of the growth in physician ratings sites have come from health plans pushing a consumer-driven approach to health care.”
Also of concern, according to Dolan, are insurer-based sites that allow patients to post unproven comments regarding their doctors, a practice that seems dangerously close to the definition of libel. The legal definition of libel is “a false and malicious publication printed for the purpose of defaming a living person.”
Patients should be aware that there might be ulterior motives to these sites before taking advantage of the information contained within. It is doubtful that insurance companies are sponsoring some of these sites simply for altruistic reasons; rather, they are hoping that they will be able to steer their customers to doctors that fit into their system in terms of cost-efficiency.
As for whether or not it can be considered libel to make potentially career-altering statements about physicians online, patients should take these statements with a grain of salt, as they must for a lot of information found on the web that is often misleading or blatantly false.
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