International health care

6º 17.040s 132º 05.676w

Fri May 03 2019

For some reason, many lifetime dwellers of the US seem to think we’ve got the best healthcare in the world. That’s nonsense, I’d like to see their metrics. Isabel and I have been both beneficiaries and victims of the US healthcare system. I’d venture to guess that emergency trauma care is among the best in the world, and for those who can pay, general healthcare is certainly first world. Preventative medicine is a joke.

Corporate employees who have managed healthcare have in many cases been pacified by the very low out of pocket costs, which encourages them to go to the doctor every time they’ve got a sniffle. Those of us who shop the health insurance market are stunned at the cost of care versus the restrictions and deductibles. It feels like a total disaster.

We purchase Obamacare (or ACA if you wish) simply for disaster insurance. The deductibles are high, but it will hopefully protect against depletion of our life’s savings. A certain level of preventative maintenance such as annual physical exams, routine colonoscopy exams at key ages and such are covered with understood exceptions.

Given how much we pay annually, around a recent birthday last Fall I elected to get a routine colonoscopy in the US simply because it was covered. It was explained up front by the physician’s staff that the procedure itself would be covered, however if any parts had to be removed and biopsy’s performed, that could run up to $1000. Wow, but fair enough, I was warned up front and elected to proceed. My insurance had been vetted, the staff knew exactly what it would pay for, etc. About a month after the procedure I received an invoice for anesthesia services from an “out of network” provider. WTF? Eventually a letter arrived from a debt collector (of course I refused to pay), and the matter is still under appeal with the insurance provider. I discussed this nasty surprise with my pal Jim, a nurse himself, and he related similar stories of the same thing happening to close personal friends. Bloody well shouldn’t be legal.

Back in 2010 I had a hernia surgery. It didn’t work out, and the surgeon simply shrugged and said he couldn’t do better. Then he retired. I let it go for years (no, it never did heal on its own), but Isabel and I both felt strongly that it should be repaired before we launched across the Pacific. Nothing more fun than a strangulated inguinal hernia 2 weeks from anywhere.

After talking to several cruisers who had undergone more complex procedures such as hip or knee replacements, we investigated the possibility of dealing with the procedure in Guadalajara, Mexico. We were remotely introduced to Lori Payne who speaks fluent Spanish and functions as an independent medical concierge at a renowned private hospital in the wealthiest district of Guadalajara. Lori arranged a telephone consult with the selected surgeon (yes, he spoke great English), I forwarded all my medical records germaine to the previous procedure, then the surgeon sent a prescription to have an ultrasound performed so he could see exactly what he was dealing with.

We were in Barre de Navidad at the time, so with the help of a local physician who spoke good English we arranged to have the ultrasound done in the nearby large city of Manzanillo. We hired a car and driver for the day and set off on our first medical/culinary adventure of the year. The physician was prepared on schedule, the equipment and facility was first rate, and it all took around 45 minutes. Just me and the physician, and he spoke excellent English. Afterwards he indicated that he would process the results then zip the imagery up and email it to both me, the referring physician in Barre, and the surgeon in Guadalajara. Total cost for the procedure was around $40 US. The referring physician cost around $20 US. The car with driver for the day cost around $40 US. We bought him a nice lunch too. It was an interesting day out, and we learned a bit about the Mexican medical system.

Once the surgeon had reviewed the imagery he invited us for a visit. JollyDogs got a few days off at Marina Mazatlan, and we took a luxury bus up to Guadalajara for a meet and greet with Lori and the surgeon who was not only a great guy, but also American College of Surgeons Board Certified. We toured the hospital faciility which was certified to American standards, and of course we tagged on a few days of cultural tourism in the area. We were delighted with the prospect, and the firm quote of something like $3700 all in. The cost breakdown included that for each physician, that for the hospital stay, the nursing staff, meals, etc. Isabel was of course invited to stay in my room on a comfy sofa.

We scheduled the surgery for the very end of June last year, and as I was required to avoid any undue exertion for a month then have a follow up exam, Lori helped us arrange a capacious furnished apartment in the lovely town of Tlaquepaque just Southeast of Guadalajara, about 45 minutes and $15 Uber ride from the hospital. We did the pre-op a couple days before the procedure, and the surgeon suggested that rather than get stressed out about being on time for the early morning procedure, what with rush hour traffic and all, the hospital would happily have us in the room the night before the surgery for no charge. Nada. Zilch. We were stunned, but gladly accepted.

Everything went according to plan. When we checked out we went to the hospital business office and paid our bills with a credit card. We paid the surgeon with a credit card. We paid cash from the ATM for some related prep procedures. The bill came in a bit less than the quote. When is the last time that happened?

The stay in Tlaquepaque was great. Lovely apartment, great arts, music and restaurant district a couple minutes walk away (think old town Scottsdale, Arizona) and a civic mercado where we went for lunch each day then shopped for fresh fruit and veg. We also tagged on a couple weeks of Spanish immersion classes at a nearby school run by a Dutch guy.

The surgery was successful. We got to live and gently explore somewhere new. It was the most satisfying and positive medical experience of my life. To top if off, the total cost was less than the deductible on our US policy.

Medical tourism has become big business around the world and the intenet has made it easy. There are excellent physicians and facilities in many countries. We’ve got friends who have been cruising the world for 25 years and tell stories of complex procedures done in Malaysia, Singapore, Thailand, India, you name it. People simply pay out of pocket, and it’s affordable.

You can buy international travel insurance. There are plenty of resources out there. Isabel’s parents used to purchase travel health insurance when they visited from the UK. Had they been badly injured in the US in an automobile accident or some such, the US medical system might have bankrupted them.

OK, now you have one less excuse. What else do you fear? Get out there and go sailing!