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> Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...).

This part gets me a lot as well, and having experienced other pay-for healthcare systems, it's extremely frustrating remembering just how much I would pay in the US even when I had fair insurance through my employer. Getting a simple biopsy done on my leg resulted in a $250 upfront new patient fee, $2300 for the biopsy, then an additional $400 for lab fees some months later. Aside from the new patient fee, I had no idea or indication about any of the other fees until a bill arrived in the mail, despite asking and persisting about it throughout the visit, and since I had to take time off of work to get an appointment, I was at a loss as to how to "make a stand" to get such information.

Compared to where I've been abroad where it's been an upfront fee for walk-in visits. Appointments were needed, but it was a day or two in advance. And when I got insurance through my workplace, it was equally simple.

So 3000$ for a biopsy: ticket to Greece and back to USA : let's say 1000€. Biopsy procedure if it's ultrasound guided around 300€. Lab fee for examining the biopsy:around 200€ max, maybe less. Hotel room for 2-4 days in Thessaloniki 120€-150€ in a decent hotel. Total:1500€ or even less. All these can be done by highly and well educate medical doctors, treatment in private clinics is very good(since you are paying in cash you always get vip treatment) and o course you can enjoy a good vacation. I always said that medical tourism is the future

So are you going to fly back when the biopsy is positive for your surgery or chemotherapy?

Chemo is often every week or month for a period of time, but the surgery is probably a one off. I'd go for it if I was able.

If you need cancer surgery and you want the best you do the opposite-- fly to the US. E.g. MD Anderson has many patients come from all over the world for surgery.

I doubt I can afford the best, an extra 100k or two for a few percentage point increase in outcome isn't a deal I'd make personally.

Surgery might be a "one-off", but cancer surgery can be brutal. People with cancer who need surgery are often nutritionally depleted and surgery takes a big toll. Recovery time in the hospital could be weeks. Rehab, getting you back to where you can wipe your own ass and feed yourself, can take months.

It's not like you would just fly in, get cut and fly back in a week.

You would have to set up some kind of support system for yourself there, which would be very expensive.

Obviously, the problem with this strategy is uncertainty. Part of the point of healthcare is that other people worry about it so you don't have to. Better the Byzantine, inefficient healthcare system you know than a system you don't know at all.

That said, I consider myself lucky to have been in Japan when my lung collapsed. The surgery itself was $80!

I love that japanese medical care is mostly inexpensive compared to the USA but at least 1/2 the doctors and dentists I've visited here over the last 20 years were complete quacks and would not be qualified to practice in he USA. No training to certification is required to be a nurse here. And, if you need special treatments like surgery it's common wisdom you should do your research on your own to find a good doctor a and then pay a several thousand dollar bribe to see them. (of course thats still cheaper than the USA for the same treatment)

I would strongly agree, especially since it's already happening in the US for those who can afford the travel time, which is probably the biggest damning factor for most people. My last job was a good job, but it was University work so it paid pittance. Likewise, with such terrible sick leave/vacation policies, it's very hard for such a strategy to really work for many Americans. Even those at my company that had been there for 10+ years only got 16 days vacation a year - my job abroad has 28 days a year standard, with the requirement that one bout of it must be at least 2 weeks in duration. It's way easier to plan a vacation around a medical procedure when you have a month to plan around it.

Even when you make a steady livable income, it's really crappy to have to go to the doctor in the US.

It's already mostly the other way around.

If you have cancer and can afford it you come to the US for surgery and chemo consults because the best treatment is here.

That's partially because of the money made in US by drug and device makers. But it's mostly because of US government funds spent on research, and because of the US university system with its medical research that attracts minds from all over the world.

I had a similar experience for a minor hand surgery. The thing is, when I called the insurance company (or was it the billing dept at the hospital? I don't remember) they went like, "oh, that's wrong" and like magic $5000 in bills disappeared. How many people just pay without asking? How many people don't care because it's the insurance co covering the bill? The whole system just seems rife with inefficiency.

My parents actually had a doctor's office say "why do you care, insurance is covering it", and the insurance company say "we'll get it fixed, but you realize you won't get anything in return".

Yeah, the system is deeply busted.

Lack of price transparency is a huge, huge problem.

Without price transparency you can't have a market system -- America already has a socialist health care system because no one can price shop.

http://www.pamf.org/forpatients/pamf-health-care-costs-and-c...

Your Better Health Care organizations do publish prices. The outfit across the street from PAMF does not publish prices and as you could guess, they end up being at least 10 times higher. For everything.

Price transparency isn't that useful without outcome transparency.

Outcome transparency without thought about capacity leads to other issues: the best don't have enough time to serve everyone.

We need to figure out how to improve the baseline rather than improve the top-end, which is what things are currently focused on (if my insurance has no problem with me going to a more expensive, highly-regarded provider, why won't I try to get in there?). How is a "market" supposed to work for life-saving surgery?

I would be very interested in how much money is wasted on wrong treatments, unnecessary tests, fixing mistakes like disease transfer in hospitals, versus just paying the best doctors and surgeons for their time.

$5000 bills showing up incorrectly isn't what I would call inefficiency. Attempted fraud maybe.

In other industries you would call health care billing practices fraud. They just make up charges and when you complain they disappear. They just try what they can get away with.

If you can justify the expense, MD VIP (http://www.mdvip.com/) is worth exploring. You basically pay an annual fee and in trade, the doctor's office caps their patient load at a certain number. The fee also includes an annual executive physical and work up.

The benefit is that with the smaller patient load, you can almost always get an immediate appointment. The doctor will actually get to know you and your history, have time to call and followup with you and overall just provide a tremendously better experience. Additionally, if you're ever travelling you can go see an MD VIP doctor wherever you are.

It's a really good setup for people who are willing to pay extra for a better experience.

We tried it after my wife went from doctor to doctor trying to figure out her symptoms that we'd experienced over the course of 2 years. The doctor she went to put some serious research time into narrowing down and figuring out what was going on...and correctly identified the issue, finally.

Our mdvip experience was different.

We paid the $1500 a year a few times. Got a thorough physical - but Dr. and office dropped the ball on follow up.

So when we didn't renew, we were bombarded by AOL-like contact wondering why we left. (We hardly ever say negative things on questions like this)

But it got worse. We wanted a simple refill on an inhaler and the mdvip Dr refused. We had to rejoin first!!! Pay $1500 for a Rx!!!

Called the former local Dr office and they Rx one emergency refill even after not seeing the practice for years.

We will go back to the mdvip dr again because but only when and if the condition calls for. The Dr may not be good at follow up but we liked his diagnosis skills

Depending on the time gap between your leaving and calling for an inhaler refill, that may have violated state ethics regulations and constitute malpractice. Docs have a standing obligation to former patients, generally regarded as something like 3-6 mos., to address emergency issues (e.g., writing a script for a life-saving inhaler).

This stuff would be absolutely hilarious, if it wasn't about health care.

I hear you. Previous office I went to I had to wait more than 30 minutes past my appointment time before being seen by the nurse (before being seen by the doctor) which didn't include "arrive 10 minutes before your appointment". Obviously this is annoying. The third time I showed up to the same office I was 10 minutes late to my appointment, and they told me I would have to reschedule or wait about 45 minutes to an hour.

I told them to cancel the appointment then. They asked if I wanted to reschedule "Nope. I'm going to find another office".

I did find another office, and the doctor was more professional, thorough, and I had next to no wait time.

What you appear to want is contradictory. Tolerance for people arriving late is incompatible with having appointments start on time, as everything gets backed up.

If you routinely have to wait 30+ minutes when you arrive to your appointment on time, and then have to wait even longer if you show up a little late then the office is already backed up on a regular basis.

The logic seems to be "if it's not going to start on time anyway then my being late shouldn't affect anything". That seems reasonable to me, or at the very least, if a doctor's office is chronically quite behind anyway, then your being late is only contributing to the problem, not causing it.

Lots of medical professionals use an app/site to help manage patient appointments. I want one of those suppliers to come out with a smartphone app for the patients to run to give the medical office real-time projected arrival time on the day of the appointment.

Then the office can offer expedited check-in for patients that use the app, because they know the patient will arrive on time and don't have to pad the check-in time estimates. Bonus for watching traffic patterns and looking for accidents/road closures, then giving the patient a heads up to start making their way to the office earlier than anticipated; bonus for storing trending data on individual patients to adjust reminders (those more consistently tardy get earlier and more frequent reminders).

So the thing is that it's not like I wait 30 minutes then see the nurse and then immediately see the doctor. It's wait 30 minutes, wait 5 minutes for the nurse, wait 20 minutes for the doctor and then she is like rushing through her appointment with me. I spend over an hour for 5-10 minutes worth of doctor time.

Always try to schedule appointments early in the day if you care about timeliness. Less chances for schedules to slip.

The problem is:

Doctor Revenue = Number of Hours Worked / Yr / Duration of Average Visit * reimbursement for average visit

That's capped, and everyone is squeezing down on it constantly. Every bit of healthcare reform in the last couple decades has been unfunded mandates (aka, increased overhead) coupled to ongoing reductions in reimbursement rates. For that matter, as is usually the case when price ceilings are implemented, demand > supply, and docs are booked to capacity in most places.

This creates a problem when it comes to hiring staff. Better staff comes directly out of your pocket, and it doesn't translate into higher revenue: it's just a cost. Er... most businesses don't throw money out of the window if they can avoid it.

The exception is billing staff (some of whom are better than others at maximizing your revenue from insurers), and if you plan on moving into a luxury all-cash niche, in which you can demand market rates for better service.

I left my last doctor after I arrived at an appointment only to find that I did not have an appointment that day. In fact, the doctor wasn't even there.