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Comment by peterburkimsher | Hacker News Reader

Culture helps - everyone here wants to be a doctor, lawyer, or engineer.

Taiwanese doctors don't get paid in money.

They get paid "credits" which have to be exchanged for money based on a parallel financial system.

Foreigners here sometimes complain that there's a focus on seeing more patients faster, so there might be a misdiagnosis or a less thorough examination.

The fact remains though - it's cheaper to fly here to have a wisdom tooth removed (without insurance) than the same operation would cost in Switzerland or the US. There isn't much resentment of medical tourism either - so, you're all welcome to visit!

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> Taiwanese doctors don't get paid in money.

> They get paid "credits" which have to be exchanged for money based on a parallel financial system.

This is really interesting. Had a quick google and couldn’t find anything. Do you have a link with more details?

Maybe they get paid with blockchain-based currency. (I kid..)

Maybe he means doctors get paid with status, and if you're a doctor you get better rates for loans.

A blockchain-based currency would be cool, and not totally different to the current system.

All I know is what a medical student at church told me - I'll have to confirm later. But I know that it's not payment as status - the doctors' salaries are set in a parallel currency, which has a changing exchange rate with real NTD. I'll find out and reply.

I think Germany has a similar system, at least for dentists. A simple check is 1 unit, root canals have more units, and the insurance sets the rate how many Euroes a unit costs...

Ok, I found out that what I heard about was the balance insurance premium, which adjusted from 4.25% to 4.55% to 5.17%. But I also think I heard that it affects things like years to work to pay off student debt, and retirement. So I think there's more to it. As I remember, it sounded like a parallel currency where doctors fees are tightly regulated, and these "exchange rates" determine their actual salary. But maybe this is my financial ignorance showing.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405348/

I have encounted free general practice doctor places in Australia that operate on seeing as many patients as possible. Basically useless if you have a difficult to diagnose problem, but very useful for getting a referal, a script for a pill, or antibiotics.

Yeah, pros and cons. GP visits are subsidised a set amount by the govt down here, and while for some doctors that means squeezing in as many visits as possible to get volume, for others it just means they get $X from the government and charge the patient an extra $Y for each visit. Many are happy to pay a premium.

This is how many GP offices work in the USA as well, especially in urban areas or offices associated with hospitals.

Unless you already know what kind of specialist you need to go see, and you can afford to go see the right one (might involve multiple visits to multiple specialists), you might literally never get help for a chronic problem that is not obvious on a differential diagnosis.

There really needs to be two kinds visits available: quick visits and check ups, and diagnostic visits. The first can be over in 10 minutes, the latter should last a solid hour.

I'm starting to wonder if "diagnostician" should be a separate specialization. Then I could make an appointment specifically to go see the diagnostician, and not bother the general practitioner, who is evidently too busy to spend more than 15 minutes diagnosing something.

This would only work if there were a mechanism to pay for diagnosis.

Internal medicine specialists are supposed to be "diagnosticians," as you envision it -- they have more training than general practitioners if they're internal medicine specialists. But they're one of the lower-paid specialties, in part because it's easy to charge for a stent or injection but in the US the act of diagnosing a problem doesn't really have a code.

My old GP (now retired) called himself a "diagnostician", and never spent less than an hour on any visit. He'd ask a lot of (prying?) questions about home-life and work-life and social-life as part of getting a holistic view of you...

He also didn't take insurance - because he didn't want to bother with it. And he wanted to be more honest in his notes than his libertarian heart felt comfortable disclosing to the insurance company or the government payers.

Isn't that how all non-Veterans Administration medical care in the US works? Genuinely curious -- my understanding is that almost all medical care profit in the US is driven by volume of procedures, and even non-profit care is reimbursed by insurance companies according to procedures.

How much does it cost to get wisdom teeth removed in the US and in Taiwan? My dentist in Toronto charges around $400 CAD per tooth for extractions, and that’s with full general anesthesia. The price is the same here with private insurance and without.

I'm wondering the same. In Germany my wisdom tooth removal took 20 minutes with local anesthesia included. It was fully covered by the regular compulsory health insurance so I don't know the cost, but seems like quite a small operation to me.

That cost me €500 in the centre of Copenhagen, there are probably cheaper dentists in Denmark.

It took a bit longer for me, a second dentist came to help towards the end.

$5 USD (150 NTD) with insurance at a clinic, up to 400 NTD at a hospital.

Compared to over $400 USD insured in the US.

The cheapest SFO<->TPE flights cost $468.

It might not work out cheaper for you, depending on your insurance plan, but it should be thought of as a serious option for all non-emergency operations.

http://michaelturton.blogspot.tw/2007/04/life-among-toothles...

I have a missing tooth and I'm getting an implant to replace it. Last week I had the post installed. It took about an hour and cost $4200. Insurance covered only the pain meds.

After that's healed, I have to get a replacement tooth mounted on the post and that's another $2000ish. I believe my dental plan will cover $1000 of that.

I don't understand how an implant can cost $4000. It was an hour of time in a dentist office. It seems about an order of magnitude too much. FWIW, I had two estimates and that was the lower one.

In Bangkok I got two wisdom teeth removed in a single operation with a local anesthesia for $300 without insurance, in a good modern clinic where everyone speaks English.

Chap I worked with used to fly back to Terhan for his dentist as well as visiting family - said his old dentist was cheaper and better than UK. Just wondering if part of that is simply cost of living difference?

Sure. A lot of medicine is pretty much a simple service business, economically. You are paying for the services of a person. These tend to be very locally priced.

But.... Medicine is not really an ordinary market, most places. It's not really a market in the US and Europe, in the sense that prices are set like other services. A big determinant of costs tends to be how well the system works.

Well UK dentistry has a different treatment philosophy than the USA for sure.. not sure if Iran is the same. The UK would claim the US overtreats. This is changing though due to private insurance va the NHS and a desire for white straight teeth.

If they offer English speaking “tour guides” I bet it’d take off.

I'm planning on visiting to get some dental work done in the coming months. I have a lot of issues and have never been able to afford proper work here in the US. To get the work done I need here would be in excess of $50,000 but my friend in Taiwan said it would cost at most $1,000 there.

Every time in the past I suggested something like that to my current dentist they had the same reaction, basically: "Oh I would never do that! You're going to get an infection and/or they are going to do such bad work that no dentist here in the US will want to touch you afterwards."

Doctors in the US are so arrogant, thinking they are the best in the world because they are the most expensive. I would love to move to Taiwan, but I suffer miserably in the jungle weather (hence why I am going in winter).

Edit: As someone with chronic health issues in the US, I have a laundry list of horror stories about doctors here. They are far, far from the best in the world.

As a U.S. based software engineer, I can say that medicine is not the only sector that has over-priced professionals. I get paid a ridiculously high salary compared with my European counterparts. I've honestly always wanted to move to Europe, but the salaries here keep me from doing so. I don't understand how the U.S. gets away with it, to be honest.

With a global economy, I don't understand how we manage to stay competitive. Same goes for Silicon Valley vs the rest of the U.S. I don't understand how there can be such a price differential, and yet the most pricey places seem to win economically.

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