Medical Outsourcing

[Billy]

Michael

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The only options being left open to the middle class are to go overseas, or support national health care. I'll have to give some more thought to the implications of this trend

When we are left with “either-or’s” we are not being creative enough in our options.

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Open up the federal programs to everyone, and mandate that everyone buy coverage if they don't already have it.

How can you ‘mandate’ that everyone buy health insurance? There will always be people who will choose to to be covered by US health insurances..
Rich_In_Tampa

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Seems to me that almost everyone, conservative to liberal, agrees that some kind of substantial reform is needed, both from a business and social perspective.

Yes, we all agree the system is broken. It’s how to ‘fix’ or manage that system is where the arguments/discussions begin.

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About the only thing most agree on is that the current scenario is highly, highly dysfunctional for almost everyone but the wealthy and the insurance carriers. High costs, mediocre quality in many cases, 30% administrative overhead, decreasing physician incomes. Retirements are postponed and career changes and entrepreneurial efforts are stymied by inability to get affordable (or any) insurance. Large employers are gasping to remain competitive due to health care. Emergency rooms and hospitals are overburdened with the un- and underinsured, and guess who pays in the end...

These are all reasons to have the system be opened up to the free markets. This is how prices are brought down and will benefit the consumer.
30% administrative overhead is because of all the paperwork that the insurance companies and lawyers et al require. The paperwork is required so the ‘right’ people will pay the (guaranteed) payment.

Employers shouldn’t’ have to gasp to remain competitive because of health care packages. I don’t believe employers should be required to give these health care packages. What if the employees were taxed on the value of that benefit? They would go shopping for a better deal, or refuse the employer provided health package. There are other options.

High cost and mediocre quality means that the open market hasn’t been allowed to come in and clean out the dregs of the system.

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In fact, socialized medicine (as in Scandinavia and France, for example) are not sounding nearly as bad as they once did.

France also virtually has guaranteed jobs there too, something I find appalling. I would not hold France up as a model for our nation. (OMG)

Yes, I have heard their health care is decent. But that country has a myriad of problems in most other areas. Many of which I would not want in the U.S.

Be well,
Akaisha
Author, The Adventurer’s Guide to Early Retirement

[Billy]

Here's the latest on changes in Healthcare in France:

British retirees in France lose free health care
By Peter Allen in Paris

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/09/03/wsarko103.xml

So I guess that still leaves Scandinavia ... Be sure to take a jacket!

Humorously,
Akaisha
Author, The Adventurer's Guide to Early Retirement

[chinaco]

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Originally Posted by FinanceGeek OK, I understand the difference in the words you wrote, but I am not understanding how the implementation would actually differ. Can we really have universal coverage while avoiding a large and cumbersome government program to administer it (the European and Canadian answer appears to be "no"). Is the model mandating auto insurance? That doesn't work well in states where insurers are forced to have universal rating, I don't see how health care insurance mandates would work out differently.

I believe we can. Pass a law. No red lining (or rating) of someone that has a health problem (period) same cost for everyone. Mandated coverage. A couple of defined standard coverage plan (that represents a minimum plan for the mandate).... But more is available if wanted (insurance companies can get creative). Bottom-line tax write-off for individuals on premium. $ for $ on tax owed not wages received. This could be implemented several ways.

I will admit, there are a few practical problems that need to be worked out... but it can work. Make the payments via payroll deduction like taxes. Bottom-line, people at the bottom are on welfare or paid for by cost shifting. They will probably be paid for by the Govt. The Govt can negotiate an HMO style plan for poor people. It is typically the cheapest approach and good enough.

Dealing with those that do not comply will be a sticky issue... but enough thought will solve that problem. Garnish their wages. The point is to make it affordable. The plan should be set it up so people can typically afford it. If they cannot afford it, they wind up in the HMO style plan. If someone can afford it and does not pay... Put the squeeze on them. If they do not die... they will be fined and have their wages garnished. Let the government collect that money along with the taxes and pay the insurer for the delinquent. Bottom line, there will alway be some holdouts just like with taxes. But most will comply.

What we have right now is each insurance company trying to increase their individual company's profits in a marginal way by excluding certain people.

[FinanceGeek]

Thanks Chinaco. If uprating were disallowed, or perhaps limited to a narrow band that was age, state, or health factor related, that would surely be better for those who cannot be underwritten now.

But wouldn't we create a situation like car insurance in MA or NJ where rates are set by the state regulatory process (rather than underwriting experience), and it winds up being terribly expensive for everyone? Yes you are guaranteed you can buy health insurance, but the premium is $10k/month. Oh, and by the way its mandatory that you buy this or go to jail.

I guess the advantage of such a system is that everyone COULD buy insurance and it would be a system of issuing tax breaks, vouchers, etc. based on income/wealth to guarantee universal access.

I still wonder as you do about enforcement. Many (including I suspect many of today's uninsured) aren't filing tax returns or working in garnish-able (is that a word?) jobs. How to reach them?

[chinaco]

FG

You probably are correct... there might be some unintended consequences, and possible difficulties. IMHO Some attempt to implement a affordable privately run system seems preferable to a government run system.

There will probably need to be some regulation on the insurance industry... But I suspect that they will make a reasonable profit. Probably a majority of the uninsured are not high risk... they just cannot afford the premium. Expanding the pool should not upset the overall equilibrium of group plans. It makes sense to craft the program to include mechanisms that would motivate people to conserve (i.e., not waste). Copays seem to work reasonably well.

We will always have some number of people that will not conform. I am not sure that sending them to jail is the answer. But, fines and other pressure would cause most to conform. Put it like this... people that have little stake in society will probably be on welfare and/or not working anyway. Some sort HMO model would be their option.

[Oliver]

I would like to outsource my medical care but have not found a HSA plan that would count non-emergency overseas medical expenditures toward the deductible.

It should be a win-win situation. In order to spend $5k in Thailand on medical care, I would be purchasing the equivalent of $10K-$15k of medical care. The likelihood that the insurance company would ever have to pay a dime shrinks. If I did exceed my $5k deductible, the insurance company would be paying a rate far below the "usual and customary" USA price.

Has anyone found such a HSA plan?

Oliver

[wanderer69]

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Originally Posted by Oliver I would like to outsource my medical care but have not found a HSA plan that would count non-emergency overseas medical expenditures toward the deductible. It should be a win-win situation. In order to spend $5k in Thailand on medical care, I would be purchasing the equivalent of $10K-$15k of medical care. The likelihood that the insurance company would ever have to pay a dime shrinks. If I did exceed my $5k deductible, the insurance company would be paying a rate far below the "usual and customary" USA price. Has anyone found such a HSA plan? Oliver

I've passed your question on. I'll let you know what an insurance contact I have in medical outsourcing says, Oliver.

[Billy]

Oliver

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I would like to outsource my medical care but have not found a HSA plan that would count non-emergency overseas medical expenditures toward the deductible.

When Billy and I were in Chapala, Mexico, there were advertisements from hospitals that said they would take care of the paperwork, and would pay your deductible for you. I don’t know how that worked…

But here in Thailand, the hospitals are set up to facilitate filling out all the paper work in order to submit it to your insurance company. I suppose you could email Bumrungrad, or one of the others and find out more info.

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It should be a win-win situation. In order to spend $5k in Thailand on medical care, I would be purchasing the equivalent of $10K-$15k of medical care. The likelihood that the insurance company would ever have to pay a dime shrinks. If I did exceed my $5k deductible, the insurance company would be paying a rate far below the "usual and customary" USA price.

Like I mentioned, most of these hospitals here in Thailand work it out with the paperwork for you since it can be so confusins. Perhaps you could check out their sites and see what they say.

Check this link, about the middle of the page…: http://www.retireearlylifestyle.com/links_medical_options.htm

Be well,
Akaisha
Author, The Adventurer’s Guide to Early Retirement

[Oliver]

I will be following up and researching the suggestions mentioned in the thread. I contacted Bumrungrad a couple of weeks ago. The info below is an excerpt of my correspondence with them.

My question

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I have been very impressed with Bumrungrad. As a result, I am considering purchasing a high deductible health plan in the USA and getting all non-emergency health care at Bumrungrad. I was wondering if you have a relationship with Aetna, Time/Fortis Health/Assurant Health, or Golden Rule/United Healthcare. It would be perfect if Bumrungrad was considered "in-network". It would save the insurance company and myself significant amounts of money if I ever became seriously ill. Could you check into this? If possible, I will purchase whichever insurance plan would allow me to do this. One insurance broker indicated that only emergency care would count toward the deductible. I hope that is not the standard practice of all USA insurance companies. Is this your experience at Bumrungrad?

This is the reply.

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We are please to inform that we have agreement for direct bill with Aetna Insurance only Global benefit plan, we can request a guarantee of payment with the assistance company who work for Aetna Global benefit plan name is HTH worldwide. You can confirm yours benefit with HTH worldwide whether you can use at our hospital or not. They contact number is +1 610 254 8730, e-mail: provider@hthworldwide.com. As for United healthcare we did not have agreement for direct bill with them, you have to pay upfront then file to claim. Regarding to the deductible, we would like to inform that we did not know for the policy detail, actually insurance will pay for the medical treatment depend on insurance policy.

PS Wanderer, thanks for passing my question on!!

[Oliver]

Here is a recent article on medical tourism. Operation Vacation - washingtonpost.com

Operation Vacation
Big Savings Have More Overseas Travelers Mixing Surgery With Sightseeing

By Cindy Loose
Washington Post Staff Writer
Sunday, September 9, 2007; Page P01
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Sunday, September 9, 2007; Page P04 Considering traveling abroad for medical care? Here are a few resources: Find hospitals overseas that have won accreditation from the Illinois-based Joint Commission International at Joint Commission International Web Site (click on "Accreditation.") Overseas hospitals with good reputations may not have pursued JCI approval or may be in the process of receiving it, so lack of JCI approval doesn't necessarily mean a hospital is inadequate. Conversely, JCI accreditation doesn't guarantee anything except that a hospital has successfully met standards, including patient outcomes, comparable to those of JCI-accredited U.S. hospitals. Tip: If a hospital's Web site hasn't been translated into English, that could be a sign that you'd have difficulty communicating there. "Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism" by Josef Woodman (Healthy Travel Media, 2007), gives concrete advice on planning a medical trip. Woodman traveled extensively in Asia to research the book. A second Singapore edition focuses on hospitals in that country. Available at Amazon.com: Online Shopping for Electronics, Apparel, Computers, Books, DVDs & more. A physician's assistant started the Web site Medical Nomad ( Medical Tourism and Medical Travel Resources - MedicalNomad) after finding dental care abroad that he couldn't afford in the United States. The independent site provides insights into destinations, procedures and planning. Healthcare Beyond Boundaries (888-691-4584, Medical Tourism - Medical Travel Abroad - Health Tour India - Overseas Surgery) represents facilities in Singapore, Thailand, India, Turkey and Mexico. As long as you're aware that the site has a financial stake in your decision, you can find useful information, including photographs. --

[Billy]

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you have to pay upfront then file to claim. Regarding to the deductible, we would like to inform that we did not know for the policy detail, actually insurance will pay for the medical treatment depend on insurance policy.

I imagine one would need to be willing to pay upfront and file with your insurance company later -- or check with your insurance policy office before you go. Certainly something to check into since hospital contracts expire and insurance companies change their policies regularly.

When Billy broke his wrist and was having surgery at Stanford Hospital, in California, he was instructed to charge his deductible on his charge card before they would allow him into the operating room (!!) This was in his home country…. So not a lot different. He had to file for all the paperwork to make a claim later.

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A physician's assistant started the Web site Medical Nomad

What an excellent website and very well organized. Thanks, Oliver.

Be well,
Akaisha
Author, The Adventurer's Guide to Early Retirement

[chinaco]

Thanks for the information Akaisha.