My surgical experience overseas

[Trek]

I recently had surgery here in Estonia and thought I'd share a bit about my experience. The reason is NOT to start any kind of political arguments discussion about health care systems (though my post clearly shows my preference in systems) but simply because I think some on the forums would find it interesting and also, because I often hear the concern, that you can live and travel abroad and not be in fear if health problems do arise. I must preface by saying that although Estonia has a medical tourism market, this was not medical tourism as I am also a citizen of Estonia and live here full time. I was just an "average Joe" that needed an operation. I originally wrote this article on a blog I started about my experiences living here. I'm not publishing my blog address just yet as I'm new to the whole blog thing and not ready to "go public." Any questions and comments are welcome.

"I recently had my first personal experience with the Estonian Health Care System. Turns out I was in need of urgent surgery that required the removal of a body part. All I can say is thank goodness this happened to me here in Estonia and not back in the U.S.

When I lived back in the States, I was self-employed and carried private health insurance to the tune of several thousand dollars per year (with annual increases) and that only covered 80% of my bills after I paid the first $500. I was responsible for paying the other 20%. There was also a co-pay for each doctor visit, around $20 I think it was. Prescription medicine I had to pay 100% upfront, but could send in forms after the fact and try to recover up to 60% of that cost. But, considering how many millions of Americans can't afford health insurance at all, I considered myself lucky to be able to afford that plan.

Here in Estonia, health care is basically "free." Regular employees, children up to 19 years old, pregnant women, students, the unemployed, retirees (63+) and a few other categories need not pay into the system for health care. Emergency care is free for everyone. Where does the money come from? Employers. Every employer pays a mandatory fee into the Estonian Health Insurance Fund for each person they employ. The only people that don't fall into the "free" category are the self-employed who pay their own social insurance into the system. Those who simply choose not to be employed, or foreigners receiving a pension from abroad are able to make their own social payments into the fund and receive the same services and coverage as everyone else. I make quarterly social payments into the Estonian Health Insurance Fund (but just a fraction of what I paid annually in the US) which gives me 100% coverage and the only payments I ever have to make outside that are 50 EEK ($4.73 USD) for appointments with a specialist. No bills ever come to me for any reason.

Some people still assume (even 16 years after independence) that Estonia must have some antiquated Soviet health care system. This couldn't be further from the truth. Estonia was quick to model the Swedish system and I have been pleasantly surprised by the quality of care I've received here. And not just me, the doctors and midwives tending to my pregnant wife have been first rate. They even have a state of the art 4D ultrasound machine at the womens clinic in Tallinn that gives you a view of your child as if it was already outside the womb.

I, however, had my operation in Estonia's second largest city Tartu, which also hosts Estonia's largest university including the medical college. So I was picked apart at the University Medical Hospital. My doctor was a young guy, probably my age or likely even less and spoke fluent English. This was helpful as my current level of Estonian doesn't include complex medical terms and procedures. He was a nice personable guy, who took his time while examining me and explaining what was about to transpire.

When I came out of surgery there were several nurses there who did a great job looking after me. Anything I needed I got right away. Even the surgeon came to check on me no less than 3 times before he left for the night. The only difference I noticed from a US hospital was you don't get a private room (though they can be arranged for a fee if space is available). It was three to a room (all with TV's), though no one was understandably in a chatty mood, so it was very quiet nonetheless. When I did leave the hospital I left with nothing more than an appointment card for a post surgical follow-up and a brochure telling me what I should and shouldn't do for the next several weeks. No bills, no waivers, no discharge papers.

I've since been to my follow-up appointment and received a clean bill of health. I feel great and knowing that I wasn't going to have to deal with medical bills coming in for the next few months, likely with mistakes (as happened following a procedure I had done in the US), I was able to concentrate solely on my recovery.

I'm sure people have had varying degrees of satisfaction with the health care system in Estonia as people would in any system around the world, but I for one have had no complaints at all."

[Texas Proud]

Not trying to get into a argument debate... and I am sure that you had a great experience...

But that is not like many locations... I was in England and it was not pretty... maybe emergency care was, but normal stuff was not...

And here in Houston we have one of (if not the) largest medical campuses with many hospitals... guess where a bunch of those foreign politicians come to get medical care?? Yep, right here....

But, you are right... if you are 'poor', America is a horrible place to get sick at times...

[Trek]

Quote:

Originally Posted by Texas Proud Not trying to get into a argument debate

Don't worry, you're not. You're talking about England and Houston. Nothing related to my post. You probably meant to put this in the other thread "England sucks and Houston is great"

[haha]

Quote:

Originally Posted by Trek Don't worry, you're not. You're talking about England and Houston. Nothing related to my post. You probably meant to put this in the other thread "England sucks and Houston is great"

[FinanceGeek]

Glad to hear you had such a good experience. I have a close friend who lives in Amman, Jordan who had to have 6 titanium pins put into his femur after a serious accident. He is a US citizen and pretty much expected the worst ... but as it turns out his story is much like yours in that he was overwhelmingly happy with the quality of care and its low cost. His Doctors all spoke fluent English and were European educated. He did mention that his wife had to pay his hospital bill in cash before they'd discharge him however, that's apparently how they handle medical billing in Jordan.

On the other hand, I'll add a second vote that medical care in the British Isles really sucks, I lived there for 18 months and every story I heard about medical care was filled with stories of long waiting lists, quotas, and other utilization ceilings. I am glad beyond belief that I didn't need surgery there. I personally know someone who had to wait over 10 months to get an MRI done. Yes, health care is "free" or close to it (unless of course you factor in the level of taxation that applies to consumer goods and wages), but in reality if you really want some life threatening intervention done soon and done right, people pay up and go elsewhere, like Houston (or nowadays - India).

It sounds like Estonia and Jordan are 2 places that are doing it right. My friend in Jordan tells me that he believes a big piece of it to be low costs of personnel, medical billing, and the near absence of legal disputes. Addressing these factors would solve a big part of the problem the US faces. On the other hand, a $1 million MRI machine in the US no doubt costs $1 million anywhere in the world, and if you need a drug that costs $1000 / month in the US it probably costs close to that anywhere else too unless there is a locally made knockoff being sold in violation of the patent (they do this in India with many drugs).

[stargazer08]

Rx drugs in the US cost more than in some other countries. I recall traveling in the Bahamas with the kids years ago. One got sick and we had to take her to a local clinic. Total cost 20 bucks for the dr and the 10 day supply of Biaxin. In the US, the Biaxin alone would have cost me $100. I wonder if medical equipment follows the same pattern.

[Peter]

Quote:

Originally Posted by FinanceGeek On the other hand, I'll add a second vote that medical care in the British Isles really sucks, I lived there for 18 months and every story I heard about medical care was filled with stories of long waiting lists, quotas, and other utilization ceilings.

Bear in mind that Brits are inveterate whiners and will always find something to complain about. So hearing stories isn't necessarily the same as reality.

Both my parents have had strokes and other medical problems recently. Their treatment and care under the British NHS has been first rate. I was over there recently and took my Dad to the local hospital for some outpatient procedures. The facility was clean, well organized, and we only had to wait 1/2 hour for his appointment. Doctors and nurses were courteous and helpful, and the equipment they used was all new; overall I would rate the experience as better than most US hospitals I've been to.

As many have said, no system is perfect. But I do think the NHS gets a bit of an unfair rap at times.

Peter

[RetireeRobert]

I recently read an article about increasing numbers of Americans going abroad for medical and surgical care. I guess it is an increasing trend, in large part because of lower costs abroad. This particular article mentioned Thailand, and how it seems to have a booming medical tourism trade.

The article went on to quote some Americans who went there for various operations, and how they spoke highly of the care they received, and their stays at "resort-like" facilities.

The thing that bothers me about this though, is how "qualified" are we (or any medical tourist) to rate the quality of a surgical procedure done on us?

Yes, we may appreciate the "personable" nurses and staff, or the "resort-like" facilities we stay in, but if we are such good judges of medical care, why do we go to doctors in the first place?

I suppose if we walk out alive, we are entitled to consider the surgery a success, and say "they are great". But I wonder about the longterm "success" rates. I guess I am looking for a "Consumers' Report" type scoring of foreign medical/surgical facilities AND staff---with the scoring prepared by Board-certified doctors!

[Meadbh]

I saw a documentary recently about a Canadian who went to India for a renal transplant and purchased the kidney from a man who needed the money for his family. The two met, which must have been a strange experience. The quality of medical care was excellent but the facility was old and decrepit and the transplant recipient developed septicemia and dehydration and almost died. His family had to go and rescue him. He is now well, but says that if he rejects the kidney, he will not repeat the experience.

Medical care abroad ranges from excellent to dreadful. The best medical care in developing countries can rival the best anywhere. Standards and expectations do differ widely across the world. The standard of medical care in North America also varies between centres. It's just that the variation is probably less.

[simple girl]

Quote:

Originally Posted by RetireeRobert The thing that bothers me about this though, is how "qualified" are we (or any medical tourist) to rate the quality of a surgical procedure done on us? Yes, we may appreciate the "personable" nurses and staff, or the "resort-like" facilities we stay in, but if we are such good judges of medical care, why do we go to doctors in the first place? I suppose if we walk out alive, we are entitled to consider the surgery a success, and say "they are great". But I wonder about the longterm "success" rates. I guess I am looking for a "Consumers' Report" type scoring of foreign medical/surgical facilities AND staff---with the scoring prepared by Board-certified doctors!

The Joint Commission International lists facilities that have passed their accreditation standards: Joint Commission International (JCI) Accredited Organizations

This is a US based agency which is a subsidiary of the Joint Commission, the largest accreditor of health care organizations in the US.

I'd certainly want to do more in-depth research than this, but it would be a good starting point, IMO.

[RetireeRobert]

Quote:

Originally Posted by simple girl The Joint Commission International lists facilities that have passed their accreditation standards: Joint Commission International (JCI) Accredited Organizations This is a US based agency which is a subsidiary of the Joint Commission, the largest accreditor of health care organizations in the US. I'd certainly want to do more in-depth research than this, but it would be a good starting point, IMO.

Thanks for the link. Ask and I shall receive!

[Trek]

Quote:

Originally Posted by FinanceGeek It sounds like Estonia and Jordan are 2 places that are doing it right. My friend in Jordan tells me that he believes a big piece of it to be low costs of personnel, medical billing, and the near absence of legal disputes.

I think that is a huge savings. Take for example my family doctor. It's just her (most family doctors here are female). No staff! This is how it happens. I call and make an appointment. Guess who answered the phone when I called for the appointment? Yep, the doctor. I arrive at my appointment time and sit in the waiting area. Guess who comes out and invites me into the exam room? Yep, the doctor. Guess who takes my blood pressure and temperature? Yep, the doctor. Guess who asks me why I'm there today? Yep, the doctor. Guess who fills out my paper chart and files it in the big wall mounted cabinet? NOBODY! It's all computerized! Guess who schedules my next appointment if needed? Yep, the doctor.

Guess how much money was saved by the doctor doing those few extra simple things? I've never spent so much time with a doctor before in the States. And all that time they are doing these other things who are they with and talking to? Yep, the patient.

And imagine the savings in no medical billing. No insurance company. No codes to remember. No phone calls to third parties. No approvals and no denials. Think about the stress all that nonsense takes away from a doctor. Just help the patients and call it a day.

There are also private health insurance companies here in Estonia that run their own private clinics. So that is available if one wishes. Before I paid into the public system I went once to a private clinic for a minor sinus thing. The clinic was on the third floor of a new fancy glass building near downtown. They had receptionists to check you in and a waiting area with multiple TV's and big cushy swivel lounge chairs. The doc was a nice woman but didn't do anything my current family doctor wouldn't do. And my out of pocket cost (not having private insurance with them) was $65 for the visit. I don't recall what the insurance with them cost or if there were exclusions, etc. But from that one experience I decided just to go with the public. Not sure what happens in the private clinics if you need surgery or emergency surgery.

One other interesting thing about the system here is that even if you pay for private insurance, you are still covered by the public one, since it's employer paid based (or if you self pay into it), as I mentioned in the first post. Just because you buy your own insurance, doesn't mean the employer doesn't have to stop paying into the public fund for you. And just to be clear, the employer alone makes the payment, the employee has nothing withheld. But the neat thing about this system, is that you can go to a private clinic for treatment, but still get your drugs through the public system at a reduced cost.

The system here isn't perfect by any means. No system ever is. You will hear people complain in the U.S., in France, in Finland and elsewhere on the top 50 list. Mine was just one mans surgical experience. I'm still alive, I feel good, I'm happy and it didn't cost a fortune. What more could I want?

One last thing. f there is a procedure that is not available in Estonia but is available in another EU country (non-experimental), the health insurance fund will cover your cost to have the treatment received outside Estonia.

Quote:

Originally Posted by RetireeRobert The thing that bothers me about this though, is how "qualified" are we (or any medical tourist) to rate the quality of a surgical procedure done on us?

I understand your point, but unless you are a surgeon yourself, how qualified could you be? Did you live? Do you feel good? Complications?

Quote:

Originally Posted by RetireeRobert But I wonder about the longterm "success" rates.

Is there such a rating on things? Even in the U.S.? I think that would be hard or impossible with so many other factors in life that could affect the outcome.