Cost of Health Care“We have the results in from the chest X-ray. Please give us a call as soon as possible so we can discuss next steps.”  A call to my doctor informed me that I might have a growth on my heart.  “Or it could be an issue with the film, we can’t be sure.  The best thing to do right now is come in for another X-ray.”

3 weeks earlier I had a chest x-ray done as a health baseline before moving out of the country, to Taiwan.  I couldn’t exactly fly back to the US to get another X-ray, and I was still in health insurance limbo because of the transition in health plans as I transitioned to an overseas position with my employer.  With an issue like this though, I couldn’t really wait, so I scheduled an appointment at a local hospital to get an X-ray and an ECG.

The experience was very different than the one I had in the US.  I checked in at the front desk and was given a number, similar to what you might get at the butcher when waiting your turn to buy meat, or at the Department of Motor Vehicles.  Maybe 15 minutes later my number came up on a screen and I entered a small office where a Doctor was sitting behind a cluttered desk.  His Harvard Medical degree was framed on the wall, and he asked me in perfect English, “What brings you in today?”

After a brief explanation, he gave me 2 pieces of paper, each with a small map of the hospital.  The Doctor wrote a brief note on each, and explained where to go for the tests and which form to give to each testing location.

10 minutes later, I had just put on a hospital gown and was standing in front of a chest X-ray machine.  10 minutes after that, I was lying on a table getting an ECG.  15 minutes later, I was back in the Doctors office.  He had my chest X-ray and ECG results on his computer monitor.  He explained that I was in perfect health, everything was normal or even better than normal.

Compared to my experience in the US, this was incredible.  My doctor had sent X-rays out to a 3rd party to be developed, after which they were forwarded to a cardiologist for review.  A week later the cardiologist called my doctor to inform him that he had difficulty reading the X-ray, there was either a growth or a defect in the film.  After some phone tag I learned all of this background story, putting me back at the beginning of the process but with some extra fear involved.  Holy crap, I might have a heart defect!

Considering all of this high tech wizardry I was a little apprehensive about cost when I returned to the front desk to pay the bill.  I remember the bill in the US approaching $1000 for just a defective X-ray.  In Taiwan, the total bill was less than $50.  Fifty.  In every way the experience in Taiwan was superior…  there was less waiting, the hospital was better staffed, the equipment was newer, the results were immediate, and it was cheaper.  And most importantly, the results were accurate

I’ve had similar experiences with dental care in Taiwan and Thailand, and other doctor visits in Taiwan.  From these personal experiences, I don’t have any of the concerns that have been expressed by friends and family when they ask, “You quit your job?!  But…  what about health insurance?!?!”

That question is heavily loaded with assumptions, fears, and serious negative in your face issues with the US medical system (*).  The real question behind the one asked is, “How will you get medical care if and when you need it?”

That sounds a lot more manageable, and the answer is fairly simple.  I’ll go to a doctor in whatever country I happen to be in, get great medical care, and I’ll pay for it with cash.  In the mean time, I’ll eat lots of fresh fruits and vegetables, get regular exercise, keep a positive attitude, and give and receive love.  Not to mention avoid the negative job related stresses of commuting and office politics

(*) There are reasons that the US spends more per capita than any other nation on health care as a percentage of GDP and spends 2X as much as the next closest wealthy nation, but still has higher infant mortality rates and lower life expectancy.  Data here.  I’ll address some of this when I write a post on our actual health insurance policy (which we will never  use.)

PS.  I never did get a refund for the defective X-ray.  With customer service like that…

Update on 17-Feb-2013:  More details about our health insurance plan and philosophy on health insurance in a new post, Health Insurance is Cheap!