
Hospitalized in Split – Intoxication - rahuldottech
https://www.reddit.com/r/croatia/comments/c7eooa/hospitalized_in_split_intoxication/
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burlesona
I’m a big free-market person, and generally skeptical of regulation and
government programs.

That being said, I think there are conditions when a free market can fail, and
one of those conditions is when you don’t have supply and demand working
rationally for one reason or another.

I’ve come to see healthcare as one of those cases.

If a doctor says the cost of your life, or your child’s life, is X... who is
going to shrug that off and refuse to pay? Thus in an unregulated market,
medical practitioners can very nearly charge whatever a patient is _capable_
of paying, and in my experience that’s exactly what they do.

Simple reforms that I think could help:

1) Published prices for all medical services offered. You should be able to
get an exact price quote and comparison shop.

2) A ban on drug advertisements. Only the US and New Zealand allow this in the
first place.

3) A cap on drug prices based on their age and manufacturing cost. I
understand that the actual cost of a new drug is much more R&D than
manufacturing, but that doesn’t justify pharma company. Given a reasonable and
predictable price cap formula, pharma will adapt.

There are a lot of other interesting and more radical ideas out there, but
these seem to me like relatively straightforward starting points that would
help remove some of the worst opacity in the US healthcare system, which
should in turn create more accountability.

~~~
Apocryphon
Universal healthcare would be a great boon for employers, as then they would
no longer have to worry about providing and paying for it as part of employee
compensation.

~~~
burlesona
I get that now. I didn’t understand it for a long time.

While a government-run universal care program doesn’t thrill me, I find the
current employer-based system to be borderline immoral.

The more I deal with the system the more it strikes me as a corrupt, crony
deal to make workers more dependent on their employer, depress wages, and
drive up medical industry profits.

~~~
sdenton4
My partner and I have, for the last couple months, been going through the
medical system hoops over a broken elbow and resulting surgery. We've
fiiiiinally started getting the bills in, along with the 'Explanation of
Benefits', and so far 100% of the bills have included a patient-oriented
error. And then spent many many hours on the phone getting them corrected.

It's goddamn criminal.

[edit: it's also 'fun' to think how much harder it would have been to identify
the bad charges prior to the ACA's explanation of benefits requirements.]

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andrei_says_
Applying market forces to medical services is another way to spell extortion.
What blows my mind is how easy it seems to condition so many people into
believing that extortion is a normal way to approach healthcare.

It is not.

~~~
pitaj
Market forces apply to every other necessity of life, why would they not apply
to healthcare?

~~~
andrei_says_
This is false.

Imagine every street being a toll road, dynamically adjusting price to the
maximum people driving to work, or to to their wedding, are willing to pay.

Imagine a fire engine arriving only after establishing the market price the
owner of a burning house is willing to pay.

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peterburkimsher
I needed to have a metal plate taken out of my ankle a year after it was
broken.

After comparing prices around the world, I realised that the cheapest option
would be to fly to Taiwan for ~500 USD and have the surgery done without
insurance for ~300 USD. The total is less than what it would cost with
insurance in other countries.

There's a recurring meme saying "Don't call an ambulance, get an Uber to take
me to hospital instead". Tangentially related, there's plenty of discussion
here on HN that led me to conclude that it's best to never talk to police,
even if something bad happens.

I have the greatest respect for firefighters, because they seem to be the only
emergency service that aren't yet horrifically corrupt.

~~~
bjornsteffanson
Also broke my ankle, and also had a plate installed via ORIF surgery. My
insurance company was billed nearly $80,000 USD, and I was asked to pay $6k of
that. And that was just the single procedure, not any of the follow-up visits
or physical therapy.

The doctor who performed the initial surgery said that it is not common to
remove the plate due to the risk and expense of another surgery procedure, so
I still have it. Been nearly 5 years. Would love to get rid of it.

If I may ask, what was your consultation conversation like when you discussed
having the plate removed with your doctor /surgeon?

~~~
peterburkimsher
The plate was put in by the same doctor in Taiwan a year earlier, who
recommended removing it. I can also recommend taking it out - I feel much
better without it.

Doctors in Europe/NZ/etc recommended not removing it because of the expense.
It was sensitive to temperature changes, so I really wanted it out. When my
bone and titanium expanded and contracted at different rates when going from a
cold winter outside to a warm house, it was uncomfortable.

If you can take a couple of weeks to fly to Asia and sit around waiting for it
to heal, that would be best. Once the stitches are out (surgery + 2 weeks)
you're able to fly again and walk without crutches. So I guess that's the
shortest time you could do it in. I'm staying for 2 months though, because I'm
waiting for a visa to move down under.

~~~
bjornsteffanson
Thanks for that info. I'm a permanent resident of Australia now, with access
to the public (and private) medical care down here. My injury and procedure
happened in the US though, and I've moved around quite a bit since then, and
haven't really seen anyone about my ankle since my last post-op visit 4+ years
ago. I enquired about speaking to a syndesmotic specialist down here but it
still seemed to be an expensive visit to be told "yeah nah everyone just keeps
the plate in nowadays mate," which is what I was expecting...so I'm always
very curious when someone has had the implant removed. Thanks again.

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franze
friend of mine does hospital consulting, basically improving whatever metrics
the hospitals have in mind i.e.: fast throughput emergency room, more non
critical sendhomes, ...

one hospital in denmark purchased an US software solution and everything
became much slower, so he was called in.

wherby the most EU patient software are focused on checkin, diagnosis and
treatment – at the end you compile an invoice – the US was focused around
billing. you need to do the billing first, then you can do the next step, then
billing, next step, then billing ...

~~~
Narretz
Did he fix without changing the system? The story of how the hospital chose
the software would also be interesting. I guess the people who made the
decision had close to no input from people that would actually use the system.

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gingabriska
So to summarize

1\. He is surprised because he didn't pay the taxes which fund healthcare in
Croatia

2\. He's not making Croatian wages

3\. He's accostomed to taking most of the wages he earns back in America to
his private bank account.

While I personally feel it's good that people receive the help specially
medical help when they need but at the same time I believe it's unfair for the
Croat taxpayers to fund treatment of foreigners because it creates a dynamic
where people with means (who can fly to and from America) get best of both the
world. A low tax environment and a place where government takes away 60% of
your earning in return of free healthcare and cheap healthcare cost.

~~~
AstralStorm
1) To scale, this is about quarter of median Croatian wage. Imagine a $400
bill.

2) Croatian would pay 0 kn, because taxes and it is a routine kind of care.
Only extended stay (beyond doctor's recommendation) would be extra paid and
not too much. Rehab if any might cost something but still not a lot.

3) Trouble begins when surgery or rare medicine is required, either in form of
long queues, high cost or plain unavailability.

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taurath
There’s always a middleman in America, and they tend to spend unlimited
amounts of money to justify their leeching off of everyone. We’ve really gone
very far away from what humans actually need or want in some areas.

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cwp
I had something like this happen to me in Ecuador. One morning I was suddenly
struck by intense pain in my torso. It just kept getting worse. I called a
taxi and told the driver to take me to a doctor, clinic, hospital etc,
whatever was closest. He took me to a clinic, where they told me I had a
kidney stone. I spent the day in a bed there, on really strong pain killers,
with doctors and nurses checking in on me periodically. Total bill, $18. I was
astounded.

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noobermin
One of the ways America maintains itself is by maintaining distance. Between
cars, sprawl, and ultimately, the Atlantic Ocean, its populace is kept in the
dark of what it's neighbors deal with and have or don't have. It's very
convenient really.

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pacaro
I just got back from Bali, Indonesia where one of my friends crashed a
scooter, the total bill for two ambulance rides, urgent care, hospital, and
scooter repair was around Rph 10,000,000 which is $700 in round numbers

Some of this can be accounted for by cost of living differences - $3 an hour
would be a good income in Bali, you can eat a reasonable meal for $2 even in a
touristic area

Some can be accounted for by the rather more minimal service that was received
compared to an American ER, and certainly my friend will need further
treatment in the US, they stabilized a broken arm, but didn't set it

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netmonk
Can you also relate the median wage in Croatia ? And how much taxes are taken
by socialistical system on the salary ?

I can understand the surprise of this person to discover that 36$ is not much
compared to what she could expect in America for similar treatment.

Most of american i meet are very surprised by the price of healthcare in
France too, but they tend to forget that State is taking aroung 60% of income.

As i am my own boss in a IT consultant job, in France, for 4500euros net (4325
euros on my private bank account), i will spend around 9000 euros from my
company (4325 transfered on my private bank account, and 4675 on monthly taxes
like healthcare, unemployement care, retirement care....).

And on those 4325euros monthly, i will be also taxed at end of year depending
on my total yearly income and my family situation (married, single, children
or not...).

So basically i should earn 9000x12= 108000 euros per year , but in reality i
get 4325x12= 51900 euros per year (minus private taxes like house taxes, and
final income taxes which is around 3000/year). So my real earning is around
48900euros yearly.

I also forget that i will have to pay a private supplementary healthcare
insurance, cause on those 36$, State will just reimburse me 21$, so private
insurance costs more than 100euros/month to sometime get those remaining
15euros back.

So 48900 euros/year for a 40yo IT guy, working in devops (married and father
of two )...ask yourself why all young talents in France are going to work in
Silicon Valley... This is not even the wage of an internship at google or
faceboo

~~~
wazoox
Now if you were in the US, you'd get much more money from the start on you
bank account. But you'll have to individually pay for health insurance, and
individually plan for retirement. In the end it will cost you exactly as much,
but instead of collective bargaining you're on your own against big insurance
companies. Unsurprisingly, this rarely ends well for the lone individual
against corporate behemoths.

~~~
netmonk
Well, just to illustrate, there is a private insurance company from Uk called
Amariz, very famous in europe. I asked to a proposal for my familly (2
adults/2 children). And where i was asked around 40k euros/year in healthcare
taxes, it will cost me around 7k at better level of coverage and service. But
even if european law are allowing it, leaving state insurance company in favor
of private in France expose individuals to justice harrassment...So most of
business owner prefer to stay away from trouble and pay far biggest fee.

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usaphp
He'll also be surprised at a paycheck that Croatian doctors get compared to US

~~~
tomlockwood
I had a zero cost drunken ambulance ride and anti-nausea shot in Australia and
the doctors here seem to be paid reasonably enough - although maybe here they
get more people going into medicine interested in helping people over
profiting from them.

And I'm sure the cost of a medical degree in America also has something to do
with that :)

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baybal2
I can add a bit about China — prices here vary by triple digits, and medical
profession is largely unregulated in smaller cities besides the most basics
(you have to have just any paper of medical qualification, and even that is
not always given.)

Quite extensive surgeries are priced in few thousand dollars each, but
emergency medicine is an outlier: a hospital in a big city can bill you up to
$15k for a trivial appendicitis surgery, but you may be lucky in a small town
and have it for just $300-$400.

Price collusions are also real here when it comes to such things.

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rahuldottech
Relevant discussion:
[https://www.reddit.com/r/bestof/comments/c7gfxj/american_guy...](https://www.reddit.com/r/bestof/comments/c7gfxj/american_guy_is_surprised_when_he_gets_a/)

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a_imho
How is that surprising though? Medical tourism has always been a thing.

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BrickandPorter
This is a quick rant that is going to be obliviated, but is this really worthy
of gaining traction on the front page of HN? It’s a quick anecdote from Reddit
about how health care is affordable outside the US. This is just comment bait
for everyone with a relevant gripe who wants to use this as a soapbox for how
they would change the US healthcare system or an echo chamber for validating
their troubles. There’s no tech discussed, no news involved, and it’s the same
conversations that come up in every healthcare related article’s comment
section.

I don’t really care what people use this site for. I have no authority as a
gatekeeper for your discussions or this community. I just think it’s really
lame that a link like this gets traction

~~~
dvfjsdhgfv
On the contrary: stories like these are a constant reminder that certain
things need to be changed, in spite of extremely powerful forces that would
prefer the status quo.

