# Medical inflation is kicking back up again **URL:** \ **Category:** The BBQ Pit\ **Created:** [August 6, 2015, 12:11am UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112 "2015-08-06T00:11:55Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [August 8, 2015, 2:17am UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/21 "2015-08-08T02:17:50Z")
I’ll try to log on and provide some more data about the US’s out-of-control spending and gross overuse of procedures later. It’s been a wicked long week in the clinical analytics trenches. > [@Wesley\_Clark](#): > > This one? > > [America’s Epidemic of Unnecessary Care | The New Yorker](http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande) > > I haven’t read it yet, I didn’t know he wrote that one until this thread. I read a few of his in the past but I thought GrunpyBunny was talking about this articles. I actually meant both articles read back-to-back; that’s a powerful way to read them. Gawande has also written [books](http://atulgawande.com/books/). Check them out! (Why, yes, I’m a fangirl…I’ve idly considered moving my medical care from Lahey to Brigham and Womens Hospital where he practices on the off-chance of running into him. THAT is a fangirl! :)) ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 8, 2015, 1:39pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/22 "2015-08-08T13:39:11Z")
> [@ZipperJJ](#): > > I can’t think of anyone I know that would be able to afford such a “vacation” in cash (or on their credit card). Or be away from home long enough to travel, heal, and travel back. > > Even if it’s half the price, people who don’t have the $20,000 for a procedure probably don’t have the $10,000 either. Easier to stay home and have it done, get in and out of there with doctors you know and trust (presumably your PCP is involved somehow), and deal with the “devil you know” health insurance and hospital industry in the US when they start calling. I’m assuming insurance would cover it. If a hip replacement cost $60,000 in the US but cost $10,000 in India, Mexico, Thaliand, etc. or $20,000 in Europe or Canada I’m guessing the insurance company would pay for airfare, hotel, and all medical costs. A physician in India has managed to cut the cost of open heart surgery down to $1,600 (he still manages to turn a profit at those prices). He wants to cut it further down to $800. in the US it costs $20,000-100,000 for the surgery. [http://www.bloomberg.com/news/articles/2013-07-28/heart-surgery-in-india-for-1-583-costs-106-385-in-u-s-](http://www.bloomberg.com/news/articles/2013-07-28/heart-surgery-in-india-for-1-583-costs-106-385-in-u-s-) [http://www.wsj.com/articles/SB125875892887958111](http://www.wsj.com/articles/SB125875892887958111) ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [August 8, 2015, 1:56pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/23 "2015-08-08T13:56:33Z")
> [@Wesley\_Clark](#): > > I’m assuming insurance would cover it. If a hip replacement cost $60,000 in the US but cost $10,000 in India, Mexico, Thaliand, etc. or $20,000 in Europe or Canada I’m guessing the insurance company would pay for airfare, hotel, and all medical costs. That would be wrong. Health insurance doesn’t apply to medical tourism. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [August 8, 2015, 2:00pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/24 "2015-08-08T14:00:32Z")
> [@FlikTheBlue](#): > > Some of the problem with overtesting has to do with fear of lawsuits if you miss something. Another part of the problem is patients demanding unnecessary testing. Does the patient with a headache have classic stress induced or tension headaches,or maybe migraines or cluster headaches? Most likely they do. But some people want to “make sure it’s not something serious.” If you tell them they don’t need an MRI, they just go looking for another doctor until they find one who will order it. A lot of times, the wasteful treatment or test is required by the insurance company. For example, taking an x-ray of a sinus infection doesn’t demonstrate anything beyond what a regular exam does. Wasteful. If a physician is contemplating surgery, s/he will order a CT to take a look at the lay of the land and so on, which is reasonable. Some insurance companies demand the less-expensive test (x-ray) before the most-expensive test (CT). ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [August 8, 2015, 2:11pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/25 "2015-08-08T14:11:12Z")
> [@GrumpyBunny](#): > > A lot of times, the wasteful treatment or test is required by the insurance company… Are you talking about the USA? For real? 😃 ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [August 8, 2015, 2:16pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/26 "2015-08-08T14:16:59Z")
> [@GrumpyBunny](#): > > That would be wrong. Health insurance doesn’t apply to medical tourism. This would be wrong. It took about 20 seconds to debunk on Google: \*\* > [@](#): > > 6 Million Americans Travel Abroad Each Year for Surgeries, Medical Treatments \*\* > [@](#): > > Major U.S. health-care players are jumping on the train, including BlueShield of California. Its “Access Baja” health plan caters to Americans and Mexicans wanting to get medical care in northern Mexico. BridgeHealth International, based in Denver, also has an overseas network. > > What’s driving the trend? > > “The cost of health care in the U.S., combined with the fact that we have a shortage in this country of physicians and, probably more acutely, nurses,” responded Boucher. “At the same time, 2008 was the first year of the ‘silver tsunami,’ with Americans turning 62 at [a rapid] rate,” he noted. > **[Dotdash Meredith - America's Largest Digital & Print Publisher](https://www.dotdashmeredith.com)** > > Dotdash Meredith is America's largest digital and print publisher, with brands including PEOPLE, Better Homes & Gardens, Allrecipes, Investopedia, Verywell, and more! Learn about career opportunities, our leadership team, and how we can help you... ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [August 8, 2015, 3:08pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/27 "2015-08-08T15:08:23Z")
I should have been less flip and stated that the majority of the time, out-of-country surgeries and treatments are not covered by US insurance companies. **up\_the\_junction** : The news report you linked doesn’t differentiate between inpatient medical surgeries that would be covered in the US (such as joint replacement) and non-covered surgeries (cosmetic) and those that might or might not be covered by an insurer (gastric bypass). Additionally, the “6 million” number is likely inflated. [\*The International Travel Medical Journal \*admits that some of the data out there could be incorrect and inflated, and quotes a new study:](http://www.imtj.com/articles/2011/new-study-us-medical-tourism-statistics-30089/) > [@](#): > > The authors highlight the significant difference between their grand total of 13,500 US medical tourists travelling via 45 medical travel facilitators and the “number of articles, studies, and reports (that) have suggested that between 500,000 and 2,000,000 Americans travel overseas each year for medical care.” They believe that their study mirrors and supports the kind of numbers quoted by McKinsey & Co (Mapping the Market for Medical Travel) who estimated “the current market at 60,000 to 85,000 inpatient medical travelers a year—numbers far smaller than others have reported.” Coverage by insurance companies for out-of-country surgeries is still available only in \*\*\*very \*\*\*specific circumstances/treatments/surgeries and for \*\*\*very \*\*\*specific insurance companies and hospital programs. You can’t just decide that it’ll be cheaper to get a new hip in Australia and jump on a plane. The majority of policies I’ve seen lately still have out-of-country exclusions. There are also concerns with liability, HIPAA, any need for recovery time, and illnesses not found in the US when you go overseas (which vary based on where you go). The [CDC](http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/medical-tourism) says: > [@](#): > > Most medical tourists pay for their care out of pocket and rely on private companies or medical concierge services to identify foreign health care facilities. These companies may not require accreditation of foreign providers, track patient outcome data, or maintain formal medical record security policies. Some insurers and large employers have formed alliances with overseas hospitals to control health care costs, and several major medical schools in the United States have developed joint initiatives with overseas providers, such as the Harvard Medical School Dubai Center, the Johns Hopkins Singapore International Medical Center, and the Duke-National University of Singapore. And the CDC cautions about problems medical tourists may face overseas that they would be less likely to see in the US: > [@](#): > > Medical tourism has been associated with complications, including infections caused by antibiotic-resistant strains of bacteria not previously seen in the United States. Patients who are considering seeking medical care overseas should be aware of this risk. Health care providers should be vigilant for the possibility of resistant infections among patients who have traveled for medical procedures. > > Several outbreaks of infectious disease have been documented among medical tourists after their return to the United States. Although patients who experience complications after receiving medical care overseas should inform their providers of their travel history and their medical history, such patients may be reluctant to divulge their travel history or may lack adequate documentation of the care they received; both can complicate treatment. And, of course, there are liability and post-op care issues to consider. If you get a raging post-op infection in your new knee, do you have to get back on the plane? What if the new knee joint is recalled? Do you have to go back? ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [August 8, 2015, 4:42pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/28 "2015-08-08T16:42:46Z")
> [@GrumpyBunny](#): > > I should have been less flip and stated that the majority of the time, out-of-country surgeries and treatments are not covered by US insurance companies. > > **up\_the\_junction** : The news report you linked doesn’t differentiate between inpatient medical surgeries that would be covered in the US (such as joint replacement) and non-covered surgeries (cosmetic) and those that might or might not be covered by an insurer (gastric bypass). I don’t care what it does, I’m just pointing out you talk like you have some authoritative pov when it’s actually garbage. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 8, 2015, 9:59pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/29 "2015-08-08T21:59:14Z")
> [@Flyer](#): > > There would be one way to get a handle on medical costs that I think would work quite effectively. Completely ban MRIs, joint replacements, heart surgery, brain surgery, new drugs – any and all medicines, equipment, and procedures developed in the past 50 years. I’m kind of with **Flyer** on this one. Medical science has advanced a lot in the last century. We should expect the proportion of the economy going to health care to increase as new categories of treatment and new specialties become widely available. And–costs aside–the total amount of health care services provided should, if anything, be going up, if PPACA has lowered barriers to health insurance and lowered the share of health care monies that can be diverted to insurer profits. None of that is in itself a bad thing, is it? ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [August 9, 2015, 1:12am UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/30 "2015-08-09T01:12:28Z")
> [@up\_the\_junction](#): > > I don’t care what it does, I’m just pointing out you talk like you have some authoritative pov when it’s actually garbage. I’ve worked in health insurance for over twenty years and currently work in healthcare analytics. So yes, I know a little more than the average asshat who quotes a badly-written, badly-researched puff piece. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 9, 2015, 3:03am UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/31 "2015-08-09T03:03:39Z")
> [@foolsguinea](#): > > I’m kind of with **Flyer** on this one. Medical science has advanced a lot in the last century. We should expect the proportion of the economy going to health care to increase as new categories of treatment and new specialties become widely available. > > And–costs aside–the total amount of health care services provided should, if anything, be going up, if PPACA has lowered barriers to health insurance and lowered the share of health care monies that can be diverted to insurer profits. > > None of that is in itself a bad thing, is it? [![](http://theincidentaleconomist.com/wordpress/wp-content/uploads/2010/10/Spending-vs-GDP-500x554.jpg) ](http://theincidentaleconomist.com/wordpress/wp-content/uploads/2010/10/Spending-vs-GDP-500x554.jpg) many wealthy nations kept spending reasonable, the US didn’t. technology is not the issue. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [August 9, 2015, 6:03am UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/32 "2015-08-09T06:03:14Z")
> [@GrumpyBunny](#): > > I’ve worked in health insurance for over twenty years and currently work in healthcare analytics. So yes, I know a little more than the average asshat who quotes a badly-written, badly-researched puff piece. It’s a shame your comments don’t reflect that. ---
**Author:** ![Eva\_Luna](https://avatars.discourse-cdn.com/v4/letter/e/e495f1/32.png) [@Eva\_Luna](https://boards.straightdope.com/u/Eva_Luna)\ **Post date:** [August 9, 2015, 6:00pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/33 "2015-08-09T18:00:48Z")
Technology is not the whole issue, and medical tourism can’t fix everything. U.S. residents pay multiples more than people in the rest of the world pay for even the most basic medical procedures and generic drugs. One small example: I got ringworm a year ago. It’s a minor fungal skin infection. The antifungal ointment used to treat it, which is on the WHO’s list of basic medications, cost less than $20 in most of the world. U.S. cost for the generic? Almost $300. Ringworm is diagnosed by looking at it: no fancy tests required. Medical tourism can’t fix everything. Who’s going to be able to move to a foreign country for months or years on end for cancer treatment, for example? ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 9, 2015, 10:27pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/34 "2015-08-09T22:27:01Z")
OK, so can we talk about this in a way that distinguishes between a) total health care expenditure as a share of headline GDP and b) actual inflation / price gouging per service rendered? ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [August 10, 2015, 1:36am UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/35 "2015-08-10T01:36:30Z")
> [@foolsguinea](#): > > OK, so can we talk about this in a way that distinguishes between a) total health care expenditure as a share of headline GDP and b) actual inflation / price gouging per service rendered? We might consider different threads for each. I tend to think that B feeds into A, but isn’t the sole cause. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [August 10, 2015, 10:21am UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/36 "2015-08-10T10:21:35Z")
It might be interesting to talk about the “acute” shortage of nurses (as mentioned in my link above) - given the cost of health care you’d be forgiven nurses weren’t all driving home to their swanky downtown apartments in new German convertibles. **Regarding the OP** : No one got back to me on my earlier maths point (not my best subject) that, if 8 million people suddenly get on board before costs decrease, of course the percentage of GDP will increase? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [August 10, 2015, 10:56am UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/37 "2015-08-10T10:56:40Z")
> [@up\_the\_junction](#): > > I don’t care what it does, I’m just pointing out you talk like you have some authoritative pov when it’s actually garbage. It’s not garbage. Back when I worked at Blue Cross Blue Shield I was involved with the unit that was investigating how to allow “medical tourism” coverage. The cost savings were enormous not just to the patient but to the insurance company back 20 years ago, I’m sure they’re more so today. Yes, there is a risk of oddball infections but you have that here (with a different list of oddball stuff). Doctors in many other countries are just as competent and innovative as American ones. Back before I was laid off in 2007 quite a few BCBS companies were allowing it under defined rules and we can expect to see that trend increase. So yeah, there are issues with US insurance coverage on medical tourism, but they’re surmountable and it is happening. I fail to see why you dismiss it, and **GrumpyBunny** , out of hand. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [August 10, 2015, 11:55am UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/38 "2015-08-10T11:55:39Z")
> [@Broomstick](#): > > So yeah, there are issues with US insurance coverage on medical tourism, but they’re surmountable and it is happening. I fail to see why you dismiss it, and **GrumpyBunny** , out of hand. Because **GrumpyBunny** said the opposite e.g. > [@](#): > > That would be wrong. Health insurance doesn’t apply to medical tourism. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 10, 2015, 1:44pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/39 "2015-08-10T13:44:14Z")
> [@up\_the\_junction](#): > > It might be interesting to talk about the “acute” shortage of nurses (as mentioned in my link above) - given the cost of health care you’d be forgiven nurses weren’t all driving home to their swanky downtown apartments in new German convertibles. > **Regarding the OP** : No one got back to me on my earlier maths point (not my best subject) that, if 8 million people suddenly get on board before costs decrease, of course the percentage of GDP will increase? Medical costs follow power law distributions. 1% consume 20-25% of all medical spending. 5% consume 50-60%, 20% consume 80%, 50% consume 97% Flip the numbers around and you find that 95% of the country uses less than half of all medical spending, 80% use 20%, 50% use 3%. I’m going to assume many who got added via obamacare are relatively low cost patients, so the costs wouldn’t increase much. Most truly sick are on Medicaid, Medicare or some other program already. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [August 10, 2015, 2:34pm UTC](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112/40 "2015-08-10T14:34:19Z")
8 million more are … insured. The cost of insurance contributes to GDP. [Previous page](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112.md?page=1) [Next page](https://boards.straightdope.com/t/medical-inflation-is-kicking-back-up-again/727112.md?page=3)