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Expat health care: how getting sick outside the US saved me $2,000

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Dateline: Kuala Lumpur, Malaysia I was reminded of an important lesson yesterday. It all started with my coming ill on Friday. Really ill. I spent the weekend in bed, sick as a dog. Fevers as high as 103.5 Fahrenheit, striking chills, a stinging throat, and a general sense of malaise. I didn’t want to reach over for my water bottle let alone get out of bed. Not one to rush to the doctor at the first sniffle, I tried to get rest and get better naturally. But that wasn’t happening. So yesterday, I went to the hospital here in Kuala Lumpur. And I can offer one piece of advice for those you don’t entirely understand the concept of expat health care: if you’re going to get sick, don’t do it in the United States. Last month, I reported that medical tourism in places like Thailand will help outsmart Obamacare among mobile, globally-minded Americans who know the health care system Obama is building is total crap. And despite my general dislike for Thailand as both a place to live and invest, the health care there is world-class. My friend Dan Andrews told me in an interview this summer that he’d get “any surgery” there. Yet Kuala Lumpur is also an excellent expat health care destination. It’s a more livable city than Bangkok, and wealthier, too. While Malaysia isn’t as trumpeted as a healthcare destination, I believe it’s an undervalued place. And Prince Court Medical Center here in Kuala Lumpur was rated the best hospital in the world for medical tourism this year. But to the point, health care in this part of the world is an incredible bargain. For everyone sucking at the teat of US propaganda, you’d be shocked at just how much money is wasted (on what, I can’t even begin to say) in the US health care system. Not so here in Southeast Asia. I walked into the emergency room at a local hospital in the middle of one of the wealthiest areas of Kuala Lumpur yesterday. While the emergency room is certainly abused by people in the west (like the case of the REALLY bad hangnail), it’s thought of as a place for life-or-death situations. Here in Southeast Asia, you can walk into an emergency room, register for an immediate appointment, and be seen by a doctor. When I went to the doctor last month to find out why I’d lost so much weight rather suddenly, I made an appointment for convenience only – it saved me about thirty minutes of waiting. When you don’t feel well enough to schedule an appointment and wait for confirmation, you just head in. Folks in The Land of the Free would love to convince you that the meaningless hustle and bustle and cold attitudes in their hospitals are the price of providing the best care on earth. Yet I disagree. I’ve found wait times to be very short in Asia when compared to the US. I know people in the US who claim they wait over an hour just to see their doctor, let alone some overworked ER physician. So when I got called into the doctor’s office yesterday, I was impressed. The physician was trained in the UK, spoke perfect English, and had a bit more patience for my questions than the frenzied medical environments you’d expect in the west. She offered to admit me to the hospital for two days (rooms cost $70 a day for a basic room with a curtain and go up to $800 a day for a two-room VIP suite with multiple TVs and a refrigerator)… or to get a shot and go home. I think you know which option I chose. My regimen called for injections of seven liquid medications, including one that required application via a thirty-minute IV drip. Once I got into my private lab room with the nurse, I started to wonder just how much all of this would cost. On top of that, I would be picking up three medications to take at home over the next week. Nothing crazy, but still. Two hours after checking in at the front desk of the emergency room, I was on my way to the hospital pharmacy to pick up my drugs. That process took all of about two minutes. Then, it came time to pay. Drum roll, please… Allow me to break down the bill. Hospital administration fee: 5 Malaysian ringgit (US$1.56) Consultation with the UK-trained ER physician: 35 Malaysian ringgit (US$10.90) Nursing care fee for one hour of on-and-off care: 15 Malaysian ringgit (US$4.67) “Consumables”; perhaps syringes, etc: 72.90 Malaysian ringgit (US$21.24… oh, they’re getting a little heady now) Pharmacy fees, including medicines injected by the nurse and take-home medications: 267.40 Malaysian ringgit (US$82.01) The total bill: $123 in Ben Bernanke-devalued US currency. Swipe the Amex and you’re on your way. You couldn’t get the homeless guy sitting in front of the emergency room to treat you that inexpensively in the United States. While I obviously recommend having international health insurance if you live overseas, it’s more important for treating cancer or if you get run over by a bus. Most everything else should be easily manageable to pay by yourself. In fact, Jeff Berwick made a comment to me that such care would have probably cost thousands in the US. Having paid almost $1,000 just to see an American ER nurse – not doctor – for a non-issue once, I believe him. I understand there are people who are worried about the quality of health care overseas. If you’re never seen just how clean the hospitals are in this part of the world are, you might have reason to think that. Yet I find the hospitals here to be far more efficient, clean, and – if it matters – friendly, than those in the west. Take away the drama of shows like “ER” and people rushing around for no reason and you get good health care. To me, good health care is that which makes me feel better and doesn’t kill me. Almost as soon as I left the hospital, I felt much better. So much better, in fact, that I couldn’t wait to start consuming all of the fatty foods I’d been missing out on in my several days of not eating. After days of fighting off 103-degree temperatures with the local version of acetaminophen, my temperature today is actually a slight bit below normal. And, to the consternation of some, I’m still alive. Amazingly, most people in Malaysia or Thailand or anywhere else aren’t dying, either. I’ve had doctors in the US tell me they wouldn’t trust expat health care in Europe let alone Asia (it is, overall, better in Asia), but seem to forget that about 100,000 people die EVERY YEAR due to medical mistakes in US hospitals. The idea of seeking out health care overseas is medical geoarbitrage at its best. Get English-speaking physicians trained at top schools in Europe, the US, and Singapore to care for you at emerging world prices. Basically, have them use one of the few good things remaining in the US – the private medical education system – then get out and provide great care in their home country. Since Malaysia is one of the wealthiest countries in Asia, they do have their own high standards here as well. I can tell you one thing, however. Obamacare, with all of its ballyhooed promises to “bring down the cost of healthcare”, won’t get you into seeing a doctor for $11. Not even close. And as things in the US get worse, try seeing a doctor on demand for anything less than a bullet hanging out of your abdomen… let alone getting in, getting treating, and getting out to go eat Indian food in two hours and eleven minutes. Guys like Barack Obama might even say my experience is proof of a health care system working TOO well. He might argue that poor nurse should be earning as much as a CEO, and my availing myself of her services for a mere fiver is rapacious. However, for those who NEED medical care, that’s not your issue. Looking beyond your own borders will, in my opinion, become increasingly popular as costs spike in the west and word gets out that care in this part of the world is by-and-large very good. Obviously, you’ll want to make sure you’re visiting a Western-friendly hospital. I know there are more local-oriented hospitals that don’t see a lot of expats and probably charge a bit less. One hospital I found online only charged $40 a night for a semi-private room if you were admitted – almost half the price of the expat health care facility I visited. Of course, it goes without saying that you won’t get on the next plane heading to Kuala Lumpur to get your sore throat looked at. But it could be a viable option for more serious procedures. Meanwhile, inexpensive expat health care is just one of the many benefits you can enjoy when you break free from the myth that only the goods and services in your home country are safe and effective. Living overseas is a great thing in and of itself, but it’s experiences like these that are the icing on the cake.


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