Dateline: Frankfurt, Germany
One of the realities of life is that every once in awhile we need the services of a medical professional. We all know that some medical expenses can be enormous. For those, you either need to have a high net worth so you can afford to pay cash for open heart surgery or for fifteen years of assisted living after a stroke, or you need to have insurance to cover those big events.
Most of us never have those events, but we all have the minor stuff. I lived in the US for many years and I hated visiting doctors. Private insurance with high deductibles, not all doctors accepted all insurance, long waits for appointment dates, long waits in the waiting room, superficial, two-minute consultations, and sky-high fees seemed to be the norm everywhere.
I’ve lived inside “the system” in the United States, Canada, and the UK. But living as a nomad moving from country to country provides the possibility to try medical care around the world and substantial benefits when it comes to minor medical issues.
The big difference in access
First of all, in places like Mexico, S.E. Asia, and even some countries in Western Europe an adult can simply walk into a pharmacy and buy many medications that require a prescription in the US, Canada or UK. Common issues like hypertension, birth control, diabetes, asthma, and others often require a person to take the same drugs year after year. So it’s a benefit to simply buy them at the pharmacy the same way you’d buy new insoles for your Reeboks.
I know some people reading this will say, “Wait! You need a medical professional to determine what medications you should be taking.” That’s true. But only up to a point. After we live inside “the system” for awhile we see firsthand that the guy who gives us our little note for the pharmacist doesn’t really evaluate anything most of the time.
Tell him you’re out of your blood pressure meds and he just nods and writes down a new prescription. And the equally educated pharmacist just has his assistant take thirty pills out of the big bottle of a thousand pills and hand them to you in a little bag. The total cost for the note giver and the pill handler is $150. In Thailand, Mexico or Spain the same drug, made by the same company with the same logo on the box costs $20 and you don’t need any note. Which arrangement would any rational person prefer?
When laser teeth whitening was costing $800+ in the US, I had it done in Thailand for about $200 by a friendly, professional dentist who spoke English and several other languages. He also did a minor cosmetic fix on one of my teeth for a relative pittance and five years later I’ve never had the slightest issue with it.
The big difference in service
My wife, Connie, had a stomach issue when we were living in China. We took the train to Hong Kong and saw a specialist. Note, she was not referred to a specialist after going through an expensive gatekeeper — she just went straight to the specialist who was happy to see her as a new patient.
I was in the room during the appointment and I can tell you I’ve never seen a more thorough and complete history taken. And it was the doctor doing it, not Connie filling out reams of paperwork or an assistant taking the information.
The doctor asked questions going all the way back to Connie’s childhood illnesses, diet and stomach issues. He examined her thoroughly. He personally performed an ultrasound and discussed the observations as he made them. He created a care plan and issued a medication on the spot instead of sending her across town to a pharmacy. He spent the better part of an hour with her and it cost about $300 — all in! She felt better within days.
Just this month I saw a physician in Valencia, Spain about a sudden issue with one ear. We searched for a nearby ENT (Ear, Nose & Throat specialist) and found one at a nearby hospital. We just walked over and ask if we could see the doctor. They asked if we had insurance and I said we would pay cash. (Technically, I could have shown my UK passport and ask for EU reciprocity, but I prefer to avoid paperwork and just paid as if I have no coverage of any kind.)
Twenty minutes later I was in the doctor’s examination room. She and her assistant spent about thirty minutes with me and performed a procedure. She also gave me a prescription for three medications, including one that the US DEA calls a scheduled drug. I paid 80 euros ($88) on the way out and there were smiles all around. They never even took my name or asked me to do any paperwork.
We paid cash for all three medications and they totaled 13 euros ($15). Done. It was 7PM so we went out for an early dinner.
By contrast, one time while visiting Las Vegas, Connie had an allergic reaction to something late at night. We went to the emergency room at a local hospital. They gave her Benadryl. The same stuff you can buy for a few bucks at Walgreen’s except they injected it instead of giving tablets. Took her blood pressure. Watched her for an hour. Said go home. That was a $1,200 visit.
Hey, I don’t want any of this to imply any particular country does or does not have the best system for the delivery of medical services to millions of people. That’s a different subject. But what I am saying is that in many places in the world a patient and doctor — as customer and merchant — can agree on services and costs, shake hands and transact their business without dozens of middlemen and rent seekers entering the picture. And that is a wonderful thing.