Ask HN: How can you buy high quality healthcare?
113 comments
So, other medical systems around the world are cheaper, but that doesn't make them magic. Chronic pain - especially back pain - is often an unsolvable quagmire for most doctors.
Not a doctor, but several family members have had to go through something similar. So here is my advice:
- Get imaging tests (Xray, MRI). And screen out the any of the worst case scenarios (like tumor or etc). But if there is nothing inherently obvious and doctors are sending you down obscure test panels, cut bait early - they're out fishing and you shouldn't expect anything worthwhile.
- For back pain, there is almost no medical solution other than surgery. If surgery is optional, don't take it. The recovery from a back surgery is brutal and long and can come with unintended consequences.
- Talk to a fitness instructor. Especially one with a formal education. This is the most underrated option - these are the true experts on kinesthesiology and recovery. You'll be surprised how much good advice they can give you in a single session - identifying which sets of muscles can be developed to take strain off your back, giving you targeted workouts to try, pain management techniques, etc.
- Patience. My father-in-law spent a year recovering from back problems. Despite trying every medical intervention under the sun, his recovery ended up taking exactly as long as his original doctor said it would. But the important thing was lifestyle interventions to prevent reaggravating the problem.
Not a doctor, but several family members have had to go through something similar. So here is my advice:
- Get imaging tests (Xray, MRI). And screen out the any of the worst case scenarios (like tumor or etc). But if there is nothing inherently obvious and doctors are sending you down obscure test panels, cut bait early - they're out fishing and you shouldn't expect anything worthwhile.
- For back pain, there is almost no medical solution other than surgery. If surgery is optional, don't take it. The recovery from a back surgery is brutal and long and can come with unintended consequences.
- Talk to a fitness instructor. Especially one with a formal education. This is the most underrated option - these are the true experts on kinesthesiology and recovery. You'll be surprised how much good advice they can give you in a single session - identifying which sets of muscles can be developed to take strain off your back, giving you targeted workouts to try, pain management techniques, etc.
- Patience. My father-in-law spent a year recovering from back problems. Despite trying every medical intervention under the sun, his recovery ended up taking exactly as long as his original doctor said it would. But the important thing was lifestyle interventions to prevent reaggravating the problem.
By “Fitness Instructor” I think you mean “Physical Therapist” (and definitely not a Chiropractor). In the US, a fitness instructor can be literally anyone who runs an aerobics class, while a physical therapist actually has medical training.
No, I mean a fitness instructor. Or perhaps a "personal trainer". There are certain certifications that exist (And some people are both trainers and physical therapists).
In my (limited) experience, physical therapists tend to have much broader recommendations. Like a PT might tell you to walk an hour a day, but a trainer might recommend a specific kind of crunch that targets the actual muscles in question.
And to OP's point, PTs are very much ingrained in the US medical system and consuming their services can be a pain in itself.
But the guys who get professional athletes back on the field every week are for the most part just personal trainers with a master's level education in sports science. THOSE are the guys you want to help your back recover.
In my (limited) experience, physical therapists tend to have much broader recommendations. Like a PT might tell you to walk an hour a day, but a trainer might recommend a specific kind of crunch that targets the actual muscles in question.
And to OP's point, PTs are very much ingrained in the US medical system and consuming their services can be a pain in itself.
But the guys who get professional athletes back on the field every week are for the most part just personal trainers with a master's level education in sports science. THOSE are the guys you want to help your back recover.
Boosting this comment, you want to talk to someone with a Masters or Doctorate in Kinesiology. Some Physical Therapists will have this or equivalent training. Some other specialists will fit the bill as well but not all.
My wife had back pain due to a disfigured vertebrae. That’s something they do not want to operate in until every other option is exhausted. Much of her pain and numbness is caused by imbalanced muscle development from a lifetime of incorrect posture and movements that compensated for the defective vertebrae. She’s worked with both a Physical Therapist and a Trainer to improve her strength and how she moves to the point that she is pain free 90% of the time. Both were referred to her by her doctors. They’re not part of a PT chain or gym.
My wife had back pain due to a disfigured vertebrae. That’s something they do not want to operate in until every other option is exhausted. Much of her pain and numbness is caused by imbalanced muscle development from a lifetime of incorrect posture and movements that compensated for the defective vertebrae. She’s worked with both a Physical Therapist and a Trainer to improve her strength and how she moves to the point that she is pain free 90% of the time. Both were referred to her by her doctors. They’re not part of a PT chain or gym.
50/50. The problem with going to fitness/sports people is they may get "distracted" with other concerns of theirs and ignore your central complaint. So if that fitness instructor is incredibly informed and clearly taking your priorities straight then, sure, go there. But if they seem to have a chronic case of "jock brain" and seem to be only concerned with your physical appearance then go elsewhere.
These aren’t fitness instructors. The trainer in this medical setting is someone that has you perform exercises to restore mobility rather than for general fitness. There’s certainly a link between the two but that’s not why you go to a hospital to work out.
Kinesiology is the study of how the body moves. While the largest target audience for that is going to be people looking for a standard gym fitness trainer, the higher degrees are wasted on that sort of thing and are better used to restore the range of motion of an elbow after a car accident.
Kinesiology is the study of how the body moves. While the largest target audience for that is going to be people looking for a standard gym fitness trainer, the higher degrees are wasted on that sort of thing and are better used to restore the range of motion of an elbow after a car accident.
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It really depends. I know plenty of people that are "fitness instructors" (mainly yoga and Pilates teachers) and I'd recommend them over regular PT in most situations. They know a ton about anatomy, how to read body imbalances, and can work with you to train your body back from injury.
Personally, I had a debilitating shoulder injury, couldn't put any weight on my right arm at all, and one of my yoga teachers put me on the path of fixing it up. Same with a low back injury, I couldn't even sit at one point and she helped fix me.
I'd 100% recommend someone with back pain visit a highly trained yoga or Pilates teacher. Some Pilates studios even take health insurance, since some are considered PT.
Personally, I had a debilitating shoulder injury, couldn't put any weight on my right arm at all, and one of my yoga teachers put me on the path of fixing it up. Same with a low back injury, I couldn't even sit at one point and she helped fix me.
I'd 100% recommend someone with back pain visit a highly trained yoga or Pilates teacher. Some Pilates studios even take health insurance, since some are considered PT.
I would be careful with shoulder injuries, your body simply can’t repair certain things like rotator cup injuries if I recall correctly.
Absolutely, some things we actually need surgery for. But most of the time it's not necessary and really the only solution is to fix poor movement patterns and to strengthen the body. A lot of back pain comes down to strength and flexibility issues.
For my shoulder the main thing that worked was getting into the habit of doing pull-ups and stretching out my pec minor. Anytime I neglect pull-ups for a while the discomfort will creep back in. I probably should also buy a split keyboard.
For my shoulder the main thing that worked was getting into the habit of doing pull-ups and stretching out my pec minor. Anytime I neglect pull-ups for a while the discomfort will creep back in. I probably should also buy a split keyboard.
So, you're definitely right- go to someone with actual medical training first. But a physical therapist's job is to get people back to basic functioning. From there, a good fitness instructor can help a person with stretching, light exercise and strength training, and stuff like posture/positioning and meal planning to maintain and improve on the initial work put in with the PT. A fitness instructor/coach is a fraction of the cost of a PT, and if you maintain a good relationship, you can just kind if drop in for guidance as needed vs going to weekly dedicated sessions.
But yeah, they can be literally anyone. A good one understands simple (bio)machines and pays close attention to how a body moves AND is a good teacher.
Edit: "A PT will get you to functional, a fitness instructor will get you to capable"
But yeah, they can be literally anyone. A good one understands simple (bio)machines and pays close attention to how a body moves AND is a good teacher.
Edit: "A PT will get you to functional, a fitness instructor will get you to capable"
It's worth keeping in mind that the quality of Xray and MRI machines vary greatly and the facility doing the scans typically won't be upfront with what machines they're using. You are the only person who is ever going to advocate for the treatment you get so you'll need to be very firm but polite to get this information.
"and the facility doing the scans typically won't be upfront with what machines they're using."
All one has to do is ask. I've even had scheduling assistants ask me what power of machine the doctor wanted.
All one has to do is ask. I've even had scheduling assistants ask me what power of machine the doctor wanted.
How i would i be able to differentiate the quality of the machines?
Depends on the type of machine/imaging to be done. For MRIs, you typically want higher Tesla values for better detail. There are also other types of imaging tech too like DTI or functional MRIs depending on what you want to look at.
Yeah, a physiotherapy course is the standard treatment for "weird body pain with no visible problem on MRI" here in Germany. I'm surprised to hear if that isn't the case in your country.
It generally is in my personal experience... But people don't like having to do work and want a quick surgical or medical fix.
> Talk to a fitness instructor.
I strongly agree out of personal experience. FIs have fixed all and every sedentary-job-induced ailment I've had so far. I highly recommend watching the athlean-x YT channel. Adding to that: also ask older, fit people you meet in the gym. They are full of good advice how to avoid injuries and, once you have one, getting over it.
I strongly agree out of personal experience. FIs have fixed all and every sedentary-job-induced ailment I've had so far. I highly recommend watching the athlean-x YT channel. Adding to that: also ask older, fit people you meet in the gym. They are full of good advice how to avoid injuries and, once you have one, getting over it.
legitster says >"- For back pain, there is almost no medical solution other than surgery. If surgery is optional, don't take it. The recovery from a back surgery is brutal and long and can come with unintended consequences."<
I have two friends who had almost identical spinal & neck issues: both got no relief until they had surgeries. Both say "Why prolong the suffering? Do the surgery!" One of them did have to wear a neck brace for months, but that was because his surgeon found the old neck vertebra was too delicate to keep, and so cut a chunk of bone out of his patient's hip, hand-carved it to the shape of a healthy vertebra and inserted it into his patient's neck. When the patient awoke he complained about the pain in his hip (his neck was fine).
Now that's the kind of surgeon I want!
I have two friends who had almost identical spinal & neck issues: both got no relief until they had surgeries. Both say "Why prolong the suffering? Do the surgery!" One of them did have to wear a neck brace for months, but that was because his surgeon found the old neck vertebra was too delicate to keep, and so cut a chunk of bone out of his patient's hip, hand-carved it to the shape of a healthy vertebra and inserted it into his patient's neck. When the patient awoke he complained about the pain in his hip (his neck was fine).
Now that's the kind of surgeon I want!
Concierge healthcare. It's also gotten more widespread than when it first became a thing, so even there I would make sure to do due diligence to see what level of service you're getting. But if you're willing to fork over the money, the level of care that you're supposedly given seems far better than even anything in stories you hear about in Europe or Asia.
Seems like you should expect to pay five digit amounts per year for the privilige though, in addition to fees per visit/service?
This is the kind of thing where I feel that if you are making FAANG tier salary in the US, you can bulldoze your way into getting better quality of life benefits privately, than someone living in say, Europe who would be making a fraction of your earnings but with better publically provided benefits.
Seems like you should expect to pay five digit amounts per year for the privilige though, in addition to fees per visit/service?
This is the kind of thing where I feel that if you are making FAANG tier salary in the US, you can bulldoze your way into getting better quality of life benefits privately, than someone living in say, Europe who would be making a fraction of your earnings but with better publically provided benefits.
This is what I came here to say - the answer is "Concierge Medicine"
In my experience, that's generally a primary care doctor that has on the order of 1/4th or fewer as many patients, but they all pay a membership fee in order to make that sustainable. That means they can spend significantly more time - like hours every week - with you.
That doctor is then well connected in the community, and can call up a friend at the local specialist/hospital/etc and cut the line for some treatments, as well get recommendations for the "best" folks in whatever speciality is needed. They'll be persistent on your behalf, and listen to you instead of dismissing.
It's unfortunate that this is necessary, but it can be had for a few hundred dollars a month, which is a pittance if you're a high earner.
In my experience, that's generally a primary care doctor that has on the order of 1/4th or fewer as many patients, but they all pay a membership fee in order to make that sustainable. That means they can spend significantly more time - like hours every week - with you.
That doctor is then well connected in the community, and can call up a friend at the local specialist/hospital/etc and cut the line for some treatments, as well get recommendations for the "best" folks in whatever speciality is needed. They'll be persistent on your behalf, and listen to you instead of dismissing.
It's unfortunate that this is necessary, but it can be had for a few hundred dollars a month, which is a pittance if you're a high earner.
Not sure why you're being downvoted. Maybe because some people perceive this as unfair - which it certainly is. It doesn't change the facts though. It is what it is.
How to locate such providers? Hundreds/month is worth it for a lot of cases.
Yes, how to locate this please?
It bills itself as "not concierge" medicine, but through a previous employer I had access to Summus, and found them extremely helpful in navigating the healthcare system.
The turnaround from me being told by a med school friend that I should "go get something checked out" to having an appointment with a dermatologist was ~1.5 days, and the total effort I spent was a few minutes filling out a form and responding to someone calling me.
The turnaround from me being told by a med school friend that I should "go get something checked out" to having an appointment with a dermatologist was ~1.5 days, and the total effort I spent was a few minutes filling out a form and responding to someone calling me.
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fwiw, FAANGs often offer complimentary One Medical plans.
One Medical is mass-market quasi-concierge medicine. It's a good compromise for middle class people. But the level of service is starkly different between One Medical and MD2. As you should expect when the costs are two orders of magnitude apart.
My employer provides something similar. While it's certainly no MD2, it's also starkly better than going through the general medical system.
Private clinics/hospitals in Europe can do this, and I'm assuming at a lot less of a price than 50k. I always go to private clinics in Europe and for getting your entire body tested costs, in Estonia, maybe a few thousand USD. I recommend Confido (https://www.confido.ee/en/). No health insurance or residency or anything required, just make an appointment, and pay for it. That's it.
In Spain I was very happy with Sanitas (http://sanitas.es/).
In Spain I was very happy with Sanitas (http://sanitas.es/).
Having lived in Estonia I caution you a bit, while the medical treatment I received there was fine, it wasn't at American standards imo (I tried both public and private over my ~2yrs of living there). If you want top tier service, I would focus west, I've heard Germany has some great clinics (e.g. Charite)
Thank you!
You should also check out the Netherlands. It's a private system but if I'm not mistaken prices are largely set by the government. Not sure if that applies only to residents though.
My Dad had something similar to what you want done at Mayo clinic. It was more of a pre-emptive high tech complete check up that took several days. He got MRI's, stress tests, etc. They received and discussed results throughout the process.
My wife just went through a serious spine/back problem. Our experience was that the turnaround between visits is so slow because the specialists are in such high demand. She is in recovery now but the time from first onset of symptoms to recovery was six months.
My suggestion is find a good doctor that specializes in managing pain to make the waiting more bearable. In my mind, a pain doctor was someone who hands out opioids and gets people addicted to drugs. Nothing could be farther from the truth. There are tons of effective treatments for pain that don't involve opioids. These range from cortisone shots to drugs that target specific nerves.
My wife just went through a serious spine/back problem. Our experience was that the turnaround between visits is so slow because the specialists are in such high demand. She is in recovery now but the time from first onset of symptoms to recovery was six months.
My suggestion is find a good doctor that specializes in managing pain to make the waiting more bearable. In my mind, a pain doctor was someone who hands out opioids and gets people addicted to drugs. Nothing could be farther from the truth. There are tons of effective treatments for pain that don't involve opioids. These range from cortisone shots to drugs that target specific nerves.
Thank you!
Look into medical tourism if that's an option for you. Country like India is a great choice for the money. They have excellent hospitals and doctors for a fraction of the cost of US healthcare. I say this as an Indian American who has lived in the US for half of my life. Don't be fooled by "Oh India is 3rd world". Not when it comes to Healthcare (if you have some money which will always be much less than what you need in the US), telecommunications and banking.
US is just not an option if you cannot deal with Insurance or don't have enough money. Unfortunately.
US is just not an option if you cannot deal with Insurance or don't have enough money. Unfortunately.
How can you determine what places are any good or not? I've seen one or two medical tourism marketplaces come and go and it doesn't seem like a solved problem. I'd be happy to try out somewhere for dentistry/something not serious or if I was truly desperate, but not sure about everything in the middle
Referrals / word of mouth. You need to talk to a few people, preferably those who have had treatments, and consider their opinion. Don't go for "medical tourism". Research multi-speciality hospitals and doctors, and contact them directly.
I definitely miss this aspect of India, affordable and easily accessible healthcare and if you can afford a premium then it will be world class as well.
This. Thailand is another option. They have a booming medical tourism business.
Be aware that if you travel to India, you will almost certainly need to bribe people during the travel process. It's something westerners tend to be really uncomfortable with and usually stresses them out.
The term you're looking for is "concierge healthcare". Check r/fatfire for recommendations - the abysmal state of US healthcare is a frequent topic of discussion.
This is an excellent recommendation since there are a few threads that specifically discuss this. I suspect your conclusion might end up being travel to the Mayo Clinic for a few weeks for diagnostic testing.
Some employers have their own health concierge in their benefits package that often goes mostly unused. I've heard positive feedback about the Stanford Health Navigation Service.
Some employers have their own health concierge in their benefits package that often goes mostly unused. I've heard positive feedback about the Stanford Health Navigation Service.
This. Also look at One Medical. It's "concierge light".
Yes, along with Forward Medical which is a similar model but having tried both I think has better service/function
Thank you!
Direct Primary Care might be a good place to start: https://www.dpcare.org/
I gave it a try last fall, and the difference is night and day: my current Dr actually works for me, whereas the last one very obviously worked for my insurance company.
Rereading your post, this is exactly what you want. He had me do a whole bunch of tests right off the bat and set about optimizing different things. His job is to keep my body working well, and he takes it seriously. In-network docs are, in my experience, mainly about hitting arbitrary metrics imposed by insurance companies.
I gave it a try last fall, and the difference is night and day: my current Dr actually works for me, whereas the last one very obviously worked for my insurance company.
Rereading your post, this is exactly what you want. He had me do a whole bunch of tests right off the bat and set about optimizing different things. His job is to keep my body working well, and he takes it seriously. In-network docs are, in my experience, mainly about hitting arbitrary metrics imposed by insurance companies.
Thank you for this! This sounds like exactly what I've been looking for for years and due to several providers being in my local area right now its been under my nose the whole time!
To anyone who has gone this route, other then needing to fall back on traditional care when its out of the scope of a DPC provider, somewhat limited options in terms of providers compared to the traditional system, and of course additional cost in addition to still wanting to have insurance when you might not need their services often, any downsides to be aware of? Just making sure its not 'too good to be true'.
My favorite feature though is it seems like if you find a qualified provider I might finally get a "Dr House" who actually listens to what I say and does something rather then just following the standard flow chart.
To anyone who has gone this route, other then needing to fall back on traditional care when its out of the scope of a DPC provider, somewhat limited options in terms of providers compared to the traditional system, and of course additional cost in addition to still wanting to have insurance when you might not need their services often, any downsides to be aware of? Just making sure its not 'too good to be true'.
My favorite feature though is it seems like if you find a qualified provider I might finally get a "Dr House" who actually listens to what I say and does something rather then just following the standard flow chart.
This is awesome! The questions is why is zero advertising for this kind of service?
Looking at the website I've found two providers near me, so I'm definitely going to check it out.
Looking at the website I've found two providers near me, so I'm definitely going to check it out.
It’s hard to get the message out in the face of the marketing dollars behind the established system.
I pay my dr like $80/mo and it’s a bargain. Having a dr whose interests are genuinely aligned with mine has been life-changing.
I pay my dr like $80/mo and it’s a bargain. Having a dr whose interests are genuinely aligned with mine has been life-changing.
Highly recommend this as I have one to. The issue though is there are limits as to what they can do. If you have an issue that is above their capabilities you'll be referred to a specialist.
This is the part that stinks as then you'll be bundled in waiting for the specialist to contact you, run their tests, and normally in a larger hospital group. So you'll be treated as a number again.
This is the part that stinks as then you'll be bundled in waiting for the specialist to contact you, run their tests, and normally in a larger hospital group. So you'll be treated as a number again.
I use one to and it's absolutely great.
For something in the neighborhood of $50k you can sign up with a concierge medicine practice such as md2. You would get an excellent primary care doctor with great connections who is able and willing to coordinate and expedite all your care. It doesn't scale to the broad population, it's not efficient, etc. but in the U.S. you can get excellent, timely care with no compromises as long as you're rich.
I'd apply to be seen at the Mayo or Cleveland clinic. While it sucks that there is a patient selection process, once you are in, they can line everything up, over a a few days, and get you an answer - at least all the testing will be done. They do have telehealth options and I found the digital experience compelling.
I'd second the medical tourism, but I've never done it myself.
I'm a patient at the Mayo.
I'd second the medical tourism, but I've never done it myself.
I'm a patient at the Mayo.
Yes, this is the same answer I would recommend (and I have also gone to Mayo for my own pain problems), but be aware that not everyone just walks in, gets tests, and gets an answer. Some of their departments are more booked than others, so while you can show up for a few days and get a slew of tests, half of your time on those days will be sitting in waiting rooms hoping one of the specialists in a booked department has a cancellation and can see you on the fly.
Also, just because they run all the tests and are great at what they do does not mean they will have all the answers for every patient. They have a fast-paced machine to crank you through which will help many people, but not all. Set your expectations accordingly, and be prepared for any result including more of, "The specialist you need is booked, come back in a few weeks."
I 100% agree to go there and get all you can from it. Just don't walk in expecting a quick easy miracle.
Also, just because they run all the tests and are great at what they do does not mean they will have all the answers for every patient. They have a fast-paced machine to crank you through which will help many people, but not all. Set your expectations accordingly, and be prepared for any result including more of, "The specialist you need is booked, come back in a few weeks."
I 100% agree to go there and get all you can from it. Just don't walk in expecting a quick easy miracle.
Since many folks have mentioned medical tourism, I'll mention three other options.
1) Forward Medical - I have had nothing but good experiences with them but they are not going to solve, just help diagnose & are a replacement to primary care.
2) Working from your symptoms to try to find a community online that has built up around this. There are several, I know that I listened to a notable podcast recently about the person figuring out their diagnosis related to lyme disease when doctors couldn't figure it out. Once you figure out a pathway, then you find a specialist and test yourself. Doctors are not great at looking outside the box for stuff, so if you have something uncommon it's going to be hard.
3) Related to 2, once you have an idea, connect with some top doctors, especially researchers at top tier institutions (think Stanford, Zuckerberg hospital, Mayo, top clinics (one in Berlin I can't remember), etc. Maybe ask a friendly doc to also post on Sermo for you (a medical focused social network) to get a broader audience. I just read the new Michael Lewis book about the pandemic and there's this guy Joe DeRisi at UCSF whose lab I guess basically looks at absolutely crazy things and fields requests all the time, might be worth calling although it's a long shot.
https://profiles.ucsf.edu/joe.derisi
https://profiles.ucsf.edu/joe.derisi
If you're willing to read a book, I can recommend Back Mechanic:
https://www.amazon.com/Back-Mechanic-Stuart-McGill-2015-09-3...
It gives you a lot of information so you can a) intelligently talk about your pain to your providers and b) build up strength and flexibility in your back to hopefully address the issue on your own.
https://www.amazon.com/Back-Mechanic-Stuart-McGill-2015-09-3...
It gives you a lot of information so you can a) intelligently talk about your pain to your providers and b) build up strength and flexibility in your back to hopefully address the issue on your own.
This book did a tremendous amount to help me with my chronic pain issues: https://www.painscience.com/tutorials/trigger-points.php
Can second that recommendation. On top of the good advice in the book about your back, the author also has a lot to say about the missteps a lot of doctors will make in treating back problems. Those missteps can serve as red flags in evaluating your medical practitioners.
If you are open to medical tourism, from experience would recommend Mexico private healthcare.
I have been very impressed with private facilities and doctors. Out of pocket costs are very affordable including lab and imaging (ultrasound, CT, and MRI). No insurance needed as long as you have proof of payment. They may request this for intensive surgical operations etc.
Another benefit is results are immediately given to you, for example say you got a CT as hospital/provider A and want to see a specialist in B, no problem just bring the findings/imaging with you. No filing petitions to get your own medical records which you may or may not get in 2-3 weeks....if they honor it, then have to file HIPPA requests etc. All this wastes time, normally in weeks in the US.
A thing that completely surprises me is the doctors provide their cell phone number, so if you have issues after hours or weekends, or they receive lab results and want to provide a recommendation, after hours, just a message away. I wish we did this in the US.
One of the better things since you are self pay is to not deal with insurance. Want to try a different medicine, don't need approval for that. Want a second opinion, don't need to run it by insurance.Is this facility/doc in my network?, no worry there. You control the entire experience.
My recommendation is to look for cities that are expat hot spots as they have medical tourism facilities, normally all speak English including the local people to cater to expats. Yucatan, Quintana Roo (cancun) and I think Jalisco.
If you are interested in more info please email me, email in my profile. My SO has problem and we have played the bounce around game along with a few ER visits mixed in. Few things are more frustrating then experiencing the US medical system first hand with no results and being helpless. Best of luck!
I have been very impressed with private facilities and doctors. Out of pocket costs are very affordable including lab and imaging (ultrasound, CT, and MRI). No insurance needed as long as you have proof of payment. They may request this for intensive surgical operations etc.
Another benefit is results are immediately given to you, for example say you got a CT as hospital/provider A and want to see a specialist in B, no problem just bring the findings/imaging with you. No filing petitions to get your own medical records which you may or may not get in 2-3 weeks....if they honor it, then have to file HIPPA requests etc. All this wastes time, normally in weeks in the US.
A thing that completely surprises me is the doctors provide their cell phone number, so if you have issues after hours or weekends, or they receive lab results and want to provide a recommendation, after hours, just a message away. I wish we did this in the US.
One of the better things since you are self pay is to not deal with insurance. Want to try a different medicine, don't need approval for that. Want a second opinion, don't need to run it by insurance.Is this facility/doc in my network?, no worry there. You control the entire experience.
My recommendation is to look for cities that are expat hot spots as they have medical tourism facilities, normally all speak English including the local people to cater to expats. Yucatan, Quintana Roo (cancun) and I think Jalisco.
If you are interested in more info please email me, email in my profile. My SO has problem and we have played the bounce around game along with a few ER visits mixed in. Few things are more frustrating then experiencing the US medical system first hand with no results and being helpless. Best of luck!
Do not underestimate private clinics in Europe. They saved my life after multiple rounds of doctors in the Washington D.C. area could not prevent me from getting repeated ear infections which led to eventual moderate hearing loss. The clinicians in a central European country took a fundamentally different approach to diagnosing me and resolved my health issue rapidly. I spent years of my life going to a dozen doctors in the Washington D.C. area without resolution prior to this. Give medical tourism a shot, it is legit.
How did you figure out where to start in Europe?
Ask on english language forums for expats in your countries of interest
Another more traditional approach, similar to concierge medicine, is executive medicine.
I think a lot of the big medical universities offer something like this:
https://www.emoryhealthcare.org/centers-programs/executive-h...
They have the connections and services available to do it all in-house and thus can make diagnosis' quicker.
I think a lot of the big medical universities offer something like this:
https://www.emoryhealthcare.org/centers-programs/executive-h...
They have the connections and services available to do it all in-house and thus can make diagnosis' quicker.
I feel you. My ex girlfriend had chronic pain and the US health system is terrible dealing with this. You go from tests to tests, surgeons quickly want to do their favorite procedures and otherwise they happily give you hardcore painkillers.
Two pieces of advice:
- Find a pain specialist who treats you like a real human and not just a science experiment or revenue source. there are some but not many
- My company produces implants for Spinal Cord Stimulation. The main indication is chronic pain that can't be treated with other means. My ex has one of our implants and it got her from seriously contemplating suicide to a good quality of life. A lot of doctors don't recommend the devices based on experiences a long time ago but the tech is way better now. The implant process is fully reversible unlike most surgeries. The main players in this area are Nevro, Boston scientific, Medtronic and Abbott (I work for one of them). Please look into it. I know several people who got their lives back with SCS.
Hope this makes sense.
Two pieces of advice:
- Find a pain specialist who treats you like a real human and not just a science experiment or revenue source. there are some but not many
- My company produces implants for Spinal Cord Stimulation. The main indication is chronic pain that can't be treated with other means. My ex has one of our implants and it got her from seriously contemplating suicide to a good quality of life. A lot of doctors don't recommend the devices based on experiences a long time ago but the tech is way better now. The implant process is fully reversible unlike most surgeries. The main players in this area are Nevro, Boston scientific, Medtronic and Abbott (I work for one of them). Please look into it. I know several people who got their lives back with SCS.
Hope this makes sense.
I believe I remember hearing that the Mayo Clinic does an extensive multi-day health checkup. They essentially shuffle you from specialist to specialist and you get a full thorough look over. I believe it’s the kind of thing that high level executives get done to make sure they’re healthy. Might be worth checking out.
Sounds like you are paying for what the NHS in the UK will offer - they'll get you there but it is often slow and quite convoluted, but it is free!
Private care in the UK can be very fast - e.g. I went from an initial consultation with a doctor for "knee pain" to having two sessions with a consultant and an MRI complete and booked in for physiotherapy within 48 hours. Things are often done the same day or within 24-48 hour turnarounds, although sometimes you can only get seen by specific consultants on certain days (e.g. they only see people on wed + Fri etc) . I am not sure what the on-ramp for that is as I go through my work health insurance but presumably you can just pay out of pocket.
www.hcahealthcare.co.uk seems to be what everything my healthcare insurance (from a BigCo) goes through, so could be worth starting there if you fancy a visit to the UK.
Good luck.
Private care in the UK can be very fast - e.g. I went from an initial consultation with a doctor for "knee pain" to having two sessions with a consultant and an MRI complete and booked in for physiotherapy within 48 hours. Things are often done the same day or within 24-48 hour turnarounds, although sometimes you can only get seen by specific consultants on certain days (e.g. they only see people on wed + Fri etc) . I am not sure what the on-ramp for that is as I go through my work health insurance but presumably you can just pay out of pocket.
www.hcahealthcare.co.uk seems to be what everything my healthcare insurance (from a BigCo) goes through, so could be worth starting there if you fancy a visit to the UK.
Good luck.
Unfortunately private care in the UK may not be so great when the NHS starts to fully break down
Can you elaborate please? Why will the private care in the UK suffer if NHS starts to break down?
And, will NHS really break down? I know it has been considered many times but enough of the population seems to be against the idea that I suspect it may not break down soon. Do you have any reason to believe it may break down?
And, will NHS really break down? I know it has been considered many times but enough of the population seems to be against the idea that I suspect it may not break down soon. Do you have any reason to believe it may break down?
Not the OP but most private healthcare in the UK is delivered by doctors, nurses and other healthcare practitioners who have either been trained by or are still working for the NHS. If you need anything more serious than minor surgery you are likely to be treated in an NHS facility by NHS staff, and many of your tests will be done in NHS labs, so even as a private patient you are still relying on the NHS being functional. Chunks of the NHS have already been privatised and compared to the systems in most other European countries it is chronically underfunded and has poor outcomes. Will it break down? Arguably it already is, but this is mostly due to a decade of ideologically driven cuts, two decades of part privatisation and three decades of continuous reorganisations that waste vast amounts of money and benefit no one.
I don't think that is imminent. They've been saying it has been on it's knees constantly since the 1990s at least (and probably longer but I personally cannot remember any further back). It got through Covid without collapsing aswell- I don't think it is going away any time soon.
> It got through Covid without collapsing aswell
Where "not collapsing" means tens of thousands of people died preventable deaths and hundreds of thousands of people suffered preventable harm because the NHS wasn't able to provide healthcare in a timely fashion to everyone who needed it.
Where "not collapsing" means people now have ten-hour waits for ambos, or ten hour waits in an ambo outside ED departments.
Where "not collapsing" means massive cuts to the services provided, leaving people mostly without NHS dentistry, with limited access to GP care, with cancelled elective care, etc etc.
Where "not collapsing" means preventable child and mother deaths because of unsafe maternity units.
Watch the news for ambo services this week.
Where "not collapsing" means tens of thousands of people died preventable deaths and hundreds of thousands of people suffered preventable harm because the NHS wasn't able to provide healthcare in a timely fashion to everyone who needed it.
Where "not collapsing" means people now have ten-hour waits for ambos, or ten hour waits in an ambo outside ED departments.
Where "not collapsing" means massive cuts to the services provided, leaving people mostly without NHS dentistry, with limited access to GP care, with cancelled elective care, etc etc.
Where "not collapsing" means preventable child and mother deaths because of unsafe maternity units.
Watch the news for ambo services this week.
What's this if it's not collapse? https://twitter.com/SittonGary/status/1534148868396531712?s=...
>I don't think that is imminent. They've been saying it has been on it's knees constantly since the 1990s at least (and probably longer but I personally cannot remember any further back).
Private Eye on "24 Hours to Save the NHS" <https://twitter.com/KulganofCrydee/status/833654730849136641>
Private Eye on "24 Hours to Save the NHS" <https://twitter.com/KulganofCrydee/status/833654730849136641>
Depending on the pain, you may want check out Dr. Sarnos book “the mindbody prescription”. I found it a few months ago on the urging of other online commentators when dealing with debilitating wrist and back pain. After reading it and applying his plan my pain disappeared.
You might want to contact the Mayo Clinic (particularly at the MN location) and see if they have what you are looking for.
For example, they tend to do programs for executives where they get a comprehensive physical over a few days:
https://www.mayoclinic.org/departments-centers/mayo-clinic-e...
In general, I've heard they are good at getting multiple tests done and multiple visits with specialists quickly.
In general, I've heard they are good at getting multiple tests done and multiple visits with specialists quickly.
I suppose it depends on your general health, medical history and what actually happened to you. Did you have an accident or is it just wear and tear, have you looked after yourself. You don't provide much information so it's hard to know if you're an athlete or are 200lbs overweight. Back and neck problems can be resolved in all kinds of way or may never be resolved. If it was me (and I do have a few issues), I'd move as much as possible, stay healthy, avoid pain medication, do yoga or pilates, use hot and cold and see a good physio and massage guy.
I've see this kind of service offered in a few private hospitals in Lithuania. So basically they assess you and depending on the complexity/uncertainty of the problem, they'd form a panel of specialists to discuss the case,etc. This allow to skip that idiotic chain, where you bounce like a ball from one doctor to another whilst none of them talk to each other. I don't know your condition or budget, but I think there are quite a few countries in Europe where you'd get something like this.
1. Concierge Medicine is the answer, as others have said.
2. In the meantime, or if concierge medicine isn't available, you can contact your insurance company and ask them to assign a care coordinator to help you get the maximum benefit from your providers. https://www.webmd.com/health-insurance/terms/care-coordinato...
2. In the meantime, or if concierge medicine isn't available, you can contact your insurance company and ask them to assign a care coordinator to help you get the maximum benefit from your providers. https://www.webmd.com/health-insurance/terms/care-coordinato...
I'm not sure if they do diagnostic work or just procedures, but the Surgery Center of Oklahoma is an interesting cash-only option. I know there are a number of similar operations. Concierge medicine is industry term doctors who directly bill patients for very personal care and skip insurance. Kinda like having a lawyer on retainer.
https://surgerycenterok.com/pricing/
https://surgerycenterok.com/pricing/
You can find a lot of world-class private hospitals in Turkey. They are quite cheap, because of the decreasing value of Lira, have great doctors, and short waiting periods.
From my observation, the best way to access top doctors is via referrals from people who have legacy wealth, as opposed to being just rich.
This seems to be a useful piece of advice in general. Rubbing shoulders with such people opens a lot of doors.
Of course, getting into such a relationship with such people in the first place isn't exactly easy to begin with unless you are already a member of the club. But if you're a really good networking type, something to keep in mind.
Of course, getting into such a relationship with such people in the first place isn't exactly easy to begin with unless you are already a member of the club. But if you're a really good networking type, something to keep in mind.
Consider seeing a doc or PA/NP in Physiatry. They tend to take a much more holistic and thorough approach to diagnosing issues, including neck-spine related pain.
Physiatry is a small specialty which most folks have not heard of. I'd encourage you to research the specialty and what it's about at the very least.
Physiatry is a small specialty which most folks have not heard of. I'd encourage you to research the specialty and what it's about at the very least.
I highly recommend that you checkout Christian Medical College, Vellore in India. It's a multi-speciality hospital and college of high repute in Asia with 2000 doctors and 3000 nurses - https://www.cmch-vellore.edu/
I've heard you can go to thailand and pay cash, but that was more for cosmetic stuff or simple things like amputations not complex stuff like cancer treatment (or really anything where the barrier is the drugs rather than skilled surgeon + access to antibiotics)
It depends on the tests. Urgent care centers can sometimes get you seen more quickly and do more tests on site. Scheduling the other tests at outpatient facilities that strictly do them (like Akumin) can have better prices and schedules.
None of this is a perfect solution though. It can take time to find the issue. Going to places with a high reputation for the area of the issue can get faster results.
Just recently I had an xray, blood work, and an ultrasound for unexplained swelling in my chest and armpit. They still don't know what it is and don't care to investigate farther. The only theory I have to go on is that it may be a medium/long term reaction to the Covid vaccine. I didn't even think of that until the ultrasound tech ask which side I got my shots on. Apparently short term swelling like this is normal enough that women are told not to get mammograms for some time (weeks) after receiving it. Additional research found this, which sounds very similar but in a different location.
https://pubmed.ncbi.nlm.nih.gov/35049235/
At least it's not cancer. Although I'm hesitant to truly believe that until a cause is found.
None of this is a perfect solution though. It can take time to find the issue. Going to places with a high reputation for the area of the issue can get faster results.
Just recently I had an xray, blood work, and an ultrasound for unexplained swelling in my chest and armpit. They still don't know what it is and don't care to investigate farther. The only theory I have to go on is that it may be a medium/long term reaction to the Covid vaccine. I didn't even think of that until the ultrasound tech ask which side I got my shots on. Apparently short term swelling like this is normal enough that women are told not to get mammograms for some time (weeks) after receiving it. Additional research found this, which sounds very similar but in a different location.
https://pubmed.ncbi.nlm.nih.gov/35049235/
At least it's not cancer. Although I'm hesitant to truly believe that until a cause is found.
Qualify for Medicaid or stay alive long enough to qualify for Medicare.
In the USA you'd have no problem walking into most doctor's offices and offering cold cash. They'd fall over each other trying to get you as a patient.
Cash is still king.
In the USA you'd have no problem walking into most doctor's offices and offering cold cash. They'd fall over each other trying to get you as a patient.
Cash is still king.
I went through something similar over decades with my migraines. "I don't believe you're in pain. Men don't get migraines." I heard, far too often.
This is not medical advice, but just what I would do in a similar situation.
I'd go in knowing I'm going to have to keep at this constantly until I'm on a treatment regimen that handled it well, for starters.
I can usually have mixed results speeding things up saying I'm ready to pay right now with a card for whatever medication/test. If someone's unavailable for scheduling then call around to every other place. Call out of the area if needed. Like you would call around for a dentist if you needed a root canal or crown asap.
Edit-Oh, also, the best time to call providers is 7-8 am on Monday or when ever they first open on their first day of the week. The worst time is anytime else, with within an hour of closing being a far maybe. But be persistent regardless, and especially if start of business Monday is too far away.
For back pain I'll try to outline some options for relief in the meantime:
-Try this shortly (20 minutes) and see whether it feels better/worse: Get something that does "far infrared" heat and try it on your neck/spine. You want to be careful to not overdo it on the heat though so use a towel between you and the heat and look for redness. Redness should be avoided. A low-cost/immediate way to try out far infrared are the instant hot packs sold at corner stores like Walgreens/CVS. Try to get the ones that are made with iron. They're basically a slow exothermic reaction that can last 8 hours+.
-Cold might work if hot doesn't.
-Lidocaine patches ("salonpass"/"icyhot") might help, too. Again, try temporarily (10-20 minutes) and see how you react to it. There are even sprays or gels (think, for sunburn) that can help locally fend off pain a little.
-A TENS unit has helped with muscle spasm pain for me before, too, but I had to leave it on the area for about an hour. Edit-look at some anatomy pictures for what muscles to target.
-A physical therapist might actually be able to help you. Look for good ones that are obviously kept up to date on things. I had one mixing ultra sound and TENS on my back and it helped immensely. The TENS made it so I could feel the ultrasound vibrations. You want to go to them to make sure you're doing stretches with proper form. X-Rays and such will help them know what to target.
Good luck, chronic pain in America is both common and not always treated equally.
This is not medical advice, but just what I would do in a similar situation.
I'd go in knowing I'm going to have to keep at this constantly until I'm on a treatment regimen that handled it well, for starters.
I can usually have mixed results speeding things up saying I'm ready to pay right now with a card for whatever medication/test. If someone's unavailable for scheduling then call around to every other place. Call out of the area if needed. Like you would call around for a dentist if you needed a root canal or crown asap.
Edit-Oh, also, the best time to call providers is 7-8 am on Monday or when ever they first open on their first day of the week. The worst time is anytime else, with within an hour of closing being a far maybe. But be persistent regardless, and especially if start of business Monday is too far away.
For back pain I'll try to outline some options for relief in the meantime:
-Try this shortly (20 minutes) and see whether it feels better/worse: Get something that does "far infrared" heat and try it on your neck/spine. You want to be careful to not overdo it on the heat though so use a towel between you and the heat and look for redness. Redness should be avoided. A low-cost/immediate way to try out far infrared are the instant hot packs sold at corner stores like Walgreens/CVS. Try to get the ones that are made with iron. They're basically a slow exothermic reaction that can last 8 hours+.
-Cold might work if hot doesn't.
-Lidocaine patches ("salonpass"/"icyhot") might help, too. Again, try temporarily (10-20 minutes) and see how you react to it. There are even sprays or gels (think, for sunburn) that can help locally fend off pain a little.
-A TENS unit has helped with muscle spasm pain for me before, too, but I had to leave it on the area for about an hour. Edit-look at some anatomy pictures for what muscles to target.
-A physical therapist might actually be able to help you. Look for good ones that are obviously kept up to date on things. I had one mixing ultra sound and TENS on my back and it helped immensely. The TENS made it so I could feel the ultrasound vibrations. You want to go to them to make sure you're doing stretches with proper form. X-Rays and such will help them know what to target.
Good luck, chronic pain in America is both common and not always treated equally.
You might have to work through this outside of the normal medical community. Have you looked into Rife frequencies and such?
Try the Mayo or health tourism.
Hope you figure it out. Feel better buddy
Move to Vancouver, Calgary, Hamilton or Toronto.
MS or Fibromyalgia would be my guess?
Also try being less polite and demanding better service.
I'm not sure why you're being downvoted. Unfortunately, sometimes you have to be really pushy with doctors. They are under a lot of time pressure and aren't always spending the time with you that you may need. You need to be your strongest advocate, sometimes that means getting aggressive with demanding support.
consider moving to Europe where there are multiple countries with excellent free healthcare systems
german, currently living in the US here: the scenario OP describes would unfortunately be the same in germany. The healthcare is good, but slow. And any non-obvious diagnosis can take a while / several specialists to figure out.
Dunno if the private health care would be any better (wait time aside), but if anything I'm surprised you can't just throw money at the problem while in the US. Did something similar to what you described twice recently and for each condition it took less than 2-3 weeks between GP, specialist and results.
Dunno if the private health care would be any better (wait time aside), but if anything I'm surprised you can't just throw money at the problem while in the US. Did something similar to what you described twice recently and for each condition it took less than 2-3 weeks between GP, specialist and results.
This is true but is it also the case with private health insurance? I've only ever been on public in Germany but others tell me it's much easier on private health insurance.
"Excellent free" might still get OP to the same delay loop he tried to escape. His US doctor might work "for the insurer" but the doctor in the free health care system might equally feel they are working "for the state". In my experience the state provided health care is mostly excellent for minors except for psychiatry which is underresourced, but for adults its roll of the dice (outcomes ranging again from excellent to abysmal) with long queues for specialists (Finland).
With wait times triple than what OP talked about..
Are there public systems in Europe where specialist waits are multiples of what OP is already experiencing?
Honestly, your wait times sound really fortunate. I’m currently in a 4-month wait to see a specialist and a 9-week wait for some standard imaging tests. (The imaging tests were delayed by staff scheduling errors combined with staff absences.) I sympathize, but also think you have it relatively good! There seem to be some issues with staffing shortages throughout the medical industry right now (possibly combined with an increase in demand now that many people are less fearful of Covid).
I don’t have any advice except to pester the scheduling staff at every turn (which is easier said than done when most places try to divert you with an automated phone tree ending in the option to leave a voicemail). It’s aggravating for sure. I have no doubt that people are dying who wouldn’t have if they had received more timely care.
I don’t have any advice except to pester the scheduling staff at every turn (which is easier said than done when most places try to divert you with an automated phone tree ending in the option to leave a voicemail). It’s aggravating for sure. I have no doubt that people are dying who wouldn’t have if they had received more timely care.
I'm sure that there is a way to buy better healthcare. Surely Satya Nadella doesn't have to go through this. What I would love to do is pay a large amount of money ($50K out of pocket not counting insurance for just the diagnosis) and go through all of the doctors/tests in two weeks. Does anyone know where I can do that? The US would be best, but can travel internationally for this too.
Would appreciate any pointers people might have, I don't even know what to Google. If necessary, the issue is neck-spine related, relevant doctors might be neurologist, rheumatologist, spine surgeon, etc.