Thursday, July 25, 2013

A Cursory Look at Health Care Costs and Services

Health care costs in the United States are a common topic of conversation among expatriates here in Peru. Many of us in our group are getting up there in age and visiting clinics more frequently. And most of us know of Americans who come to Peru when confronted with major surgery or treatment for a serious illness or disease. In every case the story is the same…the cost of transport, hotels and restaurants added to the cost of medical treatment is still significantly below the cost of medical care alone in the United States.

Not too long ago out of curiosity I contacted a well-known major insurance company and asked for information for a middle of the road health insurance policy for Maribel. The quote was $375 per month with a deductable of $3,000. The agent added that the monthly premium could be reduced if we would consider a larger deductable such as 6, 8 or $10,000. Have we really reached a point where we can casually talk about a $10,000 deductable without going into shock? According to the latest census the median income in the United States is $50,054. A $10,000 deductable is 20% of that income, and for the so-called lower middle class blue-collar worker with an income of $30,000 or less it’s at least 33%. Who can afford that cost; beside a monthly premium of $300 or so?

Let’s leave the realm of generalities and look at some medical services and expenses that I recently incurred in the United States and Peru.

A week prior to a visit to the United States I pulled an upper back muscle while doing weight lifting exercises. The occasional stabs of pain were uncomfortable but bearable until the strain healed itself – so I thought. Two weeks later I awoke in a Wisconsin hotel room literally unable to move even a finger without triggering excruciating waves of pain. Twice in my life I’ve experienced pain that I rated a 10 – appendicitis resulting in an emergency operation, and nerve pain from shingles. This pain equaled them. It took an hour just to get dressed and into the car of a friend, who drove us to a hospital emergency room. There I was given a muscle relaxant injection and a 5mg diazepam pill. The doctor also wanted upper body X-rays to rule out causes other than a muscle strain. Verbal and written instructions called for diazepam to be taken three times daily as needed and for 800mg of ibuprofen three times daily for pain. Costs amounted to:

Emergency room services…$409
Diazepam -10 pills…………….12

The pain gradually disappeared over the next two days but resurfaced three weeks later in Chiclayo.  Maribel phoned a doctor friend who recommended a clinic and orthopedic doctor. In Chiclayo, in private medical clinics, you pay in advance for an appointment. To see this particular doctor, who is both an orthopedic surgeon and traumatologist the consultation fee is $36; about three times the fee of a general practitioner. The doctor concluded I have a severely contracted muscle and prescribed Arcoxia (etoricoxib) and Tensodox (cyclobenzaprine) for seven days. He was critical of the doctor in the United States for prescribing ibuprofen. He also said therapy was necessary to “teach the muscle to relax” and recommended a therapist, whom we phoned and visited the next day. After an examination and some discussion the therapist said I would need at least five sessions consisting of fifteen minutes of muscle manipulation (I call it muscle mangling) and twenty minutes of electrotherapy. The cost for each session is $7. I’m through four sessions and am vastly improved, though even as I type this I can feel that muscle pinching me, as if to say, “go ahead…make one wrong move and I’ll contract again like you wouldn’t believe.” Anyway, the cost of treatment in Peru has been:

Therapy ($7x5).......35

I am not suggesting that costs can be compared because the services are different, but I think conclusions can be drawn. I know that in the United States you're not going to find an orthopedic surgeon/tramatologist who will consult for $36, nor a physical therapist for $14 per hour. The only remaining question is the quality of health care and I'm sure those Americans and others coming to Peru for treatment would join me in saying that health care here seems to be comparable to that in the United States.

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