Doctor’s orders may now include packing bags, leaving Puerto Rico and becoming medical tourists.
Already frustrated with long lines and a scarcity of specialists, patients in Puerto Rico are finding they may have little choice, but to follow the mass exodus of doctors and nurses off the Caribbean territory and seek treatment elsewhere.
In the last five years, some of the top doctors in Puerto Rico have left for the United States in search of higher salaries and greater reimbursement from healthcare insurers. According to the island’s Medical Licensing and Studies Board, the number of doctors in Puerto Rico fell 13 percent, from 11,397 to 9,950. The biggest loss came from primary care physicians and specialists.
Of the roughly 400 cardiologists who practiced in Puerto Rico about five years ago, only 150 or so remain. The number of anesthesiologists has dropped from roughly 300 to about 100 in the same time period, the island’s Association of Surgeons reported.
Medical professionals say they expect the situation will worsen, but what opportunities healthcare professionals can expect when they get to the United States and are confronted by new federal laws is uncertain.
Some believe President Obama’s new healthcare law – dubbed ObamaCare – may mean the United States will need more doctors amid an influx of patients who may have greater access to healthcare. But, beyond that, definitive implications from the controversial legislation remain muddied for both patients and providers.
So, the question begs whether or not those same Puerto Ricans needing treatment may be able to find affordable care on the mainland or, as a result, may have no alternative than to seek other medical tourism destinations instead.
At the same time residents of Puerto Rico may be forced to leave their homes for care, like a revolving door, medical tourism is attracting foreign patients to the island in their place. Already, two new hospitals are being built in Manati and Bayamon for the purpose of and catering mostly to travelers from elsewhere in the Caribbean, and even some from the U.S. mainland. Many of these U.S. tourists seek cosmetic surgery while their Caribbean counterparts look for specialists.
The island of 3.7 million people has no more than two pediatric neurosurgeons, even though guidelines require at least one pediatric neurosurgeon per roughly 80,000 people. Puerto Rico also lacks 93 full-time primary care physicians to adequately cover the medical needs of the population, according to statistics from the U.S. Health Resources and Services Administration, which tracks areas suffering from a shortage of health professionals. Of the island’s 78 municipalities, 37 need more healthcare professionals including the capital of San Juan and Ponce, the island’s second largest city. The island has roughly 7,000 primary care physicians.
Family and general practitioners in Puerto Rico earn about $72,000 a year, compared to $180,000 for those in the United States, according to 2012 statistics from the U.S. Bureau of Labor. That’s partly due to the lower wages on the island, where the median income is less than $28,000 a year, far below mainland standards. Puerto Rican healthcare providers also get less reimbursement from Medicare for particular services than do those in any other U.S. state or territory.
Currently, more than 670,000 people in Puerto Rico use Medicare. While the U.S. government is scheduled to revise how Medicare reimbursements are determined next year, that won’t stop doctors from leaving – and patients to follow. Whether or not Puerto Rican patients make the United States a stop or choose a destination somewhere else, will depend on how Obamacare plays out, beginning next year.
A recent study commissioned by the island’s Association of Surgeons found the doctor shortage to be aggravated by retiring doctors, and by the fact that fewer doctors are studying allergy, endocrinology, geriatrics and urology. The study also warned about a scarcity of specialists including cardiologists, anesthesiologists and orthopedic surgeons.
Researchers say the likelihood of developing Alzheimer’s disease increases substantially over time so that half the population above the age of 85 suffers with problems of memory, thinking and behavior.
If dementia has become so severe that lapses are beginning to interfere with daily tasks, there’s some good news to report that may be worth remembering.
A U.S.-based pharmaceutical company is claiming to have developed a medical device that can stop the progression of the debilitating disease. Though numerous treatments have been developed in the past to slow down Alzheimer’s, none have yet stopped the build-up of disease-causing proteins.Clinical scientists at Amylex Pharmaceuticals, Inc., believe they have come up with a solution that involves the principles of neuroscience and a device that reduces proteins in the brain and distinguishes itself from previous neurostimulants, inhibitors and vaccines.The therapy, called Betaclear™, is designed to eliminate the build-up of harmful beta-amyloid toxins before they can disrupt the connection and proper functioning of brain cells. Because the device’s process of combating the disease is extracorporeal or takes place outside the body, Amylex claims that side effects are not likely, an improvement from previous treatments.
Boon for Philippines
What’s more, Amylex plans to register Betaclear™ for clinical trials, first in the Philippines, giving the island nation a leg up on medical tourists desperate to find Alzheimer’s treatments for themselves or a loved-one.
Officials at Amylex said the decision to re-validate Betaclear™ in the Philippines came down to which country could develop the device cheaper and faster, possibly saving years and millions of dollars compared to processes from discovery to commercialization in the United States.
That doesn’t mean governing authorities in the Philippines will be any more lax in approval protocols, at least from the theoretical end, which, at this point, may be of least concern to the nearly 36 million people around the world with Alzheimer’s disease or other dementias. By 2050, that number can triple, according to a 2011 report by Alzheimer’s Disease International.
A study by the University of Washington’s Institute for Health Metrics and Evaluation (IHME) claims that Alzheimer’s jumped to ninth among leading causes of premature death in the United States, up from 32 in 1990, making it the fastest growing health threat in the nation.
Betaclear is far from a drug, but rather a “nanomachine.” As a medical process, the device has been compared to dialysis, in which a patient’s blood is coursed out and cleansed before returning to the body.
Beta amyloids are known to develop in the body and circulate through the blood stream before depositing in the brain. Accordingly, Betaclear attracts the beta amyloids out of a patient’s blood by using a special molecule that can be likened to “a magnet.” To this end, the patient’s blood goes through a chamber, from which nearby molecules in another compartment cleanse and separate the beta amyloids.
Korean hospitals are doing their share to transfer medical systems to counterparts in Saudi Arabia.
Under a project call the Medical Systems Twinning Project, one of six agreements between the two health ministries, Korea will establish hospitals – among them for brain imaging techniques and neuroscience research – in the Middle East country and begin providing Saudi Arabian medical staff with educational and management expertise.“In terms of the Twinning Project, we agreed to establish medical facilities in King Fahad Medical City to share Korean medical technologies,” said Abdullah Al Rabeeah, the Saudi Arabia health minister, in a statement released last week at an international medical tourism conference.
King Fahad Medical City is a state-sponsored hospital based in Riyadh, where Korea business giant Hyundai Engineering and Construction set up facilities in 1993.
Korean physicians will be dispatched to Riyad and four other cities to demonstrate surgical operations for Saudi Arabian doctors and medical staff, in much the same way the United States administered to the Southeast Asia nation under a similar healthcare package some 50 years ago.
Dubbed the Minnesota Project, sponsored by the U.S. Agency for International Development, the initiative trained 226 Korean medical experts, from 1955-1961, and helped spawn medical tourism in post-war Korea, luring foreign visitors with cheaper prices and faster scheduling for cosmetic surgery and infertility treatments.
Today, Arab princes and princess are common travelers to Korea for stem cell treatments and others, along with VIP patients from all over the world, including Europe, the United States and especially China and Japan.
“Hallyu,” the term used to describe the wave and spread of Korean pop culture, is making a splash in medical tourism.
South Korean leading actor and teen heartthrob Song Joon-ki attended Medical Korea 2013, a commemorative international event aimed at promoting the host country’s medical tourism industry, last week, in Seoul.Song, who was recently appointed an honorary ambassador of medical tourism by the Ministry of Health and Welfare, has been appearing in regional cities on behalf of Medical Korea, South Korea’s national brand charged with attracting foreign tourists to take advantage of the country’s medical tourism industry.
Much of the promotion has centered on South Korea’s medical tourism initiatives in the Middle East, specifically the treatment of cancers, cardiac and vascular diseases, organ transplants and cosmetic procedures. That task is made all the more challenging when considering the region’s steadfast conservative beliefs and Islamic traditions.
“The demand for closer medical cooperation between South Korea and the Middle East is rapidly increasing,” the Korea Health Industry Development Institute, a public organization established to foster the nation’s health industry, said in a statement. “We organized these events to pique greater interest in Korean medical tourism among Middle Easterners and show just how advanced Korean medical technology has become.”
Song, who is coming off his latest international film release, “A Werewolf Boy,” and a promotional video appearance for Medical Korea, is helping to lay “the groundwork and raise awareness about Korea’s medical brand among local college students,” said officials.
“Hallyu” has taken the Southeast Asian nation by storm. Even President Obama caught the local enthusiasm during a trip to the foreign capital of Seoul, in December, when he used the phrase in an otherwise-policy heavy speech to students at Hankuk University.
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Chemotherapy isn’t likely to make many bucket lists; unless, of course, you are a cancer patient desperately in need of care.
Then consider the angst and despair among those Medicare patients in need of chemotherapy who have already been turned away at their community cancer clinics. An increasing number began to learn of this unfathomable fate after April 1, when reduced funding for the national health insurance program for senior citizens took effect.
Oncologists blame the recent government sequester for making it impossible for clinics to administer expensive chemotherapy drugs to patients 65 and older and, at the stay time, remain financially solvent. Meanwhile, these patients being denied are scrambling to find treatments elsewhere including at hospitals that may not have the capacity to accommodate them.
Hospitals are pleading their cases, as well. The sequester, they claim, has left them to choose between covering their costs and staying in business or seeing patients, prompting even those who have been pushing the federal government to spend less on healthcare to call the disruption in care off-target.
Legislators had intended to somewhat shield Medicare from the sequester’s automatic budget cuts, limiting the social insurance program to a 2 percent reduction – a fraction of the limits placed on other federally funded programs.
What they may have failed to consider is the way treatments for cancer patients are covered. These drugs must be administered by a physician and are included among only a handful of pharmaceuticals that are paid for by Medicare Part B, which covers doctors visits and is subject to sequester reductions as opposed to traditional senior coverage under Part D, which is also supplemented by private insurance.
Washington typically pays local oncologists for the average sales price of a chemotherapy drug, plus 6 percent to cover the cost of storing and administering the medication. Since oncologists cannot change the drug prices, they argue that the entire 2 percent cut will have to come out of that 6 percent overhead. That would make it more akin to a double-digit pay cut.
In response to the fiscal quandary, clinics might have to make-do with reductions to staffs or other services to accommodate for the higher costs to house and deliver the cancer drugs.
Oncologists, who deal with life and death realities are not accustomed to sugar-coating, have begun to bluntly tell cancer patients they may have to look beyond local clinics for care. The first place these seniors are likely to turn for chemotherapy is a hospital, where care is considered to be more expensive.
Some actuaries suggest that chemotherapy delivered in a hospital environment costs the federal government an average of $6,500 more annually than care delivered in a community clinic. The cost differences usually trickle down to patients in the form of out-of-pocket medical bills, even if they are fortunate to find a hospital that has the capacity to treat them. That’s why, according to one study, the majority of cancer patients on Medicare receive chemotherapy at a local clinic, instead of a hospital.
The sequester should probably have less of an effect on non-profit hospitals, which are required to receive double-digit discounts for treating low-income and uninsured patients from pharmaceutical companies.
Meanwhile, some cancer clinics are preparing for the worse, even sending out notices to patients that warn them of possible breakdowns in care. Still, other facilities are continuing to see patients they expect to lose money on and, instead, are counting on the federal government to come to the rescue and provide relief.
The challenge facing patient advocates is twofold. On the one hand, pharmaceutical companies need incentives to enter markets for cures and lifelong treatments of cancer that are often less profitable than more common medical ailments like heart disease or more traditional forms of malignancy.
Secondly, and, perhaps, far more difficult — but just as important — cancer patients 65 and older may need to have the same options as their younger counterparts – largely those underinsured — who have displayed the willingness to seek high-quality and affordable medical relationships on foreign soil.
At the end of the day, all healthcare players – providers, lawmakers, insurers, employers and patients – should be looking to open all doors to treatment, not have them shut.
British leaders unveiled a sweeping plan last week to curb immigration by cracking down on benefits and access to “ health tourism, ” which may force foreigners to show proof of insurance before receiving medical care.
Prime Minister David Cameron warned those coming to Britain that they cannot expect “something for nothing” and, beginning next year, arrivals from the European Union will face a loss of jobseekers’ benefits after six months. However, immigrants will be able to continue to receive the allowance if they have been actively looking for a job and stand a “genuine chance” of finding one.
Immigrants will also not become eligible for council houses until they have been in the country for two years, with priority given to locals. A new “local residence test” will be introduced this spring with new guidelines for local authorities to follow.
Cameron said nearly one in 10 new social lettings – or government-owned housing — go to foreign nationals, up from 6.5 percent in 2007-2008 to 9 percent in 2011-2012.
He restated his view that net migration has to be slashed “radically” from hundreds of thousands a year to tens of thousands.
Cameron also said the National Health Service will be told to improve its performance on collecting fees under deals with EU members, Iceland Liechtenstein and Norway, when their nationals are awarded healthcare in the United Kingdom.
On illegal immigration, the maximum fine for companies employing illegal workers is being doubled to £20,000 and task-forces set up to discover any breaches.
The British government also plans to negotiate with other European states about making economically inactive migrants the responsibility of their home countries and limiting the amount of benefits paid for children living abroad.
“The reality is that you can’t control immigration if you have a welfare system that takes no account of who it is paying out to,” said Cameron. “You can’t control immigration if you have a healthcare system that takes no account of the people using it. And, you can’t control immigration if you have a housing policy that doesn’t take account of how long people have lived and contributed to a local area. Under my direction, this is changing.”
Cameron attacked Labour for letting immigration get “far too high and badly out of control” and making Britain into a “soft touch.” Downing Street said the measures were designed to reduce the “pull factor” of incentives that encourage foreign nationals to come and settle in the United Kingdom.
Health Secretary Jeremy Hunt believes “significantly more” than £200m-a-year is being lost because most foreign patients ineligible for free British leaders unveiled a sweeping plan last week to curb immigration by cracking down on benefits and access to “ health tourism, ” which may force foreigners to show proof of insurance before receiving medical care. are not being forced to pay up.
Instead, hospitals have to chase the payments themselves, making it a lot easier for them to declare patients to be UK nationals and let the state cover the cost, he said. Hunt also questioned to need to give tourists and foreign students free access to general practitioners, pointing out this does not happen in Australia or the United States.
Meanwhile, as Downing Street could not put a finger on the number of “health tourists” that the changes might affect, critics said the proposals would meet a backlash of legal opposition from EU officials in Brussels and doctors and authorities at home. The same observers dismissed the prime minister’s threats as more “smoke and mirrors,” suggesting many of these restrictions are already in place, but just not enforced.
Even Cameron stated any new directives would not take place until the beginning of next year, meaning EU nationals are more than likely to continue to receive full NHS care. Until then, practitioners and hospitals are under government guidelines to provide treatment and emergency care even if patients are suspected to be illegal immigrants.
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Anyone who has been to the doctor recently in the United States would be foolish to believe that medical costs have not continued to skyrocket. What they may not have known is that healthcare costs in the United States also far surpass most fees for medical procedures, tests, scans and treatments around the globe.
The International Federation of Health Plans released this week its annual report that showed the United States having the highest prices for both medical procedures and drugs per unit among the 12 countries surveyed in 2012.
Data, for example, reported the average cost of a hospital stay to be $429 in Argentina; $665, in South Africa; and $4,287 in the United States. Furthermore, a diagnostic procedure – such as a colonoscopy – will cost an average of $413 in Argentina compared to $893 in the United Kingdom and $1,185 in the United States.
Most discouraging, perhaps, were disparities in the costs for prescription drugs. Cymbalta, which is widely prescribed for depression, was found to range from $47 in France to $176 on average in the United States.
The greatest cost disparity was reported in surgical procedures where C-sections, for example, remained consistent with prior surveys, posting an average fee of $1,541 in Argentina to $15,041 in the United States.
“With the cost and availability of healthcare being an important topic around the world, it’s essential that we not only examine the disparities that exist, but also why and how certain gaps do exist,” said Tom Sackville, IFHP chief executive.
In addition to the United States, the study examined costs from Argentina, Australia, Canada, Chile, France, Germany, India, New Zealand, South Africa, Spain and Switzerland, gathering data from IFHP member organizations in each country. For a copy of the report, visit www.ifhp.com.
Of course, healthcare quality and availability can significantly vary among nations. Major factors are high costs to retain qualified medical professionals, equipment and facilities. In addition to costs, social, cultural, political and economic conditions continue to challenge nations that are intent on providing quality and affordable care.
So, why do Americans pay more for healthcare compared to other developed countries around the world? The answer may lie in that, except for the United States, almost all industrialized nations provide universal healthcare through either government run, tax-funded systems; private organizations where the government contributes a majority of the capital; or private insurance companies with regulation and subsidies to ensure coverage and non-discrimination based on medical history or existing conditions.
A closer look also reveals the United States often uses expensive diagnostic tests and performs interventions where it is not always clear whether the procedure is necessary or not. On the other hand, the United States does not have as many doctors nor hospital beds relative to its populations to, perhaps, provide the resulting diagnosed care and treatment. To further complicate matters, a disparity in healthcare coverage stands between lower-income and higher-income Americans.
Differences at Home
Among most developed nations, the United States stands out for income-based disparities in patient experiences, with below-average-earning American adults lacking primary care access, coordination, and doctor-patient relationships. A lack of health insurance only intensifies the disparities.
Uninsured adults in the United States often forgo needed care. However, even when insured, below-average-income Americans under the age of 65 are more likely to report access problems and delays than insured, above-average-earning adults.
This all may become a mute point according to some insurers and actuaries, who estimate that health insurance premiums for all individual policies will jump by more than 30 percent and small businesses will face double-digit rate hikes for their health plans next year when ObamaCare, the White House’s attempt to level the playing field in terms of cost and access, becomes effective in 2014.
The real trouble is that healthcare costs are rising everywhere. No one nation is excluded from this financial quandary; especially in times when global economies are in disarray. The overriding issue should be whether all countries are providing good quality care at lower costs; not, perhaps, which nation spends the most.
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