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Comment by decafninja | Hacker News Reader

I’ve mentioned this before, but my wife insists on traveling to South Korea for medical care. This, despite us having great insurance in the US.

As a Korean American who’s been in the US for nearly all my life, I didn’t understand it at first. Then I went with her and saw the Korean medical system in action and I’m now a believer.

You can visit one clinic and get a comprehensive full body diagnostic exam. Results come out within a week.

You can make an appointment with a doctor and get all associated procedures done (blood work, X-ray, MRI) often on the same day, same building, same staff.

What takes weeks if not months to complete in the US takes days or a week or two there.

It’s like a less personal, but sometimes faster and more efficient, version of the “concierge medicine” services popping up in the US.

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This type of service exists in the US, but it's VIP/concierge level. Insurance typically does not cover all or even most of it.

I looked into doing exactly what your wife (seems to) does at the Mayo clinic recently. It's not entirely out of the question, about double to triple my out of pocket for going local via the usual route.

What they offer is basically this: Describe your issue to a care team prior to your arrival, once you arrive you will meet with your primary specialist and get referred to any tests/etc. you may need doing. These will all be scheduled in advance and simply canceled if you end up not needing them. Even the most likely procedure(s) will be scheduled, so you end up getting done in 2-3 days what typically would take 3-6mo due to wait times via my local hospital system.

It's incredibly tempting, despite the cost. The primary reason I go without medical care is due to the constant starting/stopping of the system. I need to focus on a problem and get it done with, not let it drag on for months.

I don’t know about Korea, but I know I can save money and time by flying to Thailand and going to their top medical tourism hospital. Insurance pays for part of it, but even if not the out of pocket is less than my deductible if I just pay directly. Everything is done immediately on a walk in basis, start to finish. If I need to stay the night they even have a hotel in the hospital. If you need extended treatment they have agreements with luxury hotels to provide nursing etc and the cost is less than a normal hotel in a major American city or a nice hotel in a second/third tier city.

The medical system in America is broken. The best care is possible here, but it requires extraordinary measures to get it. For 99.9% of care it’s below third world.

Vietnam also had some good hospitals. Their lasik treatments are top notch, latest equipment, and cheap. I've had great dental work done in Saigon.

Friend of mine just got dental done in Puerto Vallarta because their dentist in Berkeley kept screwing it up, wanting more and more money.

There was a video about a dude getting a hair transplant (got bald at 25).

It was cheaper to take a week off work, fly to Turkey with the whole family, stay for a week in a five star hotel and get the treatments in a hospital than it was to do the same operation in the US.

The package covered even limo rides from the airport to the hotel and hospital =)

The exact same care is available in the U.S. for approximately the same price as Thailand, after adjusted for local cost of living.

Sorry, I've already survived once lying in a ditch getting IV fluid from a coconut while bleeding out and waiting for the morphine to cut in.

Does Thailand have real doctors now? I always put them up there with Cambodia, North Korea, Burma(Myanmar), and Hell, known for their abundance of primarily alcoholic or drug-addicted western doctors who fled their native countries to avoid criminal charges. But I ramble...

Thailand is extraordinarily developed, along the lines of South Korea. Your experience must be quite dated. The doctors in Thailand are often western trained, but are top of their fields globally. The education system in Thailand is excellent and universal, the economy is vibrant, and the infrastructure is well developed including high speed rail etc.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883860/

I've considered doing this, considering I can't get either PPO or HMO insurance to pay for an MRI here.

In India, I went got a physician appointment for next morning, diagnostics the same afternoon and results at night via a text message.

Follow up with the physician, next morning.

All out of pocket for $80. No BS bureaucracy.

American healthcare is utter garbage.

American healthcare has two problems: It's for profit, so they try to maximise the amount of money they get off patients.

And number two, the amount and cost of malpractice suits is staggering. This forces doctors to order ALL THE EXAMS for every single issue just to CYA for future malpractice cases.

Don't let hospitals lie to you. It's not malpractice and malpractice insurance.

https://carbonhealth.com/blog-post/why-is-u-s-healthcare-so-...

Most third world healthcare is for-profit. All the countries mentioned above are for-profit.

The medical office building attached to my small town hospital has a lab and x-ray suite. Sometimes you have to walk over to the x-ray suite in the hospital if they are short staffed.

I've never had one done, but I guess the hospital has an MRI also.

Every time I've interacted with one of these multi-discipline facilities (in the US), it didn't matter if you walked across the hall or across Antarctica, each office treated you uniquely and you had to fill out the same damn paperwork at each of them.

Maybe it's because Kaiser is more integrated than most providers, but that wasn't the case for me. I might've had to check in with separate receptions, but no actual paperwork

Kaiser is the only place I’ve seen where these things are seamless (still didn’t feel enough to keep them). Even CareFirst HMO doesn’t have that level of integration.

How is Kaiser? As a Newyorker looking to move to California at some point, I’ve heard both good and bad. But the fact that it seems more integrated and seamless than almost anything else in the US (maybe except concierge care?) is highly appealing.

I've heard anecdotes that their mental healthcare isn't great, and their PCPs tend to be a bit rushed (or maybe I just got unlucky when picking Dr's?). But overall I liked Kaiser. I liked how well integrated everything was, and it was easy to go to another office if my doctor was on vacation or didn't have any appt openings. I also really liked that I always knew what my appointments would cost in advance.

FWIW they kinda sucked for blood draws, when I had Kaiser I needed to make separate appointments at a lab, go in, and wait. The flip side is that when I went to urgent care with an issue they were able to say "go across the street and tell them you're here for imaging, they should be ready for you in 30 minutes or so" which was super convenient.

With my current PPO doctor, it's a bit more of a pain when I have to go to specialists and pricing sometimes feels like they call rand(600) every visit. But when the doctor wants a blood draw, a nurse comes and does it immediately, which I was was the way Kaiser did it.

I left Kaiser 10+ years ago mainly because my pcp only accepted CareFirst and I liked her enough to switch from Kaiser after nearly 15 years.

No real complaints except the PCPs seemed Alright and I didn’t like having no choice.

Because each medical practice within is its own business entity. Like the retail stores within a mall. Imagine the duplicated administrative effort.

It's ludicrous.

Also, care providers are treated like gig workers. For instance, my superior dermatologist has two practices AND a side hustle (reviewing medical images), just to stay afloat. (Two income household, raising two kids, house nearish to work, paying off student loans.)

They and their partner are debt slaves. For the foreseeable future.

It's insane.

"Small town hopital"

You're lucky you still have one. That is the greatest percentage of closed facilities as the us health system continues to consolidate into regional/national monopolies...

That is similar to Taiwan and Spain (if you use private hospitals, but it is still comparably affordable). However, these systems are going to be under a lot of pressure with aging populations and potentially decreasing number of medical professionals. In many European countries, patients are already seeing large wait times in public health systems, and some politicians are trying to cut medical budgets and push for privatization.

> What takes weeks if not months to complete in the US

Counterpoint: in New York, I’ve never had to wait longer than a day or two for diagnostics. Most of the time it’s same day.

EDIT: to clarify, I'm not claiming it's hunky dory. Just that our system isn't an excuse for these delays.

Counterpoint: in India, I've never had to wait longer than a few hours for diagnostics.

> I've never had to wait longer than a few hours for diagnostics

For an MRI? I have family in India. Bloodwork is fast. But imaging is slow.

I imagine for a country India's size there must be a few top-tier facilities that keep their MRI machines half unused for the occasional last-minute request.

Counterpoint: I’m in New York too, and I’ve given up on a few minor annoying but not life threatening health issues because of the wait times and scheduling inflexibilities between each hop of the process. I’d love a reference to your doctors (or system) :)

The saving grace for me is that my employer provides a service similar to One Medical, which at least lets me visit a doctor or nurse practitioner to get an idea of how serious something is.

The trick is to find an integrated system. NYU Langone, Mount Sinai and One Medical run decent shops. The friction in hand offs between providers, and then patient onboarding and insurance back-and-forth, contributes so heavily to these needless delays.

It feels like we could solve a lot of problems and reduce a lot of guesswork if every patient got an ultrasound, an xray, and/or an MRI as a part of intake. I know the MRI is asking a lot, but just having an objective record to look back on could help doctors immeasurably. Not to mention the people where they would immediately find the problem.

>You can visit one clinic and get a comprehensive full body diagnostic exam. Results come out within a week.

On the surface this may be appealing but on reality it can lead to a pretty big waste of resources, and quite unwarranted worry for the patient. You can allways find something wrong with people, but if its not something that they notice or are leading to anything, is it worth finding?

This is a wildly common trope that I've never heard a patient say. May I ask what nation you're in?

Especially never one that's had their expected quality of life greatly improved by treating a disease they'd adapted their mind to live with.

You'd be absolutely shocked what red-flag symptoms people will ignore out of ignorance, or just to consider (or label) themselves "perfectly healthy".

>> You'd be absolutely shocked what red-flag symptoms people will ignore out of ignorance, or just to consider (or label) themselves "perfectly healthy".

I would be very interested to know some of these 'red-flag' symptoms. Can you share a few?

Chronic anything can apply, really. It's a trope in itself: "Oh, I've always had that, that's always been like that."

Here's a few from people close to me, from recent memory.

Chronic (before each): joint inflammation, skin rashes or flaking, cough and/or post-nasal drip, allergy-related symptoms (even things like daily congestion, head pain, multi-colored wet ear discharge).

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