Any reasonable alternatives to relying on traditional health insurance?

[LuckyLuke]

Howdy folks,

I've been meaning to inquire to see what the rest of you think about the public medical system here. I'm currently paying Swiss Medical for my family (wife, 2 small kids) down here in Neuquen. I've been told by a few friends and family that I'm insuring privately "al pedo", as the public system in Neuquen is "superior" than BA. For example, our housekeeper has a son receiving brain radiation therapy for free. My neighbor just had a granddaughter delivered free. Services I couldn't imagine being free, even with insurance, in the US.

I've been told that the only real advantage to paying private insurance is if you need an operation and you want to skip to the front of the line, because while the public system is free, there are long wait times.

With the exchange rate so low Swiss Medical premiums are now more than I was paying in Texas (after federal subsidies factored) aka ~$600 USD. I've also been disappointed that even when paying privately, there are always co-pays that are usually only 50% cheaper than a walk-in uninsured ($20k - $30k). Which, certainly doesn't justify such high premiums for occasional checkups.

Background - Wife and kids are citizens, I'm a permanent resident. We are both in our early 40s, kids are small (3,5). None of us have any existing conditions or require medication. We are both monotributistas.

I've been tempted to just set aside some funds (amount ?), self-insure and trust the public system like everybody else.

Anybody have any thoughts/experience to add? A part of me feels like I'm just throwing money away down here, but being a yankee I'm still traumatized by the ingrained threat of financial ruin without being medically insured or being told to wait in the pubic hospital lobby next to the drive-by shooting victim and the redneck with an arrow in his eye.

There's also a lot of stories flying around about public hospitals having shortages of staff from private practice poaching.

 

[redlobster]

I've been tempted to just set aside some funds (amount ?), self-insure and trust the public system like everybody else.

Why call it "self-insure"? You’re just planning to drop the medical insurance, pay out of pocket, and hope for the best.

 

[ArgentinaVet]

I live in CABA and pay an outrageous 1.2 million pesos for month for two people for OSDE 450. There are never any co-pays and it comes with useful travel insurance so that is a true all in price. Im in early 40's and the wife is late 20's and we both live very healthy lifestyles and years go by that I don't use the insurance. Ive thought many times about self insuring but I can tell you some horror stories about people that had critical conditions that didn't have local insurance. Last year a friend of mine had a stroke in CABA and didn't have local insurance; he went to two or three of the best private hospitals and none would admit him without a $30,000-$50,000 USD deposit, which he was unable to come up with on the spot. Hours went by until he could make it to a public hospital where he was admitted for free and got care, but the damage was done and he died a few weeks later. In his case, if he had good private insurance and had went directly to the FLENI, he would probably still be alive today. This type of low probability risk of a catastrophic event is what keeps me paying for OSDE 450; in the unlikely event of a critical situation I am confident that I will be admitted to all the best private hospitals in Argentina without delay and get the needed care.

 

[LuckyLuke]

Why call it "self-insure"? You’re just planning to drop the medical insurance, pay out of pocket, and hope for the best.

uh yea, that's exactly what insurance is. It's a fund that pays for your medical costs and then you hope for the best. The only difference is that instead of paying some rando company (who wants to deny your claim) for emergency access to their slow paying bureaucratic fund, you set up your own in some interest bearing account. You need some throw away money to do it which, let's face it, few probably have (unless you're Warren Buffett)

 

[LuckyLuke]

I live in CABA and pay an outrageous 1.2 million pesos for month for two people for OSDE 450. There are never any co-pays and it comes with useful travel insurance so that is a true all in price. Im in early 40's and the wife is late 20's and we both live very healthy lifestyles and years go by that I don't use the insurance. Ive thought many times about self insuring but I can tell you some horror stories about people that had critical conditions that didn't have local insurance. Last year a friend of mine had a stroke in CABA and didn't have local insurance; he went to two or three of the best private hospitals and none would admit him without a $30,000-$50,000 USD deposit, which he was unable to come up with on the spot. Hours went by until he could make it to a public hospital where he was admitted for free and got care, but the damage was done and he died a few weeks later. In his case, if he had good private insurance and had went directly to the FLENI, he would probably still be alive today. This type of low probability risk of a catastrophic event is what keeps me paying for OSDE 450; in the unlikely event of a critical situation I am confident that I will be admitted to all the best private hospitals in Argentina without delay and get the needed care.

Wow...that's a wild story with a sad outcome. Any reason why your friend went a private hospital first instead of a public one? I can't imagine, mid stroke, trying to haggle it out with a private practice. How do you even deposit money that fast? Did they expect him to walk in with a briefcase of cash and partial paralysis? Terrible...

Thank you for sharing that.

 

[QuilmesSlo]

Wow...that's a wild story with a sad outcome. Any reason why your friend went a private hospital first instead of a public one? I can't imagine, mid stroke, trying to haggle it out with a private practice. How do you even deposit money that fast? Did they expect him to walk in with a briefcase of cash and partial paralysis? Terrible...

Thank you for sharing that.

I guess they should have gone to a public hospital first but if you’ve ever seen someone stroke it’s pretty terrifying and not conducive to rational thought.

 

[redlobster]

uh yea, that's exactly what insurance is. It's a fund that pays for your medical costs and then you hope for the best.

Paying out of pocket is actually the opposite of what medical insurance is. Insurance is meant to protect you against unexpected and unaffordable medical costs. Setting aside some money for health expenses is more like running a self-directed health savings account.

 

[Caribbean Cool]

Five or so years ago, when the blue afforeded us 50% discounts to a medical system that itself was dirt cheap, it was a 'delight' to pay out of pocket. Then 3 bad things happened. The peso difference was basically gone.....inflation slaughtered cheap prices......and number 3 we got older. Pura Vida

 

[Sammi]

Excellent topic, and fuel for thought .Everyday I find new differences from what I have known to be standard op in the states. I have been here for 2 years now ,minus a week every 90days of course). I am a Registered Nurse in critical care/emergency medicine in the States, (I do not have enough spanish to consider practicing in Argentina yet)

In my experience it was not an option to - not treat or delay treating based on whether you were insured or homeless. Federal law there requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. Even strokes are considered for lysis ( thrombolytic therapy) if they are in the 3 -4 hour window of onset. That is not a law here . I understand how the system here has been exploited so it's tightened up on who gets treated.

Your greatest challenge in the world of U.S. insurance was finding a cardiologist or neurologist for follow up care. But even Community health centers and walk-in clinics would juggle you and find you a referral, eventually, with lesser reputable clinicians perhaps. Being a cash or uninsured family is a delicate choice. That medical clinic, physician or specialist does not have to schedule, see you or "stabilize you". Often you won't get past the phone receptionist without a financial screening. Even get in to see that specialist with cash saved for that event you may have triggered a preexisting to try to get insurance for (because the follow up will require more to do Chemo ? Complications ? so now you need that insurance cushion and yet the has ER diagnosed already you( In the insurance providers view )while you were a cash pay. Many mental health problems are medical in nature and treatment, all cardiac, diabetics get diagnosed from an ER ketoacidosis they didn't know they had building up before an acute change So while you feel like your eating well and healthy today , tomorrow's trauma or medical event could leave you paying much more and struggling to get affordable if any insurance. Reviewing your family medical history is more critical when trying to guess ahead between cash or healthcare insurance choices I would guess.

So , I asked around about the assumption of getting treated here as a permanent resident( soon to be american born wife of a native born Argentinian) in either an ER or private clinic as ‘cash paying and uninsured’ if I saved that cash for an Emergency.
Interestingly enough the Emergency care could be a huge risk I am told. Unless I was coherent enough to arrange a wire transfer for a deposit from the states and needed acute care within banking hours...No one has to treat me. And no hospital probably will. Curiously it was also suggested to me that not being Argentinian born even once married may delay care which I found surprising.

Follow up care here is easier however, as that's solved by a bank visit on the way to see a specialist in office hours and I'm told all outpatient venues love cash which makes sense.

You set out good questions which provided me with a lot of things to consider as I acclimate myself to this new life I am building. Thank you .

 

[nikad]

Excellent topic, and fuel for thought .Everyday I find new differences from what I have known to be standard op in the states. I have been here for 2 years now ,minus a week every 90days of course). I am a Registered Nurse in critical care/emergency medicine in the States, (I do not have enough spanish to consider practicing in Argentina yet)

In my experience it was not an option to - not treat or delay treating based on whether you were insured or homeless. Federal law there requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. Even strokes are considered for lysis ( thrombolytic therapy) if they are in the 3 -4 hour window of onset. That is not a law here . I understand how the system here has been exploited so it's tightened up on who gets treated.

Your greatest challenge in the world of U.S. insurance was finding a cardiologist or neurologist for follow up care. But even Community health centers and walk-in clinics would juggle you and find you a referral, eventually, with lesser reputable clinicians perhaps. Being a cash or uninsured family is a delicate choice. That medical clinic, physician or specialist does not have to schedule, see you or "stabilize you". Often you won't get past the phone receptionist without a financial screening. Even get in to see that specialist with cash saved for that event you may have triggered a preexisting to try to get insurance for (because the follow up will require more to do Chemo ? Complications ? so now you need that insurance cushion and yet the has ER diagnosed already you( In the insurance providers view )while you were a cash pay. Many mental health problems are medical in nature and treatment, all cardiac, diabetics get diagnosed from an ER ketoacidosis they didn't know they had building up before an acute change So while you feel like your eating well and healthy today , tomorrow's trauma or medical event could leave you paying much more and struggling to get affordable if any insurance. Reviewing your family medical history is more critical when trying to guess ahead between cash or healthcare insurance choices I would guess.

So , I asked around about the assumption of getting treated here as a permanent resident( soon to be american born wife of a native born Argentinian) in either an ER or private clinic as ‘cash paying and uninsured’ if I saved that cash for an Emergency.
Interestingly enough the Emergency care could be a huge risk I am told. Unless I was coherent enough to arrange a wire transfer for a deposit from the states and needed acute care within banking hours...No one has to treat me. And no hospital probably will. Curiously it was also suggested to me that not being Argentinian born even once married may delay care which I found surprising.

Follow up care here is easier however, as that's solved by a bank visit on the way to see a specialist in office hours and I'm told all outpatient venues love cash which makes sense.

You set out good questions which provided me with a lot of things to consider as I acclimate myself to this new life I am building. Thank you .

Hi Sammi,

Most people don't know how the system works and their rights (locals or foreigners alike). In reality in an emergency, nobody is left untreated, they will either take you to the nearest public hospital, or private hospital if the person has insurance. For doctor office appointments it is easy with insurance or paying out of pocket. As a matter of fact if you get a stroke or heart attack and are near a private hospital, the must take you and stabilize you. Then you will be transferred to a private clinic that works with your insurance or a public hospital.

The real issue comes when you need emergency care, or surgery, and you think you will be able to pay out of pocket. That is when you will get rejected by most providers because they are simply not used or prepared to deal with such situation.

Services and access to certain services ( imaging, specialists, critical care ) can be a hit or miss depending on where you are living. Some people fear public hospitals, others love them. It depends on where you are. Some doctors work in in the public and private system, so do nurses.

If in the city, there are few private places where I would want to be taken to in case of a serious condition or accident. The ideal is to get the best Dr from the public hospital treating you in a private setting.

I am about to transition to the US system, got licensed last year. It will be interesting for sure. I am Arg RN and husband has been in Arg for 20 years as a perm resident.