US health care; saga of a sick expat

sergio

Registered
A lot has been written on this website regarding medical care in Argentina, especially compared with the US. As I’m on vacation in the US, laid up with a painful problem, I thought I’d post something about my experience. Several days ago I began to feel pain in my right leg. I had been on a long flight and had carried heavy bags – maybe I strained myself. The pain grew worse and I finally decided to call my health insurance company in Buenos Aires. Part of my expensive Argentine medical plan, provided by one of the best companies in Argentina, includes coverage for travellers.

After a call to the emergency number on my “carnet”, I received a call from a company in Canada who handle travellers’ assistance on behalf of the Argentine provider. I explained the problem and was informed as to where I could go for treatment – to one of the leading hospitals on the East Coast of the US. To protect the innocent I’ll just say that at this time I am staying in a big city in the Northeastern US.

At 7:30 PM on Monday I entered the ER of this well-respected institution. A few people were sitting watching a large flat screen TV; others were chatting on cell phones or resting. Before being admitted to the inner sanctum of the ER I had to go through triage, an interview process regarding my medical problem. From there I was eventually sent to registration. Calls had to be made to the Canadian subcontractor and to Buenos Aires to assure that they would cover expenses. This initial process took about two hours.

At around 9:30 I was taken into the ER area and assigned a bed in the hallway.

At 12:10 AM the doctor arrived, took a look at my leg and ordered an ultrasound. He left and I continued to wait. Growing impatient, I asked the nurse how long it would take to see the technician. She informed me that there was no technician on duty and that one had been called. Though I was told that the Emergency Room was busy, it didn’t look anything like the TV show “ER” - no sign of any desperate people, no shouting, no sense of urgency. There were several other people resting on beds like mine. A couple of the patients looked underprivileged.

1:40 AM. An orderly took me to see the technician. The results were sent to the doctor. No sign of a blood clot, though the doctor said that the ultrasound is not foolproof and that I should return in 72 hours if I do not improve.

2:30 AM. The doctor returned with a prescription and instructions; I was discharged.

It’s now Wednesday and I am worse. My leg, primarily the area around the knee and calf, is stiff and painful. Walking is very difficult. I am not sure what to do next. I’m concerned about the expenses involved – the hospital could not give me any idea of what costs would be. “Depends on your insurance” one employee commented. No one seemed to have any idea of costs. In Buenos Aires, thanks to my comprehensive insurance, I would have many resources at my disposal. Here I feel helpless.

Now to the unavoidable issue of comparisons. I’ve been to the ER in Buenos Aires a number of times over the years. I’ve received the best treatment – never a wait of over an hour – at IADT (Instituto Argentino de Diagnostico y Tratamiento). Once at another leading clinic I arrived at a busy time. The ER was understaffed and there was confusion. By complaining I got better attention. Frankly I suspect that being a foreigner was an advantage in this case. Complaining and being insistent the other evening at the American hospital would not have made the slightest difference. No one was rude or unkind – they were businesslike.

I realize that one visit to an ER is not a fair basis for a comparison. As I said, I once had problems at a leading hospital in Buenos Aires. In many years of experience, however, I have experienced a pattern of efficiency, competence and consideration at the three major private hospitals I’ve used in Buenos Aires.

In talking to the staff at the US hospital and some friends in the medical field, I’ve gleaned that the American health system is beset with a number of problems: a litigious culture that hinders efficient treatment for fear that doctors and hospitals will be sued (often for capricious reasons), the growing number of uninsured people who rely on emergency rooms for treatment - some of these people are covered by the welfare system allowing hospitals to recover all or partial costs however others will never pay anything forcing the hospitals to pass losses on to the paying public; pharmaceutical companies notorious for charging exorbitant prices; doctors who receive generous compensation.

By contrast, the medical system in Argentina is divided into two categories: public hospitals that cater almost exclusively to the poor and private hospitals of varying levels of quality that cater to those who can pay for insurance. Though there is much criticism of the American system for its failure to offer universal coverage, the fact is that the poor actually do receive treatment – treatment at the very same hospitals that serve the insured middle and affluent classes. In Argentina those who can not pay for insurance have no option but to go to public hospitals. The result is that the emergency rooms at private hospitals in Buenos Aires are not crammed with welfare cases (there are none!) and the waits are shorter. In Argentina the culture of suing has not taken hold. Doctors are underpaid. The end result is that private coverage is relatively affordable; doctors spend more time with patients. Expats are usually happy with the care they receive.

I do not doubt that the US has some of the best surgeons and specialists in the world and that the technology in leading hospitals is state-of-the-art. What I have seen, however, is that the system functions well for those who are fully insured and adequately for those who are underprivileged, have no money or property and nothing to lose when they can not pay. Those who fall through the cracks are mostly middle class people who have lost jobs, can not afford to maintain insurance and run the risk of health problems that could lead to ruinous expenses that threaten their life savings or even homes. It’s clear that the system needs reform.

I sit here looking out over a glorious snow covered panorama, rather immobilized by a painful, rigid leg. The ER doctor advised me to return to the hospital if I do not improve in 72 hours. Seventy-two hours have not elapsed and I am not better – I’m worse! I’m scheduled to return to BA next week. I'm nervous about whether I'll be up to the long flight. I’ll be glad to return to Buenos Aires and a private medical system that can better deal with my “health issue”.

I’ll update this when I have news. Any serious advice will be appreciated.
 

RWS

Registered
sergio said:
Any serious advice will be appreciated.
Regrettably (looking out at the same northeastern snow-covered landscape as you, Sergio), I can offer only empathy and a few comments.

sergio said:
In talking to the staff at the US hospital and some friends in the medical field, I’ve gleaned that the American health system is beset with a number of problems: a litigious culture that hinders efficient treatment for fear that doctors and hospitals will be sued (often for capricious reasons), the growing number of uninsured people who rely on emergency rooms for treatment - some of these people are covered by the welfare system allowing hospitals to recover all or partial costs however others will never pay anything forcing the hospitals to pass losses on to the paying public; pharmaceutical companies notorious for charging exorbitant prices; doctors who receive generous compensation.
As a lawyer who comes from a family with a few physicians and surgeons (one, a former president of the A.M.A.), I'd largely agree. The world's highest income among physicians, whether measured by nominal dollars or purchasing-power parity, is a major factor in the high costs; lawsuits, actually less; but the worst is forced free care to many, most especially to the invading waves that thunder more and more strongly against the American shore.

sergio said:
I do not doubt that the US has some of the best surgeons and specialists in the world and that the technology in leading hospitals is state-of-the-art. What I have seen, however, is that the system functions well for those who are fully insured and adequately for those who are underprivileged, have no money or property and nothing to lose when they can not pay. Those who fall through the cracks are mostly middle class people who have lost jobs, can not afford to maintain insurance and run the risk of health problems that could lead to ruinous expenses that threaten their life savings or even homes. It’s clear that the system needs reform.
Incisive analysis, Sergio. The quality of care available at the top in the States is unequalled worldwide, but the majority of Americans (I exclude the tens of millions of illegal immigrants permanently resident here) often cannot afford their own needs even for minimal medical maintenance.

sergio said:
Part of my expensive Argentine medical plan, provided by one of the best companies in Argentina, includes coverage for travellers.
I have to ask: which Argentine insurer is yours?
 

jp

Registered
Sorry to hear you're having an unpleasant time.

I'd recommend you go back to hospital before 72 hours is up, especially since your condition has got considerably worse. There's no advantage in you waiting 72 hours.

Suerte
 

sergio

Registered
Thanks for your advice, jp. I think I am not as bad as I was yesterday. Yesterday things got worse. I'll wait at least until the 72 hours are up.
For now I won't mention the health care company as I want to see how this plays out. Just take my word that it is a very important one. My intuition is that they will fully cover me. If they do it will be good advertising for them and I will reveal their name when all has been resolved.
 

RWS

Registered
Thanks, Sergio. I'll look forward to the revelation and continue to hope that you recover fully (not medical advice, but I found rest and hot baths to help with a similar affliction).
 

Grazie

Registered
Hi Sergio. I hope you are feeling better. Speaking from experience (I have Argentina health insurance) when my ear infection went amok on me after a long flight to the US. I made a phonecall to a Miami-based office that facilitated my visit to an urgent care center (since I was not bleeding, felt faint or ..you know what I mean) instead of an emergency room. They did a very splendid job taking care of me- they (the Argentina insurance) insisted on all tests and to give me some medicine - they covered it, a big smile to the doctor got me some free ear drops (hey, he was nice). And since I also have had good and bad experience in BsAs and the US doctor visit, I think sometimes we luck out on the healthcare provider that sees us. But I am sure all will work out, international coverage from Argentina is most often than not very good.
Those pain relievers must be getting you all giddy right? Just kidding! Take care.
BTW, just travel light next time :)
 

sergio

Registered
Thank you Grazie. I am better than I was last night. The option regarding treatment that I was given was not at all convenient and would have been impossible for me to get to. I was sure that I needed some sort of test and I was right - they did an ultrasound. As regards doctors in BsAs, I believe it's important to seek out doctors who are associated with the most important private hospitals. It narrows the field to the more competent physicians.
 

Dudester

Registered
Greetings Sergio, sorry to hear about the abuse/incompetence - IMHO - you are being put through. I also have relatives in Europe that are Doctors and Dentists and we have had many conversations about the pathetic American Medical Complex monster and what a massive, expensive ball of confusion and waste it has become. Hopefully I will never be at it's mercy.
Please take a few minutes and Google/Yahoo Search "DVT" - DEEP VEIN THROMBOSIS - read all you can about it and MAKE 100% SURE this is not what you are suffering from. This is a very serious condition connected to long distant flying, traveling, and sitting still for very long periods of time without enough proper/healthy moving of the limbs. Make sure your Doctors are aware of your recent air travel. Let us know how things are going. All the best, Dudester
 

jvwh3b

Registered
Sergio,

I hope by now you are feeling much better and on the way to a full recovery. American hospitals while purported to be among the "best in the world" often leave a lot to be desired.

I suffered a stroke while in Italy, and from the time of the ambulance transporting me to the hospital and until I returned to the States, my care was excellent and unparalleled. The only problem was the language difference; the medical personnel spoke little English and I spoke only English and a little Spanish. The moment I arrived in the US and went to my local hospital my trials really began; the endless same questions from different doctors and nurses, the immediate question even before being seen, "What type of insurance do you have?", lazy auxilliary staff, etc.

While it was not too pleasant, thank God your illness was not more severe. It's a shame to say it but after my own experience and the stories I've heard from friends and others, American hospitals are in a bad, and declining, state.

All the best to you.

Carl
 

steveinbsas

Registered
Dudester said:
Greetings Sergio, sorry to hear about the abuse/incompetence - IMHO - you are being put through. I also have relatives in Europe that are Doctors and Dentists and we have had many conversations about the pathetic American Medical Complex monster and what a massive, expensive ball of confusion and waste it has become. Hopefully I will never be at it's mercy.
Please take a few minutes and Google/Yahoo Search "DVT" - DEEP VEIN THROMBOSIS - read all you can about it and MAKE 100% SURE this is not what you are suffering from. This is a very serious condition connected to long distant flying, traveling, and sitting still for very long periods of time without enough proper/healthy moving of the limbs. Make sure your Doctors are aware of your recent air travel. Let us know how things are going. All the best, Dudester
This truly is one of the best posts I have ever seen on this forum. I remember (and miss) David Bloom, the NBC correspondent who died as a result of this condition. This kind of advice could have prevented his untimely death. Remembering that, I now get out of my seat and walk "about" several times when flying from BA to the USA and /or Paris. I hope others follow your advice and do the same. Thank you, Dudester.
 
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