I've always had an interest in both “third-world medicine” and international emergency medicine.  During my short career I've had the opportunity to practice medicine on 4 different continents and in many different environments.  Given these interests, and my interest in finances for health care professionals, I found a story a family member related to me recently particularly interesting and I suspect you will too.  He unfortunately had to go to the emergency department in China while working there for his employer.  With his permission, I'll quote him:

While playing basketball on Friday, I dislocated my shoulder and had to go to the emergency room to find a doctor to put it back into place for me, giving me an introduction China’s healthcare system.  The hospitals in China are all privatized now, but full health coverage is not common so you have to pay upfront for most treatments.  From one perspective, this provides economic incentives to patients to ration their healthcare and lowers overall medical expenses.  From another perspective, it makes a trip to the doctor a lot longer than it has to be.

I was seen right away after entering the mostly empty emergency room, but first the doctor had to order an x-ray and then I had to pay for the x-ray.  After getting the x-ray and taking it back, the doctor filled out a prescription for painkillers and then my friend (and translator, who made the entire process a lot easier) had to go pay for the medicine.  I probably should not call these painkillers, because thus far they seem to do little for stopping any pain.  The doctor said that Western medicine (he was probably referring to ibuprofen) worked faster, but that it was too hard on your stomach.  Frankly, at that moment, with a dislocated shoulder that was swelling and getting more painful by the minute, I did not care about my stomach but I did not have a choice.

Once the pills (again, not painkillers, because they did not lessen the pain) were given time to work, the doctor took me to the “Quarantine Room” (which looked more like a janitorial closet), asked me to lie down on the bed, and then proceeded to use what must have been the ancient Chinese method for dislocated shoulders, which consisted of taking off one of his shoes, putting his foot into my armpit for leverage and then pulling back sharply on my arm to stretch it back.  Yes, I screamed, and my friend had to turn away because he said it was too painful to watch.  Eventually the doctor relocated my shoulder, which immediately helped it to feel better, and as far as the x-rays can show everything looked fine.

In one way, the technique was very effective because I was more worried about the intense pain created by his toes digging into my armpit than I was about the pain searing through my shoulder.  On the other hand, it hurt (a lot).  I now have the privilege of taking two kinds of pills where I do not know the ingredients and cannot read the directions and I have a cream to put on each night, which is supposed to do something.  I also get to wear a sling for 3 weeks, which will make getting my luggage to and through airports this Saturday a little more challenging.

In comparing this experience to the U.S., the technique was painful and it took a long time from the time I entered the hospital to the time of treatment, but the short wait was nice and the price was unbeatable (The x-rays were $23 each and the doctor’s fee was $13.  Too bad I was gouged on the medicine ($80), especially when all I probably needed was ibuprofen and I had plenty of it already, but I was not going to complain since the total cost for my visit was about $140).

I've got to admit I was rolling on the floor laughing at the picture of this family member in a janitorial closet getting his shoulder reduced in a foreign country sans sedation.  I told him my fee for reducing his shoulder (including sedation) would likely be at least 50 times what he paid there, not counting any fees for medication and x-rays.  Then I got to thinking about how my life would be different if I only got paid $13 for a shoulder reduction.  That wasn't so funny.

Our “leaders” in Washington recently approved the “doc fix” again, but only for two months, preventing a 29% drop in Medicare reimbursement.  Reimbursements get tighter and tighter each year, and for most of us our percentage of well-insured patients continually drops.  How low could reimbursements really go?  Well, I suppose they could go all the way down to $13.  Make hay while the sun shines, my friends, and save a big chunk of every paycheck.  While I doubt our reimbursements will ever be on par with those in China, you never know what the future holds.