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Old 25-09-2012, 22:03   #46
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

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Originally Posted by mdvick View Post
+++111! I strongly recommend that you join DAN. Their insurance is amazing and you do not have to be a diver to join. I have been a DAN member since 1991 and do not regret a single penny paid them.
I looked at the DAN coverage just today (on their website), but although it is cheap, it didn't tell me for how long it is good for. They asked for the value of the trip, that is it.

Have you ever had to claim on it? If so, what procedure did you have to go through to collect, or did they pay directly?
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Old 25-09-2012, 22:53   #47
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

DAN (+1) has two programs, DANTravelAssist (TravelAssist) and their accident insurance (Accident Insurance).

TravelAssist comes with membership, which runs $35/year (or $55/year/family). It basically provides medical evacuation to nearest suitably equipped medical facility up to $100K. All travel has to be arranged through DAN's phone number.
DAN's accident insurance is really geared toward covering diving accidents. The Preferred plan ($75/year) also covers non-diving accidents up to $10K.

DAN is a great organization, and to me the $35 cost for membership is a really cheap way to get evacuation coverage. But it isn't really medical insurance, doesn't cover sickness, etc. Again, great organization and great product (IMO) but do be aware of exactly what you are getting. When you need it isn't the time to find out.
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Old 26-09-2012, 06:16   #48
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

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Originally Posted by goboatingnow View Post

You uk view is somewhat flawed. The uk has a thriving private medical industry. If you have cash you can get it done just like in the US. What you were describing was getting it done for free. This is elective surgery.



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I don't know. He had the same cash living in the UK.
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Old 26-09-2012, 07:04   #49
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

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Originally Posted by Dsanduril View Post
TravelAssist comes with membership, which runs $35/year (or $55/year/family). It basically provides medical evacuation to your home country up to $100K. All travel has to be arranged through DAN's phone number.
A small correction: DAN provides medical evacuation to the nearest suitably equipped medical facility. That may or may not be your home country.

DAN is a fantastic value as a supplement to other medical insurance - especially if one is cruising in out of the way places.

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Old 26-09-2012, 07:39   #50
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

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A small correction: DAN provides medical evacuation to the nearest suitably equipped medical facility. That may or may not be your home country.
You are correct, sorry I mis-spoke. Especially about something this critical. Makes no difference to me, but may to many. Thanks for catching that.
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Old 26-09-2012, 09:27   #51
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

Dsanduril's post has been edited at their own request to accurately reflect the coverage of the programme.
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Old 18-10-2012, 22:25   #52
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

Just wanted to update this discussion with recent experience here in Guatemala.

Went in for regular check-ups recently, as part of this got a combined abdominal ultrasound and endoscopy. Grand Total Q5,400 (about $687US). That's in a first class facility with a Guate/USA/Japan trained doc. Average cost in USA for just the endoscopy, per Internet search, $2,700US.

Looking at the totals for the full-monty: I did general exam, flu vaccination, full battery of lab tests, eye exam, dental cleaning/exam, including the above mentioned endoscopy for a total of about $1,150US. All in first-class up-to-date facilities with Guate/USA/European trained docs -- most of whom speak better English than I do.

And, icing on the cake: I really enjoy the medical care experience here (I remember dreading the hassle and expense in the USA). It's like dropping in to visit old friends once a year...we talk about sailing...they ask me a few questions...order up some tests...I actually look forward to it.

Bad news is that I've got to back off on the absolutely awesome coffee here! Man, that's gonna be hard.
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Old 22-10-2012, 22:33   #53
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I had a Doctor frient tell me that years back medical insurance was a luxury not a necessity. But the insurance companies came to them said raise your price to anything and we will pay it.

So most doctors did and now insurance is a necessity.

I went in for a physical in Tanzania plus got 2 different types of types of pills to prevent the two types malaria for a grand total of USD $6.00.

One of my crew was opening a coconut with a machete cut him self bad had to have stitches and antibiotics for a grand total of USD $8.00.

If you ever get to Tanzania visit Tanga.
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Old 22-10-2012, 23:14   #54
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

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914--goood work--i knew you guys would do well down here.
the recipes for medications are same same same world wide..just slightly different names on bottles--many are usa companies with a mexico or wherever branch factory, as is sooo costly to produce anything in usa. SNIP
A few years ago when I was an art student I lived with a girl from Puerto Rico and got a real education. While watching the news one night the subject of state hood came up. I really do not have a dog in that hunt but it clearly made her uncomfortable. Turns out about 30% want state hood, 30% independence, and 40% for it to stay a commonwealth.

Seems the reason for this is the drug industry in Puerto Rico. The tax structure is such that big drug companies locate there to make drugs. If it became a state or independent drug companies would be taxed like any other state or any other country so they would have no reason to stay there.

There are also lots of knock off drug companies, especially in India, that ignore IP laws and reverse engineer drugs from the US and make them at a fraction of the cost to produce them in the US. So basically some of the cost of high drug prices in the US is to bribe voters in Puerto Rico to stay a common wealth, some to put funds in R&D, and some for profit.
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Old 23-10-2012, 07:13   #55
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

The tax laws in Puerto Rico regarding drug manufacturing changed over a decade ago and a lot of the pharmaceutical companies either pulled out completely or downsized their operations in PR. Pharmaceutical manufacturing is still a part of their employment, but it is no longer the size it was in the past and no longer a player in the question of statehood vs commonwealth vs independence.

The cost of high drug prices in the US is just simple economic supply and demand balanced with the high cost of R&D. When the US stops paying high prices and begins to be a bit more risk tolerant with R&D, the price goes down. The pharmaceutical companies are not doing anything evil with this - they are just operating under free market conditions in a country that values and vehemently protects free markets and unimpeded business.

Gucci shoes and every other product for sale is also priced according to what one is willing to pay and are priced differently in different markets. Why should pharmaceuticals be any different?

While the cost of materials in most pill drugs are essentially zero, it takes $1 billion dollars and a potentially multi-million dollar manufacturing process to get it to that point. Much of that cost is in very expensive experimental trials and forced failures of good medicines that have some risk in them. Let alone the fact that the outdated US patent laws give a company only 5-10 years to recoup the R&D costs and make some profit.

This is because the US has zero risk tolerance and forces oversized and expensive trials and early failures through regulation, or the companies stop development because of potential future lawsuits. If you are dying of cancer, there is a good chance that a drug was developed that could help you, but was killed by the FDA because it caused a headache in 1% of the people who used it, or the company dropped development because they would never make money after fighting lawsuits by dying people over temporary headaches suffered while being helped.

True story: when Viagra was new, the manufacturer was sued by a guy who took it while driving his car and claimed that when he tuned his radio to a certain station, blue sparks shot out of his eyes, burned out his power steering and caused him to run off the road, hit a tree and suffer injuries. Despite mounds of scientific evidence, facts and expert testimony about the impossibility of sparks of any color shooting out of ones eyes, the jury handed the case to the guy and cost the company millions of dollars in one lawsuit. Of course, the lawsuits came in heavily after that with even more outrageous claims and the company has been in court almost continuously since.

And that is only a single drug that sells $4 billion each year, so can afford to fight silly lawsuits. A drug with a market potential of only a few hundred million dollars but with known side effects would never be brought forward in the US, although it may be developed for other countries.

Think Sturgeron as an example.

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Old 23-10-2012, 17:31   #56
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US drug pricing is such purely because of ( a) it's the price the market will bear. And (b) the insurance industry drives up prices because it mutualises the price of drugs and forces the resulting costs onto its customers. This happens in lots of markets with high dependency on private insurance.

Where market conditions are such that such high prices can't be obtained , hey presto drugs are cheaper. It has nothing to do with lawsuits

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Old 23-10-2012, 17:57   #57
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

Cole-not to hijack this thread, but drug costs are far nore complex than you describe. I did a Lexis search for the case you mentioned and I could find no such ccase in any state or federal court. If you ccould send a cite, I would be interested in reading it. The idea that liability law is a major factor in drug costs is belied by the statistics. If you look at even the drug company statistics, Liability costs are down in the 1-3% range of total developent costs. It is an urban myth that there are many, many frivoluos suits in which juries award uge amounts of money to plaintiff for no apparent reason. There are numeros studies showing this not to be true. As hard as it may be to admit, juries usually are pretty smart and mostly get it right.

Admittedly, the US protocols for drug approval are tremenduously expensive, and risk v. reward is a legitimate question. But there is also the huge price disparity between a drug;s cost in the us and in other countries. In short, we in the US, by paying much higher prices, are supporting the lower prices negotiated in other countries by their nationla medical systems. Congress has denied Medicare the power to negotiate drug prices here.

One means of reducing liability costs is to take the power to resolve suits from insurance companies. When you are isured, your rights are "subrogated" to the insuror. They take your position is a suit and have total control over the resolution of the action-trial, settle, whatever. They take that action in their interest, not the insured's interest. Too many contingent fee lawyers are content to play the "insurance lottery" knowing many cases will settle for something.

There is one major retailer (no name, but one of the largest in the wold), that self-insures. They force every plaintiff to go to court and prove their case, they do not seettle any cases, outside the really egregious ones. If you sue them, be prepared to actually prove your case. If you win, you get a check the next day, but they force you to prove it. Consequently, their liability costs are well below the norm and lawyers are not excited about representing cients against them.

Sorry for the hijack.
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Old 24-10-2012, 07:26   #58
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

I guess I wasn't clear on the liability costs. Certainly, liability costs for marketed drugs are small (although look at Bextra and PhenFen for examples where it is huge), but that isn't the story here. The lack of risk tolerance in the FDA and consumers build in liability costs before the drug ever gets to market.

The clinical studies the FDA requires to develop a drug are enormously expensive. Many of those studies, and their size, are simply to uncover and remove all potential risks from a drug, and if even low probability risks are present, to refuse approval after all the money has been spent to that point.

And I am not being cavalier about risks and side effects. Tylenol could not be approved today in the US due to it failing current regulatory risk and side effect tolerances. Many of the drugs developed in the 80's and now available over the counter could not be approved today in the US.

The potential for lawsuits on known small risks or side effects is used by companies in determining if they will progress drugs to market. Often, these risks and side effects are not known until much money has been spent.

All discovery and development costs put into a drug that fails to make it to market are built into the cost of a drug that does make it to market. Regulation and liability are baked into the development costs.

In 1990, it cost ~$100 million to bring a drug to market. Today, it is over $1 billion, and that cost is born in what I described above.

Then you have the patent law issue. Recouping all of the development costs and any profit must be squeezed into a very short time frame because of antiquated patent laws.

This is a bad time for pharmaceutical research - treatment for many diseases are not being pursued at all and effective treatments carrying risk are not being brought to market because of the lack of risk tolerance. Fortunately, the pharmaceutical companies are setting up major R&D centers in China, where risk is accepted and research can be done reasonably. Hopefully, the rest of the world will benefit.

As for relative marketed drug costs, my original explanation was the market forces of supply and demand and not liability and R&D. Liability and R&D effects the intrinsic cost of a drug and market forces determine the relative cost.

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Old 24-10-2012, 11:49   #59
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

I don't feel that talking about the costs of drugs verse the cost of going to the doctor's office are really related just because they are both part of medical care.

What I feel it comes down to is that is some places medical care is about money, and in others it is about medical care!
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Old 24-10-2012, 12:04   #60
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Re: Can You Share Your Medical Experiences Outside the United States or Europe?

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I forgot to mention that her doctor, the dentist, and the specialist at the hospital have all given us their cellphone numbers.
...
Same experience here in Guate, I was shocked the first time a doc here gave me his cell phone number. He gave it to me so that I could just call him later to discuss lab test results. Easier for both of us. In the US, docs always insisted that I schedule an office visit for even the most minor of things. And of course, they were booked solid for weeks, if not months, at a time and I knew I would sit in the waiting room half the day.

Another pet-peeve of mine is sitting around waiting endlessly in doc offices for a scheduled appointment -- why can't they keep a schedule? I can. I don't think I have ever seen a doc in the USA as scheduled. In fact, got a little irate once years ago, when I still had a real job -- at the time, if you did the math, I was making substantially more per hour than any doc -- and I was waiting on him? I threatened to bill them for wasting my time -- didn't speed up the process of course...

Here in Guate I have never been kept waiting for more than a few minutes for a scheduled appointment.
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