Ask HN: How can you buy high quality healthcare?
I've been dealing with a serious health issue that is a major problem in my life, I am in constant pain, I can barely work. My experience with the US healthcare system has been abysmal - I go to a doctor, the doctor sends me to get tests, it's 3 weeks, after that another 3 weeks to see a specialist, 3 weeks more for more tests, etc, etc. I've been ping-ponged around for 4 months with little progress in terms of diagnosis.
I'm sure that there is a way to buy better healthcare. Surely Satya Nadella doesn't have to go through this. What I would love to do is pay a large amount of money ($50K out of pocket not counting insurance for just the diagnosis) and go through all of the doctors/tests in two weeks. Does anyone know where I can do that? The US would be best, but can travel internationally for this too.
Would appreciate any pointers people might have, I don't even know what to Google. If necessary, the issue is neck-spine related, relevant doctors might be neurologist, rheumatologist, spine surgeon, etc.
113 comments
[ 2.9 ms ] story [ 175 ms ] threadSome employers have their own health concierge in their benefits package that often goes mostly unused. I've heard positive feedback about the Stanford Health Navigation Service.
US is just not an option if you cannot deal with Insurance or don't have enough money. Unfortunately.
In Spain I was very happy with Sanitas (http://sanitas.es/).
Dunno if the private health care would be any better (wait time aside), but if anything I'm surprised you can't just throw money at the problem while in the US. Did something similar to what you described twice recently and for each condition it took less than 2-3 weeks between GP, specialist and results.
I gave it a try last fall, and the difference is night and day: my current Dr actually works for me, whereas the last one very obviously worked for my insurance company.
Rereading your post, this is exactly what you want. He had me do a whole bunch of tests right off the bat and set about optimizing different things. His job is to keep my body working well, and he takes it seriously. In-network docs are, in my experience, mainly about hitting arbitrary metrics imposed by insurance companies.
Looking at the website I've found two providers near me, so I'm definitely going to check it out.
I pay my dr like $80/mo and it’s a bargain. Having a dr whose interests are genuinely aligned with mine has been life-changing.
This is the part that stinks as then you'll be bundled in waiting for the specialist to contact you, run their tests, and normally in a larger hospital group. So you'll be treated as a number again.
To anyone who has gone this route, other then needing to fall back on traditional care when its out of the scope of a DPC provider, somewhat limited options in terms of providers compared to the traditional system, and of course additional cost in addition to still wanting to have insurance when you might not need their services often, any downsides to be aware of? Just making sure its not 'too good to be true'.
My favorite feature though is it seems like if you find a qualified provider I might finally get a "Dr House" who actually listens to what I say and does something rather then just following the standard flow chart.
I'd second the medical tourism, but I've never done it myself.
I'm a patient at the Mayo.
Also, just because they run all the tests and are great at what they do does not mean they will have all the answers for every patient. They have a fast-paced machine to crank you through which will help many people, but not all. Set your expectations accordingly, and be prepared for any result including more of, "The specialist you need is booked, come back in a few weeks."
I 100% agree to go there and get all you can from it. Just don't walk in expecting a quick easy miracle.
I don’t have any advice except to pester the scheduling staff at every turn (which is easier said than done when most places try to divert you with an automated phone tree ending in the option to leave a voicemail). It’s aggravating for sure. I have no doubt that people are dying who wouldn’t have if they had received more timely care.
Seems like you should expect to pay five digit amounts per year for the privilige though, in addition to fees per visit/service?
This is the kind of thing where I feel that if you are making FAANG tier salary in the US, you can bulldoze your way into getting better quality of life benefits privately, than someone living in say, Europe who would be making a fraction of your earnings but with better publically provided benefits.
In my experience, that's generally a primary care doctor that has on the order of 1/4th or fewer as many patients, but they all pay a membership fee in order to make that sustainable. That means they can spend significantly more time - like hours every week - with you.
That doctor is then well connected in the community, and can call up a friend at the local specialist/hospital/etc and cut the line for some treatments, as well get recommendations for the "best" folks in whatever speciality is needed. They'll be persistent on your behalf, and listen to you instead of dismissing.
It's unfortunate that this is necessary, but it can be had for a few hundred dollars a month, which is a pittance if you're a high earner.
The turnaround from me being told by a med school friend that I should "go get something checked out" to having an appointment with a dermatologist was ~1.5 days, and the total effort I spent was a few minutes filling out a form and responding to someone calling me.
Of course, getting into such a relationship with such people in the first place isn't exactly easy to begin with unless you are already a member of the club. But if you're a really good networking type, something to keep in mind.
My wife just went through a serious spine/back problem. Our experience was that the turnaround between visits is so slow because the specialists are in such high demand. She is in recovery now but the time from first onset of symptoms to recovery was six months.
My suggestion is find a good doctor that specializes in managing pain to make the waiting more bearable. In my mind, a pain doctor was someone who hands out opioids and gets people addicted to drugs. Nothing could be farther from the truth. There are tons of effective treatments for pain that don't involve opioids. These range from cortisone shots to drugs that target specific nerves.
https://profiles.ucsf.edu/joe.derisi
Not a doctor, but several family members have had to go through something similar. So here is my advice:
- Get imaging tests (Xray, MRI). And screen out the any of the worst case scenarios (like tumor or etc). But if there is nothing inherently obvious and doctors are sending you down obscure test panels, cut bait early - they're out fishing and you shouldn't expect anything worthwhile.
- For back pain, there is almost no medical solution other than surgery. If surgery is optional, don't take it. The recovery from a back surgery is brutal and long and can come with unintended consequences.
- Talk to a fitness instructor. Especially one with a formal education. This is the most underrated option - these are the true experts on kinesthesiology and recovery. You'll be surprised how much good advice they can give you in a single session - identifying which sets of muscles can be developed to take strain off your back, giving you targeted workouts to try, pain management techniques, etc.
- Patience. My father-in-law spent a year recovering from back problems. Despite trying every medical intervention under the sun, his recovery ended up taking exactly as long as his original doctor said it would. But the important thing was lifestyle interventions to prevent reaggravating the problem.
Personally, I had a debilitating shoulder injury, couldn't put any weight on my right arm at all, and one of my yoga teachers put me on the path of fixing it up. Same with a low back injury, I couldn't even sit at one point and she helped fix me.
I'd 100% recommend someone with back pain visit a highly trained yoga or Pilates teacher. Some Pilates studios even take health insurance, since some are considered PT.
For my shoulder the main thing that worked was getting into the habit of doing pull-ups and stretching out my pec minor. Anytime I neglect pull-ups for a while the discomfort will creep back in. I probably should also buy a split keyboard.
In my (limited) experience, physical therapists tend to have much broader recommendations. Like a PT might tell you to walk an hour a day, but a trainer might recommend a specific kind of crunch that targets the actual muscles in question.
And to OP's point, PTs are very much ingrained in the US medical system and consuming their services can be a pain in itself.
But the guys who get professional athletes back on the field every week are for the most part just personal trainers with a master's level education in sports science. THOSE are the guys you want to help your back recover.
My wife had back pain due to a disfigured vertebrae. That’s something they do not want to operate in until every other option is exhausted. Much of her pain and numbness is caused by imbalanced muscle development from a lifetime of incorrect posture and movements that compensated for the defective vertebrae. She’s worked with both a Physical Therapist and a Trainer to improve her strength and how she moves to the point that she is pain free 90% of the time. Both were referred to her by her doctors. They’re not part of a PT chain or gym.
Kinesiology is the study of how the body moves. While the largest target audience for that is going to be people looking for a standard gym fitness trainer, the higher degrees are wasted on that sort of thing and are better used to restore the range of motion of an elbow after a car accident.
But yeah, they can be literally anyone. A good one understands simple (bio)machines and pays close attention to how a body moves AND is a good teacher.
Edit: "A PT will get you to functional, a fitness instructor will get you to capable"
All one has to do is ask. I've even had scheduling assistants ask me what power of machine the doctor wanted.
I have two friends who had almost identical spinal & neck issues: both got no relief until they had surgeries. Both say "Why prolong the suffering? Do the surgery!" One of them did have to wear a neck brace for months, but that was because his surgeon found the old neck vertebra was too delicate to keep, and so cut a chunk of bone out of his patient's hip, hand-carved it to the shape of a healthy vertebra and inserted it into his patient's neck. When the patient awoke he complained about the pain in his hip (his neck was fine).
Now that's the kind of surgeon I want!
I strongly agree out of personal experience. FIs have fixed all and every sedentary-job-induced ailment I've had so far. I highly recommend watching the athlean-x YT channel. Adding to that: also ask older, fit people you meet in the gym. They are full of good advice how to avoid injuries and, once you have one, getting over it.
https://surgerycenterok.com/pricing/
https://www.amazon.com/Back-Mechanic-Stuart-McGill-2015-09-3...
It gives you a lot of information so you can a) intelligently talk about your pain to your providers and b) build up strength and flexibility in your back to hopefully address the issue on your own.
Private care in the UK can be very fast - e.g. I went from an initial consultation with a doctor for "knee pain" to having two sessions with a consultant and an MRI complete and booked in for physiotherapy within 48 hours. Things are often done the same day or within 24-48 hour turnarounds, although sometimes you can only get seen by specific consultants on certain days (e.g. they only see people on wed + Fri etc) . I am not sure what the on-ramp for that is as I go through my work health insurance but presumably you can just pay out of pocket.
www.hcahealthcare.co.uk seems to be what everything my healthcare insurance (from a BigCo) goes through, so could be worth starting there if you fancy a visit to the UK.
Good luck.
And, will NHS really break down? I know it has been considered many times but enough of the population seems to be against the idea that I suspect it may not break down soon. Do you have any reason to believe it may break down?
Private Eye on "24 Hours to Save the NHS" <https://twitter.com/KulganofCrydee/status/833654730849136641>
Where "not collapsing" means tens of thousands of people died preventable deaths and hundreds of thousands of people suffered preventable harm because the NHS wasn't able to provide healthcare in a timely fashion to everyone who needed it.
Where "not collapsing" means people now have ten-hour waits for ambos, or ten hour waits in an ambo outside ED departments.
Where "not collapsing" means massive cuts to the services provided, leaving people mostly without NHS dentistry, with limited access to GP care, with cancelled elective care, etc etc.
Where "not collapsing" means preventable child and mother deaths because of unsafe maternity units.
Watch the news for ambo services this week.