I think health insurance is the biggest scam - and 30% of people are better off without it. Here are my reasons why I discourage insurance:
1. Health insurance schemes have a profit motive. They use your money to make money so they can pay you for any health costs that you MAY incur.
2. Health fund profitability: Health funds control alot of money, which means that they invest in large companies that are liquid enough that the fund can buy & sell without impacting too greatly on the stock price. For security reasons and liquidity reasons they also invest in bonds. For this reason, if you have a good understanding of investments and enjoy it, you can actually make more money than they do. But the big benefit is that if you are healthy, you dont need to pay out any costs
3. Alternative insurance: If you think about it, we confront many types of risks in our life, whether health, car, house insurance, and we all go to private enterprise. But they have a profit motive. I think it makes alot more sense to set up a fund within your own family....extended family if you are not wealthy enough to pay your own way. Try to find an independent custodian for the funds would be my strategy for extended families because there are often favourite siblings and graft. The big benefit is the money stays within the family, and you can share resources like investment ideas.
4. No subsidisation: The problem with insurance is that our risks are not all the same but insurance premiums are within your specific age category. I'm sure laws in each country prevent discrimination by insurance companies, even rational discrimination. The implication is that if you are healthy, you are subsidising unhealthy families, whether they have a genetic disposition or just dont take care of themselves with preventative care. If you subscribe to the idea of 'social harmony' and helping others, maybe you think that, but then again maybe you prefer to decide your own benefactors.
5. Knowing the downside: Its noteworthy that alot of people just dont understand their national insurance scheme, the rules, their options, and for this reason they are not in a position to make reliable judgements about the benefits of insurance. It doesnt help that health insurance schemes are so complex. That in itself is a cost, and not reading the fine print on the contract is a BIG RISK, which is what insurance is intended to protect you from. In some countries the public health system is almost as good as the private system, and in some instances or areas it can even be better. The best way is to monitor the media, but keep those horrid stories in perspective because alot of people are satisfied with their treatment.
6. Knowing your options: We are lead to believe that you are going to be hugely exposed if you dont have health insurance, but there are options. Often you are just subjected to wait lists, sometimes without even discomfort. But I think if you cant get service from a public hospital, you can always pay. If the costs are prohibitive consider going overseas or buying your medicines online (overseas). Medical care in the Philippines or India can be as good or even better than in western countries. The reason is that the best doctors in poor countries are often foreign educated and service a small 'wealthy class'. But I advise you to pay at least to go to one of the top 5 hospitals. Beds might be $40/night. Some western public insurance schemes like Japan include dental. In Australia all taxpayers must pay Medicare, which functions essentially as a tax.
7. Personal diversification: An insurance scheme diversifies people's risks. My suggestion is that you collectivise the risks within the family or among a trusted group of friends, say your college mates, and then internalise the savings. Of course our lives change, so it makes sense to have a cashing out strategy.
Anyone interested in setting up such a scheme or participating in one can contact me.
Saturday, September 29, 2007
Sunday, September 23, 2007
Simple answers for complex problems
It seems to me that a great many problems pass under the radar because governments and health professionals attempt to present complex processes or issues as simple so that they might appeal to a broader audience. Of course education demands that you tailor your communication to the intellectual capacity of the audience. But when you are addressing an audience that exhibits a wide range of intellectual capacity, doesn't it make sense to actually target your audience rather than give them a simple message. Governments are the main provider of health advice and they tend to use the television as their preferred media. The other important media are direct mailing (letterbox drops) and brochures stocked at medical centres and hospitals. The appeal of TV is that it reaches most people, but one has to wonder if the message is just too simple and thus unprovocative to make an impact. Certainly we can't leave it to the food companies to educate people in good health. Not just because they have a conflict of interest in terms of the dietary value of their foods, but becaus they are ven worse than governments in over-simplifying the message.
By way of example, about 5 years ago my doctor informed me that I had a high cholesterol level. I was eating too much cheese and white bread and doing little exercise. The reason this didn't bother me was that I was not overweight. The media had created a perception in my mind that 'fat = cholesterol'. Recognising that my perceptions about 'good health' were misguided I promptly started reading alot of health books on diet, self-improvement, etc. As a result, not only did I learn that thin people dont necessarily have low choloesterol levels, I learned that it was actually that the type of cholesterol and the ratio of HDL and LDL is more important.
The current problem is that perceptions are more important than facts, which means misinformation, lack of disclosure and context dropping are rampant in product labelling. You might ask - why is that. I think its because it costs advertisers too much to correct the perceptions of other advertisers, and there is no industry-wide effort to correct those misconceptions. Basically not only does food have to be nutritious, it has to taste good. In fact taste is a bigger selling point, because whilst we can be high-minded about help, most people circum to temptation. The implication is that food producers are left choosing between salt, sugar or fat as a way of satisfying the taste preferences of consumers. But there are other issues as well. It matters are great deal what our food looks like. So expect transition trans fatty acids so your margarine spreads easily.
Another problem is relative standards. We might be told that a certain cheese is 25% less fat, but by what standard is that good. There is a very healthy 'low cholesterol' olive oil based spread on the market that discloses that 'it is virtually free of trans fatty acids'. But there is virtually no nicotine in cigarettes as well, so one wonders about these relative standards. At the end of the day, I would suggest in 2 years time, you could be learning that:
1. Trans fatty acids are not the problem they are thought to be, in fact they have good aspects
2. Trans fatty acids are seriously carcinogenic in very small amounts.
You might wonder why food manufacturers are placing ingredients into food that they really have no understanding of. This in itself is reason enough to eat unprocessed foods like fresh fruit and vegetables. The problem is - its hard to know what is 'fresh' anymore in the sense that even these staples can pose a risk in terms of contamination by insecticides, fungicides, etc. Increasingly food producers are using genetically modified foods, and whilst many of these crops are being developed to reduce chemical application to crops, there is the possibility that the GM-solution might pose a different threat.
I have mixed thoughts on GM foods because the reasons for modifying them, or the outcome of modifying them is mixed. The rationale for tinkering with the DNA of a food gene is to:
1. Make the food look more presentable (saleable) in the store. To the extent that this gives the food a longer shelf life, more durable is a good thing, but i think the consumer would like to believe that taste, texture and juice content will remain the same. I can't believe that biotech companies would alter the good aspects of a food unless it was a compromise. The implication is that they are not just altering a single gene.
2. Make the food resistant or repulsive to insects or disease by adding certain DNA that has this characteristic
It should be apparent that the food producers concern is factors that helps the producer - not the consumer. The implication is that consumers have no advocate. It matters only that you are satisfied at the point of sale, even though you will ultimately not know until you cut open and taste the food. But thats no worse that the experience we would have with processed food, in which case we have no idea what the condition of that purated food could be, and what additives have been used to preserve colour. In these instances where consumers are treated as ignorant fools utimately it is deaths that are going to cause a revision of health/food preparation standards. The problem is - if its a slow death - from GM poisoning (if any such evidence emerges), you can bet that little will be done because its not an immediate problem and the industry will be geared up to protect their established procedures, brands or ingredients.
An example of context dropping is where you have food producers advertising 'low salt' food varieties, but they preserve taste by adding more fat and preservatives. Or a 'low sugar' has high fat, or a 'low fat' yoghurt has low sugar. The reality however is that it ultimately matters more what role a certain food plays in your diet. The implication is that people should be planning a balanced diet and have a shopping list that relates to a dietary plan. There is little consensus but the greatest support seems to be for a low GI, high carb diet with an emphasis on lean red meat and fish. The appeal of low GI carbs are that they are more slowly converted into sugars absorbed into the blood stream. Now 'low GI foods' may seem highly promising but the same problem exists - if you eat alot of 'low GI food' it will still be converted into soluble sugars, and any excess sugars will be converted into fat. The implication is that whilst complex carbohydrates (low GI) like vegetables and non-tropical fruits might be good for you, if you eat too many of them, you will put on fat.
This brings us to the last point - your overall energy balance. At the end of the day people tend to be eating more and exercising less because of changes in lifestyle, social behaviour and technology. We are playing less sport and playing more computer games or using computers. Perhaps the best opportunity to create good habits is by organising your life - schedules provide one form of structure, organised activities another. Planning is another good strategy - in the sense that you can identify all the qualities you want in a house. eg. A library 1km away with a lan to walk there. You can buy an apartment right above a shopping mall or 1km away so you get the benefit of exercise getting there. Alot of eating is actually anxiety-related. When we have a build up of mental anxiety we want a physical 'release'. We often use food to medicate these needs when in fact exercise is a better alternative. Previously I lived at Terrigal and whenever I had one of these moments I would walk along the beach - it proved to be about 3 times a day. Being near a forest is another great opportunity or just a quiet residential area.
By way of example, about 5 years ago my doctor informed me that I had a high cholesterol level. I was eating too much cheese and white bread and doing little exercise. The reason this didn't bother me was that I was not overweight. The media had created a perception in my mind that 'fat = cholesterol'. Recognising that my perceptions about 'good health' were misguided I promptly started reading alot of health books on diet, self-improvement, etc. As a result, not only did I learn that thin people dont necessarily have low choloesterol levels, I learned that it was actually that the type of cholesterol and the ratio of HDL and LDL is more important.
The current problem is that perceptions are more important than facts, which means misinformation, lack of disclosure and context dropping are rampant in product labelling. You might ask - why is that. I think its because it costs advertisers too much to correct the perceptions of other advertisers, and there is no industry-wide effort to correct those misconceptions. Basically not only does food have to be nutritious, it has to taste good. In fact taste is a bigger selling point, because whilst we can be high-minded about help, most people circum to temptation. The implication is that food producers are left choosing between salt, sugar or fat as a way of satisfying the taste preferences of consumers. But there are other issues as well. It matters are great deal what our food looks like. So expect transition trans fatty acids so your margarine spreads easily.
Another problem is relative standards. We might be told that a certain cheese is 25% less fat, but by what standard is that good. There is a very healthy 'low cholesterol' olive oil based spread on the market that discloses that 'it is virtually free of trans fatty acids'. But there is virtually no nicotine in cigarettes as well, so one wonders about these relative standards. At the end of the day, I would suggest in 2 years time, you could be learning that:
1. Trans fatty acids are not the problem they are thought to be, in fact they have good aspects
2. Trans fatty acids are seriously carcinogenic in very small amounts.
You might wonder why food manufacturers are placing ingredients into food that they really have no understanding of. This in itself is reason enough to eat unprocessed foods like fresh fruit and vegetables. The problem is - its hard to know what is 'fresh' anymore in the sense that even these staples can pose a risk in terms of contamination by insecticides, fungicides, etc. Increasingly food producers are using genetically modified foods, and whilst many of these crops are being developed to reduce chemical application to crops, there is the possibility that the GM-solution might pose a different threat.
I have mixed thoughts on GM foods because the reasons for modifying them, or the outcome of modifying them is mixed. The rationale for tinkering with the DNA of a food gene is to:
1. Make the food look more presentable (saleable) in the store. To the extent that this gives the food a longer shelf life, more durable is a good thing, but i think the consumer would like to believe that taste, texture and juice content will remain the same. I can't believe that biotech companies would alter the good aspects of a food unless it was a compromise. The implication is that they are not just altering a single gene.
2. Make the food resistant or repulsive to insects or disease by adding certain DNA that has this characteristic
It should be apparent that the food producers concern is factors that helps the producer - not the consumer. The implication is that consumers have no advocate. It matters only that you are satisfied at the point of sale, even though you will ultimately not know until you cut open and taste the food. But thats no worse that the experience we would have with processed food, in which case we have no idea what the condition of that purated food could be, and what additives have been used to preserve colour. In these instances where consumers are treated as ignorant fools utimately it is deaths that are going to cause a revision of health/food preparation standards. The problem is - if its a slow death - from GM poisoning (if any such evidence emerges), you can bet that little will be done because its not an immediate problem and the industry will be geared up to protect their established procedures, brands or ingredients.
An example of context dropping is where you have food producers advertising 'low salt' food varieties, but they preserve taste by adding more fat and preservatives. Or a 'low sugar' has high fat, or a 'low fat' yoghurt has low sugar. The reality however is that it ultimately matters more what role a certain food plays in your diet. The implication is that people should be planning a balanced diet and have a shopping list that relates to a dietary plan. There is little consensus but the greatest support seems to be for a low GI, high carb diet with an emphasis on lean red meat and fish. The appeal of low GI carbs are that they are more slowly converted into sugars absorbed into the blood stream. Now 'low GI foods' may seem highly promising but the same problem exists - if you eat alot of 'low GI food' it will still be converted into soluble sugars, and any excess sugars will be converted into fat. The implication is that whilst complex carbohydrates (low GI) like vegetables and non-tropical fruits might be good for you, if you eat too many of them, you will put on fat.
This brings us to the last point - your overall energy balance. At the end of the day people tend to be eating more and exercising less because of changes in lifestyle, social behaviour and technology. We are playing less sport and playing more computer games or using computers. Perhaps the best opportunity to create good habits is by organising your life - schedules provide one form of structure, organised activities another. Planning is another good strategy - in the sense that you can identify all the qualities you want in a house. eg. A library 1km away with a lan to walk there. You can buy an apartment right above a shopping mall or 1km away so you get the benefit of exercise getting there. Alot of eating is actually anxiety-related. When we have a build up of mental anxiety we want a physical 'release'. We often use food to medicate these needs when in fact exercise is a better alternative. Previously I lived at Terrigal and whenever I had one of these moments I would walk along the beach - it proved to be about 3 times a day. Being near a forest is another great opportunity or just a quiet residential area.
Monday, August 6, 2007
Using medical services in developing countries
This posting comes in 3 parts:
1. Medical emergency
2. Elective medical treatment by foreign doctors or dentists
3. My observations about medical services
Medical emergencies
I am an avid traveller to developing countries - having been to about 30 of them. In that time I have avoided serious medical ailments, though it has at least given me an idea of what I can expect in different countries in terms of costs, services and competency, as well as the risks from poor food preparation. So let me describe those situations.
1. Haiphong City, Halong Bay, Vietnam in 2001: This is a few years ago now, but I'm quite sure nothing has changed. I was sweating profusely with a bad fever. I went to a local first aid hospital where I managed to find a doctor that spoke English. He was rather young looking, but in my search for symptoms I noticed a yellow spot on my leg. I thought maybe an iodine deficiency or something. Actually it was just an old bruise. Anyway he seemed to have less of an idea. Really I got no help. So I decided to go to Hanoi, as I know there was a international hospital there with western doctors. Within an instant I was diagnoses flawlessly. I had food poisoning from a local restaurant where I was eating daily. Sick despite being very selective about what I ate. The other issue I had in Hanoi was a fungal infection. Basically a big 'moon-shaped' inflamation around my anal passage to be medically correct. Well I paid $US120 for that profound advice, which didn't bother me much because I was just relieved I didnt have some rare skin disease, but they charged me $20 for a generic fungal cream that would cost $6 in my country, and $3 locally. Well I will be wiser in future. They are really praying on the fact that you dont know if foreign medicines are available in the country, and where to get them. Because whom do you ask for advice - few speak English, and who knows where a drug store is unless you've need one in a developing country....well its not easy in Vietnam...but Philippines is easy.
2. Lipa City, Batangas, Philippines: Lipa is a small city 80km south of Metro Manila. It has a small hospital. I paid Y600 ($US12) to see a GP. Being a foreigner I pay alot more, but the good news is that I go to the start of the queue (20-people long). I suspect they are free patients. He gave me little time, in fact he had an assistant gather all the info, so I spent just 1minute with him...I did however get the chance to sit down. In that one minute he referred me to a urologist. The urologist had the same system, a queue outside, which I didnt have to wait through, but that was little comfort because he kept me waiting for 90mins inside his office along with 6 other people - not patients mind you, but sales people from pharmaceutical companies - Pfizer and a competitor. I thought this highly suspicious, but I guess at least he is letting them compete against each other. I'm just wondering to what extent commission will feature in the selection criteria. But anyway...he kept me waiting so long...then again....he offers me just a 30sec appointment which cost me P800 ($US16) because he has another appointment. On reflection I am paying about $US720/hour for services that would cost me $US350-400/hour in the west...and I'm waiting twice as long as any western medical centre....go figure. I didnt even get to sit down, and he sends me off to the lab. The lab seemed to be where all the work was done. Yet that cost me just P220 ($US5). I didnt bother returning to the specialist for an opinion...I just interpreted the results myself.
3. Medical Central, Robinsons Galleria Shopping Mall, Ortigas Centre, Metro Manila: I went to a local medical centre in Metro Manila. This is by no means an upmarket one. A nurse gets your pulse, and asks you the basic questions, then you wait 30-40mins for a doctor. At this place I was treated like any other patient. Thats a good thing. The service at this place was much better though since I had a 15min consultation, though I found that the staff has a low level of medical knowledge.
Another ok medical centre I found was on the 5th floor of the Shangrila Mall in Ortigas Centre, Metro Manila. Its the place I would go for minor ailments.
4. Medical City Hospital, Ortigas City, Metro Manila: This is a private hospital, and is considered one of the best in the Philippines. I found the standard of medical care equal to, if not better than any I have received in the western world. The catch though is that I paid for it. I had a blood test, stool test and scan of my intestinal organs and 2 consultations for P16,000 ($US320). Not cheap by any means. But problem resolved....I was tired after 3 weeks of non-diagnosis.....thats 3 weeks of diarhorea...and the advice....you have a bacterial infection...drink more water, avoid alcohol and oily foods. :) There are 2 other private hospitals in Metro Manila which have a similar standing of service:
5. Asia Hospital - further info coming??
6. St Lukes Hospital - further info coming??
7. Another??
What became apparent to me is that hospitals are very good because they offer a higher standard of care, they have the capacity to carry out most tests you need to perform...though I suspect if I wanted to get tested for the antibodies that would prove I had celia disease, I might need to go to a western hospital. But as it was I just had an intestinal infection and not a gluton intolerance. The cost of a room in a public hospital is about the same as a hotel (P2000 or $US40 per night). Consultations and testing might just be P1000-2000 ($US20-40) compared to P15,000-20,000 ($US300-400) at a private hospital.
Elective Medical Treatments
There are alot of skin treatment places in the Philippines though I have no idea as to the quality of care. I suspect they are not high because of the lack of codification of standards. There is however certainly a trade-off between standards and price. I'd hate to risk using a dodgy service provider who sees $$$ without any duty of care.
I met a foreign guy who was friends with a Filipino girl who recommended that I go to a certain dentist for care. I was accustomed to paying $US110 just to clean and checkup in Australia, but I paid just P600 ($US12) in the Philippines. But get this - I went to an upmarket dentist in the Rockwell Centre, Makati City, Metro Manila. This guy is well qualified and attends conferences in the USA. His equipment was more modern than anything I'd seen in Australia. Dont know why Australian dentists are so tight with their equipment. Never found one with digital cameras..but maybe that has changed since. I can tell you that the level of care and attention that I received from this upmarket dentist far exceeds anything I received from the 5-odd dentists I've been to in Australia.
Though I note that when it came to receiving 'significant care' like the recapping of 2 teeth, the cost went up considerably. I was quoted $US750....and I suspect this pricing was more in line with western prices. I suspect the motive was that I no longer appeared to have a Filipino friend. So the moral of this story is...you will get more competive prices if you have Filipino friends....better still if they ngotiate for you over the phone.
I believe there are similar opportunities to avail of cheap medical services in Thailand and India. But dont go to westerners in developing countries, as they will charge you more for the privilege, and its just possible they are there because they breached some ethical standard in their home country. Such doctors can more readily pay off an official in Asia to get a licence here. Asia is so corrupt. Alot of Asian doctors are educated in western countries....to varying degrees.
Actually my observation is that the quality of formal medical education is not so bad in developing countries, but that the low attention to medical standards and training after they have graduated is the problem. Perhaps someone can comment on this. The reason I say this is because I think you might learn alot of theory at university (in whatever subject you do), but without training in applied medicine, you are likely not going to develop into a fine doctor. That observation comes from personal experience and talking to a young medical graduate from the Philippines. He's a smart guy, and I think the lack of institutional support in the Philippines on the training side would have undermined his capacity to provide good service. So I think its more important to recognise doctors that have worked overseas as opposed to have studied their full degree in the USA. Another qualifier I will make. I think in diagnosing conditions, critical thinking is an important capability, and I dont think Asian culture is conducive to those skills. Even the western world tends to marginalise critical thinks in adulthood, but its worse in Asia. So if its not familar to them, they are unlikely to offer helpful advice.
My observations about health service
As a foreigner there is a tendency for them to charge you a 'foreign price' as opposed to the local price. They dont tend to do that however if you are accompanied by a Filipino, or better still the initial inquiry is made by a Filipino national. In case you are wondering...servicing foreigners is a very controversial issue in the Philippines. Every year the best graduate doctors, programmers and others from the best universities get offered jobs overseas. Critics argue that some of these people received free education yet render no service to Filipinos. The reality is however that these Filipinos repatriate huge amounts of money back to the Philippines - equal to 30% of the national GDP.
1. Medical emergency
2. Elective medical treatment by foreign doctors or dentists
3. My observations about medical services
Medical emergencies
I am an avid traveller to developing countries - having been to about 30 of them. In that time I have avoided serious medical ailments, though it has at least given me an idea of what I can expect in different countries in terms of costs, services and competency, as well as the risks from poor food preparation. So let me describe those situations.
1. Haiphong City, Halong Bay, Vietnam in 2001: This is a few years ago now, but I'm quite sure nothing has changed. I was sweating profusely with a bad fever. I went to a local first aid hospital where I managed to find a doctor that spoke English. He was rather young looking, but in my search for symptoms I noticed a yellow spot on my leg. I thought maybe an iodine deficiency or something. Actually it was just an old bruise. Anyway he seemed to have less of an idea. Really I got no help. So I decided to go to Hanoi, as I know there was a international hospital there with western doctors. Within an instant I was diagnoses flawlessly. I had food poisoning from a local restaurant where I was eating daily. Sick despite being very selective about what I ate. The other issue I had in Hanoi was a fungal infection. Basically a big 'moon-shaped' inflamation around my anal passage to be medically correct. Well I paid $US120 for that profound advice, which didn't bother me much because I was just relieved I didnt have some rare skin disease, but they charged me $20 for a generic fungal cream that would cost $6 in my country, and $3 locally. Well I will be wiser in future. They are really praying on the fact that you dont know if foreign medicines are available in the country, and where to get them. Because whom do you ask for advice - few speak English, and who knows where a drug store is unless you've need one in a developing country....well its not easy in Vietnam...but Philippines is easy.
2. Lipa City, Batangas, Philippines: Lipa is a small city 80km south of Metro Manila. It has a small hospital. I paid Y600 ($US12) to see a GP. Being a foreigner I pay alot more, but the good news is that I go to the start of the queue (20-people long). I suspect they are free patients. He gave me little time, in fact he had an assistant gather all the info, so I spent just 1minute with him...I did however get the chance to sit down. In that one minute he referred me to a urologist. The urologist had the same system, a queue outside, which I didnt have to wait through, but that was little comfort because he kept me waiting for 90mins inside his office along with 6 other people - not patients mind you, but sales people from pharmaceutical companies - Pfizer and a competitor. I thought this highly suspicious, but I guess at least he is letting them compete against each other. I'm just wondering to what extent commission will feature in the selection criteria. But anyway...he kept me waiting so long...then again....he offers me just a 30sec appointment which cost me P800 ($US16) because he has another appointment. On reflection I am paying about $US720/hour for services that would cost me $US350-400/hour in the west...and I'm waiting twice as long as any western medical centre....go figure. I didnt even get to sit down, and he sends me off to the lab. The lab seemed to be where all the work was done. Yet that cost me just P220 ($US5). I didnt bother returning to the specialist for an opinion...I just interpreted the results myself.
3. Medical Central, Robinsons Galleria Shopping Mall, Ortigas Centre, Metro Manila: I went to a local medical centre in Metro Manila. This is by no means an upmarket one. A nurse gets your pulse, and asks you the basic questions, then you wait 30-40mins for a doctor. At this place I was treated like any other patient. Thats a good thing. The service at this place was much better though since I had a 15min consultation, though I found that the staff has a low level of medical knowledge.
Another ok medical centre I found was on the 5th floor of the Shangrila Mall in Ortigas Centre, Metro Manila. Its the place I would go for minor ailments.
4. Medical City Hospital, Ortigas City, Metro Manila: This is a private hospital, and is considered one of the best in the Philippines. I found the standard of medical care equal to, if not better than any I have received in the western world. The catch though is that I paid for it. I had a blood test, stool test and scan of my intestinal organs and 2 consultations for P16,000 ($US320). Not cheap by any means. But problem resolved....I was tired after 3 weeks of non-diagnosis.....thats 3 weeks of diarhorea...and the advice....you have a bacterial infection...drink more water, avoid alcohol and oily foods. :) There are 2 other private hospitals in Metro Manila which have a similar standing of service:
5. Asia Hospital - further info coming??
6. St Lukes Hospital - further info coming??
7. Another??
What became apparent to me is that hospitals are very good because they offer a higher standard of care, they have the capacity to carry out most tests you need to perform...though I suspect if I wanted to get tested for the antibodies that would prove I had celia disease, I might need to go to a western hospital. But as it was I just had an intestinal infection and not a gluton intolerance. The cost of a room in a public hospital is about the same as a hotel (P2000 or $US40 per night). Consultations and testing might just be P1000-2000 ($US20-40) compared to P15,000-20,000 ($US300-400) at a private hospital.
Elective Medical Treatments
There are alot of skin treatment places in the Philippines though I have no idea as to the quality of care. I suspect they are not high because of the lack of codification of standards. There is however certainly a trade-off between standards and price. I'd hate to risk using a dodgy service provider who sees $$$ without any duty of care.
I met a foreign guy who was friends with a Filipino girl who recommended that I go to a certain dentist for care. I was accustomed to paying $US110 just to clean and checkup in Australia, but I paid just P600 ($US12) in the Philippines. But get this - I went to an upmarket dentist in the Rockwell Centre, Makati City, Metro Manila. This guy is well qualified and attends conferences in the USA. His equipment was more modern than anything I'd seen in Australia. Dont know why Australian dentists are so tight with their equipment. Never found one with digital cameras..but maybe that has changed since. I can tell you that the level of care and attention that I received from this upmarket dentist far exceeds anything I received from the 5-odd dentists I've been to in Australia.
Though I note that when it came to receiving 'significant care' like the recapping of 2 teeth, the cost went up considerably. I was quoted $US750....and I suspect this pricing was more in line with western prices. I suspect the motive was that I no longer appeared to have a Filipino friend. So the moral of this story is...you will get more competive prices if you have Filipino friends....better still if they ngotiate for you over the phone.
I believe there are similar opportunities to avail of cheap medical services in Thailand and India. But dont go to westerners in developing countries, as they will charge you more for the privilege, and its just possible they are there because they breached some ethical standard in their home country. Such doctors can more readily pay off an official in Asia to get a licence here. Asia is so corrupt. Alot of Asian doctors are educated in western countries....to varying degrees.
Actually my observation is that the quality of formal medical education is not so bad in developing countries, but that the low attention to medical standards and training after they have graduated is the problem. Perhaps someone can comment on this. The reason I say this is because I think you might learn alot of theory at university (in whatever subject you do), but without training in applied medicine, you are likely not going to develop into a fine doctor. That observation comes from personal experience and talking to a young medical graduate from the Philippines. He's a smart guy, and I think the lack of institutional support in the Philippines on the training side would have undermined his capacity to provide good service. So I think its more important to recognise doctors that have worked overseas as opposed to have studied their full degree in the USA. Another qualifier I will make. I think in diagnosing conditions, critical thinking is an important capability, and I dont think Asian culture is conducive to those skills. Even the western world tends to marginalise critical thinks in adulthood, but its worse in Asia. So if its not familar to them, they are unlikely to offer helpful advice.
My observations about health service
As a foreigner there is a tendency for them to charge you a 'foreign price' as opposed to the local price. They dont tend to do that however if you are accompanied by a Filipino, or better still the initial inquiry is made by a Filipino national. In case you are wondering...servicing foreigners is a very controversial issue in the Philippines. Every year the best graduate doctors, programmers and others from the best universities get offered jobs overseas. Critics argue that some of these people received free education yet render no service to Filipinos. The reality is however that these Filipinos repatriate huge amounts of money back to the Philippines - equal to 30% of the national GDP.
How to manage your health affairs
The topic of this post might make you wonder - what are 'health affairs' - isn't that some government bureaucracy? Well yeh...and it exists because individuals fail to take responsibility for their personal affairs - in this case health.
I have learned the hard way that its important to have a systematic and deliberate strategy and plan for managing your life, and that the earlier you develop such a strategy the more fluid the system will operate and the less cumbersome adminstrative challenge it will become. The intent of my health strategy is to know ahead of time the way I should live in order to maximise my capacity to enjoy it, as well as to prolong my life as long as possible so I can achieve as much as possible within the limits of my 'human capability'.
It is my firm believe that having a strategy is not a waste of time. I believe that the time I spend researching health issues, understanding my body and developing my strategy is going to be repaid in several respects, which I think will become apparent over the course of this posting.
Of course there is a trade-off. I am not suggesting that we need a study health issues for years. I am well aware that there are doctors who do that. I am saying that you need to take personal responsibility for your health issues, because unless you are wealthy enough to have a personal health care expert managing the health aspects of your life, I can guarantee that you know more about aspects (symptoms, medical history) of your health than your doctor. The problem with way health is currently managed is that:
I have learned the hard way that its important to have a systematic and deliberate strategy and plan for managing your life, and that the earlier you develop such a strategy the more fluid the system will operate and the less cumbersome adminstrative challenge it will become. The intent of my health strategy is to know ahead of time the way I should live in order to maximise my capacity to enjoy it, as well as to prolong my life as long as possible so I can achieve as much as possible within the limits of my 'human capability'.
It is my firm believe that having a strategy is not a waste of time. I believe that the time I spend researching health issues, understanding my body and developing my strategy is going to be repaid in several respects, which I think will become apparent over the course of this posting.
Of course there is a trade-off. I am not suggesting that we need a study health issues for years. I am well aware that there are doctors who do that. I am saying that you need to take personal responsibility for your health issues, because unless you are wealthy enough to have a personal health care expert managing the health aspects of your life, I can guarantee that you know more about aspects (symptoms, medical history) of your health than your doctor. The problem with way health is currently managed is that:
- Division of responsibility: There is no clear demarcation of responsibility when you visit a doctor. Its not readily apparent what role you should perform, what your job is. Many of us just turn up and expect them to know. Certainly no one helps us, which is why we have to take pro-active steps to prepare ourselves to get the best possible outcome.
- Personal interest: Apart from the initial interest in your personal history, I think doctors tend to take little interest in patients personal care. That is a sad testimony to the level of empathy that doctors generally have. I truly think most of them hate their jobs...sticking fingers up people's arses...and the need to always be there. Its a job that requires a genuine paternal care, but I think alot of doctors grow weiry of that concept over time...which was perhaps idealistically conceived. Or perhaps its because they are dealing more with foot fungus and sexually transmitted diseases than with life threatening diseases.
- Conflict of interests: Often you have medical centres with their own pharmacy (drug store). It might be 'seemingly independent' but rest assured if its in the same building, there is a relationship with the owner. Its worth finding out the cost of various medicines at various stores because I have found big differences...even huge mark-ups for late night service. Your doctor might recommend a medicine that he believes will do the trick, but is that because he receives a commission from a pharmaceutical company or the pharmacy. Is he rejecting a cheaper generic product or a home remedy. I am amazed when doctors and dentists claim that the results of the medical tests you undertake is their property by virtue of them holding them. Find out your doctors policy on that issue. Since the ascension of medical centres, I think the 'commercialism' has perhaps given away to the need of patients for flexible options.
- Unorganised structure: Professionals are amongst the most self-indulgent and poorly organised people on earth because they always want to do their own thing - and doctors are no exception. Consider that its only now that we are seeing computerisation of medical records, which means doctors can actually read another doctors writing. It means a doctor can have access to a patients full medical history, and easily transfer these records to other doctors.
- Lack of relationship: Unless you have been able to retain the same relationship with a family doctor over the years, its likely that your doctor has joined a medical centre, where they share facilities and administrative staff. There are pros and cons to this set-up. The benefit is that doctors can make more money sharing facilities, as well as have more flexibility with working hours. The problem is that patients no longer have a relationship with their doctor, and it means that bad doctors tend to be supported by this system. Why? Because you get a 2nd opinion rather than returning to the old one.
So I offer the following health care tips:
- Be selective: When you go to a medical centre, never accept just any doctor, becaus you will be assigned to the doctor that no one else wants an appointment with, whether its because they are incompetent, impersonal or inexperienced. A better strategy is to ask for any specific doctor from the list on the wall. If they are not ready, have another choice. I have routinely found that if you dont ask for a doctor, you get a bad one. Often some immigrant doctor with poor training, offered a resident work permit because of the shortage of skilled local doctors. Rural areas have little choice unfortunately.
- Know your risks: Few people have the spare time to get a medical degree, or to spend weeks learning about their health isues. However it is worthwhile understanding the top 10-20 biggests threat to your gender. These lists are often provided in the newspapers and are easily found on the internet. By researching these ailments and making some notes about threats, preventative measures you can take to avoid, and symptoms you can expect to identify.
- Be prepared: I dont know about you, but for years I was going to doctors and expecting them to determine my health issue with little help from me. I simply didnt give it much thought, and they showed no concern for my lack of knowledge too. The implication is that they had to search for symptoms as opposed to me telling them. I could say I was in pain, but was not particularly sure where it was. I have since learned to attend a doctor's appointment PREPARED, which means that over the 3 day period in which I am ill, I will make a note of what symptoms I feel (note anything out of the ordinary), when it occurs, how frequent, where it is, and its nature. Writing a note on my PDA ensures I dont forgot it, since its always with me.
- Know your symptoms: Another aspect is knowing how to describe how I feel. Often I found I didnt have the vocabulary to describe what I was feeling, or even what constituted a symptom. But its ok if you write down unrelated issues, as the doctor will know the difference. You can find a list of symptoms that you can check on the internet. Dont rationalise a disease - so read through the list dispassionately before you attempt to match a condition to it. See www.wrongdiagnosis.com.
- Do your own research: I cant understate the importance of researching your condition on the internet. Many of my doctors are impressed when I display some knowledge of my condition. My family has a history of Celiac Disease - simply a gluton (wheat) toxicity or intolerance - yet a great many doctors didnt know about it. There are websites that allow you to type in your symptoms to get a list of possible conditions. My advise is to independently research those conditions to see if you have a match. You might identify other symptoms that were not readily apparent to you. Its important that you let the doctor diagnose rather than tell him his job. Tell him you did some research on the internet...ask him why he thinks your condition is not ...... since you display symptoms ..... By keeping your doctor accountable, you can have greater confidence in his professionalism. If you are in doubt, seek a second opinion before you self-diagnose. Doing research can actually save you money and time. Knowing that I needed to fast before taking a blood test, I didnt take any food or fluids for 10 hours before my appointment. Of course you might not care if you have a free health system.
- Ask questions: You need to establish whether your doctor is credible becaus you need to know whether he is in a position to know your condition, and if not whether you need to seek a 2nd opinion. Doctors are humans, so if they have a low self-esteem or pride in their position, they might not willingly convey their ignorance on a medical issue, but look for other signs, eg. Body posture or tone. But by far the best approach is critical thinking. Asking probing questions is the best approach, and research is intended to help you identify those. A good doctor will respect you for taking an interest (I have found), insecure or incompetent doctors will get defensive and attempt to derail you. Dont be perturbed, they are telling you they are not capable of helping you at the standards of service you require....so dont see them again.
- Understand the doctors perspective: Understanding the motivations of your doctor can help you get better service and save money. The longer time you spend with a doctor, the more he will treat you like a human being. The more you corner him, or attack his diagnosis, the more defensive he will be. In some countries (Philippines) doctors are illegally selling medicines directly. This can bias the doctor's judgement and result in you being prescribed medicines that have more severe side-effects. Avoid these doctors as they are crossing an ethical divide. Doctors often have deadlines for meetings or a queue of patients. Dont be surprised if they short-change you on service so they can alleviate these pressures. Protect yourself.
- Prevention: Determine what is a healthy way of living. I am a great believer that our bodies give us a great deal of information about our health condition. Try different diets and see what impact it has on you. Consider your level of energy, gastro-intestinal condition, flatulence, weight control. You should get blood tests for cholesterol (HDL/LDL) as well. Doctors are only concerned with our health at times of ailment, but many conditions are discovered too late, and can be avoided through prevention. I am skeptical that there is 'one diet' for all people....maybe it depends on your genetic makeup. Maybe our bodies adjust if we adopt a regular diet. Regardless, you cant ignore empirical evidence of what constitutes a healthy body.
- Family History: Ask your parents and grandparents if there is any medical condition or affliction that is affecting your family that might have a genetic link. Upon identifying any such issues, research the ailment and make notes. Dont forget to provide your information to other family members. I found out that my family had incidences of celiac disease and a rare (rubbing) eye condition. Fortunately pretty good with respect to cancer.
- Standards of comparison: You really dont know what a good doctor is until you've had one, so experiment with some. I dont mean just a few at your local medical centre. Go to some up-market suburbs 20km away to see what type of service wealthy people are receiving, and what they are paying for it. Professionalism is mostly the result of personal ethics rather than anything genetic. Wealthy people are accustomed to paying more for service, so expect doctors in those communities to know better. If it costs more, then economise....just go there when you have a critical ailment as opposed to a common cold.
Alot of the advise here does not just apply to personal health. I dont know much about cars, but I apply the same critical thinking skills to car mechanics. Mechanics and other tradespeople are famous for over-servicing customers with no knowledge of their field. So ask probing questions to determine how necessary a certain component replacement is. The chances are they will be applying very 'high' standards to your car, or very conservative 'replacement policies' in an attempt to increase their profits. Alot of them aren't 'directly' dishonest, but they are not acting with regard for your best interests if they dont make you informed, and that is a breach of professional standards of care for the interests of the customer.
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