Getting a New Knee or Hip? Do It Right the First Time

An informative article on joint replacement by Lesley Alderman appeared in the New York Times recently. It talks about the things that a patient should keep in mind if considering a joint replacement (hip replacement or knee replacement) surgery. Following is the article as it appeared on the NY Times website.

THERE is nothing like a new hip or knee to put the spring back in your step. Patients receiving joint implants often are able to resume many of the physical activities they love, even those as vigorous as tennis and hiking. No wonder, then, that joint replacement is growing in popularity.

In the United States in 2007, surgeons performed about 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier. Though these procedures have become routine, they are not fail-safe.

Implants must sometimes be replaced, said Dr. Henrik Malchau, an orthopedic surgeon at Massachusetts General Hospital in Boston. A study published in 2007 found that 7 percent of hips implanted in Medicare patients had to be replaced within seven and a half years.

The percentage may sound low, but the finding suggests that thousands of hip patients eventually require a second operation, said Dr. Malchau. Those patients must endure additional recoveries, often painful, and increased medical expenses.

The failure rate should be lower, many experts agree. Sweden, for instance, has a failure rate estimated to be a third of that in the United States.

Sweden also has a national joint replacement registry, a database of information from which surgeons can learn how and why certain procedures go awry. A registry also helps surgeons learn quickly whether a specific type of implant is particularly problematic. “Every country that has developed a registry has been able to reduce failure rates significantly,” said Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn.

A newly formed American Joint Replacement Registry will begin gathering data from hospitals in the next 12 to 18 months.

Meanwhile, if you are considering replacing a deteriorating knee or hip, here are some ways to raise the chances of success and avoid a second operation.

EXPERIENCE COUNTS Choose – or request a referral to – an experienced surgeon at a busy hospital. “The most important variable is the technical job done by the surgeon,” said Dr. Donald C. Fithian, an orthopedic surgeon and the former director of Kaiser Permanente’s joint replacement registry.

Ask for recommendations from friends who have had successful implants and from doctors you know and trust. When you meet with the surgeon, ask how many replacements he or she does each year.

VOLUME MATTERS A study published in The Journal of Bone and Joint Surgery in 2004 found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

The researchers documented a similar trend when it came to hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

ADJUST EXPECTATIONS Not everyone with joint pain will benefit from a joint replacement.

An implant can help reduce pain and improve mobility if the joint surface is damaged by arthritis, for instance. But a new joint will not help pain caused by inflammation of the surrounding soft tissue, said Dr. Berry, who is also vice president of the board of the American Academy of Orthopaedic Surgeons.

Some people with mildly arthritic joints, for instance, can manage well with the judicious use of medication. “Surgery comes with complications and risks, and should not be approached lightly,” Dr. Berry said.

Joint replacement is not a minor operation. If you have uncontrolled high blood pressure or another serious chronic condition, a joint operation may simply be too risky for you.

NARROW YOUR OPTIONS “There is no one best joint,” Dr. Berry said. “A successful replacement depends on selecting the right implant for the patient.”

A good surgeon will recommend an implant that makes sense for your age, activity level and the shape of your joint. Younger or very active people who place more physical demands on the implant, for instance, may benefit from newer hard-on-hard bearing surfaces, like those made of ceramic, said Dr. Joshua J. Jacobs, chair of orthopedic surgery at Rush University Medical Center in Chicago.

In general, be wary of the latest, most advanced new joint. There is little evidence to support the use of more expensive designs over basic ones, said Dr. Tony Rankin, a clinical professor of orthopedic surgery at Howard University. One recent study found that premium implants fared about as well as standard implants over a seven- to eight-year period.

Be skeptical, too, of advertising gimmicks. “I had a 78-year-old patient with a perfectly good knee replacement come in and ask if she should have gotten the ‘gender knee,’ which she had seen advertised on TV,” Dr. Rankin recalled. “She was doing well, but was swayed by the idea of a knee made just for women.”

GATHER THE DATA Once you have a recommendation or two from a surgeon, find out how well the joint has performed in others and if there are known complications. The newer metal-on-metal hip implants, for instance, are somewhat controversial and may cause tissue and bone damage in certain patients.

Ask if the hospital has a registry that tracks joint replacements. If so, ask to see the data on the implants you are considering.

It is also helpful to understand what the operation involves, including the materials that will be used and how the surgeon plans to fix the joint to the bone. You can learn more about your operation at the American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org.

If you want to delve deeper, look at a large national registry from another country, like Australia. The annual report of Australia’s registry lists knee and hip implants that had a “higher than anticipated revision rate.”

A caveat: the information can be difficult to parse for a layperson. “A surgeon can provide perspective on information that, taken out of context, could be misleading,” Dr. Rankin said. So discuss it with your surgeon.

PLAN YOUR RECOVERY To avoid complications during your final stage of recuperation, discuss with your doctor in advance the support you will need when you return home, Dr. Berry advised.

Recovery takes a different course for each patient, depending on the type of procedure and implant. In general, expect mild to moderate pain for the first few weeks. Some patients are able to return to work in one to two weeks, but full recovery can take six to 12 months, Dr. Jacobs said.

Make sure you have the help you need in the initial stages of recuperation. Since you may have difficulty getting around and won’t be able to drive right away, you may want to have a friend or family member stay with you. You may even need to hire an aide or visiting nurse.

Follow your doctor’s orders, and don’t rush your recovery. You don’t want your new joint to fail because you couldn’t resist carrying loads of laundry up and down stairs, or felt compelled to rearrange the patio furniture.

If the new joint is given time to heal, you will find plenty of opportunities for all that in the future.

Related links

  • Affordable joint replacement surgery overseas
  • Cost of knee replacement or hip replacement surgery
  • What joint replacement surgery patients are saying
  • Medical tourism
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    Chris Y from USA had a hip replacement surgery at Fortis Hospital, Mumbai, India facilitated by Healthbase. Following is his story about his experience with medical tourism abroad for hip replacement surgery.

    About 5 weeks ago I went from the USA (Raleigh, North Carolina) to Mumbai, India, for hip replacement surgery. I have been home for a while now and am happy to report I am making great progress toward total recovery.

    My hip problem was with me many years, but only showed itself during the past one year. In that year my gait went from normal to limping to a sort-of painful hop on only my good leg. Clearly I was in need. So I researched greatly many options both in the USA and abroad and found that more hip operations were successfully performed overseas, specifically in India. Through my research I connected with Moe, who is Healthbase’s Customer Support Manager. He patiently answered each of my questions, even when I would call again and ask new and different questions. Moe arranged for a 3-way conversation with the surgeon of my choice, who, also through my research, I chose to be the world-renowned hip resurfacing/joint replacement surgeon, Dr. Kaushal Malhan. After consideration, I realized that Healthbase, Dr. Malhan, and Fortis hospital were the right choices for me.

    About 3 months later I was ready to take a trip to Mumbai, India to become whole again. Being adventurous, I arranged for my own airfare, while Moe arranged for my hospital stay, and the date of my surgery. My stay in the hospital was for a total of 12 days and 12 nights, which went by very quickly.

    I hopped on the plane, (actually 3 planes), and was met at the airport (at 1 am) by Bharat, who is Fortis hospital’s International Patient Relations Manager. That same night I was brought to my room, where my check-in went fast and easy.

    Let me tell you about my room. It was spacious (it was actually called a suite). It was well lit and very clean. I had all the amenities I could want – a TV, a computer, a phone, a refrigerator (stocked with complementary juices), a large easy chair, hot water-maker for coffee, lots of pillows to lounge with, and a very big bathroom area. Every day during my stay the cleaning crew came to clean everything (even the bathroom) and to change my linens.

    The day after my arrival was devoted to surgery prep, which went like clockwork. It was obvious the staff had plenty of experience. I was scared, as I had never had surgery before, but was reassured at each step by every one of the staff member’s professional demeanor. The next day was my surgery, which apparently went very well. (In addition, I also needed bone grafting – this had been explained to me the day before the surgery). I felt well and strong almost immediately after the surgery. For a few days after the surgery I was given, it seems, just the right amount of pain medication, since I felt no pain, yet could easily read a newspaper, had a normal sleep pattern, and a good appetite.

    Doctors, nurses, and dieticians would stop by my room daily to ask how I was feeling, did I need anything, and would I like to have anything different foodwise. The meals were always very tasty, as I could choose daily from a menu book, which had a wide variety of Indian or Continental cuisine. I could specify anything I would like to eat for any meal. I did eat a large amount each day, and had fresh fruit plates at least twice a day. Also, the kitchen was just a phone call away, so I could ask for anything at any time, day or night.

    I am now moving about several hours each day without crutches or a cane. My gait is coming back, and I am exercising using the routine I was taught while in the hospital. I am completely free of medication, and foresee a time in the near future when I will be able to once again take up long-distance bicycling and walks on the beach. Dr. Malhan’s skill as a surgeon has made this possible, and his minimally-invasive techniques have definitely aided in the speed at which my recovery has progressed.

    So here is the bottom line. My being a patient in Fortis Hospital was a good decision, a smart financial decision, and from a surgical standpoint, a very wise decision. My room was big and clean, the care I received was very good, the food was absolutely great, and the physical therapy I received was specific to my needs, intense but not overbearing, to which I also attribute in large part my very rapid recovery (they claim the Physiotherapy Department as ‘World Class’ – I can attest their skills truly make them such).

    Anyone who is considering joint resurfacing or replacement should seriously consider the many advantages of having Healthbase as their medical tourism facilitator. In addition, I highly recommend the staff at Fortis Hospital in Mumbai, India, and especially Dr. Kaushal Malhan, whose world-renowned surgical expertise continues to create successful outcomes in patients such as myself.

    Thanks Healthbase!

    Related links

    Healthbase, the leading US-based medical tourism provider, has partnered with a JCI accredited German hospital in order to bring wider options and greater convenience to Americans, Canadians, Europeans and others looking for affordable, timely and high quality medical and dental treatments.

    Healthbase Online Inc., the leading and award-winning medical tourism facilitator based in Boston, MA, has announced partnership with a Joint Commission International accredited hospital in Germany. With the addition of this JCI accredited hospital, Healthbase now has a network of over 100 health care and dental care providers spread across 18 countries. For the medical tourist it means more choices, wider variety and greater convenience.

    According to Saroja Mohanasundaram, CEO of Healthbase, “With growing demands from our consumer base for a quality tertiary medical care center in Europe, we are excited to have our newest Germany-based healthcare provider onboard. Our new member provider is JCI-accredited thereby giving the peace of mind to our patients regarding the high standards of quality that will be delivered by it. Our German provider offers a full complement of services and is an excellent choice for patients looking for orthopedic, spinal and bariatric treatments at a much discounted rate compared to USA and much faster access to service compared to that offered by public health care systems in Canada or the UK.”

    For patients from Europe, especially from the European Union (EU), this would be as good as going to a local hospital with the advantage of high or higher standard of service and without the inconvenience of the infamous waitlists as seen in government-sponsored healthcare systems such as the National Health Service or NHS in the United Kingdom.

    The hospital offers procedures like joint replacement procedures (such as hip replacement surgery and knee replacement surgery), spinal procedures (such as spine fusion surgery and artificial disc replacement surgery), and weight-loss procedures (such as lap band surgery, gastric bypass or RNY procedure and gastric sleeve surgery), among hundreds of other procedures.

    The favorable geographical location of Germany means that for patients coming from North America the flight times are shorter compared to other famous medical tourism destinations such as those in Asia. For those traveling from other European countries it is at a stone’s throw.

    Mohanasundaram adds, “We have carefully chosen our German provider after a rigorous selection process keeping in mind all aspects of affordable, safe and top quality medical tourism care. Patients can expect as much as 50 to 70% less cost compared to the cost of care in other developed countries such as the United States. Also, the staffs at our German provider speak English, thus, making communication easy.”

    Healthbase has the biggest and geographically most expanded network of healthcare and dental care providers in the industry. Patients have a wide selection of destinations to choose from for their low cost high quality medical care and dental care needs. These include Germany, India, Thailand, Singapore, South Korea, Malaysia, Philippines, New Zealand, Jordan, Turkey, Hungary, Belgium, Spain, Costa Rica, Panama, Brazil, Mexico, and USA.

    Healthbase serves the American, Canadian, European, African, Asian, Middle-Eastern and Asia Pacific markets, and offers more than 200 procedures.

    About Healthbase Online Inc.:
    Healthbase, an award-winning US-based medical tourism and dental tourism facilitator, is a one-stop source for global medical and dental choices, connecting patients to leading internationally accredited healthcare providers in 18 countries including India, Thailand, Singapore, South Korea, Turkey, Germany, Panama, Costa Rica, Mexico and USA. Healthbase caters to individual consumers, self-funded businesses, insurers, benefits plan consultants, third party administrators and those using Consumer Directed Healthcare Plans (CDHPs) or voluntary benefit plans. Healthbase coordinates over 200 procedures in various categories like orthopedic, spinal, cardiac, bariatric, urology, oncology, dental, cosmetic and general surgery. Some of the common procedures offered are Birmingham hip resurfacing, total hip replacement, knee replacement, ACL repair, rotator cuff surgery, spinal fusion, spinal disk replacement, heart bypass surgery, lap band, gastric bypass, cancer treatment, liposuction, dental implants, crowns, bridges, etc. for a fraction of the cost in the US with equal or superior outcomes. To ensure that patients receive the best care possible, Healthbase works mainly with hospitals that have international accreditations like JCI. To learn more, call 1-888-691-4584, email info.hb @ healthbase.com or visit http://www.healthbase.com.

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    Why Health Care Costs Keep Rising – Analysis and Solutions

    It’s no secret that the health care in the United States is expensive. But have you wondered why this is the case? Here’s an excellent analysis of the situation that we came across with proposed solutions of what can be done to cut down prices for the health care consumer – something which we feel you will find useful too. So, read on…

    Summary

    When economist Charles Wheelan published an analysis titled “The Top 10 Reasons for Soaring Health-Care Costs,” it was refreshing to read about the problem from an economics point of view. What Wheelan did not cover, however, was what we can do to address the issues that continue to cause health care costs to spiral out of control. What follows is a point-by-point look at Wheelan’s top 10 reasons followed by a discussion of what we are doing—or could do—to control costs better.

    Analysis

    Reason 1.
    Nobody Shops for Value

    Wheelan argues that when it comes to health care, everyone wants and expects the best. “There’s no medical equivalent of Wal-Mart,” he writes. “Everyone wants Neiman Marcus.”
    Solution: Some health plans are addressing this issue by discouraging patients from using expensive facilities for common problems, such as a sore throat, through co-pay incentives and member education. Not only are patients encouraged to find a less expensive facility, they also are encouraged to ask the doctor to write generic prescriptions.
    The question is, how do patients know which facilities offer reasonable prices and quality medical care? It will take greater health care cost and quality transparency—and better consumer education—to get health care shoppers to the same level of sophistication they use in buying other high-end goods (e.g., cars), but progress is being made. A number of health plans now offer cost information on various treatment options, and web sites such as HealthGrades offer quality information on doctors, making it possible for people to shop for health care online.

    Reason 2.
    Medical Innovations Are Usually More Expensive

    The basis of medical progress is learning to do new things, no matter the cost. In the case of pharmaceuticals, the system has been designed so new drugs are expensive. Breakthrough medications receive patent protection, and the better the drug, the more its producer can charge. High prices yield high profits, which creates an incentive to develop the next generation of drugs.
    Solution:Although we, as a society, have agreed to pay more for innovative medications and medical devices, especially those that introduce new cures, we have not agreed on who is going to pay for them. Part of the solution lies in the expansion of employer-sponsored wellness and health promotion programs that focus on keeping healthy people healthy and helping those who are sick to better manage their illnesses by steering them toward proven treatments. Value-based benefit plan design tries to achieve this by removing barriers that may be barring patient access to the most effective medications.
    Furthermore, not all innovations (which include diagnostic tests, imaging tests, medications and medical devices) should be treated equally. While some add value, some do not. One solution is to use a creative plan design that identifies the most effective innovations and reimburses them with a premium.

    Reason 3.
    Some Health Care Is a ‘Luxury Good’

    Used as a technical economic term, a “luxury good” is something wealthy people demand in disproportionately greater amounts than less wealthy people do. Richer societies and richer people within a society have higher expectations for health care. They expect medical fixes—such as hip replacements, stomach stapling and Lasik eye surgery—for problems that people with lower expectations will just tolerate.
    Solution: While it’s easy to poke fun at medical tourism, it may well emerge as one of the solutions to this problem. Medical tourism generally involves traveling to another country for non-emergency care, including knee replacements, shoulder surgery and even heart bypasses. A knee or hip replacement that may have a retail price of $65,000 to $80,000 in the United States costs between $8,000 and $10,000 in India. The Deloitte Center for Health Solutions predicts that the number of Americans using medical tourism could jump tenfold over the next decade, to nearly 16 million a year.

    Reason 4.
    We Don’t Pay for What We Consume

    Health care is unique in that neither the service provider nor the patient gets the bill, especially when insurance out-of-pocket maximum provisions are reached. The patient who is directly involved in the transaction has little incentive to control costs when out-of-pocket costs are removed. When insurance companies try to do so, it can lead to arbitrary limits on care, time-consuming hurdles for more expensive procedures and additional bureaucracy for doctors. Even then, it’s easy to game the system.
    Solution:One possible solution is moving away from fee-for-service provider reimbursement and returning to a staff-model health maintenance organization (HMO), where providers employed by the health plans are charged with offering patients the most cost-efficient care without compromising quality. Two studies have found that this model works quite well. A 2002 paper in the British Medical Journal (BMJ), “Getting More for Their Dollar: A Comparison of the NHS with California’s Kaiser Permanente,” compared HMO provider Kaiser and Britain’s National Health System (NHS), concluding that Kaiser achieved better outcomes than the NHS for similar inputs. And a 2003 study in the BMJ, “Hospital Bed Utilization in the English NHS, Kaiser Permanente, and the US Medicare Program: Analysis of Routine Data,” which reported on hospital stay lengths, produced similar conclusions.
    Over the past few years, several large employers have brought care delivery on-site in the form of clinics, using the same premise as the staff-model HMO. Revisiting global provider payments per admission or bundled payments for treating all the medical needs of specific patients with chronic disease might return to favor.

    Reason 5.
    Baumol’s ‘Disease’

    Not a disease, but an important insight by economist William Baumol on what afflicts certain sectors of the economy, such as health care and higher education. He found that as societies become richer, labor-intensive endeavors, such as health care, become increasingly expensive relative to goods and services that can be produced using less labor. As long as the doctor-patient relationship remains relatively unchanged, health care costs will rise faster than prices in general.
    Solution: Because there are no economies of scale, a surgeon cannot perform more than X number of surgeries and a primary care physician (PCP) cannot see more than X number of patients in a day (although we have seen the latter rise dramatically in the past two decades). For them to keep up with others, who are earning more money in less time because of technological advances, they have to increase their unit cost.
    Pay-for-performance-type programs can help identify providers who are practicing quality medicine in the most judicious and cost-effective way. Once such high-quality and cost-efficient providers are identified, patients need to be directed to them. Specialized cancer and transplant centers are a good example of where upfront costs are relatively high but long-term outcomes are better and repeat illnesses are fewer.

    Reasons 6 & 7.
    Living Longer and Living an Unhealthy Lifestyle

    Not only are people living longer (which in itself increases health care costs), but too many people are living unhealthy lives. This includes smoking, eating fast food and driving instead of walking, to name but a few.
    Solution: While we can’t change the fact that people are living longer (nor would we want to), we can help them live healthier lives. The latest shift in health care is to focus on keeping the healthy healthy and to stop diseases from progressing from bad to worse. This can be achieved through wellness and health promotions, health education and coaching, communicating information on healthy lifestyle choices, and making sure those who need care have access to the right care at the right time to maximize clinical and economic value. People who are at risk or at high risk can be identified via health risk appraisals and sophisticated technology and tools, such as predictive modeling, which uses claims data to identify risk.

    Reason 8.
    The Uninsured

    The uninsured end up costing the system a great deal of money. In a family that is uninsured, a child with a high fever and a bad cough will probably be treated in a hospital emergency room—a very expensive use of a trauma center and its highly trained staff. Or the child might not be treated at all until five years later when he or she develops asthma or another chronic condition that could have been managed far less expensively with better primary care.
    Solution: This is a problem that needs government intervention. Although President Barack Obama has pledged to intervene, his health care program has yet to be addressed—specifically, how his programs will cover all Americans in the most cost-effective delivery setting.
    One solution that plan sponsors can undertake in the meantime involves helping their pre-age-65 retirees with health insurance. They can take advantage of the innovative solutions that some health plans now offer—allowing employees to prefund premiums that contribute toward buying coverage after retirement but before they are eligible for Medicare.

    Reason 9.
    The High Cost of End-of-Life Care

    Even people who are treated successfully for heart disease or cancer eventually die. Any medical success begets additional medical expense, which is especially true for end-of-life care. The last six months of life are typically the most expensive period of a person’s life.
    The escalating cost of treating illness at the end of life raises moral and politically charged issues that are difficult to address: What is the actual value of using expensive treatments on people whose life expectancy is drastically limited, even with the treatment? While other countries have begun to base coverage decisions, in part, on how many years of quality life a treatment is expected to produce—for example, the clinical guidelines created by the U.K.’s National Institute for Clinical Excellence—this issue still seems to be taboo in the United States. Most of these costs are incurred by Medicare and Medicaid.
    Solution: We need to be better at considering quality of life in decisions about treatments and services for chronically ill elderly patients. It has been suggested that Medicare and Medicaid could form a governing body of clinicians that can make and authorize these difficult decisions.
    In addition, society needs to make better use of hospice care. Employers and plan sponsors should educate their beneficiaries about hospices and the situations in which they are the best option.

    Reason 10.
    Malpractice Suits

    Malpractice is more of a legal problem than an economic one because doctors tend to practice “defensive medicine” out of fear of being sued. Seeking to avoid lawsuits, they have an incentive to over-treat all kinds of maladies. Research shows that physicians in countries such as the United States—where the risk of malpractice suits is high—tend to order more investigative tests than those in countries with less risk, such as the U.K. (See, for example, the New York Times article “Why Does U.S. Health Care Cost So Much?”)
    Solution: Washington Post columnist George F. Will has proposed an appropriate solution to this complex issue. We have juries of people who have no knowledge of the complexities of medicine handling decisions on whether a patient’s death resulted from negligence on the part of the physician or whether the doctor did everything in his or her power to save the patient. Instead, the state judicial system could create a panel of highly qualified judges with access to independent clinicians who are familiar with the highly complicated nature of such cases and remove some of the emotional overreactions by juries that result in disproportional monetary awards that should be reserved for cases of gross negligence. This will help physicians use sound clinical judgment instead of practicing defensive medicine.

    One More Reason: Lack of Access to Complete Information
    Doctors collect and create a lot of information—everything from notes to diagnosis codes. The insurance companies add another level of data. While much of this information could be used to improve treatment and reduce costs, no one is in a position to see it all. A doctor who prescribes a treatment doesn’t know what it costs or whether the patient’s insurance covers it. An insurance company that questions a doctor about a treatment might never receive all of the information it needs. When a patient switches providers, it can result in duplicate tests and services and potentially dangerous treatments. All this creates tremendous administrative waste and resource consumption for providers and payers.
    Solution: Electronic medical records (EMR) and health information exchange (HIE) are two steps in the right direction toward health care interoperability (the ability of different information technology systems and software applications to communicate; to exchange data accurately, effectively and consistently; and to use the information that has been exchanged). Developing standards for EMR interoperability is at the forefront of the president’s health care agenda. Many physicians have computerized practice management systems that can be used in conjunction with HIE, allowing them to share patient information (e.g.,lab results, public health reporting), which is necessary for timely, patient-centered and portable care.
    Similar movement is happening on the payer side, which is attempting to collect more information from providers as well as consumers. They are making decision-support tools available to their beneficiaries, to help them navigate the system. Some payers are also adopting personal health records, which members can take with them if they change insurance providers.
    Another step in the right direction is the patient-centric medical home model, in which a patient’s physician knows everything there is to know about that person’s health care. This requires comprehensive patient management software that allows the physician to coordinate all the care the patient needs.

    Conclusion
    The good news is, there are potential solutions to most of the reasons health care is so expensive. The real challenge is in getting the different stakeholders to work together to solve this monumental problem.

    * Analysis by: GLG Expert Contributor
    * Analysis of: Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth
    * Published at: http://www.brookings.edu

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    The health insurer Wellpoint is testing a new program that gives covered patients the option of going to India for elective surgery, with no out-of-pocket medical costs and free travel for both the patient and a companion.

    The program is being tested at Serigraph, a printing company in Wisconsin whose managers have been looking for ways to curb rising health care costs, said Dr. Razia Hashmi, chief medical officer for national accounts for Anthem Blue Cross and Blue Shield, which is affiliated with Wellpoint.

    “This is a first for us,” Dr. Hashmi said. “We will be monitoring every aspect of this very closely, to make sure everyone is satisfied and there are good clinical outcomes.”

    By the year 2010, more than 6 million Americans annually will be seeking medical treatment abroad , according to the Deloitte Center for Health Solutions, a consultancy. The potential savings are significant. Knee surgery that costs $70,000 to $80,000 in the United States can be performed in India for $8,000 to $10,000, including follow-up care and rehabilitation, Dr. Hashmi said. Similar savings could be achieved for such common procedures as hip replacements and spine surgery .

    If other insurers follow Wellpoint, Dr. Hashmi said, the trend ultimately may pressure on United States hospitals to be more competitive in their pricing.

    Critics say that’s unlikely.

    “There have been some reports of hospitals that have been willing to match the prices, but I don’t know how they’re doing that,” said Howard Berliner, a professor of health policy and management at State University of New York Downstate Medical Center in Brooklyn. “The reality is there’s just no way that most hospitals can respond to this. It’s just like any service that’s outsourced – the price is so cheap abroad that there isn’t much an American company can do about it.”

    At the same time, he said, the program could potentially siphon off the healthiest, most profitable patients from a local hospital.

    Dr. Hashmi predicted that the program would appeal primarily to people who have traveled abroad. Many employees of Serigraph, which has offices in India, are familiar with the country.

    “The quality is comparable” to care provided in the United States, Dr. Hashmi said. All the physicians speak English, and patients can share their medical records and consult with a surgeon in India before making the trip, she said.

    The pilot program arranges for patients to be picked up at the airport and provides special meals to prevent food-borne illnesses. The program complies with the American Medical Association guidelines on medical tourism and uses hospitals accredited by the Joint Commission International.

    Dr. Hashmi said it had actually been easier to evaluate the quality of medical care abroad than in the United States. “There is a lot more willingness to share data about complication rates, the total number of procedures and the outcomes,” Dr. Hashmi said. “We’re able to get detail per hospital and per physician.”

    In addition to saving out-of-pocket costs for surgery for patients, the program could potentially help keep insurance premiums affordable, Dr. Hashmi said.

    More at: NY Times

    For information about affordable surgery overseas, visit Healthbase.

    Now you can get medical tourism type price and quality for procedures received in the US.

    How is that possible?
    Because Healthbase has partnered with several US healthcare providers that offer procedures at very competitive prices that are comparable to what American-accredited foreign providers offer.

    So now affordable high quality medical care is made available closer to home for patients from the US, Canada and Mexico. Patients from European countries and other nations looking for top quality care in the United States also stand to benefit from this partnership.

    According to Saroja Mohanasundaram, CEO of Healthbase,

    Majority of our clients from North America are drawn to medical tourism for the cost advantage it offers. However, some may not be able to take advantage of it due to the travel involved. So Healthbase has negotiated with US-based providers to offer the same top US-standard quality of care to our customers at a much reduced rate than what is prevailing. Hence, those who need quick access to top quality healthcare can avail of the low prices right here at home.

    We all know that US providers charge a much higher rate to uninsured patients than they do to insured patients or insurers. But not anymore. A heart bypass tagged at over $100,000 (for uninsured patients) can now be had for an 85% discount. Such rates also closely match the lower foreign rates.

    Mohanasundaram adds,

    Our US providers offer a complete slew of services in all departments of medicine including cardiac (heart bypass, valve replacement, aneurysm repair), orthopedic (hip replacement, total knee replacement), general surgery, diagnostics, and so on

    Who to contact for discounts on major procedures conducted within the US?
    Healthbase

    Further reading:
    News release from Healthbase about this partnership

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    Healthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.Healthbase Logo

    MIS 2-INCISION HIP REPLACEMENT

    Zimmer MIS 2-Incision Hip Replacement is a minimally invasive alternative to the traditional hip replacement surgery. The minimally invasive surgery is done by making two small incisions about 1½ to 2 inches each to separate the muscles and tendons to access the hip joint as opposed to the traditional hip replacement surgery which typically involves a 10- to 12-inch incision and cutting of those tissues. For the MIS 2-Incision surgery, orthopedic surgeons trained in minimally invasive surgical techniques use specialized instruments to perform the surgery.

    The MIS 2-Incision Hip Replacement technique considerably reduces the recovery time as muscles and tendons around the hip joint are not generally cut as they are in the traditional hip replacement surgery. So there is less tissue trauma involved in this minimally invasive approach resulting in faster and less painful rehabilitation of the patient which in turn results in quicker return to work and daily activities. Also, because smaller incisions are made, the surgery leaves smaller scars. Other benefits of this surgery are shorter hosptial stay and reduced blood loss compared to traditional hip replacement surgery.

    Performance-wise, the hip replaced through MIS 2-Incision Hip Replacement performs the same as that through the traditinal approach. Also, the replacement hip – comprised of a stem, ball and socket – is the same high quality, clinically proven prosthesis that is used in traditional surgery.

    Anybody who is a right candidate for traditional hip replacement surgery is also a right candidate for MIS 2-Incision Hip Replacement except those who are extremely overweight, are very muscular, have recently had a blood clot or an unstable medication that places them at higher risk for complications, or those who have already had hip replacement surgery on the same hip.

    Read here for information about a more bone-conserving approach to hip replacement called Birmingham hip resurfacing surgery or BHR.

    Cost and Availability of MIS 2-Incision Hip Replacement

    In the US, MIS 2-Incision Hip Replacement surgery can be very costly. If you are uninsured or underinsured then this could translate into a substantial out-of-pocket expense for your orthopedic treatment.

    Healthbase offers a large network of international partner hospitals which offer the best MIS 2-Incision Hip Replacement surgery overseas at an affordable price.

    Register or login to get your FREE personalized quote for a cheap Hip Replacement surgery abroad (MIS 2-Incision hip replacement surgery or traditional hip replacement surgery).

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