What are we paying for?

Out in the cold on a Sat night

[This anecdote is from last week.] Our son was sick last evening and through the night--unable to keep any food down. This morning, while I was washing my hair at 6 am, a Doctor arrived to our apartment. He took Enji's temperature, examined his throat, pushed and poked around his abdomen (ruling out an appendicitis--Zorig's fear). This was what we'd call a "house call" in America--something that existed back in the 1700 and 1800s--but unheard of in these modern times. I asked Zorig how he got a doctor to come at 6 am. He said he called the "emergency number." This is the same number you'd call if you needed an ambulance. Apparently it can be used for house calls! Zorig called around 5:30 am; the doctor arrived shortly after 6.  Curious, I asked, "what does that cost?" The answer--nothing! As a Westerner, I was baffled by this reality. 

My guess is that this is a remnant of the socialist/communist time period in Mongolia (from the 1920s to 1990 when Russia withdrew). As an American, we are groomed to believe that you get what you pay for. Paying nothing for a doctor's opinion, in your home, at 6 am....is hard to comprehend. While I know there are many issues with Mongolian healthcare and I have numerous friends and colleagues that have shared horror stories with me, I am yet amazed by what happened. Enji was sick with a 24 hour bug and returned to school the next day.

This is just one example of a few I'd like to discuss. Before moving to Mongolia I had never lived abroad--within another culture/country/way of life.  While I had been deployed with the U.S. military, there was always our own healthcare options available. But here in Mongola, I am simply an expat living abroad and using the options available to me. 

My Chiropractor's sign

Here are some examples of what I have experienced (yes, some are a bit specific/personal). Keep in mind that I have NO health insurance (I know....OH THE HORROR...but honestly, I find it freeing!) and pay for everything out-of-pocket:

• I visited Intermed (hospital where many foreigners and well-off Mongolians seek treatment) for a pelvic exam (something women do periodically). I paid just $17.00 for the exam and a urine lab test.
  **NOTE: To schedule an exam or appointment of any sort--you pay 35,000 Tugrik. (When I first got here that equalled about $17.50, with the tugrik value dropping, it's now $14 or less).
• I visited a chiropractor (Mongolian man who trained in the U.S.) and paid $10 for a one-hour spine focused massage followed by an adjustment. Kicker--after four visits he told me that my "treatment was finished" and I didn't need to come anymore. Now WHAT chiropractor in the U.S. would ever say something like that? In the U.S. I paid $32.50 for ONLY an adjustment and that was IF I went every other week--aka--was on a plan[A sidenote here: In the U.S. I started going to a chiropractor when I was 35 years old. I continued to go on "maintenance" until I left. I went at least once or more often twice a month. AND I STILL HAD ISSUES!!! I lived in Mongolia for 16 months before I HAD to visit a chiropractor. I'm thinking the hard beds and more minimalist way of life are GOOD for the human body--all the cushy stuff we use in the U.S. to make our lives "nice"....might actually be doing us physical damage AND costing us MORE money.]
• I went to Intermed to see the dentist for a cleaning. I paid the 35,000 for my appointment and an additional 102,000 for the cleaning. Grand total: about $62. Oh.....and did I mention that the entire cleaning was completed with an Ultrasonic. While hand-held scalers (aka scrapers can be as effective--it takes WAY longer). You can read here about the Pros and Cons of both. In the US I paid for well over an hour of cleaning--most of it scraping--while here it was about 30 minutes and cost WAY less--while using an electronic tool. I don't know about you....but I prefer the Ultrasonic. In the U.S., hygienists would ONLY use the Ultrasonic for the backside of my bottom front teeth (where coffee stains build up). I prefer the service and approach I received here. Granted....I don't have dental insurance to "cover" my twice annual cleanings....but at $62, I'm okay with the option. In the U.S. that dental "EOB" would show that my "cleaning" costs well over $200-300, I suspect. And that's WITH the wonky math about being "in network" or "out of network" etc.
• I choose to go to a Laser Emneleg (hospital) to have some dark spots on my face "lasered." I paid $75 for two visits--the first to laser the spots (from forehead, down my face, and including my neck) and the second to do a skin peel and cooling milk mask. I wouldn't call myself an especially vain person--but I could NEVER afford such a treatment in the U.S. The doctor wanted to inject something to lighten a couple of spots and I declined. BUT....I may go back for that.   

Many of my colleagues have health insurance as they are "foreign hires" whereas I'm a "local hire." Many of them will NEVER reach their deductible ($200, I believe) to be able to use their insurance benefits. Granted...IF you have a serious incident--for example need to have your gall bladder removed--then YES, you would use your benefits. But for the average, every day kinds of issues--paying out of pocket is completely affordable. Almost CHEAP. 

Pic taken from my front-seat bus-ride home

I've heard that having a baby here costs about $1,000. If you want a completely private and pampered experience--at most $5,000. What does that cost in the U.S? (I have no idea!)

Now....I will add that for foreigners there can be a great distrust of some of the medical advice one receives here in Mongolia. Beliefs about health and wellness can be vastly different. As a general rule, I don't find that Mongolians have as much education as Americans do around the science behind sickness (and the diet is still lacking--not nearly enough vegetables and far too much wheat and oil); additionally, there is great value placed in superstition or what we might call old wives tales, as well as great stock in traditional medicine practices. I'm NOT against traditional medicine as a concept. However, I don't believe that spending a week to ten days in the hospital for "treatment" which includes a series of injections seems at all necessary. Especially when it's just scheduled like a week at the spa or resort. Nor do I think a sinus infection requires surgery--but have been told as much by my own husband. I believe that generally the body will heal itself with responsible self-care--extra sleep, lots of fluids, and increased Vitamin C (I do love the seabuckthorn juice here!). Most Mongolians I know seem to run off to the hospital at the first inkling of an illness. I ONLY go to the hospital if it's an emergency OR I've been fighting something for 10 days to two weeks. 

As Americans experience--a stay in the hospital is EXPENSIVE. Shoot....when I had my emergency gall bladder surgery in 2014 I spent a full week in the hospital and the surgery included an epidural for post-surgery pain management.  My entire bill was over $56,000!!!!! I paid my maximum out-of-pocket which was $6,000. Here in Mongolia, at a hospital that treats expats, an individual having a similar experience--six nights in the hospital and gall bladder removal--the bill just over 5.7M Tugrik which converts to about $2,380. 

All of these examples--but ESPECIALLY THIS LAST ONE--make me wonder, what in the hell are we paying for in America? Like really....what the heck is going on? Before I moved here MANY people asked me about health insurance. Would I have it? What was the coverage? Where would I get treated? Honestly, I don't miss a damn one of those EOB statements that showed me BULLSHIT math. I love that I can pay out-of-pocket and get decent care. Now I realize that if I were in a terrible accident, I might feel differently. I can't say I'm impressed with what I've seen here in the form of rehabilitation after major surgeries. And Mongolians that CAN go abroad (mostly Korea) for treatment, DO. That is telling. There is NO perfect system....but I can say that I don't miss the American system AT ALL. And I seriously wonder what we are all paying for (perhaps all the malpractice insurance that doctors have?). 

As the CDC reports here (from January), more than 750,000 American travel abroad for what is termed "medical tourism." More recently it was reported in The Fiscal Times that approximately 1.4M Americans will go abroad this year seeking medical treatment because it's TOO EXPENSIVE in their OWN country. The article says a handful of American insurance companies would rather pay travel and treatment expenses abroad, than within their own borders.

So really....what the heck is going on in America? I *cringe* at the thought of ever having to return to a healthcare system that seems SO outrageous.