Ok, this is the last thing I'll say about health care, in Hong Kong or otherwise. First, I heartily recommend last week's This American Life episode about the exploding costs of health care.
Said episode prompted me to ask my pregnant friend about the costs of maternity care in HK. Her first baby was at a public hospital, and the second one will be in a private one. A number of things surprised me about our conversation:
1. The costs were much less than I expected, even at the fancy private hospital on The Peak. An average normal delivery here in a private hospital runs between HK $60,000 and $100,000, which is about US $7500-13,000. That includes a 3 day stay, doctor's fees, epidural and anesthesiologist's fees and pediatric care. I don't know how much insurance paid for our delivery of Finn in the US, so maybe these costs are comparable (anyone know?), but honestly, US $10,000 seems sort of cheap. It's not cheap, I know that, but that's the point.
At a public hospital, on the other hand, for people with an ID card, it truly is cheap--between HK $1000-$10,000 (if in a private room), which is about US $100-1200. Lots of people choose a half/half option, going to a private doctor for prenatal care and then delivering in a public hospital. Private prenatal care runs between HK $10,000-20,000, which is about US $1280-2560.
2. The costs, both for prenatal care and for the delivery packages, are readily available. Hospital websites have them posted as well as online forums like geobaby. Maybe you can find a breakdown of the prices for medical services in the US, but I've never seen one. Having insurance meant I never cared what the cost was for a service, I just cared if it was covered.
3. One practice I find appalling here is that some doctors (and hospitals) charge more for their services if you use a private room rather than a shared room--up to twice as much. The only thing I can chalk this up to is pure greed--how could it possibly cost more to care for a person in a private room? You already pay more, of course, to the hospital for the private room, which makes sense. But to pay more for the doctor's fees, for the delivery, for the epidural, for the anesthesiologist? That's crazy.
Showing posts with label Politics. Show all posts
Showing posts with label Politics. Show all posts
10.12.2009
10.04.2009
Health Care: a quick update
A quick update regarding maternity care in public vs. private systems in Hong Kong.
Were we to have a baby here, a priority for us would be to have the best possible chance of a natural delivery, with few medical interventions. (And lest you think I'm just trying to be a super-woman, this is as much because I'm a total scaredy-cat when it comes to hospitals, needles, IVs and the like as it is anything else.) What I've heard lately, in several conversations with women who've delivered here, is that for my goal, the public hospitals are the way to go. This is entirely anecdotal, and our speculations about why this is so are just that: speculations. But for what it's worth, here they are:
1. Cost. C-sections are expensive, flat-out. So in the public system there's no incentive for doctors to push for one unless truly necessary. Of course the fear is that doctors might encourage against one even when necessary, but nothing I've heard would suggest that happens here. They also don't hold out on medication for women who want it.
2. Doctors. In public hospitals, you see a team of doctors for pre-natal care (called ante-natal care here, but that always confuses me) and whoever is on call catches the baby. In the private system, you pick a doctor for all the prenatal care and the delivery, and so they have every incentive to encourage scheduled c-sections and to speed up labor that isn't fitting well into their schedule.
3. Population. Rates of scheduled sections are very high in the private hospitals, and this likely has something to do with both the doctors who work there, and the women who use the private system. Have to be wealthy, likely to be busy, working at an executive or managerial level, have a short maternity leave, etc.
4. Trickle effect. When the majority of women get scheduled sections, nurses and doctors don't get as much practice at helping women have natural, non-medicated births. They don't know what positions to suggest, they don't have as many tricks for helping with pain relief, and they don't always see or have experience with the wide range of "normal" in labor and delivery.
Let me be clear that this isn't to suggest that birth in the public system is always rosy ... laboring in the ward sounds horrendous to me, and I've heard very mixed reports on the amount of labor support you get from the nurses and midwives. But still, I was surprised to hear that for a natural delivery, the public system can be a better option.
Were we to have a baby here, a priority for us would be to have the best possible chance of a natural delivery, with few medical interventions. (And lest you think I'm just trying to be a super-woman, this is as much because I'm a total scaredy-cat when it comes to hospitals, needles, IVs and the like as it is anything else.) What I've heard lately, in several conversations with women who've delivered here, is that for my goal, the public hospitals are the way to go. This is entirely anecdotal, and our speculations about why this is so are just that: speculations. But for what it's worth, here they are:
1. Cost. C-sections are expensive, flat-out. So in the public system there's no incentive for doctors to push for one unless truly necessary. Of course the fear is that doctors might encourage against one even when necessary, but nothing I've heard would suggest that happens here. They also don't hold out on medication for women who want it.
2. Doctors. In public hospitals, you see a team of doctors for pre-natal care (called ante-natal care here, but that always confuses me) and whoever is on call catches the baby. In the private system, you pick a doctor for all the prenatal care and the delivery, and so they have every incentive to encourage scheduled c-sections and to speed up labor that isn't fitting well into their schedule.
3. Population. Rates of scheduled sections are very high in the private hospitals, and this likely has something to do with both the doctors who work there, and the women who use the private system. Have to be wealthy, likely to be busy, working at an executive or managerial level, have a short maternity leave, etc.
4. Trickle effect. When the majority of women get scheduled sections, nurses and doctors don't get as much practice at helping women have natural, non-medicated births. They don't know what positions to suggest, they don't have as many tricks for helping with pain relief, and they don't always see or have experience with the wide range of "normal" in labor and delivery.
Let me be clear that this isn't to suggest that birth in the public system is always rosy ... laboring in the ward sounds horrendous to me, and I've heard very mixed reports on the amount of labor support you get from the nurses and midwives. But still, I was surprised to hear that for a natural delivery, the public system can be a better option.
9.15.2009
Health Care: a view from Hong Kong
I know everyone is talking about health care reform these days, and while I'm sure you can guess that I strong opinions on this, I'm going to save those for another day. Instead, I just want to offer a few observations from Hong Kong, which has both a public and a private health care system.
When Matt was in the negotiating stage for this teaching job, I was still pregnant. We asked to look at the insurance policy, wanting to understand the health care we would have here. We were told it was a very good policy, but we were shocked when we read that it didn't cover well-baby visits, vaccinations, maternity care, or any services for congenital health problems. We decided to accept the job anyway, but with the private caveat that if Finn was born with any health problems, we simply wouldn't go, since insurance wouldn't cover it.
And then we got here, and I was asked the very first week by a fellow teacher's wife if we decided to get the insurance coverage for Finn and myself. (The employee is fully paid for, we contribute for the family coverage.) I truly thought it was a silly question and said "Of course," wondering what kind of irresponsible mum this was.
And she, on the other hand, a Chinese-Brit, with Chinese frugality and the experience of the NHS, thought that I was the irresponsible one, paying for expensive coverage I may or may not need, when the government offered more-than-adequate care for free.
What a wake up call! I knew, of course, intellectually, that other countries have other ways of providing health care. I knew that other countries offered universal coverage. But the idea of needing insurance in order to get health care is so deeply ingrained in me that when making decisions for our family, I couldn't imagine anything different.
And not until last spring did I understand that, in many instances, the public health care offered is actually better than private. The reason that insurance doesn't cover congenital health problems is that if you have any complications with your pregnancy or delivery, and if the baby is born with any problems, you are automatically transferred to the public system. That's where the best equipment is, the latest technology, and the best specialist doctors.
We were told last year that we should choose which hospital we would want to go to in the event of an emergency, as the ambulance drivers won't choose for you. And when we asked around for advice, we were told consistently that for an emergency--any kind--the public hospitals are where we would want to be.
As far as I can tell, the major difference between private and public care--besides cost, of course--is comfort. In private hospitals you pay at different levels for a shared room or a private one. The food is better. Visiting hours are longer. You may or may not get better nursing care. In public hospitals, you pay virtually nothing for a ward room, then you can pay for shared rooms or private ones.
Comfort is not an insignificant issue, of course. And I'm not in love with health care here, but it's due to cultural issues rather than quality, and all of our experiences thus far have been with the private system. We don't plan to have a baby here because many of the attitudes around birth and support for breastfeeding aren't what we want--but that's true in both public and private settings. When asking women who have given birth in the hospitals here---public or private---about their experience, a common response is "Oh, it was fine. I was able to get an epidural right away." (!)
I would love to find out the cost comparison between health care in the two systems--not the out of pocket cost, or what the insurance pays, but the cost of the health care itself. What relationship does cost have to quality? And how do we decide what "quality" is? I guess those are questions, aren't they ...
We're about to begin our foray into the public system. Tomorrow Finn will have his 18-mo check-up and vaccines at the Anne Black Maternal and Child Health Clinic, right here in North Point. So far, getting an appointment was painless and quick (called Monday, appt. set for Wednesday.) I've heard that the developmental checks are longer and more thorough at the gov't clinics than with private doctors--I'll let you know.
update: The appt. today was fine, with a much more thorough development check--felt like the well-baby visits we had back home. The entire visit was much more "specialized"--there are designated nurses (and rooms) for the measurements, the interview (this is the developmental part, with a nurse), the consultation (this is the physical exam by the doctor), and the vaccines (they call it The Injection Room). Of course, there is a bit of a wait in between seeing all these folks--the entire visit was 2 hours, and I estimate that we were seeing someone for 1 hour of that time, and waiting the other hour.
Contrast that with our visits to the private doctors: Probably only 45 minutes total, but only 15 minutes seeing someone, the rest waiting.
When Matt was in the negotiating stage for this teaching job, I was still pregnant. We asked to look at the insurance policy, wanting to understand the health care we would have here. We were told it was a very good policy, but we were shocked when we read that it didn't cover well-baby visits, vaccinations, maternity care, or any services for congenital health problems. We decided to accept the job anyway, but with the private caveat that if Finn was born with any health problems, we simply wouldn't go, since insurance wouldn't cover it.
And then we got here, and I was asked the very first week by a fellow teacher's wife if we decided to get the insurance coverage for Finn and myself. (The employee is fully paid for, we contribute for the family coverage.) I truly thought it was a silly question and said "Of course," wondering what kind of irresponsible mum this was.
And she, on the other hand, a Chinese-Brit, with Chinese frugality and the experience of the NHS, thought that I was the irresponsible one, paying for expensive coverage I may or may not need, when the government offered more-than-adequate care for free.
What a wake up call! I knew, of course, intellectually, that other countries have other ways of providing health care. I knew that other countries offered universal coverage. But the idea of needing insurance in order to get health care is so deeply ingrained in me that when making decisions for our family, I couldn't imagine anything different.
And not until last spring did I understand that, in many instances, the public health care offered is actually better than private. The reason that insurance doesn't cover congenital health problems is that if you have any complications with your pregnancy or delivery, and if the baby is born with any problems, you are automatically transferred to the public system. That's where the best equipment is, the latest technology, and the best specialist doctors.
We were told last year that we should choose which hospital we would want to go to in the event of an emergency, as the ambulance drivers won't choose for you. And when we asked around for advice, we were told consistently that for an emergency--any kind--the public hospitals are where we would want to be.
As far as I can tell, the major difference between private and public care--besides cost, of course--is comfort. In private hospitals you pay at different levels for a shared room or a private one. The food is better. Visiting hours are longer. You may or may not get better nursing care. In public hospitals, you pay virtually nothing for a ward room, then you can pay for shared rooms or private ones.
Comfort is not an insignificant issue, of course. And I'm not in love with health care here, but it's due to cultural issues rather than quality, and all of our experiences thus far have been with the private system. We don't plan to have a baby here because many of the attitudes around birth and support for breastfeeding aren't what we want--but that's true in both public and private settings. When asking women who have given birth in the hospitals here---public or private---about their experience, a common response is "Oh, it was fine. I was able to get an epidural right away." (!)
I would love to find out the cost comparison between health care in the two systems--not the out of pocket cost, or what the insurance pays, but the cost of the health care itself. What relationship does cost have to quality? And how do we decide what "quality" is? I guess those are questions, aren't they ...
We're about to begin our foray into the public system. Tomorrow Finn will have his 18-mo check-up and vaccines at the Anne Black Maternal and Child Health Clinic, right here in North Point. So far, getting an appointment was painless and quick (called Monday, appt. set for Wednesday.) I've heard that the developmental checks are longer and more thorough at the gov't clinics than with private doctors--I'll let you know.
update: The appt. today was fine, with a much more thorough development check--felt like the well-baby visits we had back home. The entire visit was much more "specialized"--there are designated nurses (and rooms) for the measurements, the interview (this is the developmental part, with a nurse), the consultation (this is the physical exam by the doctor), and the vaccines (they call it The Injection Room). Of course, there is a bit of a wait in between seeing all these folks--the entire visit was 2 hours, and I estimate that we were seeing someone for 1 hour of that time, and waiting the other hour.
Contrast that with our visits to the private doctors: Probably only 45 minutes total, but only 15 minutes seeing someone, the rest waiting.
11.03.2008
Final Argument for Obama
This long campaign is finally coming to an end. I've been getting emails from the Obama campaign for weeks now, asking for volunteers, and other than donating money, I haven't done anything. So this morning I decided to try to make some calls--I can do it through skype and it's still early Sunday night in the States. After leaving a lot of messages, reminding people to vote and telling them where their polling location is, I finally reached someone. She very decisively said she did not want to talk about the election and hung up. At that point I had to stop--I remember how much I hated all the phone calls we got in New Hampshire leading up to the primaries.
But how to help? I believe this election is really important, even more so when I look at my sweet boy and imagine what kind of country and world he's going to grow up in. So this is my what I can do--encourage you all to vote, first of all. I want Finn to grow up in a country with an active and vital democracy. And second, please consider voting for Obama, even if you're Republican or pro-life or whatever might keep you from voting for him.
It used to be more about the issues for me, but lately it has been as much about the character of the man.
When I think about the kind of leader I want Finn to look up to and emulate, I can think of no one better than Barak Obama. He's an intelligent, kind, hard worker who has truly lived the American Dream, who has a servant's heart, who embodies family and moral values. He's the only politician I hear talking about the need to teach our teenagers that sexuality is sacred, about the need for parents to turn off the TV and spend time with their kids.
He's even-tempered, rational, positive and willing to think in new ways. The 9/11 commission said that one of the biggest failures on our part that kept us from preventing 9/11 was a failure of imagination. I don't think Obama will suffer from a failure of imagination, about what could go wrong on the one hand, but even more, about what go right, what could change. He clearly dares to dream big, and I think he will dream big for all Americans.
He has consistently asked us all to hope this campaign, rather than to fear. This is the first vote I've cast that was much a vote for someone as against someone. It feels good to vote out of hope rather than fear. But I have to add that I do fear for our country with McCain/Palin at the helm. I fear more unnecessary wars, I fear increased terrorism, I fear a larger deficit, I fear having two hot-heads close to the trigger of nuclear arms. If their campaign can't even keep the peace internally, how do we expect them to engage in delicate diplomatic efforts?
Ok, no more fears. I welcome any discussion about this, especially if you're on the fence. Remember to vote!
But how to help? I believe this election is really important, even more so when I look at my sweet boy and imagine what kind of country and world he's going to grow up in. So this is my what I can do--encourage you all to vote, first of all. I want Finn to grow up in a country with an active and vital democracy. And second, please consider voting for Obama, even if you're Republican or pro-life or whatever might keep you from voting for him.
It used to be more about the issues for me, but lately it has been as much about the character of the man.
When I think about the kind of leader I want Finn to look up to and emulate, I can think of no one better than Barak Obama. He's an intelligent, kind, hard worker who has truly lived the American Dream, who has a servant's heart, who embodies family and moral values. He's the only politician I hear talking about the need to teach our teenagers that sexuality is sacred, about the need for parents to turn off the TV and spend time with their kids.
He's even-tempered, rational, positive and willing to think in new ways. The 9/11 commission said that one of the biggest failures on our part that kept us from preventing 9/11 was a failure of imagination. I don't think Obama will suffer from a failure of imagination, about what could go wrong on the one hand, but even more, about what go right, what could change. He clearly dares to dream big, and I think he will dream big for all Americans.
He has consistently asked us all to hope this campaign, rather than to fear. This is the first vote I've cast that was much a vote for someone as against someone. It feels good to vote out of hope rather than fear. But I have to add that I do fear for our country with McCain/Palin at the helm. I fear more unnecessary wars, I fear increased terrorism, I fear a larger deficit, I fear having two hot-heads close to the trigger of nuclear arms. If their campaign can't even keep the peace internally, how do we expect them to engage in delicate diplomatic efforts?
Ok, no more fears. I welcome any discussion about this, especially if you're on the fence. Remember to vote!
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