Inhospitable Hospitals

April 27, 2009 3:36 PM

Can anyone point me towards detailed comparisons or information about the management fees and/or costs at hospitals in other countries?

My uncle, who is a doctor in the Philippines, had a stroke and was in a coma for months. He had brain surgery and doctors will not complete the procedure (i.e. place the part of his skull that was removed due to swelling, back on his head) until payments are made in full. Since my relatives are short 12,000 USD, he is stuck in the life threatening situation of an incomplete brain surgery. It is a bit unbelievable that it is standard procedure for hospitals in the PI to not complete emergency procedures without full payment. The sad thing is, since he is a doctor, the procedure itself was free. All of those hefty fees are just management fees - fees for using hospital equipment. It does not seem that there is any way out of this situation now, but after the fact, I would like for there to be press exposure on the topic of changing these unreasonably high management fees and lack of ethics in certain hospitals.

I came across BioMedCentral - Ethics as well as Medical Decision Making but I would appreciate any further advice/sources covering the issue. Thanks.

posted by johannahdeschanel to science & nature (2 comments total)

I'm so sorry to hear about your uncle. Is he still in the hospital and they are refusing to complete the procedure? Or has he left and they won't readmit him?

At most hospitals in the US, the hospital (or "management") fee covers everything except the services of physicians. This includes the services of nurses, various therapists, salaries of other support personnel, equipment, supplies, medications, lab and radiology services (though not radiologist services), and overhead. Physicians usually bill separately for their services.

Major surgery can easily run in the tens of thousands of dollars in the US, but due to insurance contracts a hospital may only get half that. The exact amount a hospital charges is up to the hospital, and can vary widely among hospitals even in the same community.

Here are some links to US hospital charges I was able to track down:
Cleveland Clinic (pdf)
St. Luke's, in Iowa
ProHealth, a small hospital system in Wisconsin

Large international hospitals that do a heavy medical tourism business often also have this information on their websites. Read carefully to see whether doctors' fees are included - this may vary.
Bumrungrad, in Thailand

Try searching with "hospital charges" as the search term. That is a more common way to describe these charges, at least in the US. Disclosing charges is coming in to vogue with US hospitals, so there is quite a lot of US-specific information available.

My heart goes out to you and your family, and I hope you are able to get this resolved soon.
posted by jeoc at 4:38 PM on April 27

Hey, thanks for your insight and kind words. Yes they are still witholding treatment on him. The rest of our family has already been contributing for the past two months, but it does not seem to be enough to cover the new fees that came as a bit of a surprise. Apparently it is not uncommon for medical practices to be so horrible in developing countries such as PI that people will even sell their own tissue samples for money. It is understandable that the cost of neurosurgery is high because of the materials and fees (plastic and metal which cost more than the surgeon himself) but there is no reason that hospital fees should be as high as 800,000 ppesos (which I just realized is not 12k but 16k). If a doctor's family in Manila is unable to afford medical procedures, I have no idea how other families with lower income even escape this problem. A friend reminded me that these issues happen even in geriatric centers in developed countries such as our own but certainly not to this extent. I noticed on the St. Luke's link that you sent that, "Emergency service will never be delayed or withheld on the basis of a patient’s ability to pay."
Yeah. This needs to be addressed internationally. It looks like Japan is currently undergoing a major medical ethics shift. Hopefully doctors can convince their hospital management to take that route as well.
posted by johannahdeschanel at 6:56 PM on April 27