Speaker 1: Episode two ninety nine is medical tourism a good way
Speaker 1: to save money with doctor David Vquist. Welcome to the
Speaker 1: Frugal Friends podcast, where you'll learn to save money, embrace simplicity, rice,
Speaker 1: and liver rich your life. Here your host Jen and
Speaker 1: Jill O. Welcome to the Frugal Friends podcast. My name
Speaker 1: is Jen, my name is Jill, and today is an
Speaker 1: episode that nobody asked for. We wanted it. I was
Speaker 1: I don't know what it was, but I was thinking
Speaker 1: about medical tourism and how shady it sometimes feels or seems,
Speaker 1: and I was like, is I mean we are the
Speaker 1: podcast about saving money? We are the ones that need
Speaker 1: to be talking about this, right, Yeah? If you can
Speaker 1: travel somewhere and save money on your medical procedures, should you?
Speaker 1: Should you? Could you? Yeah? And then came the task
Speaker 1: of Okay, who's going to talk about it and what
Speaker 1: kind of person are they going to be? And I
Speaker 1: was nervous about what kind of person we would get
Speaker 1: to talk about this, but we looked out so hard
Speaker 1: with doctor v Quist. He is such a gem. All
Speaker 1: of our fears subsided and is completely knowledgeable about the
Speaker 1: subject without being biased. It was literally everything I needed
Speaker 1: to really learn objectively about this topic. I mean, there
Speaker 1: might be some bias, but he definitely has done a
Speaker 1: ton of research on the topic. No specific sponsorships that
Speaker 1: he's trying to push or ways that he's making money
Speaker 1: off of it. He's genuinely curious about it, has researched
Speaker 1: it a ton, and is just an expert in wealth
Speaker 1: of knowledge, not only as a doctor in the medical field,
Speaker 1: but someone who has done some extensive research on this
Speaker 1: particular content of medical tourism. So we could not have
Speaker 1: found a better person, I don't think, or a more
Speaker 1: kind person to talk on this topic. I'm so excited
Speaker 1: for you all to listen before we continue to geek out.
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Speaker 1: tie in though they don't sound very pleasant, but a
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Speaker 1: a makeover you want. So why do we talk so
Speaker 1: much about healthcare Because it's one of your where you're
Speaker 1: going to find one of the biggest bangs for your
Speaker 1: buck when you are saving and one decision in the
Speaker 1: healthcare in your healthcare spending can save you thousands, if
Speaker 1: not tens of thousands, and no latte decision can do
Speaker 1: that for you. So we have a few other episodes
Speaker 1: like episode two hundred and thirty negotiating Medical Bills and
Speaker 1: Debt with doctor Virgie Bright Ellington. We have episode two
Speaker 1: fifty four how to Save Money on health Insurance with
Speaker 1: Eileen Doherty, and now we are continue that with episode
Speaker 1: two ninety nine on medical tourism. And we are personally
Speaker 1: not for or against it. This is literally our quest
Speaker 1: for knowledge on the topic, and we're super excited that
Speaker 1: we were able to have that conversation with doctor David
Speaker 1: v Quist. He's the founder and director of the Center
Speaker 1: for Medical Tourism Research. So it's the first academic center
Speaker 1: in the world to study the growing industry of medical tourism.
Speaker 1: So his cross border experiences have translated into a broader
Speaker 1: worldview with a richer appreciation of how globalization has greatly
Speaker 1: impacted health systems over the last few decades, and how
Speaker 1: technology has really made this a lot more accessible and
Speaker 1: even safer. So let's broaden our horizons, broaden our understanding
Speaker 1: a how doctor v Quist to explain this to us
Speaker 1: without further ado, Doctor Vequis, thank you so much for
Speaker 1: joining us on the show. We are super excited to
Speaker 1: talk about this topic. I'm very excited to learn more
Speaker 1: about it. Absolutely, yes, thank you for being here. It's
Speaker 1: good timing for us too. My husband and I were
Speaker 1: just talking about, oh, maybe getting a dental procedure abroad
Speaker 1: instead of in the States, but we know little to
Speaker 1: nothing about that process. So thank you for coming and
Speaker 1: illuminating us. So for starters, can you explain a little
Speaker 1: bit about what is medical tourism? How does it work?
Speaker 1: Just kind of one oh one? Absolutely well. The first
Speaker 1: thing to know is that this history of what we
Speaker 1: call arbitrage, meaning going to find something that is in
Speaker 1: higher quantities or else or in a higher quality level
Speaker 1: somewhere else has been around since the beginning of history,
Speaker 1: so medical tourism itself has been around since the beginning
Speaker 1: of history. We've seen situations back in ancient Egypt where
Speaker 1: people would travel to Egypt for these really great practitioners
Speaker 1: that were there at the beginning of civilization, and even
Speaker 1: during Roman times, people would travel to places like what's
Speaker 1: now known as Switzerland and what's now known as Turkey
Speaker 1: for things like the baileynoe therapy or water based therapies,
Speaker 1: and also the travel for again to get access to
Speaker 1: things or potentially get access things at lower cost has
Speaker 1: been around for a very long time, and the modern
Speaker 1: iteration of it, it's essentially health seeking behaviors and patient consumerism,
Speaker 1: which is truly changing the world. It's not just in
Speaker 1: the United States, not just in Canada, it's not just
Speaker 1: in Europe, it's not just in Asia. It's everywhere, and
Speaker 1: we're seeing people all around the world basically getting access
Speaker 1: to information, primarily through the Internet. The Internet has been
Speaker 1: the great equalizer, if you will, and allow people to
Speaker 1: have more and more information about what's available and potentially
Speaker 1: what the cost are, and that has led to greater
Speaker 1: amounts greater amounts of consumerism, greater amounts of health seeking behaviors,
Speaker 1: greater amounts of transparency. And that's essentially basically allowing people
Speaker 1: to get access to the care that they need, when
Speaker 1: they need it, and at the costs that they can
Speaker 1: afford to get it at. That's a helpful framework because
Speaker 1: I think when I hear medical tourism or going somewhere
Speaker 1: else for our procedure, it feels outside of the norm.
Speaker 1: But to realize and hear you describe this has gone
Speaker 1: on since the beginning of time as far back as
Speaker 1: we can see, but it feels as though one of
Speaker 1: those suations where people find themselves in like a scam
Speaker 1: or a botched surgery, or there can be a lot
Speaker 1: of fear around it. So to hear from someone with
Speaker 1: your background and expertise saying this is a reasonable way
Speaker 1: of going about certain medical responding to certain medical needs,
Speaker 1: the health seeking behaviors, it's really helpful. Yeah, yeah, thank you,
Speaker 1: It really is. If you think about it. What you
Speaker 1: sometimes see in the media coverage is what's going to
Speaker 1: draw in viewers. So if you hear that thousands of
Speaker 1: people went abroad and receive surgeries that did not result
Speaker 1: in complications. Is that going to be something you're going
Speaker 1: to click on? Is that clickbait? And the answers know
Speaker 1: so the unfortunately what we hear is the circumstances that
Speaker 1: were negative. Now, from a scientific standpoint, what we don't
Speaker 1: know is you have to know both numbers. You have
Speaker 1: to know the number of people had both successful outcomes
Speaker 1: and the number of people that had unsuccessful outcomes in
Speaker 1: order to understand the incident rate of particularly bad outcomes. Unfortunately,
Speaker 1: we don't have good data on that. So in science
Speaker 1: and statistics, what you have to do is go back
Speaker 1: to the null hypothesis, which is the assumption that there
Speaker 1: is no statistical differences at this point based on what
Speaker 1: we know about foreign healthcare providers. Say in places like Mexico,
Speaker 1: is that so many people in Mexico have either trained
Speaker 1: in the United States, They've done continuing education in the
Speaker 1: United States, they have linkages to US based healthcare systems
Speaker 1: and processes, they use the same protocols, the same protocols.
Speaker 1: Say that John Hopkins uses are seen all around the world.
Speaker 1: I can go into sub Saharan Africa and find John
Speaker 1: Hopkins protocols because they're shared. So there hasn't been sign
Speaker 1: iificant amounts of research done on the comparative nature of
Speaker 1: quality outcomes in a country like Mexico versus the United States.
Speaker 1: So at this point, what we do know is you
Speaker 1: probably have to go to the null hypothesis, which means
Speaker 1: there's probably not significant differences. Now, one other interesting element
Speaker 1: when it comes to the US and Mexico relationship is
Speaker 1: the Mexican government back and around two thousand and eight
Speaker 1: nine implemented the US based accreditation system. So the Joint
Speaker 1: Commission Accreditation, which all hospitals in the United States basically use,
Speaker 1: is the same accreditation system they're used in Mexico. So
Speaker 1: they're essentially used in the same quality systems. I would
Speaker 1: guaranteed it, except for your listeners right now that ninety
Speaker 1: nine percent of Americans don't know that, and it's so
Speaker 1: essentially the things you hear in the media. Can we
Speaker 1: be honest. It's there's sensational and people will click on
Speaker 1: those things and they make interesting points. But from an
Speaker 1: actual scientific standpoint, we don't have evidence to show that
Speaker 1: Americans going abroad are getting that much worse care than
Speaker 1: they are in the United States. Quite frankly, wow, that
Speaker 1: research is helpful because I think, for whatever reason, probably
Speaker 1: media and the anecdotal kind of stories that people have heard,
Speaker 1: there's this idea that you're not going to get any
Speaker 1: better care other than rite within a ten mile radius
Speaker 1: of your home. Yeah, and I think for every like,
Speaker 1: I am not super knowledgeable about like any negative stories
Speaker 1: on medical tourism are regarding like international procedures, but I
Speaker 1: am very familiar with family telling me negative experiences they've
Speaker 1: had with procedures in the States. So it like that's
Speaker 1: what got me started thinking about how they can't, Like
Speaker 1: I wonder if there is a big difference, because I
Speaker 1: have heard I don't know why my family have so
Speaker 1: many medical procedures, but none of them seem to be
Speaker 1: happy with the level of care. And so it is
Speaker 1: just really interesting how we're like very quickly because of
Speaker 1: our proximity to be trusting of, you know, what's right
Speaker 1: in front of us, and then like think that everything
Speaker 1: outside of what we know is very sketchy. Yeah, So
Speaker 1: it's it's an interesting confirmation bias essentially that we don't
Speaker 1: know what we don't know, but we're very sure of it.
Speaker 1: Even though we don't know, we never hopef we know
Speaker 1: that we don't know. Um. So, the United States, don't
Speaker 1: get me wrong, has extremely good care. If you look at,
Speaker 1: for example, survival rates, five year, ten year survival rates
Speaker 1: in terms of oncology, some of the best in the world.
Speaker 1: We do have some of the best healthcare systems and
Speaker 1: some of the best providers in the world. But interestingly
Speaker 1: those good outcomes. There was a very old politician several
Speaker 1: years before the PPACA what some people call Obamacare was passed,
Speaker 1: that suggested that the United States was islands of excellence
Speaker 1: within a sea of mediocrity. And I love that saying.
Speaker 1: That's a wonderful saying, and we do have. If you
Speaker 1: were to go to some of the best facilities systems
Speaker 1: in the world Johns Hopkins, Cleveland Clinic and the Anderson
Speaker 1: Mayo places like this, you are truly receiving some of
Speaker 1: the best care on the planet. And we do have
Speaker 1: excellence in the United States. Just the disparity and also
Speaker 1: the diversity in terms of the payments that people pay
Speaker 1: is one of the bigger issues. And so what we
Speaker 1: find interesting point in medical tourism, there tends to be
Speaker 1: a bimodal distribution. You see very wealthy people, for example,
Speaker 1: in years past, Kobe Bryant, Peyton Manning, Alex Rodriguez, who
Speaker 1: was a baseball player that played with the Yankees. They
Speaker 1: all went abroad to places like Germany for care when
Speaker 1: they were in the top one percent of the US
Speaker 1: population in terms of wealth, So they traveled abroad. And
Speaker 1: we see wealthy people travel abroad for destination spas. We
Speaker 1: see people wealthy travel abroad from cosmetic surgery. Interestingly, in
Speaker 1: some of the least affluent households in the United States
Speaker 1: and places that are very low socio economic status. For example,
Speaker 1: here in Texas, down on Larrio Grand Valley, we see
Speaker 1: a large number of people traveling for healthcare abroad among
Speaker 1: those populations, so a bimodal distribution, meaning we see more
Speaker 1: people that are wealthy and more people that are essentially
Speaker 1: poor traveling for healthcare. The middle class are the people
Speaker 1: that typically have the belief system that you brought up,
Speaker 1: which as they say, let's just stay here, let's just
Speaker 1: do what's comfortable, let's just do what's here locally, And
Speaker 1: they're the ones that are quite frankly, not taking advantage
Speaker 1: of either higher quality or lower cost care. Yeah, it
Speaker 1: sounds like just because there is good care to be
Speaker 1: found within the United States. It's not to the exclusion
Speaker 1: of good care to be found elsewhere, and that there
Speaker 1: might be varying reasons for people to do that, either
Speaker 1: higher levels of care or maybe less expensive, but quality
Speaker 1: care to be found if you kind of shop around
Speaker 1: around the world, Yes, absolutely, and so here's some great
Speaker 1: points since I got some numbers and some other things
Speaker 1: for you. It's not just shopping around the world, but
Speaker 1: shopping within the United States. Several studies from within the
Speaker 1: United States have shown the pricing within even a state
Speaker 1: such as the state of California for C sections. For example,
Speaker 1: there was a study that showed there was a five
Speaker 1: hundred percent disparity difference in the price for a C
Speaker 1: section from one hospital to another, just in one state alone.
Speaker 1: So you could essentially drive from one hospital to another
Speaker 1: hospital and pay a five hundred percent difference. So we've
Speaker 1: seen some great things happen in the United States that
Speaker 1: are helping with that, and some of these trends are
Speaker 1: legal regulatory under the Trump administration and now extended under
Speaker 1: the Biden administration. We have transparency now where most hospitals
Speaker 1: share their pricing, including their cash prices in a recent
Speaker 1: study that we did here in South Texas, we found
Speaker 1: that the cash price difference between a MRI, which cash
Speaker 1: price a little over three hundred dollars versus the other
Speaker 1: types of payment systems, which include Medicare, Medicaid, and private insurance,
Speaker 1: was about twelve hundred dollars a little over twelve hundred dollars. Interestingly,
Speaker 1: if you look at the out of pocket expenses that
Speaker 1: most people, including mute ladies, probably pay, you're going to
Speaker 1: pay probably a twenty dollars or more depending on the
Speaker 1: location you go to. Then you have a deductible which
Speaker 1: is going to be at least a thousand dollars, probably more.
Speaker 1: If you have a family, you're looking at two thousand
Speaker 1: dollars or more. So. Essentially, interestingly, paying the cash price
Speaker 1: rather than going through your insurance and the lords, you
Speaker 1: ignored the fact that you have insurance and just paid
Speaker 1: the cash price, went to the imaging center, the hospital,
Speaker 1: the doctor's office and say how much will you give
Speaker 1: me the MRI for If I pay you cash right now,
Speaker 1: you will probably get a lower price than you would
Speaker 1: have paid using your out of pocket expenses, your copay,
Speaker 1: and your deductible. I've got a sneaky suspicion about that
Speaker 1: blows the mind, right, isn't that fascinating? So not only
Speaker 1: have this disparity and this cash price difference, so a
Speaker 1: couple of great things are going on. We're seeing increasingly
Speaker 1: more companies, billion dollar companies that are rolling out retail
Speaker 1: health options. We have technology companies. For example, I'm familiar
Speaker 1: with a company here in Texas that's called Lasso. Laso,
Speaker 1: a software company which allows people to go on an
Speaker 1: app and find cash prices. And we're finding that increasingly
Speaker 1: there are systems and companies and brands that are trying
Speaker 1: to introduce you to ways in which you can negotiate
Speaker 1: lower cost sometimes cash discounted cash prices for these various
Speaker 1: sidures and it's basically better than it ever has been before. Yeah,
Speaker 1: I love that. That's good to know. So let's talk
Speaker 1: about procedures and locations abroad. What are the most common
Speaker 1: kinds of procedures people will seek to get done abroad,
Speaker 1: and what are the most common locations people can expect
Speaker 1: to travel to. Now. Yeah, as I know, you have
Speaker 1: listeners from all around the world, so we do have
Speaker 1: to talk about not just here in North America, but
Speaker 1: all around the world, so it depends on where you're
Speaker 1: located and where you're comfortable with going. So what we
Speaker 1: find when it comes to medical tourism, particularly international medical tourism,
Speaker 1: is the most prevalent feature is that somebody has a
Speaker 1: comfort level with where they're going. So if they've been
Speaker 1: to Europe before, then they'll be comfortable going to Europe.
Speaker 1: If they've been to Mexico before, they're comfortable going to Mexico.
Speaker 1: If they've been to Thailand before, then they're comfortable with
Speaker 1: going there. So we see flows of people traveling to
Speaker 1: locations that they're not only very comfortable with, but that
Speaker 1: they understands their culture and environment, language, those types of things.
Speaker 1: So some of the most common destinations in the world
Speaker 1: are some that you probably have heard of or you
Speaker 1: can easily find on the internet. People travel from all
Speaker 1: around the world to India, a place that I'll be
Speaker 1: visiting again here in February. People travel from all around
Speaker 1: the world to places like Turkey. People pay travel from
Speaker 1: all around the world to places like Mexico, Colombia, Dominican Republic,
Speaker 1: let's see Philippines, Singapore, the Malaysia. They also travel to
Speaker 1: if you will first world destinations for typically higher quality care.
Speaker 1: For example, people will travel to the United States, people
Speaker 1: will travel to Germany, people will travel to Korea for
Speaker 1: very high quality care. And in many cases they'll pay
Speaker 1: cash as well. They've paid more than they would have
Speaker 1: paid in their country, but they go there because quite frankly,
Speaker 1: they know they're going to get some of the best
Speaker 1: care in the world. Awesome. Yeah, it sounds like people
Speaker 1: are going everywhere and it depends on what they're looking for.
Speaker 1: Have you seen any trends of these are the common
Speaker 1: things that this country might excel in. Yes, So the
Speaker 1: in general, what people tend to travel for is what
Speaker 1: they feel that they're going to get value for them.
Speaker 1: So there was a really good book that was written
Speaker 1: by Harvard professor, very famous Harvard professor, doctor Michael Porter,
Speaker 1: who suggested that within healthcare, we need to stop having
Speaker 1: these artificial distinctions of the idea of quality as distinct
Speaker 1: in the consumer's mind from cost. The idea it's for example,
Speaker 1: if I were to tell you that you needed to
Speaker 1: buy a new car, one of the things you would
Speaker 1: do is you would probably look for a car that
Speaker 1: actually had functional utility. In other words, you'd want something
Speaker 1: that had an engine, you'd want something that had the
Speaker 1: steering wheel, you'd want them something that had tires. So
Speaker 1: you could get a cheap car down in a wrecking
Speaker 1: yard that doesn't have any of those things right, but
Speaker 1: it doesn't have functional utility for you. So just getting
Speaker 1: the cheapest thing isn't the best way to look for healthcare.
Speaker 1: What you're typically looking for is what is the best value,
Speaker 1: and that's cost and quality. So again knowing that like food,
Speaker 1: certain there's certain things that are better than other things
Speaker 1: in terms of taste, in terms of nutrient value, things
Speaker 1: of that nature. So when you're looking for healthcare, you're
Speaker 1: looking for the quality you will accept at the price
Speaker 1: you can pay. So you have to kind of balance
Speaker 1: those two things together. So when we're can it value,
Speaker 1: we find that people find value in things where they
Speaker 1: can't really distinguish between the overall quality. So dental so
Speaker 1: for example, most people think that for example, if I'm
Speaker 1: going to have a dental procedure, even something where a
Speaker 1: tooth is removed and you have it replaced with prosthetic
Speaker 1: or an implant, most likely I'm not going to die
Speaker 1: on the chair, the dental chair while they're doing the surgery.
Speaker 1: So therefore, from my values perspective, if I can save
Speaker 1: hundreds of dollars doing that and the value has not
Speaker 1: that much different between an American dentist and saying a
Speaker 1: dentist in Costa Rica, then at that point you're going
Speaker 1: to go, well, you know, if I can save hundreds
Speaker 1: of dollars at pace for the airplane ticket, I get
Speaker 1: to go to a beautiful country maybe after the dental
Speaker 1: procedure and me and my family go to the beach
Speaker 1: and enjoy that. You're getting a vacation and the dental
Speaker 1: procedure for the costume in the United States, then it's
Speaker 1: got extreme amounts of value. So what we find is overall,
Speaker 1: dental procedures tend to make up perhaps upwards of say
Speaker 1: forty to fifty percent of all the procedures that are
Speaker 1: medical and dental nature. Now, there is some research out
Speaker 1: there that argues that wellness procedures actually are even greater
Speaker 1: in terms of the total market share, but it's very
Speaker 1: difficult to distinguish between, for example, a person traveling internationally
Speaker 1: and going to the spa at the hotel from somebody
Speaker 1: that goes to a destination spot. So those numbers are
Speaker 1: a bit inflated, but we do know that wellness is
Speaker 1: very large. Past that we see a lot of general
Speaker 1: surgical procedures that includes and sometimes broken out the cosmetic surgery.
Speaker 1: And that's for again for situations where is a little
Speaker 1: bit of an extra extra costs that you probably don't
Speaker 1: need to spend because quite frankly, you don't need it,
Speaker 1: But it also conclude something where somebody affects how they
Speaker 1: feel about themselves and so therefore they want to have
Speaker 1: a better quality life if you will for those types
Speaker 1: of procedures. Again, you can save a great deal of money.
Speaker 1: Some of the medical tourism literature says in general, for
Speaker 1: surgical procedures, you're going to save, depending on the country,
Speaker 1: anywhere from say fifty to seventy percent of what you
Speaker 1: would in say Europe or Canada or in the United
Speaker 1: States if you're paying out a pocket. And interestingly, by
Speaker 1: the way, Canadians also travel for healthcare. Many people don't
Speaker 1: realize that, but Canadians travel because they have very long
Speaker 1: wait times and so therefore if they have to wait
Speaker 1: six months for a procedure, they're oftentimes more likely to
Speaker 1: come into the United States or go to another foreign
Speaker 1: country to get access to that and pay cash rather
Speaker 1: than wait for that six months before they can get
Speaker 1: access to a doctor. Personally, I'm experiencing my own barriers
Speaker 1: to entry decrease. Like my aversion to this idea is
Speaker 1: kind of softening. And I mean especially with that Costa
Speaker 1: Rica example. So interesting that we've seen this really fascinating
Speaker 1: trend that came from Asia, then we see it in
Speaker 1: the United States now, particularly among women. What we have
Speaker 1: is these kind of ladies travel abroad trips where they'll
Speaker 1: do it as a group, and you see this places
Speaker 1: like there's a website called the Real Self as I
Speaker 1: recall that has listings forums of women that get together
Speaker 1: and they'll talk about how much they paid, where they went,
Speaker 1: what their experiences were with certain providers when it comes
Speaker 1: to things like cosmetic surgery. So they oftentimes combine a
Speaker 1: medical trip with a vacation and they'll go as a
Speaker 1: group and they negotiate a group price, and they're able
Speaker 1: to take advantage of really very good care in places
Speaker 1: like the Dominican Republic. I was in the Dominican Republic
Speaker 1: and there's many many Americans to go there, and essentially
Speaker 1: you go to two different locations. You go to a
Speaker 1: cosmetic surgeon and then you get, for example, a mommy
Speaker 1: makeover of some type. And then what you do is
Speaker 1: you go to a rehabilitation location that's typically on the beach,
Speaker 1: and then what you'll do is you sit on the beach,
Speaker 1: you drink my ties or Margarita's, and basically rest and
Speaker 1: relax after the surgery, and you've saved a great deal
Speaker 1: of money. In fact, it's in many cases it's actually
Speaker 1: cheaper than the procedure in the United States, and you
Speaker 1: get a vacation for it as well. I feel like
Speaker 1: you're already kind of describing how some people enter into
Speaker 1: this and how they're choosing to do it safely. But
Speaker 1: from your perspective and what you've seen, what would you
Speaker 1: say to someone who wants to pursue medical tourism safely,
Speaker 1: maybe in as least stressful, difficult kind of a manner.
Speaker 1: Where would they begin? How would they pursue that? That's
Speaker 1: a great question. So there are a number of businesses
Speaker 1: out there that have cropped up over the years that
Speaker 1: are what we call facilitator businesses, and these are essentially
Speaker 1: for somebody like my age. I remember when there was
Speaker 1: travel agents and travel agencies were a thing, and it's
Speaker 1: essentially a travel agent that arranges for care for other people,
Speaker 1: and sometimes they have some more information than you might have.
Speaker 1: But quite frankly, based on the research and based on
Speaker 1: my personal beliefs, that you can find most of the
Speaker 1: information you need through various sources on the internet. Now,
Speaker 1: even though I've stated that the research shows that overall
Speaker 1: from outcome standpoint and obviously from a cost standpoint, that
Speaker 1: this is beneficial when it comes to healthcare, any additional
Speaker 1: factors that contribute to healthcare experience can possibly induce risk.
Speaker 1: So obviously buy or beware by going abroad, by going
Speaker 1: even a long distance, you may be away from your
Speaker 1: support system that could be potentially a problem. Many people
Speaker 1: that travel do bring a spouse sort of loved one
Speaker 1: with them, family member with them. Interestingly, you may not
Speaker 1: be aware of this, but some company excuse me. For example,
Speaker 1: Walmart was one of the leading companies that did this
Speaker 1: for many years have introduced what's called domestic medical tourism
Speaker 1: in their health benefits. And what they do is they
Speaker 1: will pay for a worker, employee and a spouse to
Speaker 1: go to one of the centers of that like I
Speaker 1: mentioned earlier, like Mayo Clinic, and then they'll pay for
Speaker 1: those treatments there because most the centers of excellence actually
Speaker 1: have lower cost basis than a traditional hospital. So a
Speaker 1: good hospital typically it can do things, believe or not
Speaker 1: cheaper than a hospital that's average. And so we oftentime
Speaker 1: see people travel with some support system. But whenever you travel,
Speaker 1: whenever you go somewhere else, there's the added potential of
Speaker 1: infection rates, there's added potential of complications that could occur,
Speaker 1: and that puts you away from your support systems, things
Speaker 1: of that nature. So it's not without some risk, but
Speaker 1: it's a matter of you determining whether that risk is
Speaker 1: appropriate based on the financial decision that you are going
Speaker 1: to make. It's occurring to me that we might also
Speaker 1: be more so talking about a procedure or some sort
Speaker 1: of specific one time medical care rather than maybe a
Speaker 1: more chronic complex. Maybe also depending on what the comorbidity
Speaker 1: might be, that your doctor might kind of know your
Speaker 1: situation and you're well acquainted with your doctor for years
Speaker 1: and years, might not be the situation in which you're
Speaker 1: going abroad for something. Yeah, excellently, do you mind if
Speaker 1: I make just a couple of points that would be helpful,
Speaker 1: very helpful to your listeners. So obviously I trust my
Speaker 1: primary care physician. Many people do. And you have to
Speaker 1: understand that your primary care physician is wanting you to
Speaker 1: stay in that local region, obviously for the reasons I
Speaker 1: mentioned to increase kind of your total risk portfolio. But
Speaker 1: also you have to understand that your primary care physician
Speaker 1: perhaps is friends with other specialists in the area. They
Speaker 1: go to the country club together, they their families know
Speaker 1: each other. So if you're asking them whether you should
Speaker 1: travel somewhere else, even outside of your region. It could
Speaker 1: be somewhere outside of your city, your county, even state,
Speaker 1: or it could be internationally, the answer is most likely
Speaker 1: that they're going to say no, because if the word
Speaker 1: gets back that you to their friends that oh, I'm
Speaker 1: not suggesting the specialists in my local area and suggesting
Speaker 1: other people outside my local area. It actually there's a
Speaker 1: relationship there, there's a network there. So please realize that
Speaker 1: there may be some bias in some cases that people
Speaker 1: will will not suggest that. Then the other thing we
Speaker 1: have to talk about the big issue in the room,
Speaker 1: and I'm sure you've had another I looked through some
Speaker 1: of the wonderful podcasts you've done, but we knew needed
Speaker 1: to talk about one of the things, which is the
Speaker 1: best way to reduce your healthcare cost overall for your
Speaker 1: life is good health. So you have to lose the weight,
Speaker 1: You have to eat nutritious food. Prevention studies over and
Speaker 1: over again in the United States sort of the last
Speaker 1: several decades have found that over thirty percent of the
Speaker 1: total healthcare cost or due to your lifestyle. So if
Speaker 1: anything you can do to lose the weight, eat better food,
Speaker 1: do some moderate exercise, reduce your stress and anxiety, find
Speaker 1: ways to live a better life, you're gonna end up
Speaker 1: saving money over a long time. So interestingly, most people
Speaker 1: don't realize this. One of the most healthy populations in
Speaker 1: the entire United States. You guys probably wouldn't even guess
Speaker 1: this even if I gave you like a hundred chances
Speaker 1: you're ready. The Amish. The Amish, oh yeah, people live
Speaker 1: generally longer than most of US populations. They tend to
Speaker 1: be healthier, and interestingly, they engage in medical tourism. What
Speaker 1: they do is they do cash payments, and they typically
Speaker 1: neotiate a cash payment as a contract if you will
Speaker 1: for the entire Amish community at local facilities. And what
Speaker 1: they do is they're choosing. They choose the facilities that
Speaker 1: obviously give them the best care, that give them the
Speaker 1: best price. And then what they'll do is they'll travel
Speaker 1: outside of their communities to other communities to be able
Speaker 1: to get access to care. And yet they and they
Speaker 1: have They receive no government payments, no government intervention, no
Speaker 1: government public health and yet they they're one of the
Speaker 1: healthiest populations in the United States, and we oftentimes want
Speaker 1: to we want to forget about them and think that, oh,
Speaker 1: that that's an anomaly. It's not an anomaly. They exercise,
Speaker 1: they eat well, they pay in cash for their healthcare,
Speaker 1: they reduce their stress, they have good support systems. My gosh,
Speaker 1: they have great support systems. I mean, it's I'm not
Speaker 1: saying we should live like the Amish. I personally love
Speaker 1: my phone and I loved my technology, and I love
Speaker 1: my life. But you know, there's a lot of things
Speaker 1: to be learned there, and yeah, we shouldn't discount out completely.
Speaker 1: Do you know what else is a healthy practice and
Speaker 1: habit and reduces stress and we should be implemented every
Speaker 1: week every week. The Bill of the week. That's right,
Speaker 1: it's time for the best minute of your entire week.
Speaker 1: Maybe a baby was born and his name is William.
Speaker 1: Maybe you paid off your mortgage, maybe your car died,
Speaker 1: and you're happy to not have to pay that bill anymore.
Speaker 1: Duck bill, Buffalo bills, Bill Clinton. This is the bill
Speaker 1: of the week, Doctor v Quist. Every week we invite
Speaker 1: a listener or our guests on to share with us
Speaker 1: their bill of the week, and we would love to
Speaker 1: hear yours today. Oh I was telling you, ladies earlier.
Speaker 1: My wife and I have always been considered frugal, and
Speaker 1: our parents somewhat disapproved of it. Our kids thought we
Speaker 1: were a little weird when they were going up at
Speaker 1: their frugal now and all gen Z I think is
Speaker 1: the same way. And I tell you why. It's just
Speaker 1: it brings me a sense of pride and a sense
Speaker 1: of satisfaction when I know that I'm getting something for
Speaker 1: a discount and I'm being a good steward with my money.
Speaker 1: And so I have to tell you. We pay off
Speaker 1: for credit cards every month, we have very few bills.
Speaker 1: In fact, we're almost paid off with our house and
Speaker 1: that will be essentially our last loan that we ever
Speaker 1: have for the rest of our lives, and so we've
Speaker 1: paid off everything whenever we can, simply by living frugally.
Speaker 1: And the one of the things that it brings me
Speaker 1: a lot of satisfaction just happened last week is we
Speaker 1: get a percentage back from our credit card which is
Speaker 1: associated with Sam's Club. So we go into Sam's Club
Speaker 1: and they Now what they do is they have the
Speaker 1: option at the POS system where you can actually take
Speaker 1: your percentage that you made that month and take it
Speaker 1: directly off the bill. So I went into Sam's bought
Speaker 1: a whole month's worth of food that we could use
Speaker 1: and various other things. It was like ninety five dollars.
Speaker 1: I had eighty five dollars on my Sam's Card credit
Speaker 1: rewards that I received, So I paid like ten dollars
Speaker 1: at Sam's and I've got this huge thing of food
Speaker 1: and toilet paper and everything else I needed in front
Speaker 1: of me. And when you're paying ten dollars for that
Speaker 1: because I used my credit card for gas and everything else, Wow,
Speaker 1: what a great feeling. That's awesome. Well done art to
Speaker 1: love a good Sam's Club hauls and using up those
Speaker 1: credit card rewards, that's amazing. Especially when that credit card
Speaker 1: gets paid off every month. That's the key. Yes, if
Speaker 1: you all listening, it happened to be able to get
Speaker 1: out of Sam's Club or Costco only paying ten dollars,
Speaker 1: or you love your credit card rewards points, or you
Speaker 1: know you're just a person named Bill. Visit forgal Friends
Speaker 1: podcast dot com slash Bill. Leave us your bill. We
Speaker 1: love them all, we love collecting them. And now it's
Speaker 1: time for lightning roun woo. All right, So for this
Speaker 1: week's Lightning Round, we are all going to take turns
Speaker 1: answering this question. And we amended it a little bit
Speaker 1: because Jill and I realized we didn't have an answer
Speaker 1: for the original one, so we're like, maybe we should
Speaker 1: amend it slightly. But what was the time you were
Speaker 1: surprised by the cost of a healthcare related item or
Speaker 1: overpaid for a healthcare related item? What'd you do about it?
Speaker 1: What'd you do about it? So, doctor v Quist, I'm
Speaker 1: sure you have a lot of stories, whether it's personal
Speaker 1: or from other people you've heard of, So please, without
Speaker 1: going against HIPPA, so I have one that's pretty So
Speaker 1: for those of you that have employer based healthcare, you
Speaker 1: probably know that the census. The type of employees that
Speaker 1: are in your organization determine your costs essentially of your
Speaker 1: healthcare because if you're fully insured, or even if you're
Speaker 1: self insured essentially, by the way, self insurance means the
Speaker 1: company pays directly for the healthcare costs to say, hospitals
Speaker 1: and doctors. Vers fully insured, you go through an insurance
Speaker 1: company that kind of handles that for you. So at
Speaker 1: my university, and I sure hope they don't get mad
Speaker 1: at me for saying this, but we were essentially paying
Speaker 1: almost a thousand dollars a month for family health insurance
Speaker 1: out of our paycheck every month. That wasn't the the
Speaker 1: match from the university. So my wife had used our
Speaker 1: employee education benefits and we had met in grad school,
Speaker 1: but she decided she didn't she wanted to be at
Speaker 1: stay hoole mom. Later, she decided, now that the kids
Speaker 1: are getting out of the house, she wanted to go
Speaker 1: back and be a nurse. So she went back to
Speaker 1: school just to take some nursing classes. Finish that, got
Speaker 1: a job with the local hospital. Sorry long story, but
Speaker 1: you're ready. She got basically health insurance that has saved us.
Speaker 1: You're ready for this drumroll, please seven hundred dollars a month?
Speaker 1: What yes? So for literally the last year a little
Speaker 1: over a year now, since she graduated with her nursing degree,
Speaker 1: we have basically got seven hundred dollars a month back
Speaker 1: by going with one insurance plan through the hospital system
Speaker 1: she works with versus the university program that we had.
Speaker 1: So I tell you what, my gosh, that has been
Speaker 1: just an incredible savings for us, an incredible blessing for us.
Speaker 1: So I'm sure tool and the kids are out of
Speaker 1: the house and she she was to stay at home
Speaker 1: mom for the entire time. And we by the way, also,
Speaker 1: if you have any friends or family that work at university,
Speaker 1: some universities give you free tuition for your children. So
Speaker 1: all my kids have gone to school for free. My
Speaker 1: wife went to school for free. We never paid a
Speaker 1: tuition bill for them. And now now because of her job,
Speaker 1: we now have saved seven hundred dollars a month. So
Speaker 1: thank you very much to her. I love you very much. Money.
Speaker 1: And wow, that's a that's an insane amount. Like no,
Speaker 1: I don't think about that. If you if you were
Speaker 1: in Africa, it could probably feed and clothe the village
Speaker 1: for seven hundred dollars a month, easily every month, and
Speaker 1: then we were doing that just one family. Oh what
Speaker 1: a lovely story of how you responded to that amount
Speaker 1: of healthcare. Yeah, how about you? So similarly, I'm going
Speaker 1: to go along the lines of saving money there. Through
Speaker 1: the healthcare plan that we have, we get free telehealth
Speaker 1: doctor's visits, so with things that I kind of already
Speaker 1: know what's going on, but I would like to know
Speaker 1: if there could be anything prescribe because I'm not able
Speaker 1: to heal up on my own. And so this would
Speaker 1: have been a couple months ago I was having an issue.
Speaker 1: I knew what the issue was, and I knew what
Speaker 1: would resolve it. I didn't need a doctor's visit, but
Speaker 1: I needed a doctor to be able to like confirm
Speaker 1: it and prescribe me something for the fix. So had
Speaker 1: a free telehealth call, then went to the pharmacy to
Speaker 1: pick up the prescription, and I was already with my
Speaker 1: good RX app to get the discount and all of that.
Speaker 1: Didn't even need eat it because this prescription was like
Speaker 1: five dollars and thirty cents. I was shocked at the price.
Speaker 1: I really thought this is probably gonna be a couple
Speaker 1: hundred dollars and I'm gonna need to figure out, oh
Speaker 1: my goodness, five dollars. So the whole thing where I
Speaker 1: and I didn't pursue the care for about a week
Speaker 1: because I'm like, I can resolve this on my own
Speaker 1: by drinking apple cider, vineger and eating a bunch of yogurt,
Speaker 1: and it just was not resolving itself. And but I
Speaker 1: should not have waited a week because in the end,
Speaker 1: between the doctor's visits and getting the medication, it was
Speaker 1: five dollars modern medicine, y'all. I know, I learned. I
Speaker 1: learned my lesson just make the phone call. So for me,
Speaker 1: this was with my first child. I he was breech
Speaker 1: and he was a boy, So standard proceed they go
Speaker 1: to a pediatric orthopedic doctor to get there to get
Speaker 1: check for hip DISPLAYCIA and I brought him in to
Speaker 1: get to get the check at the week that they
Speaker 1: told me to and they were like, they charged me
Speaker 1: for the appointment. They charged me for then reading what
Speaker 1: the x ray from the appointment said, and in that
Speaker 1: appointment said, oh, we couldn't read it, so you need
Speaker 1: to come back for another x ray and then pay
Speaker 1: for another appointment for to read and I was like,
Speaker 1: what what if this could have been? And he's like, oh, yeah,
Speaker 1: he's just a little bit too small, um. And I
Speaker 1: was like, I could have just come in like two
Speaker 1: weeks later. They grow like weeds and those first few months,
Speaker 1: So what did you do? Did you pay for it twice?
Speaker 1: So I paid for another X ray and I did
Speaker 1: not pay for a follow up appointment because in my experience,
Speaker 1: if something is wrong, they call you a million dime.
Speaker 1: So I was like, no news is good news. And
Speaker 1: he runs fine. He runs too fine. Um, So that
Speaker 1: is not medical advice. We don't do as we do.
Speaker 1: But and also they wouldn't let me negotiate the bill either.
Speaker 1: They were so hard on it. Like I was able
Speaker 1: to negotiate down my like delivery bill, but they were hard.
Speaker 1: And I guess it was because it maybe it was
Speaker 1: a specialist within the hospital and the within the children's hospital,
Speaker 1: but they were not having it. So that was another surprise,
Speaker 1: great story, this is all over the place. Well, yeah,
Speaker 1: this is a vulnerability segment. Well I mentioned this at
Speaker 1: the beginning when we were just talking before the show started.
Speaker 1: But I am just so proud of what you two
Speaker 1: are doing and helping your listeners to save money and
Speaker 1: have a better quality of life, and it's gonna bear
Speaker 1: so much fruit. And just thank you for everything that
Speaker 1: you two do, and it's just wonderful. Thank you for
Speaker 1: your kindness, doctor Request, and for being on the show
Speaker 1: and for just introducing our listeners to this concept. If
Speaker 1: they want to learn more from you, the research that
Speaker 1: you're a part of, where can they get more from you?
Speaker 1: So absolutely so, you can go to medical Tourism research
Speaker 1: dot org, sorry org, Medical Tourism research dot org and
Speaker 1: definitely just keep looking at the articles on medical tourism
Speaker 1: and you look at my name on a Google search
Speaker 1: and you're going to find a bunch of different research,
Speaker 1: including recently research about getting pharmaceuticals in Mexico. And we
Speaker 1: also have some research coming up on being able to
Speaker 1: retire abroad and save a great deal of money and
Speaker 1: retire earlier. So just keep watching and listening. We'll have
Speaker 1: more research coming out. And again, there's no reason that
Speaker 1: healthcare needs to consume your life and cost as much
Speaker 1: as it does. And thanks to advice like this podcast
Speaker 1: and research we're doing, people are going to have better lives.
Speaker 1: And I had one question that I forgot to ask earlier,
Speaker 1: but do you have information on your website about how
Speaker 1: someone can find one of those reputable like travel agencies
Speaker 1: for medical tourism or someplace to direct people to their
Speaker 1: Unfortunately no, So the because we're an academic research center,
Speaker 1: were extremely neutral. We're just interested in the trends and
Speaker 1: the research on it, so we don't give advice. Obviously,
Speaker 1: that's between yourself and your physician and your own conscience
Speaker 1: and what your your preferred level of risk is. Um So,
Speaker 1: I'm sorry I can't give more detailed or more specifics
Speaker 1: to people. It truly is buy or beware, but I
Speaker 1: can tell you that the world is a better place
Speaker 1: than it ever has been before, and there's more options
Speaker 1: than ever before. And that's what your listeners should take
Speaker 1: away from this. Thank you doctor the quest. Absolutely, I
Speaker 1: don't know what I was expecting, but that's certainly exceeded
Speaker 1: my expectations. It's one of those and I'm sure if
Speaker 1: you if you read the title of the episode, you
Speaker 1: were like, oh no, one whatto it running out of content?
Speaker 1: But we thought the same thing. I was like, oh no,
Speaker 1: this is probably I had it on the schedule and
Speaker 1: I was like, I took it off, and then because
Speaker 1: we actually couldn't find an expert to talk with us.
Speaker 1: And then doctor Viquis like he responded and scheduled, and
Speaker 1: I was like, oh crap, now we actually have to
Speaker 1: do this episode. And so it was really it was
Speaker 1: really great to learn more about the common procedures where
Speaker 1: you might be going. And I mean, when you're looking
Speaker 1: for a travel agency to book this kind of thing,
Speaker 1: I think, since doctor Viquiz couldn't ethically recommend one, I
Speaker 1: think just do your own due diligence. I mean, I
Speaker 1: did some googling. They're definitely out there. They're not hiding. So,
Speaker 1: like with anything, reach out to several see who you
Speaker 1: feel best about going with. Yeah, ask around too, because
Speaker 1: chances are you've got people within your network who have
Speaker 1: explored medical tourism. And I appreciate how doctor Viquis pointed
Speaker 1: out that it's not just traveling abroad or internationally. Medical
Speaker 1: tourism is can happen within the country that you're living in.
Speaker 1: I mean, and I know plenty of people who will
Speaker 1: travel across the country for certain medical procedures if a
Speaker 1: hospital is known to be better than another. So I
Speaker 1: think for me, it really highlighted the areas of bias
Speaker 1: and ignorance, like where I think or relate in a
Speaker 1: certain way to my understanding of the medical world and
Speaker 1: how we make good medical decisions and really kind of
Speaker 1: decreasing that barrier to entry and understanding more about it. Yeah,
Speaker 1: I think I definitely had some biases and I knew
Speaker 1: that going in, and I wanted to be educated and
Speaker 1: not convinced, and I feel like that happened. And so
Speaker 1: I mean, I'm excited. If I ever need a root canal,
Speaker 1: maybe i'll I'll try this out. Take a friend, you know. Yeah,
Speaker 1: I mean, not for the friend's sake to have a
Speaker 1: nice little vacation. But I do appreciate what he said
Speaker 1: about the support and having a support network. You never
Speaker 1: know what you're going to encounter in your own recovery,
Speaker 1: and yeah, having such a familiar face could be really important. Yeah,
Speaker 1: it is something where there are a few other things
Speaker 1: to account for doing something either abroad or even across
Speaker 1: the country, that you don't need to account for if
Speaker 1: you're going down the street. And so that's something to
Speaker 1: consider if you want to explore this option. Is it
Speaker 1: worth paying more to be really close to home. Is
Speaker 1: there something in the country that's maybe a nonprofit hospital
Speaker 1: that's comparable that. I'm okay playing somewhere in the middle.
Speaker 1: So yeah, just another instance where getting creative and doing
Speaker 1: your due diligence will save could save you money, our
Speaker 1: increase your quality. Thank you everyone for listening, for tagging
Speaker 1: along in our own quest for just greater understanding. I mean,
Speaker 1: medical bills is where we spend so much money. Many
Speaker 1: times it's unforeseen. Sometimes it happens in the midst of
Speaker 1: a crisis. So wherever we can figure out ways to
Speaker 1: decrease those costs. I mean, we're here for We're at
Speaker 1: least here to learn more, and thanks for being here
Speaker 1: with us. We love, love, love reading your kind reviews.
Speaker 1: Obviously we love kind people. Doctor v Quist was one
Speaker 1: of them, and we especially loved this kind review. It
Speaker 1: comes from J and D forty one two eleven, game changing,
Speaker 1: no shame approach to personal finance. I am a podcast
Speaker 1: binger and this podcast is worth the binge. Jen and
Speaker 1: Jill encourages their community to choose frugality as a lifestyle
Speaker 1: rather than a temporary tool to save money. Focusing on
Speaker 1: a balanced approach to financial freedom rather than sacrificing everything time,
Speaker 1: family and friends, mental health, etc. Just to make the
Speaker 1: debt payoff date one year sooner. Bravo. I feel like
Speaker 1: I can finally say I have found friends that have
Speaker 1: the same mindset of stewardship as I do. Oh my gosh,
Speaker 1: I feel like you have summarized our podcast ethos and
Speaker 1: approach J and D forty one to eleven in like
Speaker 1: the best possible way. And it's reviews like this that
Speaker 1: make it helpful for others to identify is this podcast
Speaker 1: going to be right for them? That's the whole hope
Speaker 1: with a review of helping others determine should I even
Speaker 1: give this a try? Is it going to be for me?
Speaker 1: And you did an excellent job of highlighting really what
Speaker 1: we're all about, so thank you for that kind review. Yes,
Speaker 1: and the more reviews we have, the less people think
Speaker 1: that we're just stealing them from our friends and family
Speaker 1: and writing them ourselves. So that's why we ask so often.
Speaker 1: So thank you JN D forty one two eleven, and
Speaker 1: thank you all treasured listeners. If you enjoyed the show,
Speaker 1: please take a minute to leave a rating and a review. Again,
Speaker 1: it helps other potential new listeners know what this podcast
Speaker 1: is all about if it's going to be a good
Speaker 1: fit for them, And again, we love the kindness. Do
Speaker 1: you just want to be kind to us? Go leave
Speaker 1: us a review. Absolutely, see you next time. Frugal Friends
Speaker 1: is produced by Eric Sirianni. Did you want to say
Speaker 1: something about the Mommy makeover? We were just talking about
Speaker 1: that the every day we were in the car, and
Speaker 1: we're just commenting on how normal it's becoming. People just yeah,
Speaker 1: getting botox or my Mommy makeover. I actually thought about
Speaker 1: that this morning, about how I said it's a blessing
Speaker 1: to look average because I've never felt the desire to
Speaker 1: accentuate any part of myself with like a Mommy makeover
Speaker 1: or botox, because, like I mean, I feel like good looking.
Speaker 1: People want to accentuate that and keep that going through procedures,
Speaker 1: and I've never felt a need to because it's just
Speaker 1: prolonging averageness and it's a blessing I think. I mean,
Speaker 1: I thought about that this morning when I was looking
Speaker 1: in the mirror. Stop it, you are making me laugh.
Speaker 1: It's a very funny concept, like I don't need to
Speaker 1: accentuate more averageness. You are not average looking above average,
Speaker 1: I don't think very beautiful woman inside and out, with
Speaker 1: so much wisdom, knowledge to share with the world. Who
Speaker 1: needs botox? When I have you, I'm your botox ingestions.
Speaker 1: Come on over to my house, baby girl. I'll give
Speaker 1: you what you me. I'll give you your mommy makeover
Speaker 1: and in mid tie. Yeah, and I won't have to
Speaker 1: compete the my time, won't have to compete with the
Speaker 1: major pain meds that you will inevitably guess. When he
Speaker 1: was saying that, I was like, well, you probably shouldn't
Speaker 1: have the mid ties after the procedure because you're probably
Speaker 1: gonna be on like vicodin or something, So keep that
Speaker 1: in mind. Just keep it in mind, keep it in mind.
Speaker 1: I'm not here to tell you what to do.