UNIT 4: HEALTH CARE

The Q Classroom

Teacher: Today we'll discuss the Unit 4 question: "How is health care changing?" Let's start with Sophy. First of all, do you think haelth care is changing?

Sophy: Oh, of course.

Teacher: How?

Sophy: Well, for one thing, technology. There's new technology all the time. Nowadays, doctors can perform surgeries with lasers that leave hardly any scar. And there are lots of new technologies for detecting illnesses.

Teacher: OK, technology is one aspect of health-care change. What else? Yuna?

Yuna: There are more specialists now. You can find doctors who focus on your particular problem.

Teacher: That's true. As the field of medicine grows, more people need to specialize, don't they? What else? How else is health care changing? Felix?

Felix: I think there is more emphasis on prevention now. They used to wait until people got sick and then try to cure them, but now we know about nutrition and the importance of a healthy lifestyle, and they can do tests to see if someone has a high chance of getting a particular illness.

Teacher: So, we've got technology, more specialiss, more emphasis on prevention, is there anything else? What do you think, Marcus? How else is health care changing?

Marcus: Hmm. People live longer now. That must be changing health care. There's probably more focus on diseases you can get when you're older.

Felix: That's true. Also, because people are living longer and older people need more health care, it means that health-care systems are costing governments more than they used to.

LISTENING 1: VACATION, ADVENTURE, AND SURGERY?

Listen for Main Ideas

Bob Simon: Thailand – an exotic vacation land known for its Buddhas, its beaches, the bustle of Bangkok. But for people needing medical care, it's known increasingly for Bumrungrad Hospital, a luxurious place which claims to have more foreign patients than any other hospital in the world. It's like a United Nations of patients here.

They're cared for by more than 500 doctors, most with international training. The hospital has state-of-the-art technology, and here's the clincher: the price. Treatment here costs about one-eighth what it does in the United States. That's right, one eight. Curt Schroeder is the CEO of Bumrungrad.

Simon: This place where we're sitting right now is the number one international hospital in the world?

Mr. Crut Schoeder: I haven't heard anybody ye who's told us that they take more than 350,000 international patients a year.

Simon: One of them is Byron Bonnewell, who lives 12,000 miles away in Shreveport, Louisiana, where he owns and runs a campground for RVs. A year and a half ago, he had a heart attack, and his doctor told him he really needed bypass surgery.

They told you that you were going to die.

Mr. Byron Bonnewell: Yeah, they did tell me I was going to die.

Simon: You did not have insurance.

Mr. Bonnewell: Did not have insurance, no.

Simon: He estimates he would have had to pay over $100,000 out of his own pocket for the operation he needed, a complicated quintuple bypass.

And did you actually decide not to do it?

Mr. Bonnewell: Yeah, yeah, I did. I guess I'd rather die with a little bit of money in my pocket than live – live poor.

Simon: He says his health was deteriorating quickly when he read about Bumrungrad Hospital.

Mr. Bonnewell: I was in my doctor's office one day having some tests done and there was a copy of Business Week magazine there. There was an article in Business Week magazine about Bumrungrad Hospital. And I came home and went on the Internet and made an appointment, and away I went to Thailand.

Simon: He made that appointment after he learned that the bypass would cost him about $12,000. He chose his cardiologist, Dr. Chad Wanishawad, after reading on the hospital's website that he used to practice at the National Institutes of Health in Maryland.

Mr. Bonnewell: That's where he practiced for a number of years.

Simon: Right.

Mr. Bonnewell: Every doctor that I saw there has practiced in the United States.

Simon: You never called him.

Mr. Bonnewell: No. Never talked to him.

Simon: But three days after walking into the hospital, he was on the operating table. Two weeks later, he was home.

How was the nursing? How was the treatment?

Mr. Bonnewell: I found it so strange in Thailand because they were all registered nurses. Being in the hospital in the United States, you see all kinds of orderlies, all kinds of aides, maybe one RN on duty on the whole floor of the hospital. In Thailand, I bet I had eight RNs just on my section of the floor alone. First-class care.

Simon: That's what the hospital prides itself on, its first-class medical care, which it can offer so cheaply because everything is cheaper here, particularly labor and malpractice insurance. You can get just about any kind of treatment, from chemotherapy to plastic surgery.

The rooms look more like hotel rooms than hospital rooms, and that's no accident. The idea was to make the whole hospital look like a hotel, and a five-star hotel at that. Take a look at the lobby: boutiques and restaurants to suit every taste and nationality.

Mr. Schroeder: Part of the concept was to create an environment when people came in, they didn't feel like they're in a hospital.

Simon: What's wrong with – I mean, this is a hospital. What's wrong with looking like a hospital?

Mr. Schroeder: Because nobody really wants to go to a hospital.

Simon: India wants to become the world leader in medical tourism and might just make it. Alongside the familiar images of the country: teeming, dusty streets, poverty, you can add gleaming, new private hospitals.

... The hospital boom in India was fueled by India's growing middle class, who demanded access to quality health care. Now, the country known for exporting doctors is trying hard to import patients.

The most important player is the Apollo Group, the largest hospital group in India, third largest in the world.

Anjali Kapoor Bissel is a director of Apollo's international patient office.

Why is it important to get foreign patients here?

Ms. Aniali Kapoor Bissell: It makes sense to establish India as sort of like the world destination for health care.

Simon: That's the ambition – that India should become the world...

Ms. Bissell: Destination for health care, that's right.

Simon: But why should foreigners come here? Well, it's even cheaper than Thailand for most procedures, with prices about 10 percent what they would be in the US.

Stephanie Sedlimayr didn't want to spend the tens of thousands it would have cost her for the hip sugery she needed, and she didn't have insurance. So with her daughter by her side, she flew from Vero Beach, Florida, to the Apollo Hospital in Chenmai...But she didn't come here just to save money. She came for an operation she couldn't get at home. It's called hip resurfacing, and it's changed people's lives.

It hasn't been approved yet by the FDA, but in India. Dr. Vijay Bose has performed over 300 of them.

Simon: What did it cost you?

Mr. Stephanie Sedlimayr: $5,800.

Simon: Including food, service, nurses, the works?

Ms. Sedlmayr: Private nurse after surgery, and, feeling always that they were just totally attentive. You – if you rang the bell next to your bed...somebody was there immediately.

Simon: By the time she left India, she was into the tourism part of her treatment, convalescing at a seaside resort an hour's drive from the hospital.

Is this standard, thet when somebody gets surgery at a hospital here, they come to a resort like this afterwards?

Ms. Sedlmayr: Yeah, they suggest it.

Simon: This, too, is not very expensive, is it?

Ms. Sedlmayr: $140 a day, including...

Simon: For you and your daughter.

Ms. Sedlmayr: For myself and my daughter, including an enormous, fabulous breakfat that they serve until 10:30.

Simon: I think a lot of people seeing you sitting here in what's usually called post-op, and hearing your tales of what the op was like...

Ms. Sedlmayr: Uh-huh.

Simon:...are going to start thinking about India.

Ms. Sedlmayr: Yeah, and combining surgery and paradise.

LISTENING 2: MEDICAL TRAVEL CAN CREATE PROBLEMS

Listen for Main Ideas

Reporter: Medical tourism is now a huge industry all over the world, especially in Asia and the Middle East. Medical tourists are people who travel to other countries to get medical care they cannot get at home...or for care that they would have to wait too long for at home...or they would have to pay too much for at home. Many countries are eager to gain customers in this healthcare market – about $40 billion a year and growing. A recent study showed that in 2008 the Middle Eastern country of Jordan had over 210,000 patients from some 48 foreign countries, bringing in around a billion dollars. And the list of countries providing these services keeps growing and growing, and now includes Turkey, Costa Rica, Argentina, South Africa, Hungery, India, Thailand, and Brazil.

But is there a downside as well? Some critics point to the difference between the care provided to the medical tourist, and the care provided to the typical resident of the country.

Maria Torres represents World Health Focus, a nonprofit agency working to promote better health across the globe.

Ms. Torres, why is World Health Focus studying this growing trend of medical tourism?

Maria Torres: Well, we know there are many financial advantages for the host countries. Medical tourism clearly brings in a lot of money. Developing countries like Thailand and India benefit not only from the income, but from the added jobs and more advanced medical equipment and technology. However, we're becoming concerned about the quality of medical care available to the people who live in these countries. And right now, we're focusing on problems medical tourism might cause for the poorer residents of these countries.

Reporter: If medical tourism brings in new technology and creates jobs for skilled professionals, like doctors and nurses, it seems like this would help the local people. So, what do you see as the problems?

Maria Torres: Well, the main problem is for the people with low incomes. They go to public hospitals and clinics for medical care... . Let me give you an example. In India in 2003, 75% of the total amount spent on health care was in the private sector. But most of India's population – much of it is rural – is served by government run health facilities. And less than one in three of these public health facilities has enough doctors and nurses, equipment, and medicine to provide good medical care. In other words, millions of people in rural India have difficulty getting the basic medical care they need.

This is in stark contrast to the medical facilites in cities that provide care to medical tourists. In these facilities, they have plenty of medicine, state-of-the art equipment, and many highly skilled doctors and nurses. About 80% of the specialises in India are in large cities. World Health Focus is concerned that doctors and nurses will choose to take jobs in these mordern, urban hospital rather than in the public hospitals in the rural areas. So, as we see it, the basic medical care available who go to government – run health facilities, especially in rural areas, could get worse if medical tourism continues to grow.

Reporter: As Maria Torres memtioned, the amount of money available for public health is not the only problem. And India is not the only country where there is a concern that medical tourism may create a shortage of doctors who are willing to work in public health care. Thailand is facing a similar problem.

Siriraj Hospital, in the center of Bangkok, is the largest public hospital in Thailand. More than a million patients go there each year for medical care under the national health care insurance system. It's the oldest hospital after the dealth of his son, Siriraj. He wanted o have a hospital that would serve the basic medical needs of the people of Thailand, as well as provide training for doctors. Every day, 365 days a year, Siriraj Hospital is crowded with patients seeking medical care.

On our visit to Siriraj Hospital, we met with Dr. Pan Chittarong, who has worked at Siriraj Hospital for more than ten years. We asked him how medical tourism is affecting the hospital.

Dr. Pan Chittarong: Well, right now, our main problem is we have trouble keeping doctors. Doctors leave public hospitals like Siriraj Hospital to pratice in the private sector hospitals. And I can't blame them, really. The private hospitals are modern, with all the technology. And the doctors can make more money in the private hospitals.

Unfortunately, doctors sometimes have to make a difficult choice between taking care of people at a public hospital, or making good money at a private hospital. Just last week, the head of surgery at our hospital resigned to go to work at Bumrungrad Hospital, a private hospital.

Reporter: So the main reason doctors are leaving is for more money?

Dr. Pun Chittarong: Yes, but that is not the only reason. Medical tourists usually come here for some kind of surgery. So these private hospital need more surgeons and other specialists. They don't need primary care doctors. And many surgeons and specialists would rather work in these private hospitals where they can focus on one medical problem. This is easier and much less stressful than dealing with a lot of people's health problems all day in a public health facility.

Reporter: We asked Maria Torres if World Health Focus is concerned about more doctors choosing to work as surgeons and specialists.

Maria Torres: Certainly. We have found that when a country becomes a medical tourism center, priorities can change. There is a shift away from primary, basic care toward greater specialization. Primary care doctors are the ones who see people when they are sick. They are the one who take care of children and keep average people healthy. But medical tourists need specialists like surgeons more than anything else. Medical tourism may be encouraging more and more medical students to choose to focus on these specialties, rather than the general practice that local people are most likely to need.

Reporter: Although medical tourism can cause problems, there may be solutions, according to Dr. Chittarong and Maria Torres.

Dr. Pan Chittarong: Many of our doctors want the best of both worlds. They feel an obligation to take care of the local people, but also want to have the advantages of working in the private sector. As a result, some work at Siriraj full-time, and part-time at Bumrungrad. So I feel encouraged. I see the doctors using their training and experience in both places.

Maria Torres: I think, in time, countries like India and Thailand will find a balance between serving the medical tourist and the local polulation. Obviously, medical tourists bring in money to a country, but countries what to take care of their own citizens, too.