Monday, February 23, 2009

Last Shout Out to the Korean Medical System

Here I am at my hospital, Hanyang University Hospital. I'm going through a series of regular tests. Being an insulin dependent diabetic and having Graves' Disease (a thyroid disorder) means I've got more tests than usual to take on a yearly basis. I got here a few minutes late for my 9:40am OB/GYN appointment. But, in spite of running five minutes behind, it's been smooth sailing.

My OB/GYN was female, as I requested, and her English was pretty decent. She talked me through the exam and caught that I'd not had a mammogram in over five years. It was time for another one. The nurse sped me off to pay for the exam and then took me to the exam room. The exam tech was really friendly and was honest that it was going to hurt. It did. Ouch.

I have my final appointment with my endocrinologist tomorrow, so I had to go to give them what they needed for a bunch of lab tests. Then it was off to my scheduled eye exam. For those that don't know, diabetes wreaks havoc on your blood vessels, internal organs and also messes with your heart. That's why it's really important for diabetics to keep their blood sugars in as normal a range as possible. As a result, diabetics ought to do yearly eye exams. Not just the ones where you look at a chart but the unpleasant one that requires your pupils to be dilated. That way the doctor can literally get a good look inside to see if there is any diabetic retinopathy (eye damage from diabetes).

Right now, that's the phase I'm in. My pupils are dilating, and I've got to refocus every minute or so because I'm sitting here typing on my laptop.

So, for those that don't know, it's worth saying again. At least on the university hospital level, medical care here is modern, affordable and efficient. Like any system, there are frustrations and glitches. It's not perfect. I went to one clinic that really did cut corners to the point that all I did was walk in, say what I needed and walked out with a prescription. That's dangerous. Also, a lot of doctors here have a God-complex, so their listening skills aren't the greatest. They're not really used to a pro-active patient.. They're much more used to telling a patient what's wrong with them and not being questioned. In contrast, I'm the sort of person who gets out and does the research so I know a fair bit about the latest research regarding the two conditions I have. Those are the most irritating points, but there are doctors with God-complexes back home. At least here I can afford to see a doctor.

As a whole, the system is much easier to navigate and much more accessible in terms of cost. The worst thing would be communication issues. If you don't speak Korean, it can be a problem. If you speak Korean, it can be frustrating because almost everyone assumes you've got no clue. Today I had a doctor express pure shock that I could read her name in Hangul even though she could see from my chart that I'd been here for a few years. (I'm sorry but how dumb must a person be to not know how to read Korean after being here that long?) However, I've learned to just smile, realize they're doing their best and try not to take things at more than face value. It's worked well for me. I've blogged about having a scratched cornea and having excellent service. I've blogged about other positive experiences here as well. Being someone with experience in both the US and Korean health care systems, I've got to say Korea slays the US in terms of accessibility. When I was at Ewha, I didn't have the public health insurance card and I could afford to pay out of pocket for my medical exams, tests and medicines. I could never afford that out of pocket in the States for two years. I truly think the US system is a travesty. How can such a developed nation have so many people who don't have access to basic health care?

With that said, I'm not looking forward to wandering back into the morass that is the US medical system, especially in this crap economy. However, it comes with going home and having two chronic conditions to manage. The fact is, I can't avoid it even if I wanted to.

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  1. I agree totally and have enjoyed quick thorough care here in Korea when needed. Who out ever think you could be and in out of the hospital in an hour with x-ray and scripts for under 100 bucks! Definitely will mourn that when the time comes for us to return to the States.

    I also HATE the pre-existing clauses insurance companies are using to deny care. I thought that was dealt with and abolished long ago. It sucks and needs to be fixed.

    Good luck with your move back. I'm interested to hear if you have trouble adjusting. I think I will big time. I've enjoyed my time here in Korea and have made some lifelong friends.

  2. I'll miss it for sure. Predictably, I was getting sad in the hospital yesterday. Those corridors are very familiar because I've been a patient there, at this point, for years now.

    I'll have adjustment pains for sure. But I left a pretty vibrant and HMO-insured life behind when I came here ;) The trade off back home is to basically get full-time work. With the economic crisis that will be more of a challenge, but I'm going to hustle my ass off when I get home.

    To be perfectly honest, I'm anxious to get back to it. In spite of any anxiety and the shitty health care system, I really feel like it's time for me to go home.

  3. I too live with a chronic illness (Crohn's and colitis). I am doing fine but need the regular blood tests. So far it has all been very pleasant and affordable for me here in Korea.

    In America I didn't have health insurance and relied on city public health programs in San Francisco. I would spend almost 2 hrs in a waiting room just to get a blood test. And it wasn't fun of course, I had to wait with drug addicts waiting to get get their they yelled and spazed out. That's SF for you!

    I think you can still get good care back home but to get it you have to go through a lot of research and figure out what insurance policy is the best. I use to work at an insurance company and never really understand health insurance and its deductible plans...but good luck! hehe

  4. I came to Korea from San Francisco also. I was lucky as I had HMO coverage when I was there. I didn't, however, in law school and fell into that system briefly. You're right. It sucked. But when you're in a situation where you don't have any other options, it's better than nothing.

  5. Do you know of anyone who has had actual surgery here? My stateside doctor thinks I may have a gallbladder issue that might require removal, but I am slightly hesitant about having something as invasive as that done here.

  6. If you're going to do surgery here, first, I'd say go to a university affliated hospital that has a rep for working with foreigners.

    That narrows it down to just a few - Hanyang University (eastside near Wangshimri Station), Soon Chun Hyang University (in Hannam just south of Itaewon) and Yonsei University (in Shinchon) are the three that come to mind. There are others.

    I'd go to for other hospital options. One bit of advice, get a second opinion and know the process. Korean doctors tend not to explain much (probably a language barrier).

  7. Now that you're back in the US, you'll find that even with insurance, you'll still be paying more out of pocket with deductibles and co-pays that you did without insurance in Korea. Whenever the topic of health care comes up with friends and colleagues, I quote prices for services and medicine in Korea and China and emphasize that while lower salaries explain part of the difference, the facilities were excellent, clean and equipped with recently imported diagnostic and treatment tools.

    Back when Clinton was in office, Americans weren't ready for a major change in our health care system. Now we are.

  8. Yes and no re out of pocket costs. I was lucky enough that, most of my life, I did have health care coverage. So I have to disagree with you saying out of pocket costs are more expensive with insurance here. In some cases, they're not.

    The issue here is, if you're not working or married to or a dependent of someone who is working, well, you're S.O.L. when it comes to medical coverage. It's like a great club. Once you're in, man, are you treated well. If you have a disease like mine that's very dependent on equipment, it's a lot of stuff to pay for.

    When I left the States I had Blue Shield HMO coverage. When I was employed after university, I had another HMO. On both plans EVERYTHING was covered, and I had a very small co-pay for things like my needles, test strips, insulin and what-not. In Korea, the trade off is health care that isn't so overpriced that you can't access it if you're not insured. In Korea, however, all of those diabetes supplies that are necessary for diabetes management I had to pay for. That's insulin, blood glucose test strips, needles, my insulin pump, the pump's equipment and connectors, etc. The thing is, for most things in Korea, that stuff over the counter is very inexpensive.

    However, there were some that cost the same. I had to pay out of pocket for my insulin pump. That was around $4,500. Here the pump and the accessories would be covered if you're insured. When you're not, that's when your costs skyrocket. In fact, I'll be completely honest and say that as soon as I get coverage, the first thing I'm going to do is upgrade my insulin pump. It's time for a new one. This one maybe has another year before it gives up on me and, technologically speaking, it's already out of date.

    Again, when you're insured, however, your insurance pays for all of those things less your deductibles and/or co-pay. For me, I always choose a plan that is for someone like me who is at the doctor and pharmacy frequently. So, when you're insured in the States, it's a great deal if you've got a disease like mine which is very dependent on testing and self medicating (that's what taking insulin is = giving yourself insulin multiple times on a daily basis.)

    So, I have to disagree that I paid more out of pocket when I was insured here. That actually might be part of the problem. As a diabetic in Korea, I didn't have a problem with paying a little more. It's a luck of the draw issue, but the trade-off was I could afford to see a doctor once a month with the insurance and, even when I was without it (when I was at Ewha) between the student health coverage for colds, teeth cleaning and other stuff and the out of pocket costs for medical care, I could afford it. I was in the same situation when I was in the States in law school and it was impossible to maintain.

  9. When I went with my standard company medical insurance. Which really will only be good if I get cancer or something. I was kind of worried how I'd pay for my medical care. Well one day I went to the doctor and got treated for the flu. I got the flu taken care of, used no insurance heck I didn't even show them any form of ID. I paid $10. You tell me in America where I can get treated for the flu and only spend $10.

  10. Well, Niklas, you can't. ;)

    BTW, I just found your comment. It looks like I skipped it by mistake.

    (Note to self: run a search for any other comments I might have missed.)


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