See the comments at the end!
I had a wholly satisfying encounter tonight with the Swiss medical system. It started, as you might imagine, with a worry: I appeared to have a deep vein thrombosis (clot, aka DVT), which in the worst cases can be fatal. I was processed promptly, with good news, at a good price.
Chief complaint: swelling, redness and pain in the foot
Last week while traveling I developed what seemed to be gout: a painfully swollen big toe joint. Long story short, five days and a long overseas flight later the symptoms had shifted and I wondered if it could now be a DVT. My doctor, with images and discussion via Skype & email but unable to physically examine me, said yes, I should go have it checked out.
Great: nothing like looking for medical services in a strange city, I mean strange country. Where to go? What’s this going to cost this uninsured foreigner? How long will I wait?
My trip host and the hotel desk agreed I should go to the walk-in clinic at the railroad station, across the street. Ginny and I gathered our things, and 15 minutes later we’d found the clinic and were waiting in line, with one person ahead of us. I checked in, and ten minutes later was called into an exam room.
Outcome:
To make a long story short, an hour later we were out of there, having received:
- Initial consult with a nurse
- Initial meeting and exam with a doctor
- Blood work – CBC and D-Dimer, which he said would check for a by-product of clotting. (If it’s negative, no clot; if positive, more tests.)
- Results, discussion (D-Dimer was negative – must be the gout), and discharge instructions
- A syringe of heparin (blood thinner) for Ginny to inject in me before our flight home Friday – just in case, as a safety measure against possible DVT during the flight home.
Total bill: 292 Swiss francs … $308. And 75 minutes after we walked in, we were on our way to a late dinner.
I can’t help but wonder what this would have cost in any American clinic. But, no matter; I was very happy. Heck, I’ve had trips to the barber shop that took longer than this.
Here’s to Klinik St. Anna, the hospital that runs this walk-in clinic. I couldn’t have been happier with the people, the service, and the caring experience. And the price was great for the service received.
See, America, it can be done! Let’s do it.
Sorry to hear about your troubles over there. I hope all goes well on your trip home.
A recent uncomplicated trip to the ER for a worrisome eye problem cost my insurer and me $1300. No labs, no instruments, no medicines, and no procedures. This was for an eye check with an ophthalmascope, a visual acuity, check of peripheral vision…all done by a NP.
Good service,,, outrageous bill.
May I humorously add something along the lines of footing the bill? Glad you’re (mostly) ok. You gotta stick around, old timer.
Dave Glad you are OK. Price for the heparin in my local CVS is $103.
From Facebook: Gangadhar Sulkunte [in France] – The pricing here confirms what was written in the Time magazine article. We had to go to an emergency room once. The price including X-ray and evaluation came to a grand total of €21!
Outstanding – that you only have a mild case of gout, not a DVT; that you found caring, fast, and effective treatment at a cost that’s in line with reality, not greed (or worse, cluelessness, which I think drives most pricing decisions in US healthcare); that you’ve reported it so clearly and well above.
Switzerland’s model of healthcare includes an insurance model that’s not single-payer, that includes consumer choice of insurance carriers and plans, and offers premium assistance to low-income people. Sound familiar? If you don’t know Regina Herzlinger, you should. She’s a leading health-econ thinker, a professor at Harvard’s B School, and a big proponent of putting the Swiss model in place here in the US. Some context in an HBR news item from ’10 .
Congrats on the good-news-all-’round. Have Ginny hug you for me =)
Here’s the link again to the HBR item, managed to achieve link-fail in last comment :/
http://www.hbs.edu/news/releases/Pages/swisshealthcare2010.aspx
An interesting experience–and very glad to hear that you received a diagnosis and are doing well.
The ER doc part of me is curious as to why you received a d-dimer rather than an ultrasound. Had you come to an ER in Boston, you might have received different treatment. I probably would have done an ultrasound first. Here’s why. Let’s say that your d-dimer is negative: am I convinced that the false negative rate is low enough that I would stop there? If it’s positive (let’s say, if you have a superficial blood clot, it might be positive), wouldn’t I do the ultrasound anyway? And the ultrasound is a noninvasive and safe test, unlike CTs, for example, that do carry a risk of radiation. Finally, it is the definitive test for DVT–so why not do that?
Anyway…. all this is a pure intellectual exercise. You had a great experience–and I’m very pleased that the doctor really listened to you and involved you in your own decision-making to your care!
Hi Leana! Thanks for coming here – this is indeed too big for Twitter.
At my primary’s suggestion, I did ask about ultrasound. He said yes, they have it at the clinic, but if the d-dimer was negative, it strongly suggested no clot.
He did say it wasn’t certain but the chance of false negative was low. (Do you know?)
Do you know how much an ultrasound costs? Maybe I can go back and ask them the cost here.
Thanks for chiming in – I love learning more about the thought process!
Hi Dave! Thanks for the response! I’m curious what the cost of an ultrasound is there. No clue what it costs here ala Steve Brill’s recent article. Just to plug in for ultrasound: in addition than having virtally no side effects and being a more sensitive test (I think d-dimer sensitivity is in the 80s%), it’s a faster test…
The south is different in health care offerings because so much here is new.
The best bet in town: the walk in clinic. Two weeks ago my sister had a nasty dog bite. I suggested the walk in clinic affiliated with a large nonprofit (?) system here, Memorial Hermann.
What an amazing experience. Facilities were excellent; she was in an exam room w/in five minutes and saw intake, a physician then an RN within thirty minutes. Shots of antibiotic and tetnus on the spot. Her co-pay was $100. I don’t know what was billed but will ask.
This underscores the amazing variance in care based on markets. What would the situation have been for someone without insurance? A good question. It also underscores that good service and care can be delivered quickly and efficiently with the right design. My sister needed attention but if we’d had to suck it up at local ER with the Friday night car accidents we’d still be there.
It’s amazing to see the variety of responses on walk-in car.
I’m glad you’re ok, Dave. Enjoy the rest of your trip!
Awesome story, Dave.
The test’s ability to ‘predict’ a DVT depends on (a) whether they used a highly sensitive test or a more run-of-the-mill D-dimer test and the (b) overall chance that you might have a DVT (low, medium or high). But it turns out that if you’re in the low chance category, either D-dimer test is pretty darn good at saying you don’t have a DVT if the test is normal.
More info at: http://www.bmj.com/content/329/7470/821.pdf%2Bhtml
Take care of yourself, man!
Sue, how would I know if it’s a highly sensitive D-dimer test? This one was by Roche…
re: walk in clinics: Here in Boulder CO I used a community hospital affiliated emergency clinic for a 2nd degree burn (dropped boiling water). I was taken by how efficient it ran and how delightful and happy the clinicians acted. The guy debriding me said that yeah, they like their gigs and their culture is different from that w/in the hospital. It showed.
D-dimer sensitivity: this discussion points out how challengingly hard it is to function as an e-patient even for we who know a little something. In my languaging about it I say “be a professional question-asker” and “use a mental periscope to try to see around the next corner” and other sorts of proactive behavioral things. Hugely challenging, and this thread seems to be suggesting some possible failure of complete pro-advocacy.
So Dave, were you in pain or distressed at the clinic? Did you feel secure/satisfied with the treatment options provided? Did you feel that you had enough information to make informed consent? Is some of the difference arising in this thread due to international medical cultural differences (is there a global/western standard of treatment for the symptoms which with you presented?) Did you ever think to ask a down the rabbit hole cascade of questions that have arisen here? And, does it matter?
4 years ago, my sister (American & English citizen)broke her wrist skiing in Cuchoval (sp?)France. She was taken by ambulance to a french clinic. They set the fracture and kept her overnite for observation. She was released the next day and told to followup with her British physio in 6 weeks. After 6 weeks, he looked at the injury and advised her to return to France if she had any complications as the French doctors had done an excellent job. Total cost- $700 pounds sterling…
The Roche D-Dimer has a sensitivity of 99.3% and a negative predictive value of 99.4% for DVT. I pulled the info from the FDA 510(k) approval
Thanks, Gerald! Great to hear!
I haven’t gotten back to the clinic to ask what they charge for an ultrasound.
I wonder if anyone’s ever done a comparison re which is more “definitive.”
Re the price of ultrasounds to look for blood clots:
I had an ultrasound in a Seattle hospital last August to look for a possible blood clot in my left arm. This was not associated with an ER visit. The hospital billed the insurance company $468, and the insurance paid the hospital $302.