My Involuntary Medical Tourism – and a bad pattern for the U.S.

I was in Singapore a few weeks ago for a mixture of work (digital innovation) and play (attend a wedding). Good times. Until the night before the wedding, when with our Australian friends who’d kindly flown up to meet us,

we went out to the deservedly famed Indian restaurant in the PanPacific hotel.

You’ll note that the entrance is pretty dark, to prepare you for the quite dramatic lighting inside.  My friend and I, strolling in, approached the image of Ganesha you see in the picture. Unfortunately I overlooked the 5” high platform on which the Remover of Obstacles was displayed, and tripped — as I fell, I caught a finger on the crossbar on the wall resulting in the all but complete evulsion of the nail (you don’t want me to explain.)

I mentioned the hotel by name above because the staff could not have been more solicitous and competent, and after providing me a napkin full of ice suggested I visit Raffles Hospital, a mile away.


Here begins the voyage of discovery. 

My wife and I appeared at the emergency room check-in desk, and before any administrative questions were asked I was seated in an examination room. The doctor appeared within two minutes to take a look.  He offered me two options.  They could remove the nail, basically hanging by a thread, and I would just wait to see if a new one would grow back; or they could remove it, wash it, reinsert it where it belonged, and stitch it onto the finger.  He told me the latter would improve the chance of a normal nail growing in, so that’s what I chose.

Half an hour later we were done, including a precautionary X-ray I requested. I went back to my hotel with a kit of dressing supplies and medications.

The total bill was 465 Singapore Dollars, or $372. (That X-ray I asked for was taken and read for $80.)

When I got back to the US I went to see my doctor, who said that she’d never heard of reinserting a nail back into a finger, and admired how well it was healing.  She also said that at Mass General Hospital the cost would have been in the thousands.

Let's review: Instant service; a treatment with a great outcome that likely wouldn’t have been tried in the U.S.; and a cost an order of magnitude less than the U.S. equivalent.

Travel indeed broadens the mind.

So it was with a changed point of view that I read of the difficulties of the U.S. blood industry, facing sharply declining demand. The trend is “wreaking havoc in the blood bank business, forcing a wave of mergers and job cutbacks unlike anything the industry…has ever seen.” Transfusions are down from 15 million to 11 million units over the last five years, it turns out, despite the aging of the population, costing the industry $1.5 billion in revenue.

Granted, this was in the business section.  But I couldn’t help wondering why the medical advances at the root of this development weren’t the headline — e.g. total hip replacement formerly required 750ml (1.5 pints) of blood and now uses only 200ml.

To return to the difference in cost between Raffles and Mass General – perhaps this has something to do with it: “Nonprofit organizations collect whole blood from unpaid donors, but hospitals may pay $225 to $240 a unit, according to executives in the business, which covers a variety of costs, including testing. If the unit is billed to the patient, the price can be $1,000 or more.” – CAM