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May 09, 2008

The good, the bad, and the different: accessing health care services on vacation overseas

While on vacation in Israel last month, I had occasion to sample the local health care system.  My teenage son needed an antibiotic, to nip in the bud a recurring respiratory issue.  Fortunately, I had noticed a neighborhood health clinic a couple of blocks from the apartment we were renting in Ramat Gan, a Tel Aviv suburb.  My wife took him into the clinic in the late morning (he sleeps like a teenager, regardless of time zone).  After a little intake dance (and discussing Blue Cross Blue Shield coverage in a country with national health insurance), a nurse determined that he probably needed an antibiotic, but that he would have to be seen by one of the physicians before a prescription could be written.  (What, no NPs? No PAs?)  It was 12:05.  Unfortunately, she came back a few minutes later to report that the docs had all left the building at noon, so -- no chance of getting a prescription.

The options: go to a clinic in another nearby suburb (the nurse called ahead and determined that it was unclear whether, or for how long, a doctor would be there) or head to a nearby emergency room.  The nurse recommended the emergency room: "All the tourists go there."

I drove the ten or fifteen minutes to Tel Hashomer Hospital.  It is a giant university medical center, with about 20% of the signage one might expect.  It took me a while to find the pediatric emergency department (after a brief, but heated, argument about parking).

Once in the pedi ED, service was quick, and -- take note, ED administrators everywhere -- nobody asked about source of payment prior to service.  (That may have canceled out the delay in care due to lack of signage.)  The triage nurse seemed to be the sort of person every physician asks to run interference with other nurses and other hospital departments, so it took her a while to get through the history.  My son was seen almost immediately by a physician who ordered a chest x-ray (done down the hall, image transmitted via PACS back to her workstation), and a nebulizer treatment (in a room designed to accomodate multiple patients at once, including one whose mother found it a convenient spot for breastfeeding).  The doc sent us off with a prescription (to be filled at the "Super-Pharm" in the next hospital building).

Oh, and on the way out, the unit clerk validated my parking ticket and said she'd mail out a form for me to have signed and returned by my PCP.  Then she remembered I was a foreigner.  I waved my BCBS card -- again -- but she cheerfully informed me that the hospital did not deal with overseas insurance.  She printed a bill and I paid by credit card:  it was about $250 for an ED visit, including physician services, an x-ray and a nebulizer treatment.  (Not bad, eh?  The only excessive cost for the visit was the airfare . . . .)

It was after 4:00.  I picked up the antibiotic, and we headed back to the apartment to pick up the rest of the family and head south, five hours later than planned . . . .

When we returned to the States, I called BCBS.  The visit is covered; they're sending me a form to fill out and return with the hospital bill (it's in Hebrew, but they say they'll have it translated in Virginia). 

The hospital visit delayed our arrival at Shakespeare's Falafel Stand in Beersheba (yes, really), but it was an interesting peek into another country's health care system.  Still, I don't think I can deduct the trip as a business expense.         

-- David Harlow


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Great post! Thanks for sharing your story.


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