My Trip to the Hospital in Malaysia, and Thoughts

I’ve been in Malaysia for a little over two months now and am quite, but pleasantly, surprised to say that one of areas I’ve learned the most about is healthcare. I learned first hand about the Malaysian healthcare system within the first two weeks of arriving. As some of you may know, I have a severe allergy to peanuts. I, unknowingly of course, ingested a food containing a substantial amount of peanuts. Within 10 seconds of swallowing the food I ate I knew there were peanuts in it. I had never gone into full-blown anaphylactic shock in my 21 years of being allergic to peanuts. I had never used an Epi-pen before. In past reactions, I had usually only eaten very small amounts of peanuts before and one dose of Benedryl and plenty of water had done the trick. Not this time around. As I gulped water hoping that this would be one of those times where everything would go back to normal within a few minutes, I felt my throat swelling up and my breath getting shallower and shallower. I had two options: inject myself with my Epipen and go to a hospital in Malaysia, or, well, I guess there was only one option because I sure as hell wasn’t going to risk dying here.

I had my friend, a fellow student named Xyn, drive me to the nearest hospital. I injected myself with an Epipen on the way there, and while it didn’t resemble Chev Chelios’ experience too closely, it certainly helped me avoid the worst of anaphylactic shock. We arrived at the hospital and went to the ER where they admitted me immediately. I had some very nice nurses check my vital signs and hook me up to a heart monitor machine. They thoroughly questioned me about how I was feeling and had me recount minute by minute what had happened since I ate the food containing peanuts 20 minutes earlier. I saw a doctor who asked me the same questions, asked me if I felt like I needed more epinephrine, and checked over my vital signs again. The doctor said I was doing just fine and quite frankly I felt just fine: quite relieved that I was going to be all right after probably one of the most serious allergic reactions I had ever experience.

The doctor said I was free to go and the nurses took me off the heart monitor. In total I was there for about an hour and always had someone tending to me. I left the ER and was directed to go to the payment counter. I had left my apartment in quite a hurry and hadn’t thought to bring a debit card or much cash. As I walked to the payment counter I started to fear a bill upwards of 600, 700, 1000 ringgit and realized I would probably have to ask Xyn to borrow some money.

I arrived at the payment counter…

Let us recount my hospital visit:

-Immediate admittance into the emergency room
-Staff of two nurses and one doctor tending to me for a period of one and one half hours
-Plenty of fancy medical machines measuring vital signs and stuff

… My bill was 30 ringgit: the equivalent of about USD 8.50.

I’m not even a citizen here and I’m able to go to the ER for under 10 bucks. I chuckled at the fact and thought to myself, “what a good deal!”

My trip to the ER faded to the back of my mind over the next days and weeks and I was occupied with exploring the new culture and country that Malaysia had to offer me.
I’m a bit of a news junkie so I’ve been staying up to date with all the happenings back stateside and around the rest of the globe. One issue at home that has no doubt sparked much interest this summer is the debate about healthcare reform. I’ve been keeping up to date with the town hall meetings, the death panel talk, Obama’s calls for bipartisanship, the Group of Six, etc, etc. It all brought back the notion that my $8.50 trip to the ER had cost less than my co-payments for my 10-minute appointments to get vaccines to come to Malaysia.

The other night as I did my usual, but unproductive, cruising of the Internet, I googled: “average cost of emergency room visit in Minnesota.” It gave me this nice link.

“The average E.R. visit costs $1,049…” And that was in 2002.

Better yet, I found the average cost of a trip to the ER for an allergic reaction to a bee sting, which is the same allergic reaction I have when I eat peanuts. The cost listed is $1,050. Granted, it does say that the trip “could also include hospital stay.” This cost, along with many others, is located here.

OK, so if I would’ve seen the bathrooms at the hospital I was at before I went to the ER, I might have not of been as comfortable as I was. I’ll admit that the nurse was amazed with my spent Epipen and told me she had never seen one before. The doctor asked me, “If you’re allergic to peanuts, then why did you eat them?!” I could tell the walls were white at one point in time. The florescent lights created a feeling that was more akin to the basement of a comic book store. The scene was interesting, but I received care and attention that ensured I was going to be all right.

Granted, I did not limp into the ER bleeding all over the place missing an eye or an appendage, but I did feel as if my life was at risk. I’m not so sure how much my medical bill would have been in the US had I gone into the ER in the same condition.

My trip to the ER was inexpensive. No, ridiculously inexpensive. How inexpensive? Think of it this way…

We seem to love our McDonalds-economics, so lets look at it that way.

Let’s consider a few figures…

$8.50 for ER trip to Malaysian hospital
$1,050 for ER in Minnesota in 2005

Taking into consideration the $1,050 figure “could also include a hospital stay,” let’s say I theoretically stayed one night at the Malaysian hospital. To makes things interesting, one night at the five-star Marriot in Kuala Lumpur costs $92 a night. So…

$100.50 for ER visit in Malaysia and one night at the five-star Marriot in KL

Back to McDonalds. The cost of a Big Mac in Malaysia is $1.88 and in the US $3.57. (Taken from The Economist)

ER visit in Malaysia = about 5 Big Macs
ER visit in Minnesota = about 294 Big Mac
5 star vacation at Malaysian hospital = about 53 Big Macs

Interesting.

Secondly, going off of this clever idea from The Economist.

The hourly minimum wage in the United States as of July 24th, 2009 = $7.25

Unfortunately there is no such thing as “minimum wage” in Malaysia. However, keeping with our McDonalds theme the hourly wage at McDonalds here in Malaysia is 3.5 ringgit an hour, which is roughly $1 an hour. From what I can tell, McDonalds seems to be one of the better, more stable jobs here.

Let’s imagine I work in Malaysia at McDonalds, and at home in the US I work a minimum wage job.

Hours to pay off ER visit in Malaysian = 8.5 hours = about one work day
Hours to pay off ER visit in US = 144 hours = 18 eight hour work days
Hours to work off hospital stay with 400 thread count sheets = 100.5 hours = about 12.5 eight hour work days

These calculations are far from perfect. I don’t know what kind of benefits McDonalds offers its employees here, I don’t know how many people have health insurance plans, and I don’t know if my hospital visit was expensive or not by Malaysia standards, I assumed the full amount of the salary would be paid towards the costs (in which case it would take much longer to pay the costs), but do note the rather large discrepancies in costs. I went to a public hospital, was admitted immediately, and walked out of the hospital doing all right. It costs less for a one-night stay at the Hilton and an ER visit here in Malaysia than it does for a visit to the doctor for a sore throat in Minnesota, $109 in 2003.

Most of my peers here are from Canada and Finland, both countries where the respective governments offer a healthcare plan. From conversations I’ve had with students from those two countries, what I can beam is that: taxes are a bit higher, sometimes you have to “wait in line” for a routine checkup, but in the end everyone is delivered high quality health care for no out of pocket costs.

I’ve met many people throughout my travels here where their respective government offers an insurance plan, and honestly I’ve heard no complaints.

The moment that really sparked my interest in the healthcare system in the US came out of a conversation I had with a few local Malaysian students. I had told them the story of going to the hospital and how it cost me only $8.50 and that it was an absolute treat because it was so cheap. I mentioned that the average trip to the ER costs over $1000 back in the US. The locals were bewildered. One asked me, “If you’re poor, what do you do?” I said, “You know what, I don’t know.”

A 2009 study released by the American Journal of Medicine (here), found that in 2007, 62.1% of all bankruptcies had a medical cause. There are plenty of legitimate reasons for filing for bankruptcy, but no one should go bankrupt paying for healthcare costs. I encourage you to read the report, heart-wrenching statistic after the other.

Let’s visit my previous calculations. Let’s say I were to have an allergic reaction and go to the ER and spend one night at the hospital in the US. I work a minimum wage job that has no benefits. I get a bill for $1,050. I couldn’t imagine my next 1.5 paychecks going to pay for my trip to the ER. What would I do if I were unemployed? Out of that 62.1%, how many people do you suppose worked a job that paid minimum wage? An hourly wage job? Were denied healthcare for a preexisting condition? Could not afford premiums? The list of circumstances, most of which I think are illegitimate, goes on and on and on.

Why is there opposition to healthcare reform in the United States? Why do people protest against a government-sponsored plan? The next time you hear someone say government sponsored healthcare is socialism, that the government is going to make euthanasia or abortion a policy, or whatever other bogus myths are being circulated, realize that a McDonalds worker in Malaysia making one dollar an hour probably has more affordable healthcare than many Americans.

Also, for those curious:

http://www.myhealthcare.gov.my/index.asp

There I am in 50 years living out my dream of a five star hospital visit complete with a view of the Petonas Towers. But seriously, the homepage advertises: “… a Heart Bypass costing USD130,000 in the United States would cost only around USD9,000 in Malaysia.”

Ian

Sources:
http://www.economist.com/daily/chartgallery/displaystory.cfm?story_id=14288808
http://pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf
http://www.consumerhealthratings.com/index.php?action=showSubCats&cat_id=274
http://www.mnhealthplans.org/consumers/documents/HowMuchDoesItCost2005.doc
http://www.hotels.com
http://www.bluecrossmn.com/bc/wcs/groups/bcbsmn/@mbc_bluecrossmn/documents/public/mbc1_emp_comm_topic_er.hcsp