Archive for the ‘Health’ Category

I’m into the third week of the UI (user interface) design course I am taking via Coursera called Human Computer Interaction. The lectures for this week include a discussion of some prototyping techniques to use to quickly create a mockup of the interface for your system. The objective is to have a prototype to put in front of users to see how they interact with it and identify issues early in the development cycle. One of the techniques is called the “Wizard of Oz” method.

The name is inspired by the movie of the same name in which the wizard is really just a small man behind a curtain who is pulling the levers to make something much bigger appear operational. This technique is really great for early evaluation of user interfaces because you don’t have to spend a lot of time solving complex issues in the backend. You just need to have an interface that looks somewhat realistic. A “wizard”, which is a person behind the scenes not usually visible to the users, operates the controls to make it appear as if an automated system is actually running everything.

Today I was reading a story at Natural News with the headline “Head fake! Is Healthcare.gov only an empty shell MOCKUP of a working Obamacare exchange?” and it struck me right away that maybe healthcare.gov really is just a mockup in a Wizard of Oz prototype fashion. All the evidence would seem to indicate that. Like the fact that the people in charge can’t even say how many people have signed up through the system. That kind of information just falls out of a real system. Maybe they don’t know because it really is just a mockup with a bunch of people behind the scenes pulling the levers and they have to poll all them and collate the information before they know.

Another reason to think it might just be a mockup is how quickly and thoroughly it has been overwhelmed. Seriously, any system designed for this purpose would have to consider this volume of users at initial roll-out. I don’t think there is really any system on the backend.

And finally, anyone who has done contract work for the government knows how ridiculous it is. It is standard procedure to have specifications thrown at you that are bloated, poorly written, and often times scoped by inexperienced people. Then the specs get changed repeatedly, causing rework and delays. Then there is a funding issue at the end of each fiscal year when funding runs out, the project has to shutdown, and then later gets restarted again when the funding finally comes through, but in the mean time the previous development team went off and found other jobs. I know this one well from my previous work at an aerospace firm where I was a project manager.

My guess is that the system was not completed in time due to all the vagaries of government contracting. The government was firmly committed to a roll out date, but the system wasn’t ready so they threw up a mockup. The wizards, of course, were immediately overwhelmed.

I shouldn’t be smug about this. Being smug tempts fate. But I can’t help it, because I don’t have to sign up for Obamacare! That’s right. Because I am an expat I can completely ignore all the nonsense and overreach of the U.S government as it forces everyone residing in the U.S. to purchase a product even if they don’t want it. As an expat who resides more than 330 days per year outside of the U.S. I am presumed to have “Minimal Essential Coverage” under the ACA so I am not required to purchase health insurance and am not subject to any penalty for not doing so.

So now that I have tempted fate by gloating about this I will worry that the USG overreach will extend further, and in the future they will force people like me who don’t even visit the U.S., and therefore cannot receive medical care in the U.S., to purchase U.S. health insurance anyway. They could very well do that since they already do many things that are completely unreasonable. Perhaps if they do force that on expats they will make some sense of it by requiring insurance benefits to be paid to where we actually use medical services, which is at our local medical facilities outside the U.S. That might be reasonable, although it is likely that the cost of insurance will far exceed any benefit we receive. That’s because I can meet my “Minimal Essential Coverage” by paying out of pocket since I get better health care at a fraction of the cost compared to the U.S. Here’s a good example, my foot surgery at Siriraj Hospital.

After I had that surgery I wondered how much would it cost in the U.S. Questions like that have long been tough to answer due to the sleazy evasiveness of the U.S. medical industry who won’t quote prices and just drop a bomb on you afterwards with outrageous fees. For this post I did some Googling and found something interesting called HealthCareBluebook.com. They list a “fair price” of US$16,398 for foot surgery consisting of $2,074 for physician services, $13,855 for hospital services, and $469 for anesthesia services. Here is the link. Interesting. That is 20 times the price I paid when I had my surgery at Siriraj Hospital in Bangkok by one of the top foot specialists in the country. Let me just say that I am a bit surprised the multiple is that high. I was expecting a multiple of 5 to 10.

Now what would happen if I had to buy insurance under Obamacare? I’m guessing that a single year of premiums would be more than the US$709 I paid for the surgeon + two nights in a private hospital room + anesthesia that I paid for my foot surgery. And of course I would have some deductible, probably at least 10% of the bill which would be at least US$1,600 for that surgery in the U.S. So probably at least, I mean the very least, I would be US$2,500 out of pocket for that procedure if I had U.S. insurance and did it in the U.S. And of course I would not have enjoyed the warm care and hospitality of the Thai medical staff; they are so nice and make you feel so comfortable even in difficult circumstances.

So no thanks America. I will stay right where I am. I just need to keep working on how to protect my hard-earned assets from the next attempted grab by the USG. We all do, no matter who we are or where we are.

Thai doctor review website

Posted: May 5, 2012 in Health

I happened upon a website called MyThaiDoctors.com which is a review website where visitors can post reviews and details of their experiences with doctors in Thailand. There are also blog posts about various experiences such as the one about how Thai doctors moonlight at multiple hospitals.

I like the idea of the site and it seems like the site owner(s) got off to a very good start by checking which reviewed doctors are American Board Certified and including that information. Unfortunately, it seems like that energy was lost since the site lists the last update of board certified doctors as October 2008. Another thing that is inevitable with review type sites is that you get either strongly negative or strongly positive reviews. People are rarely motivated to go online and write a review if a product or service simply met their expectations. That is a bit unfortunate since the majority of doctor visits are probably not very eventful but rather get the job done. So there are vastly more doctors that would probably get a 3 or 4 star rating than the small number of 1 and 5 star ratings. The site does have an extensive list of Thai doctors, 3,188 in fact. It’s just that the vast majority are unrated.

I usually do my annual health screening in April each year. This year I had been planning to do it but still hadn’t decided where. An SMS message I received on Friday helped me make a quick decision. The text message said that Bangkok Hospital Korat was offering a deep discount on the price of annual physical exam packages but I had to act fast because it was only for April 28 until April 30. And this was a real discount for a change, 60% no less! It wasn’t some tricky pricing game either because I checked on the price list I already had and the normal price was about 9,000 baht while the special price was 3,200 baht. This was for the VIP package which is a pretty thorough screening but does not include some optional blood work nor exercise stress test.

I thought it was going to be packed with people but it wasn’t, probably because of the short notice, or maybe because I arrived before 8:00 a.m. on a work day. Service was good and the consultation with the doctor at the end was very good with her spending plenty of time. I think this kind of deep discount is rare for them because I heard one of the doctors and a nurse talking about how they had never heard of such a deal. The customer rep at the front desk said they do offer discounts regularly, often on the ninth of each month, but nothing like 60% off

I’ve made a few posts previously about some of the odd claims about medical tourism to various places. Being in Thailand I get to experience the health care here first hand on a regular basis. That experience prompted me to write up a little article busting a few common myths about medical tourism to Thailand. It’s up at the Ezine Articles website now so if you follow that link you can have a look.

The three myths I talk about are easy and sort of obvious, although the one about malpractice recourse is a little more opaque for someone who doesn’t regularly read news about Thailand. There is a fourth myth that I plan to write about in the future. It’s about the quality of care from private hospitals versus public hospitals in Thailand. I’m going through something at the moment, a saga of sorts, and some of the experiences have been rather enlightening. Long story for a future post or article.

In my earlier post about flu vaccination I picked on the excuses a nurse was giving for avoiding getting her shot. It turns out there are a lot of people like her. WebMD has a story about the high percentage of people who are not planning to get vaccinated this year, like 43% of Americans overall and 51% of people over 65. The reasons given by those surveyed for not getting the shot were

  1. 45% cited that the swine flu epidemic was overblown last year
  2. 44% said they were concerned about the side effects of the flu vaccine
  3. 41% were concerned about its safety
  4. 30% felt the flu vaccine doesn’t work anyway

Reason number 1 seems really dumb. Reasons 2 and 3 are perhaps realistic, although pretty small causes for concern. Number 4 is true in about 10% to 20% of people according to published reports so that is legit, and it is hard to actually know the true effectiveness rate because some of the 80% to 90% who got the shot and didn’t get sick were never exposed and we don’t know who those people are.

The more annoying statistic is that 28% of health care workers say they won’t get the flu vaccine. Those people are the ones who have heavy exposure and can easily pass it to many other people.

Got my flu vaccination

Posted: October 1, 2010 in Health

The small clinics in the nearby town have this year’s flu vaccination available now. So I got mine. The version offered here is called Influvac 2010 (southern hemisphere). The composition if three vaccines: A/California/7/2009 (H1N1)-like strain, A/Perth/16/2009 (H3N2)-like strain, and B/Brisbane/60/2008-like strain. So I guess I should be protected now for this year, assuming the forecast was correct for which strains will make the rounds.

Since it is the season there seems to be a number of stories around from the anti-vaccination crowd. I have to admit that I don’t quite understand their objections. I have seen several assertions from these groups.

Some say that vaccines are of little benefit and are pushed mainly as a source of profits for big pharma. Sure, how beneficial a vaccine is must vary from disease to disease. Certainly for some of the older devastating diseases like smallpox vaccines have made all the difference. The profit motive – no doubt, because that is what big pharma is all about. Still, I’m not sure that this makes a valid point for avoiding vaccination.

I have read the stories in which some parents are claiming that their child’s autism was brought on by vaccination. I don’t know what to make of that. Obviously if the vaccines are causing that problem the number of cases is an extremely small percentage of the children who are vaccinated. So I’m not sure that there is a real issue there, Except of course the devastating impact for some individuals, the majority of people are benefited by the population be immune to those serious diseases.

There is another group which is making claims about some kind of government conspiracy, that vaccines are some kind of intentional infection that will be used to control the masses, or something like that. I couldn’t stick with those stories long enough to read them through.

And lastly was a story I read today on the BlogHer blog by a woman who says she is a nurse (no link because the blog owners don’t allow trackbacks and require you to log in to add comments – they’re doing it wrong if they want quality comments and links to their blog). That author’s main beef seems to be that she hates being told she has to do something, in that she is railing against the possibility of mandatory flu vaccinations for health care workers. She then proceeds to throw out a number of nonsense arguments to support her case. So, being the call-em-out kind of person I am I want to pick apart her case.

First she spends a couple of paragraphs trying to use an analogy to make her case because, as she says, she “gets to mention them half as much as [she] would like to .” Strike one. Analogies are sometimes useful but more often they are not because the reader ends up spending more time trying to resolve the parts of the analogy that don’t align with the situation in question. Waste of space. Delete those two parts of the story and just get to the situation at hand, not how the flu and a hurricane are alike.

Then she gives some statistics on the chances of getting the flu. I don’t know if they are correct but regardless she draws the wrong conclusion. She says that the CDC reports that the chances of getting the flu if you don’t get vaccinated are 5 to 20 percent and she implies that those rates are too small to make the vaccination worthwhile. Wrong conclusion. Those are some pretty significant numbers. Although no details were given on how that percentage range was determined, it seems likely that overall number is simply total infection rate divided by total population. So lots of demographic sectors are lumped together, including sectors who have on average a higher infection rate as well as those with a lower rate. Those with no exposure to others would have a zero infection rate. Those exposed to many sick people would have a higher rate, like health care workers for example.

Then we have her statistical analysis, starting with this:

We all know the flu vaccine is not 100% effective at protecting anyone from the flu. But did you know this?
In any given year an estimated 10 to 20 percent of vaccinated people will still get the flu. So, even if every person in the country was vaccinated, each year between 10 and 20 percent of people would still get the flu. That’s not much different than 5 to 20 percent of non-vaccinated people.

It is saying that the people who are vaccinated get the flu at a higher rate than those who are not vaccinated. So how could that make sense? It would make sense in light of the demographic issues I mentioned in the previous paragraph. It is highly likely that the people who get vaccinated are high risk groups, and that without vaccinations their infection rate would be much higher. The conclusion that the infection rate for vaccinated and non-vaccinated people is practically the same so vaccinations aren’t needed is based on incomplete information.

Finally we get to hear that “the precautions a health care worker is taking to prevent other hospital-born illnesses are the same precautions that help prevent the spread of colds, viruses, and the flu.” I think we have all heard already about the very high rate of infectious disease spread in hospitals so an argument based on the precautions health care workers take is an strong argument for mandatory vaccinations for them.