by Delbert Chumley, MD
Bexar County Medical Society
President 2007
I recently had the opportunity, as
BCMS President, to represent our
organization during visits to two
countries, and I would like to share with
you a few interesting observations.
In early October, I accompanied several
physicians from UTHSCSA, led by
Dean William Henrich, to Mexico City,
where we visited with students and faculty
at the UNAM (National Autonomous
University of Mexico) medical school.
The purpose of the visit was to explore
ideas to improve and expand the present
student exchange program and to possibly
add a shadowing program for
UNAM students with BCMS members.
In addition, initial groundwork was laid
to increase the awareness of San Antonio
as a destination city for healthcare. We
had a very productive meeting and were
impressed by the quality of the medical
school and its faculty, and with the
maturity and enthusiasm of its students.
As you may know, approximately 90
percent of Mexico’s population is covered
by two federally subsidized insurance
programs: one for the employed
and the other for the indigent. These
programs function similar to a large
HMO, requiring utilization of specific
hospitals and doctors, depending on the
plan. The remaining 10 percent of health
insurance is private. This has resulted, as
you would expect, in a bifurcated system
with a significant number of Mexican
citizens either paying out-of-pocket for
care in the better equipped and staffed
private hospitals and by private practice
physicians or traveling to the United
States for care. Now, in spite of this,
Mexico, with a population about onethird
of our country, graduates over four
times as many physicians as we do each
year. Students enter medical school right
out of prep school (our high school
equivalent) and spend six years in training,
the last year being comparable to a
public service program where they provide
healthcare to underserved areas of
Mexico, living among the people for
whom they care. Of the 22,000 graduates,
only 25 percent will find post-graduate
medical education positions, given
the limited number available. The remaining “unmatched” students are left
to find work in other areas. It made me
wonder why any young Mexican student
would pursue a medical degree. Yet the
students I met were as energetic and
bright as any I have met in our country.
In November, I led a group of BCMS
physicians to Kumamoto, Japan, to visit
our sister medical society, the Kumamoto
City Medical Association (KCMA). We
alternate years visiting each other, during
which time we not only spend time
socializing but also discussing the similarities
and differences in healthcare
between our countries. This was a very
special visit, since it not only represented
the 20th anniversary of the formation
of San Antonio and Kumamoto as sister
cities, but also the 15th anniversary of
the medical societies’ affiliation and the
100th anniversary of the KCMA. I offer
the deepest thanks to my Japanese colleagues
for their warm and sincere hospitality
and for their friendship.
In some aspects, healthcare in Japan
and the United States are similar, and in
other ways very different. For example,
Japan is experiencing the same problems
with their version of Medicare: aging
population, increasing utilization of
services, diminishing physician reimbursement,
and spiraling costs. Yet hospital
stays remain unregulated, with an
average stay, for example, of four to five
days for an uncomplicated delivery. A
utilization nurse would have a heyday in
their system! The “specialized” hospital
concept is very popular in Japan, with
many physician-owned “niche” hospitals.
I visited several, including ENT,
OB/GYN, and even GI, and I was very
impressed with their quality of care and
level of service. Although this concept
has not been universally accepted in our
country, it provided me insight as to its
true potential benefit: consumer-driven
healthcare. The Japanese tend to shop
around, selecting a hospital not only on
quality and physician staff but also on “perks,” such as five-star hotel-like
accommodations, rooftop dining, and
gourmet meals. This has resulted in stiff
competition among hospitals with continued
efforts to offer the best care possible
at the lowest price. It reinforced to
me that if you haven’t already implemented
a performance-improvement
program in your practice, with benchmarking
and documentation of your
results, you should definitely consider
doing so. Forget “pay-for-performance.”
I honestly believe that future changes in
healthcare coverage will focus more on
shifting a significant portion of the
financial responsibility to the patient,
resulting in a consumer-driven system
similar to the one I witnessed in Japan.
American patients will also shop around
for the best deal for their health care
dollar. Without documentation of your
quality of care, you may end up as a bottom
feeder.
These experiences were very educational
to me. I saw some aspects of medicine
that were better than ours and others
that were worse. However, there were two
observations that were similar, whether
in a country across the border or on the
other side of the world. Increasing costs
and access to care are universal problems,
and Hippocrates would be proud:
doctors still put their patients first.
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