A word to the wise about going to the doctor on Oceania Riviera

[robbie21]

Below is a response I made to a similar thread over a year ago. Same issues and the same lack of understanding of basic business economics.

 

"When you worked in Financial services did you personally receive all the charges to your clients? I think not. A portion went for rent; amortization of computers, telephones and other services; all the pretty brochures to advertise your business; your secretary and the janitor that cleaned your office. You paid way more for the overhead than for the doctor. By the way, it would seem to me you got emergency room service without the typical long wait for about the same price.

 

A medical clinic is no different than any other business and in fact, some of the required medical equipment is quite expensive. On a ship some equipment and supplies, while required by regulation or prudence, may be very underutilized. When I was running a medical clinic I could amortize the cost of an expensive piece of equipment over perhaps 10 doctors ordering 25 to 50 tests per day. On a ship that same equipment might be used 3 or 4 times a day. It still costs the same it just doesn't pay for itself as fast or as often. On a ship certain supplies are required for potential emergencies and often expire without being used and must be discarded and replaced. Another unique cost.

 

Based on my experience I rather doubt the Oceania shipboard medical clinics are better than breakeven operations if even that."

 

I would add that the equipment, medications and supplies required for a ship's medical office is a lot more than your home doctor's office. There is no emergency room down the street and no 911 service in 5 minutes and no Walgreens on the corner.

 

Another issue that came up in that thread is that some luxury lines have lower medical charges than Oceania. I believe that those line subsidize medical services out of general fare revenue the same as they do liquor and shore excursions. On those lines everyone pays for the medical services. On Oceania you pay for what you use - for medical and for your booze. That allows a somewhat lower overall base fare. That's the way it is ;).

 

Robbie

[StanandJim]

No additional set up costs and they could charge what the actual expenses are and not 10 to 20 times that. This is one area that Oceania should not rip us off. :(:(:(

For each ship, Oceania is paying, feeding and lodging two or three doctors, as well as several nurses, none of whom can be sent home midway through a slow shift, then lay out the money for all of that medical equipment, AND keep the Medical Center continuously supplied with fresh medications and supplies..

 

Beyond that, they must carry international liability Insurance for the whole setup.

 

The costs must be staggering.

[Shawnino]

Below is a response I made to a similar thread over a year ago. Same issues and the same lack of understanding of basic business economics.

 

"When you worked in Financial services did you personally receive all the charges to your clients? I think not. A portion went for rent; amortization of computers, telephones and other services; all the pretty brochures to advertise your business; your secretary and the janitor that cleaned your office. You paid way more for the overhead than for the doctor. By the way, it would seem to me you got emergency room service without the typical long wait for about the same price.

 

A medical clinic is no different than any other business and in fact, some of the required medical equipment is quite expensive. On a ship some equipment and supplies, while required by regulation or prudence, may be very underutilized. When I was running a medical clinic I could amortize the cost of an expensive piece of equipment over perhaps 10 doctors ordering 25 to 50 tests per day. On a ship that same equipment might be used 3 or 4 times a day. It still costs the same it just doesn't pay for itself as fast or as often. On a ship certain supplies are required for potential emergencies and often expire without being used and must be discarded and replaced. Another unique cost.

 

Based on my experience I rather doubt the Oceania shipboard medical clinics are better than breakeven operations if even that."

 

I would add that the equipment, medications and supplies required for a ship's medical office is a lot more than your home doctor's office. There is no emergency room down the street and no 911 service in 5 minutes and no Walgreens on the corner.

 

Another issue that came up in that thread is that some luxury lines have lower medical charges than Oceania. I believe that those line subsidize medical services out of general fare revenue the same as they do liquor and shore excursions. On those lines everyone pays for the medical services. On Oceania you pay for what you use - for medical and for your booze. That allows a somewhat lower overall base fare. That's the way it is ;).

 

Robbie

 

Your response was poor a year ago and it hasn't aged well.

 

You're talking about a for-profit environment in Washington State (or similar).

 

The claim is that the medical clinic on a ship shouldn't be a profit centre.

 

Sure there are all kinds of Greedonomics arguments as to why costs on ships should be high. Amortise this, profit margin that. Just as we wouldn't expect a ship's galley to intentionally give us food poisoning to drive up doctors' visits, we should be able to expect that a cruise ship doesn't look upon its clients' misfortunes (illness) as an extra way to make money. They have lots of other ways to make money (photos, shore ex, casino, alcohol, whatever...).

 

Run the medical centre at cost. Buy drugs where they are less expensive (generics from Israel or some such instead of brand names in the USA). Hire doctors and nurses that don't require American salaries. Do your passengers a solid instead of bending them over in their time of need

[JimandStan]

Another example of knee-jerk-itis, where people say, "It seems like they should be able to...." without any information, and then put forth their opinions.

FWIW, amortizing a piece of equipment would still be part of running an operation at cost.

[Hawaiidan]

Cruise lines shouldn't be making the medical centre a profit centre--especially when, sometimes, it's the cruise line's food that sends pax there.

 

This should be the one thing on the ship offered honestly at-cost.

 

Your missing the point, The charges do not go to O, they go to to the contracting agency who supplies the medical staff.

It is the Doctors and agency who set the prices for service... not O

9000 for IV therapy I assume over a week Antibiotics are not a one shot deal but long course at least 5-7 days or more, Ex rays Multiple I assume, Medicine Doctor, attending nurses, supplies. and blood work CBC's to monitor the infection....

Hey my Wife just saw a specialist for a 4 hour series of tests it ran $11,000 !!! Fro 4 hours... Wake up its later than you think Doctor Kildare retired

 

The shock comes when the patient has been blindly having their medical bills submitted to insurance and is totally un aware of reality.

I remember when a hamburger used to cost 15 cents and a new Corvette . was $3600.00.. times have changed doctors no longer use Leaches...... stuff costs

[robbie21]

Your response was poor a year ago and it hasn't aged well.

 

You're talking about a for-profit environment in Washington State (or similar).

 

The claim is that the medical clinic on a ship shouldn't be a profit centre.

 

Sure there are all kinds of Greedonomics arguments as to why costs on ships should be high. Amortise this, profit margin that. Just as we wouldn't expect a ship's galley to intentionally give us food poisoning to drive up doctors' visits, we should be able to expect that a cruise ship doesn't look upon its clients' misfortunes (illness) as an extra way to make money. They have lots of other ways to make money (photos, shore ex, casino, alcohol, whatever...).

 

Run the medical centre at cost. Buy drugs where they are less expensive (generics from Israel or some such instead of brand names in the USA). Hire doctors and nurses that don't require American salaries. Do your passengers a solid instead of bending them over in their time of need

 

My point, had you been paying attention at all, is that, in my professional opinion based on 40 years in the business is that the medical services on board are, "at best. a break even operation". I do not have access to their accounts but I do have knowledge and experience with respect to the costs involved in an operation like this. I am also aware of their fees and of comparable fees in clinics and ER's. I do not see how they could be making a profit and I suspect that fees do not come anywhere near covering their costs.

 

Here is a simple statistic for you to consider. The average family practice physician ideally cares for (has an enrolled patient population) of around 1500 people. This group is age distributed near the national average, ie, children to retirees. He or she does not provide specialty care such as cardiology nor is emergency room service provided. Drugs are not stocked or dispensed. Lab services are generally done by an outside service (and charged by them).

 

 

On the R ships there is one doctor and around 1000 passengers and crew. The passenger population is skewed older which means more medical care is needed. Also, the passengers are more prone to needing medical care than at home due to higher levels of activity, exposure to new environments, different food and new diseases. Much of the crew works in an industrial environment and is more prone than average to injury and illness. On a personal note I am often struck by the number of passengers I meet on Oceania who really should not be traveling. I have seen people with serious angina, heart disease, COPD and other conditions that should keep them near a hospital. I admire their spunk but not their judgement.

 

 

Unlike your family doctor the ship's doctor has to be prepared to handle injuries and medical emergencies and conditions that your local doctor would simple send to the ER, a specialist or to the hospital. His clinic has to be equipped and stocked for these contingencies whether or not he ever uses those supplies and equipment. These are all real costs. I don't think these ship board clinics are a profit center - I think they operate at a loss to Oceania.

 

 

Robbie

 

PS - to Hawaiidan. You are right of course. I think the outside contractor is just for the doctor and maybe the nurse. They provide a credentialed and certified staff. I would guess that equipment and supplies are provided (paid for) by Oceania since they are "installed". I don't know how the fees are set or who gets the money but, as you say, fees charged are not particularly out of line compared to USA charges for similar services.

Edited May 6, 2018 by robbie21
added comment

[Hawaiidan]

My point, had you been paying attention at all, is that, in my professional opinion based on 40 years in the business is that the medical services on board are, "at best. a break even operation". I do not have access to their accounts but I do have knowledge and experience with respect to the costs involved in an operation like this. I am also aware of their fees and of comparable fees in clinics and ER's. I do not see how they could be making a profit and I suspect that fees do not come anywhere near covering their costs.

 

Here is a simple statistic for you to consider. The average family practice physician ideally cares for (has an enrolled patient population) of around 1500 people. This group is age distributed near the national average, ie, children to retirees. He or she does not provide specialty care such as cardiology nor is emergency room service provided. Drugs are not stocked or dispensed. Lab services are generally done by an outside service (and charged by them).

 

 

On the R ships there is one doctor and around 1000 passengers and crew. The passenger population is skewed older which means more medical care is needed. Also, the passengers are more prone to needing medical care than at home due to higher levels of activity, exposure to new environments, different food and new diseases. Much of the crew works in an industrial environment and is more prone than average to injury and illness. On a personal note I am often struck by the number of passengers I meet on Oceania who really should not be traveling. I have seen people with serious angina, heart disease, COPD and other conditions that should keep them near a hospital. I admire their spunk but not their judgement.

 

 

Unlike your family doctor the ship's doctor has to be prepared to handle injuries and medical emergencies and conditions that your local doctor would simple send to the ER, a specialist or to the hospital. His clinic has to be equipped and stocked for these contingencies whether or not he ever uses those supplies and equipment. These are all real costs. I don't think these ship board clinics are a profit center - I think they operate at a loss to Oceania.

 

 

Robbie

 

PS - to Hawaiidan. You are right of course. I think the outside contractor is just for the doctor and maybe the nurse. They provide a credentialed and certified staff. I would guess that equipment and supplies are provided (paid for) by Oceania since they are "installed". I don't know how the fees are set or who gets the money but, as you say, fees charged are not particularly out of line compared to USA charges for similar services.

 

Well put, I worked in the paramedical field and my wife an RN. Personally I was impressed with the state of the art clinic/ER on the0 ships... They have diagnostic equpt that costs hundreds of thousands... Run everything from a drop-in clinic to a ICU/Cardiaccare/ and Trauma center plus a full Lab, all rolled into one!!!

 

Some of the equipment I saw was better than many hospitals in the US have... and most all foreign countries. .Care costs and where are you going to go for a CVA or Septic shock patient in Easter Island 2000 miles from anywhere with care ???

[njhorseman]

For each ship, Oceania is paying, feeding and lodging two or three doctors, as well as several nurses, none of whom can be sent home midway through a slow shift, then lay out the money for all of that medical equipment, AND keep the Medical Center continuously supplied with fresh medications and supplies..

 

Beyond that, they must carry international liability Insurance for the whole setup.

 

The costs must be staggering.

 

In my sole exposure to Oceania's medical staff, earlier this year on Marina, there was only one doctor and one nurse on board.

[The A Train]

Sorry, but, it's one doctor and two nurses.....always!

 

And, significant overcharges for services!

[sugarbird]

To add to the recent discussion of my excessive bill on Oceania--I have shown my detailed bill and treatments to my primary care doctor and 2 other doctors--they all felt the charges were excessive and hard to believe.

[RJB]

To add to the recent discussion of my excessive bill on Oceania--I have shown my detailed bill and treatments to my primary care doctor and 2 other doctors--they all felt the charges were excessive and hard to believe.

does not supprise me at all. They are ripping us off with the bills just like health care in the U.S.

[janert]

This was not on Oceana but on the Pacific Princess on 2017 WC. While in NZ area I noticed a area of my calf was red and I had a inflamed area the size of a dime. I went to the medical office and saw the PA. She had me come back in an hour to see the doctor. This ship is a 600 passenger ship. It had a doctor and 2 PA's from South Africa. I was treated for 8 days in a row with antibiotics, a ointment, dressing change. Then I had minor surgery to drain the inflamed area. Then 4 more days of check up. It was over $3000. The alternate was for me to leave the ship and go to the hospital. This would have been terrible as we were only 1/4 way through the World Crusie. All my treatment was great. My secondary and cruise insurance did cover all the costs.

Edited May 6, 2018 by janert
Add more

[Mura]

You know, I do understand the concern about what seem like excessive charges. When I visited the doctor on two occasions in November '05 on Regatta when I tore my meniscus (just prior to boarding), I thought the $500 bill was excessive. But insurance DID pay it. (I wasn't on Medicare yet!)

 

But I'm concerned that people may read this and then avoid going to the doctor when they really SHOULD. A loyal poster on this list died on board not that long ago, and had he had the choice I'm sure he would have opted to see the doctor.

 

Going in for a cold is one thing ... going in for a serious problem is another. But it might be counterproductive to avoid going to the Med Center on the ship just because of $$$.

 

I don't like to spend it either!

 

Mura

[Shawnino]

Your missing the point, The charges do not go to O, they go to to the contracting agency who supplies the medical staff.

It is the Doctors and agency who set the prices for service... not O

9000 for IV therapy I assume over a week Antibiotics are not a one shot deal but long course at least 5-7 days or more, Ex rays Multiple I assume, Medicine Doctor, attending nurses, supplies. and blood work CBC's to monitor the infection....

Hey my Wife just saw a specialist for a 4 hour series of tests it ran $11,000 !!! Fro 4 hours... Wake up its later than you think Doctor Kildare retired

 

The shock comes when the patient has been blindly having their medical bills submitted to insurance and is totally un aware of reality.

I remember when a hamburger used to cost 15 cents and a new Corvette . was $3600.00.. times have changed doctors no longer use Leaches...... stuff costs

 

Two points:

 

1) Correct: You are indeed assuming facts not in evidence.

 

2) Just because O contracts it out doesn't absolve them of responsibility.

Jacking up the cost of shore-ex, tightening the slot machines, raising the drinks prices... whatever, that's all discretionary spend and O should be able to get whatever they think they can.

Doing that with medical is reprehensible--whether they're taking it directly from pts, or getting a kickback from a contractor.

[RJB]

Two points:

 

1) Correct: You are indeed assuming facts not in evidence.

 

2) Just because O contracts it out doesn't absolve them of responsibility.

Jacking up the cost of shore-ex, tightening the slot machines, raising the drinks prices... whatever, that's all discretionary spend and O should be able to get whatever they think they can.

Doing that with medical is reprehensible--whether they're taking it directly from pts, or getting a kickback from a contractor.

Very well said.

[Hawaiidan]

Very well said.

 

 

with all due respect both of you folks need to smell the roses....it is 2018 not 1960. My assumption, based on what the patient described are all the normal medical procedures for a sever infection requiring IV therapy daily CBC's and xray is normal meds like Cipro aint cheap. The medical equipment required for that treatment costs hundreds of thousands... It seems like a lot because it isnt what you think it should be without detailed knowledge of what goes on in an ER.... Medical treatment nowadays has to be over the top because of the fear of legal issues. ( did you do everything doctor?) We all end up paying for that.

 

I have, personally and professionally experienced more than a few similiar conditions and have been also treated on Marina for similar septic problems $6000.00 was cheap As Lay people, your are also assuming from your perspective you need to look at it from the medical perspective. From my perspective $6000 was not excessive I just finished a 2 month hospital stay the ran 1.3 million.... that I deemed just fine

 

I once listened to a guy who told me he had both arms dislocated, To save money he wrny to the ER and told the doctor he only dislocated his right arm. He watched how he did it and went out to the parking lot and relocated his left arm to save money..

 

Hey, we all have insurance, and pay a premium, car, home, theft, and medical for which we pay. and for which they pay for any incident. Thats what you pay for... them to cover the costs. You can argue its you money but in reality it is the insurance providers who underwrote you If you get sick they dont raise your rates like a car policy.

 

Shakespear wrote " Me thinks thou doth protest too much" Worthy of consideration and ponder

Edited May 7, 2018 by Hawaiidan

[Shawnino]

with all due respect both of you folks need to smell the roses....it is 2018 not 1960. My assumption, based on what the patient described are all the normal medical procedures for a sever infection requiring IV therapy daily CBC's and xray is normal meds like Cipro aint cheap. The medical equipment required for that treatment costs hundreds of thousands... It seems like a lot because it isnt what you think it should be without detailed knowledge of what goes on in an ER.... Medical treatment nowadays has to be over the top because of the fear of legal issues. ( did you do everything doctor?) We all end up paying for that.

 

I have, personally and professionally experienced more than a few similiar conditions and have been also treated on Marina for similar septic problems $6000.00 was cheap As Lay people, your are also assuming from your perspective you need to look at it from the medical perspective. From my perspective $6000 was not excessive I just finished a 2 month hospital stay the ran 1.3 million.... that I deemed just fine

 

I once listened to a guy who told me he had both arms dislocated, To save money he wrny to the ER and told the doctor he only dislocated his right arm. He watched how he did it and went out to the parking lot and relocated his left arm to save money..

 

Hey, we all have insurance, and pay a premium, car, home, theft, and medical for which we pay. and for which they pay for any incident. Thats what you pay for... them to cover the costs. You can argue its you money but in reality it is the insurance providers who underwrote you If you get sick they dont raise your rates like a car policy.

 

Shakespear wrote " Me thinks thou doth protest too much" Worthy of consideration and ponder

 

Once again you have assumed something not in evidence, that we are "lay people".

 

You may fancy yourself an expert. I don't know that to be true. Are you even as much as a doctor?

 

But I do know that what you're describing (over-the-top costs for drugs, two months hospital stays that cost $1.3 million, litigious malpractice cases...) are very American things. I won't claim it's unique to America, but I do know many countries where things don't work that way.

 

Oceania, and other lines, source crew, food, and equipment worldwide to offer potential cruisers a vacation at a competitive price. When it comes to medical, though, it feels very much like the conversation went:

 

Contractor: "You give me a monopoly on shipboard medical services, and I'll soak your passengers for as much as I possibly can. In return, I offer you a briefcase full of cash."

Oceania: "Where do we sign?"

[RJB]

Once again you have assumed something not in evidence, that we are "lay people".

 

You may fancy yourself an expert. I don't know that to be true. Are you even as much as a doctor?

 

But I do know that what you're describing (over-the-top costs for drugs, two months hospital stays that cost $1.3 million, litigious malpractice cases...) are very American things. I won't claim it's unique to America, but I do know many countries where things don't work that way.

 

Oceania, and other lines, source crew, food, and equipment worldwide to offer potential cruisers a vacation at a competitive price. When it comes to medical, though, it feels very much like the conversation went:

 

Contractor: "You give me a monopoly on shipboard medical services, and I'll soak your passengers for as much as I possibly can. In return, I offer you a briefcase full of cash."

Oceania: "Where do we sign?"

I believe that you are totally correct. Oceania and the other cruise lines that do this should be shot.

[LAexNY]

I believe that you are totally correct. Oceania and the other cruise lines that do this should be shot.

 

Once again, you enjoy attacking everything Oceania does.

I continue to be amazed you are even on this board, let alone continuing to cruise Oceania.

[RJB]

Once again, you enjoy attacking everything Oceania does.

I continue to be amazed you are even on this board, let alone continuing to cruise Oceania.

You do not read everything that I post, or you can not read English, but most things we are very happy with. I will not just be a cheerleader for O when they are wrong.

[Sea42]

I believe that you are totally correct. Oceania and the other cruise lines that do this should be shot.

Wow. All you have to do is buy the proper insurance and this will never be an issue for you.

[LAexNY]

You do not read everything that I post, or you can not read English, but most things we are very happy with. I will not just be a cheerleader for O when they are wrong.

 

Oceania should be shot?

[Hawaiidan]

Once again you have assumed something not in evidence, that we are "lay people".

 

You may fancy yourself an expert. I don't know that to be true. Are you even as much as a doctor?

 

But I do know that what you're describing (over-the-top costs for drugs, two months hospital stays that cost $1.3 million, litigious malpractice cases...) are very American things. I won't claim it's unique to America, but I do know many countries where things don't work that way.

 

Oceania, and other lines, source crew, food, and equipment worldwide to offer potential cruisers a vacation at a competitive price. When it comes to medical, though, it feels very much like the conversation went:

 

Contractor: "You give me a monopoly on shipboard medical services, and I'll soak your passengers for as much as I possibly can. In return, I offer you a briefcase full of cash."

Oceania: "Where do we sign?"

 

 

assumptive Reasoning sir, that you a lay person, because it you were not you would have totaly understood the situation and what is normal for a MD to do in cases of a systemic infection . Ask tour family doctor or any ER MD on what they would do

Nope I am not a MD but was a licenced para-medical ALS provider for many years. That's somewhere above an RN and below a doctor short of a PA.

I understand clearly your distaste for the medical professionals as greedy and ego centric and the costs of delivering that care likewise.

 

That's your take and you are entitled to that reality of yours... For you that's everything you believe, right or wrong. I am cool with that but it dosen't make you right either. The same goes for me too and what I base my reality on.

 

Not living in a socialist dictatorship we must recognize that competent, reliable and responsible medical treatment costs and advances in medicine do not come cheap. . Hey years ago we used IV on severe trauma, now we use infusing bone screws. that can work better to save a patient.

 

Move to Cuba, I think they pay those rip off doctors some $28 a week If I remember correctly... Maybe check into a Cuban hospital to get some bargin rates. Hey its your life and if you can save a dime go for it.

Hey My insurance paid the 1.3 million all but $10. It saved my life and I would have gladly paid 2x that for life.... Whats yours worth???

 

You can always get more money, you can not get more time or a second chance many times

 

Wishing you all the best in life and health and hope you never need health care you never expected......

[WpgCruise]

Move to Cuba, I think they pay those rip off doctors some $28 a week If I remember correctly... Maybe check into a Cuban hospital to get some bargin rates. Hey its your life and if you can save a dime go for it.

 

While I agree with much of your argument, you might best check out the quality of health care in Cuba vs that of the U.S. You''ll find more Dr.'s per capita, a lower cost per capita and arguably better results based of life expectancy and child mortality rates. Some of the leading Dr's in fields such as Cancer Care, Heart Disease, Neo Natal care are Cuban trained.

 

The point being that your argument looses much of it's effectiveness when you provide opinions instead of facts.

 

An interesting link:https://www.huffingtonpost.com/blake-fleetwood/cuba-has-better-medical-c_b_19664.html

[Shawnino]

While I agree with much of your argument, you might best check out the quality of health care in Cuba vs that of the U.S. You''ll find more Dr.'s per capita, a lower cost per capita and arguably better results based of life expectancy and child mortality rates. Some of the leading Dr's in fields such as Cancer Care, Heart Disease, Neo Natal care are Cuban trained.

 

The point being that your argument looses much of it's effectiveness when you provide opinions instead of facts.

 

An interesting link:https://www.huffingtonpost.com/blake-fleetwood/cuba-has-better-medical-c_b_19664.html

 

I think you've successfully diagnosed a raging case of Americanitis.

 

What I struggle to figure out is why ordinary Americans tolerate their health care system. For the amount of $$$ thrown at it, results are pretty mediocre (especially in the categories you mention... life expectancy, cancer...). Patriotism I guess.

 

What I really can't figure out is why anyone would want to come on the Internet and argue in favour of propagating this broken system of "charge as much as you possibly can" onto a cruise ship.