Cataract Eye Surgery In Malaysia

I had my second cataract done here in Malaysia, so I thought I would give a comparison between my surgery 5 years ago in the USA (Rex Hospital Outpatient Surgery, Raleigh, NC) and a similar surgery performed in Malaysia (Assunta Hospital Day Surgery Unit, Petaling Jaya, Malaysia).  The surgeon in Raleigh was a recent graduate of a Baylor University Ophthalmology residency program with a medical degree from University of Michigan (UM), while the surgeon in Malaysia was a graduate of the University of Malaya (UM) medical school and a Singapore residency in Ophthalmology.

In comparison the physical medical practices could not have been more different.  In North Carolina the surgeon practiced in a large practice dedicated to eyes.  Staff abounded,  at least four were involved in check in, and the waiting room was well appointed.  Patients were ushered into sub waiting rooms where eye drops were administered by physician assistants.  Some procedures were administered by the staff person and eventually you were placed in an examination room to wait for the physician.

In Malaysia, the physician is part of the specialist clinic run by the hospital.  Check in occurs at a very efficient intake department, and the patient is given a several forms which follow you through the appointment. You then make you way to the physician's office.  Two nurses assist the physician, by taking your paperwork and matching it with the records that had been previously delivered by the hospital records office.  Eye drops are administered as necessary. Nurses scan bar codes to record procedures which automatically update your bill resulting in no wait at check-out. 

In Raleigh, the physician saw...maybe 4 patients per hour, in Malaysia, patients appear to be seen every 10 minutes.  In contrast to Raleigh, the physician administers all procedures other than the eye drops.  In contrast to Raleigh, a question about cost is answered directly by the physician (his estimate was within 1% of the final cost....including all pharmaceuticals).  In Raleigh, the time from arriving at the Dr.'s office until I was out the door was probably 1.5 hours, in Malaysia, at Assunta Hospital it is probably 45 minutes.  The questions is, did I get the same service.  Yes I think so, but Malaysian medical practice appears to be more efficient, especially in the scheduling and back office work.

The billing methods are different, especially since I am not covered by an insurance letter.  I have insurance, but must pay in advance and get reimbursed afterwards.  Most Malaysians are covered by some sort of insurance had thus have registered an insurance letter from their provider with the hospital.  In North Carolina I went to the physicians practice to pay my deductibles.  No discussion of costs other than deductibles were discussed, and I seriously doubt if the physician actually knew all the costs involved.  In Malaysia, I had to pay 80% of the estimated costs up front, with the remainder due immediately following the surgery, prior to release from the Day Surgery Unit.

In the US on the day of the surgery, I was requested to check in at least one to two hours prior to the surgical appointment.  At this check in, I provided my insurance information, and filled out forms and forms and forms. I had been a patient at this hospital before, but it did not seem to matter.  After waiting a good 15 to 20 minutes, the check in clerk took an addition 15 minutes of time filling out paperwork.  In the US, I went to the Outpatient Surgical Unit, was assigned a bed, a curtain was drawn, I changed my clothes into a hospital gown that you tried to tie behind your back.  I then got into the bed, as waited for the doctor to appear.  Since my surgery was in the afternoon, I had to fast, and stop taking my standard prescribed medications at least 12 hours prior to surgery.  I think I was given an oral sedative.  The doctor was running behind schedule, so my surgery was 1 hour late.

In Malaysia, I went to the hospital intake unit as normal and gave them my hospital ID card.  The check-in process took approximately 5 minutes (including the wait in the queue...there were 10 numbers before mine).  I proceeded to the Day Surgery Unit and waited approximately 10 minutes.  Although I fasted, I was instructed to take my standard medications.  The nurses checked my blood pressure, pulse, etc. prior to going to a dressing room.  In contrast to the US standard hospital gown (now paper), I was given a freshly laundered and pressed sarong, plus some flip-flops.  The patient has a lot more personal privacy.  My clothes went into gym lockers and I kept the key.  I was then ushered into a surgical waiting room and waited approximately 10 minutes..

In the US, I was wheeled into the surgical theatre (actually closer to a closet) and transferred to the operating table.  What I remember of the procedure was bright lights, and a light show not seen by me since the drug induced ones in the 1960's.  When the surgery was completed, I was taken back to the recovery room.  I violated hospital rules by self medicating with my normal diabetic medications...thus saving a lot of money.  After about an hour of recovery, I was released to the tender mercies of my wife, was driven home and spent the remainder of the day resting.  No check out with finance when leaving.  I had a follow-up appointment the following morning.  I then drove 200 miles to attend the wedding of a friend's daughter.  My only problem was my inability to thread a needle to replace a lost button (Liz is hopeless on these minor domestic chores).  Two additional follow-up appointments occurred, one a week later, and second at the end of a month when the refraction was done for my replacement glass lenses.

In Malaysia, I was escorted and walked back to the surgical operating theatre.  Everything was on schedule.  I got up on the surgical gurney....it was short with my feet handing over the end.  The surgery was cold and my toes felt it.  The doctor and the nurse both confirmed which eye was being operated on, each twice, repeating the question differently to make sure were were all satisfied.  I think I had a topical anesthetic drops and some more were added.  The doctor explained what he was doing, which did a lot to calm me.    Electronic voices were speaking telling the doctor when certain processes were complete (polishing the capsule) something I did not remember from the US.  When the surgery was completed I was rolled into a recovery room.  It was empty, but within an hour it was overflowing with one nurse for all 10 of us.  Standard monitors periodically checked my O2 level, blood pressure and pulse.  After an hour I was walked to the changing room, changed my cloths and went out to meet Liz.  I needed to go to the finance office to check out and pay the remainder due.....virtually nothing at this time, and picked up my medications from the pharmacist.  I got a thorough review of my medications before returning to the Day Surgery Unit for release. Medications were reviewed again and I was sent home.  I walked down to the taxi queue and we went home.  Follow-up was the next day, 4 days later, a week post-op, two weeks post-op, and a month post-op when refraction was done.  No problem reading immediately following surgery and I could continue to use my existing eyeglasses.

What was the same?  The eye drops used were identical, and the replacement lenses were of the same manufacture.

The bottom line.  Both the surgeries in the US and Malaysia were successful.  The recovery in Malaysia was easier as my prescription lenses did not need to be changed.  I actually no longer need my lenses for distance, but since my driver's license says "corrected" I continue to use them.  I do not drive here in Malaysia.  What did I appreciate.  Well, the creature comforts in the US were better (nicer couches), longer beds, but the wait times were incredible.  The complete lack of knowledge about the costs in the  US adds to the stress of the operation.  It is only when bills begin to arrive in the mailbox that you begin to understand the costs.  I do not have them here, but the retail cost was well in excess of USD $5,000.  Then the insurance information came in with the costs being dramatically cut (pre-negotiated prices).  All in all, I recall the total cost being close to USD $2,000 (deductibles, co-pays, refraction costs).  In Malaysia, I appreciated the doctor knowing the cost of his services (accurately), the efficiency of the administrative procedures.  I appreciated getting the costs from the hospital at the time  I left the building. The total cost was less than USD $1,800.  I have yet to submit the claims to my US insurance company which is secondary to Medicare.  Medicare premiums are mandatory at about USD $99 per month, but reimbursement for services overseas are forbidden.

As an aside, both Liz and I get our prescription medications in India.  They are made by the same companies that supply the US generics, and our cost is less that the deductibles we would otherwise pay.

Doug with his plastic protective eye cover.