Availability of health care providers - how to factor this in a move?

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
Topic Author
boglegirl
Posts: 282
Joined: Mon Dec 17, 2012 1:41 pm

Availability of health care providers - how to factor this in a move?

Post by boglegirl » Mon Dec 18, 2017 9:23 am

We live in HCOL area that doesn't really feel like our "forever" home. We hope to move to a lower cost of living and less metropolitan area in 3 years or so.

However...for the last few years, I've had some significant health issues. When I was younger and would read articles about the "Best Places to Retire" and they listed medical care as the top factor, I always wondered why. I'm only 50, but now I know. :( Currently, we're within 10 minutes from primary care doctors and a small community hospital, within 20 minutes from specialists and a larger regional hospital, and 30 minutes from a major research-center university hospital.

Because of my latest health issue, I'm really in a quandary. We'd always thought it would be OK to live somewhere like Bend, Oregon...doctors and hospitals nearby, with "the big city" doctors only 3 hours away. But now I'm not so sure. Please share how availability of health care affected your retirement life decision.

User avatar
dm200
Posts: 21969
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Availability of health care providers - how to factor this in a move?

Post by dm200 » Mon Dec 18, 2017 10:26 am

boglegirl wrote:
Mon Dec 18, 2017 9:23 am
We live in HCOL area that doesn't really feel like our "forever" home. We hope to move to a lower cost of living and less metropolitan area in 3 years or so.
However...for the last few years, I've had some significant health issues. When I was younger and would read articles about the "Best Places to Retire" and they listed medical care as the top factor, I always wondered why. I'm only 50, but now I know. :( Currently, we're within 10 minutes from primary care doctors and a small community hospital, within 20 minutes from specialists and a larger regional hospital, and 30 minutes from a major research-center university hospital.
Because of my latest health issue, I'm really in a quandary. We'd always thought it would be OK to live somewhere like Bend, Oregon...doctors and hospitals nearby, with "the big city" doctors only 3 hours away. But now I'm not so sure. Please share how availability of health care affected your retirement life decision.
What I would investigate is whether (or how) modern technology, electronic records, etc. can bring the expertise you need/want to you or your local Physicians.

btenny
Posts: 5135
Joined: Sun Oct 07, 2007 6:47 pm

Re: Availability of health care providers - how to factor this in a move?

Post by btenny » Mon Dec 18, 2017 11:45 am

OP. The best I can say is it is complicated and very dependent on you and what you will accept. It also depends a lot on the town you select and where it is with respect to other bigger towns nearby.

I live part time in Lake Tahoe. It is a small town with a small local hospital. There are lots of orthopedic doctors, some GPs, some baby doctors and a few other specialties. But it is a really small town of only 25K residents plus a ton of tourists. So it will not support many specialists. It has a HCOL but is a wonderful place to retire like I did. Ski accidents and water sports accidents are routine and handled well. The orthopedic guys are some of the best in the country. But if you crack your head in a fall and need a neurologist or brain surgery you will be loaded to a helicopter and taken to Reno (61 miles) or Sacramento (102 miles), both high level trauma centers or Carson City (28 miles) for moderate stuff. Same for a heart attack. The local hospital has no catheter lab or stent capability. So off you go for a chopper ride. But the hospital and all the local EMTs are aware of these limits and work well with the air service and local doctors to give the best treatment possible. PM me if you want to hear more details and how this all has worked for me. I trust the local system but know it is not as good or as fast as treatment in Phoenix where I also have a home.

So I guess it depends. Good Luck.

staythecourse
Posts: 6993
Joined: Mon Jan 03, 2011 9:40 am

Re: Availability of health care providers - how to factor this in a move?

Post by staythecourse » Mon Dec 18, 2017 2:38 pm

My suggestion is wherever you decide to move test drive it out for 3-6 months. Rent a place there and go make an appointment with a new primary care doc and whatever specialists you need. Talk to them and see if you are comfortable with them. Go and get the workup they want at the local hospital and see if you like/ feel comfortable with the hospital.

Personally, I would not move anywhere too small or out of the way if you have serious medical problems. There are MANY issues that you don't think of, but have seen patients go through because of location of where they live. For example, Husband gets a stroke and stays in the nearest big city for inpatient therapy (PT, OT, etc...). Wife has to live on her own and drive herself back and forth each day just to visit her husband for the next 3-6 months as he recovers.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

jebmke
Posts: 9783
Joined: Thu Apr 05, 2007 2:44 pm

Re: Availability of health care providers - how to factor this in a move?

Post by jebmke » Mon Dec 18, 2017 2:50 pm

We didn't entirely think through and investigate the availability of health care when we retired. We have been in a small town/rural environment now for 10 years and we have concluded that in addition to being questionable when we got here, things have gotten worse in the last 10 years. Like btenny, in our area if you need trauma care or acute cardiac care you are looking at either a 1.5 hour (on a good day) ambulance ride or a helicopter ride. I have had two friends (older) who each barely made it to the cardiac care unit in Baltimore in time. Eventually we will move back to an urban area.
When you discover that you are riding a dead horse, the best strategy is to dismount.

User avatar
dm200
Posts: 21969
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Availability of health care providers - how to factor this in a move?

Post by dm200 » Mon Dec 18, 2017 3:02 pm

Maybe others have knowledge or opinions on this, but my opinion is that the divide between areas with better availability of providers and areas with worse will grow. Unfortunate for those in such "underserved" areas.

JGoneRiding
Posts: 1797
Joined: Tue Jul 15, 2014 3:26 pm

Re: Availability of health care providers - how to factor this in a move?

Post by JGoneRiding » Mon Dec 18, 2017 3:05 pm

Is it at all heart related? A lot of smallish communities lack cardio specialist even moderate size that you would really think do have one don't. As stated up thread this means copper ride. Possible to be expensive I know people die every year in our county due to in ability to get some where fast enough, esp in winter with a storm

whomever
Posts: 882
Joined: Sat Apr 21, 2012 5:21 pm

Re: Availability of health care providers - how to factor this in a move?

Post by whomever » Mon Dec 18, 2017 3:11 pm

Like anything else, there are tradeoffs. I'm not sure the choice is limited to Bend or, say, Seattle. There are places in the hinterlands, like Spokane or Billings that are medical hubs for large surrounding areas. If you live 30 minutes outside of either of those, that's a lot more rural than 30 minutes outside Seattle. This depends, of course, on just how uncommon the particular care you need is.

It is an issue, though. We've been fortunate to live some of our lives in places where the nearest supermarket of any kind was an hour away, and the nearest town over 50K in population was hours away. I think that's easier to do when you're under 50 than when you're over 70.

mega317
Posts: 3060
Joined: Tue Apr 19, 2016 10:55 am

Re: Availability of health care providers - how to factor this in a move?

Post by mega317 » Mon Dec 18, 2017 3:46 pm

It's a risk I personally wouldn't be willing to take. There are infinite little things that can go wrong when you're some distance from the best care available. Long rides for catheterizations, where time is critical, are one good example. Small town docs are usually very good, but there are things they just don't see so they don't know the nuances of treatment.

Another more likely example, less severe but may happen repeatedly, is you have a minor problem that the small town primary care doctor isn't completely comfortable with, so they refer you to the specialist hours away, which may be totally unnecessary and is a waste of a day and some money. Or you have a chronic problem requiring a specialist and have to travel hours on a regular basis.

Katietsu
Posts: 2421
Joined: Sun Sep 22, 2013 1:48 am

Re: Availability of health care providers - how to factor this in a move?

Post by Katietsu » Mon Dec 18, 2017 4:08 pm

It was challenging dealing with parents and in laws who needed transported 1.5-2 hours (depending on traffic) for medical care during their later years. That distance does seem much when you rarely need to make the trip and/or are not too frail. When the need for such services becomes weekly or monthly and/or the patient is struggling with an illness that really knocks them down, it is sometimes very difficult. Often one even compromises on care because the travel is too much.

If a hospital stay is needed, it is much harder on the spouse who typically ends up in a family house or hotel or exhausting themselves from the drive.

If you work hard at it, some of this can be helped if you find a specialist is willing to work to have some of the care provided at the community hospital.

It is a trade-off. I, personally, would make that trade off if I had extended family or other strong ties to the community. Otherwise, I would not or I would be prepared to be nimble and ready for a quick move if needed.

Topic Author
boglegirl
Posts: 282
Joined: Mon Dec 17, 2012 1:41 pm

Re: Availability of health care providers - how to factor this in a move?

Post by boglegirl » Mon Dec 18, 2017 4:10 pm

staythecourse wrote:
Mon Dec 18, 2017 2:38 pm
...
Personally, I would not move anywhere too small or out of the way if you have serious medical problems. There are MANY issues that you don't think of, but have seen patients go through because of location of where they live. For example, Husband gets a stroke and stays in the nearest big city for inpatient therapy (PT, OT, etc...). Wife has to live on her own and drive herself back and forth each day just to visit her husband for the next 3-6 months as he recovers...
The bolded is one of the main problems I've been considering. For my most recent hospitalization, it sure was nice to be 20 minutes away, so I could have visitors, and also so my husband wasn't worried about leaving me at the hospital to sleep in his own bed since he'd be so close.
btenny wrote:
Mon Dec 18, 2017 11:45 am
...I trust the local system but know it is not as good or as fast as treatment in Phoenix where I also have a home.

So I guess it depends. Good Luck.
Do you get most of your care (annual checkups, etc) in Phoenix? I wouldn't mind being more rural if I also had a second home in an area with better access to care. I'm not worried about the emergency care* so much as dealing with possible chronic conditions or illnesses that crop up. But I don't think 2 retirement homes is the path we're on.
*although now you've given me something else to consider!
JGoneRiding wrote:
Mon Dec 18, 2017 3:05 pm
Is it at all heart related?...
No, none of it is heart related. The big thing is that I keep getting The Cancer. Had a bout in my 30s, again in my 40s, and then again as a welcome to the 50s. So now I have a degree of paranoia about it. I even joked to my husband about looking for houses in Houston just so we can be near MD Anderson so I'll be ready for the next round!

I have a relative who lives 3 hours from the nearest decent-sized city. When she got breast cancer, her choices were: 1.lumpectomy with 6 weeks of follow-up radiation, or 2. Mastectomy with no follow-up care. She chose #2, ONLY because it was too much of a hassle to get the radiation (spending 5 days a week for 6 weeks in the city). I don't want to make my care decisions for reasons like that. Maybe I've just answered my own question.

User avatar
Pajamas
Posts: 6015
Joined: Sun Jun 03, 2012 6:32 pm

Re: Availability of health care providers - how to factor this in a move?

Post by Pajamas » Mon Dec 18, 2017 4:16 pm

There are many reasons that life expectancy is lower in rural areas and I suspect that lesser availability and lower quality of health care are some of them.

If you need specialist care now, what if you need it even more later? Three hours to a specialist is a big deal. Even one or two hours can be a problem if there is an urgent need or if you are inpatient at a small local hospital.

You also need to consider coverage. Just because there is a specialist three hours away doesn't meant that they will see you unless you have coverage they accept or pay out of pocket.

protagonist
Posts: 6021
Joined: Sun Dec 26, 2010 12:47 pm

Re: Availability of health care providers - how to factor this in a move?

Post by protagonist » Mon Dec 18, 2017 4:22 pm

Bend is not in a vacuum. Plus , given its appeal, I would imagine it has its share of decent physicians, who tend to want to live in nice places.

Cancer rarely requires high level emergency care, and Portland is not very far if you needed to see a top specialist.

My impression of Oregon is that it is a progressive state and thus I would think it would have good health insurance, though I don't know that for a fact. OHSU is a fine institution.

I wouldn't let "potential" health problems stand in the way of your living where you want to live. You have nothing to fear but fear itself.

delamer
Posts: 9114
Joined: Tue Feb 08, 2011 6:13 pm

Re: Availability of health care providers - how to factor this in a move?

Post by delamer » Mon Dec 18, 2017 4:25 pm

This is a tough issue, and one my husband and I are wrestling with as we decide whether to a build retirement home on a lot we bought near a medium-size city. A decent hospital is 15 minutes away, but a superior academic hospital and specialists are 2.5 hours away.

My in-laws live 1.5 hours away from a major city and when my FIL had a heart attack, they had to rely on neighbors, initially, and then their kids taking vacation/sick leave to get them through a hospital stay, follow-up visits, testing, etc. and even basic stuff like grocery shopping. Their closest child was 3 hours away, and the others 10 hours. The in-laws were in their late 70’s at the time.

On the other hand, they lived in and enjoyed their retirement location for 15 years without needing any help.

User avatar
ResearchMed
Posts: 9370
Joined: Fri Dec 26, 2008 11:25 pm

Re: Availability of health care providers - how to factor this in a move?

Post by ResearchMed » Mon Dec 18, 2017 4:26 pm

boglegirl wrote:
Mon Dec 18, 2017 9:23 am
We live in HCOL area that doesn't really feel like our "forever" home. We hope to move to a lower cost of living and less metropolitan area in 3 years or so.

However...for the last few years, I've had some significant health issues. When I was younger and would read articles about the "Best Places to Retire" and they listed medical care as the top factor, I always wondered why. I'm only 50, but now I know. :( Currently, we're within 10 minutes from primary care doctors and a small community hospital, within 20 minutes from specialists and a larger regional hospital, and 30 minutes from a major research-center university hospital.

Because of my latest health issue, I'm really in a quandary. We'd always thought it would be OK to live somewhere like Bend, Oregon...doctors and hospitals nearby, with "the big city" doctors only 3 hours away. But now I'm not so sure. Please share how availability of health care affected your retirement life decision.
We are in a VHCOL area, and expect to stay here, even though we've briefly thought about how much farther our money would go in a medium or, even better, a low COL area.

In part, this is where almost all of our long term friends and colleagues are. We've each been here since the '70's.
And we very much like the cultural and academic activities. But this part could be managed with frequent trips back.

It's the medical... that is what is probably going to keep us here.

We do like it here, a lot.
Would we rather retire to a lower COL area? Sure!
But it's not likely to happen.
(As an aside, we'd also love to retire to some wonderful climate with great culture, but that's most assuredly not going to be lower in cost. But we can vacation in special places, at least while we are able. And after that, well... then, the health care becomes even more critical.)

We'll be staying where the there is top medical care, and the specialists "know our names" :annoyed

RM
This signature is a placebo. You are in the control group.

obgraham
Posts: 1222
Joined: Mon Jan 28, 2013 7:30 pm

Re: Availability of health care providers - how to factor this in a move?

Post by obgraham » Tue Dec 19, 2017 12:29 am

I've posted on this topic before, but the amount of BS here provokes me again.

First off, I know Bend pretty well, know several folks there who themselves are physicians, and with significant health issues of their own. Bend is not a backwater of health care. There are plenty of very experienced and very good docs, who want to locate there for the same reason that OP says he does. They also have a good relationship with OHSU for areas that benefit from such, like pediatric surgery, or selecting an oncology protocol tailored to the individual patient's case.

Those of you who think that good health care requires being seen in a tertiary care teaching center, are just plain wrong. I've seen more than my share of poor outcomes and incompetently performed surgeries coming from some of our best known academic centers.

Don't misunderstand: there are high risk patients, and there are cases of rare disease that absolutely should be treated by tertiary centers. If you sustain multi-system trauma or major burns you will and should be transported to one of our centers that does just that. But the vast majority of medical care is relatively straightforward and well within the purview of being treated by our community doctors (who were all trained in our academic centers!).

Everyone's entitled to their view: if you can't see living more than half an hour from a megamedicalcenter, that's fine. But please don't pass up the place you prefer thinking there's nobody there to look after you.

Topic Author
boglegirl
Posts: 282
Joined: Mon Dec 17, 2012 1:41 pm

Re: Availability of health care providers - how to factor this in a move?

Post by boglegirl » Tue Dec 19, 2017 3:21 pm

obgraham wrote:
Tue Dec 19, 2017 12:29 am
I've posted on this topic before, but the amount of BS here provokes me again.

First off, I know Bend pretty well, know several folks there who themselves are physicians, and with significant health issues of their own. Bend is not a backwater of health care. There are plenty of very experienced and very good docs, who want to locate there for the same reason that OP says he does. They also have a good relationship with OHSU for areas that benefit from such, like pediatric surgery, or selecting an oncology protocol tailored to the individual patient's case.

Those of you who think that good health care requires being seen in a tertiary care teaching center, are just plain wrong. I've seen more than my share of poor outcomes and incompetently performed surgeries coming from some of our best known academic centers.

Don't misunderstand: there are high risk patients, and there are cases of rare disease that absolutely should be treated by tertiary centers. If you sustain multi-system trauma or major burns you will and should be transported to one of our centers that does just that. But the vast majority of medical care is relatively straightforward and well within the purview of being treated by our community doctors (who were all trained in our academic centers!).

Everyone's entitled to their view: if you can't see living more than half an hour from a megamedicalcenter, that's fine. But please don't pass up the place you prefer thinking there's nobody there to look after you.
Just to be clear, I wasn't casting aspersions on Bend or its doctors or hospitals...it was just an example of the type of city we're considering, which has a hospital, but is 3 hours from a 'big city' hospital.

I really appreciate all the feedback. We've got a lot to consider over the next 3 years. Right now health care is weighing on me because of my current diagnosis, but perhaps I'll be worried about other things by then. My next thread might be: "Should we choose a retirement location based on MLB or at a minimum, MiLB AA or AAA?" :D (for that reason, Spokane is out...Class A short-season team won't do it for us...)

obgraham
Posts: 1222
Joined: Mon Jan 28, 2013 7:30 pm

Re: Availability of health care providers - how to factor this in a move?

Post by obgraham » Tue Dec 19, 2017 3:34 pm

Spokane is out...
Good. Scruffy place, that!

hoops777
Posts: 2692
Joined: Sun Apr 10, 2011 12:23 pm

Re: Availability of health care providers - how to factor this in a move?

Post by hoops777 » Tue Dec 19, 2017 5:40 pm

Well,there is nothing more important than your health.Make a list of the places you would like to move to and research the type of healthcare you need.If you clearly put healthcare number one it should be fairly simple to determine.I personally would rather not have to depend upon helicopters,especially when I am older and retired.However,you may be surprised when you research at just how good the healthcare is in many smaller cities like Bend.
K.I.S.S........so easy to say so difficult to do.

kenoryan
Posts: 215
Joined: Tue Sep 12, 2017 7:11 pm

Re: Availability of health care providers - how to factor this in a move?

Post by kenoryan » Tue Dec 19, 2017 5:55 pm

protagonist wrote:
Mon Dec 18, 2017 4:22 pm
Bend is not in a vacuum. Plus , given its appeal, I would imagine it has its share of decent physicians, who tend to want to live in nice places.

Cancer rarely requires high level emergency care, and Portland is not very far if you needed to see a top specialist.

My impression of Oregon is that it is a progressive state and thus I would think it would have good health insurance, though I don't know that for a fact. OHSU is a fine institution.

I wouldn't let "potential" health problems stand in the way of your living where you want to live. You have nothing to fear but fear itself.
Bend is expensive. And cost of real estate is going up rapidly with influx of californians.
Cancer doesn't require the kind of immediate care that cardiovascular disease does. Portland will work.
OHSU is a very good hospital.


Did you look at Hillsboro? Close enough to OHSU but just far enough from the madness.


Me, personally, I'm looking at Ann Arbor MI or nearby towns. Other option is Madison WI.

littlebird
Posts: 1527
Joined: Sat Apr 10, 2010 6:05 pm
Location: Valley of the Sun, AZ

Re: Availability of health care providers - how to factor this in a move?

Post by littlebird » Tue Dec 19, 2017 6:38 pm

When we retired (early and very early, respectively) we were attracted to the rural lifestyle, but chose instead a large senior community with a healthcare situation very much like your current one. Although we were in excellent health at the time, the availability of healthcare was a large factor in our decision. After all, it was going to be our retirement home.

Fast forward 30 years. We have been extremely happy with our decision - for many, many reasons - and the healthcare situation among them. While our healthcare experiences have been good to very good, what we've seen of the experiences of others has really confirmed our satisfaction.

My spouse has been in hospitals several times in the past five years or so, and each time I have encountered people, usually women, whose spouses have been helicoptered in from small towns and very rural parts of AZ and adjoining states. The stress and disruption visited on these women, most of whom flew in on the helicopter with their extremely sick or injured husbands, has been nothing short of shattering. With no clean clothes, no car, often no friends or family nearby, having left the dogs, cats, horses, etc. alone, needing a place to shower and stay after the first night or two sleeping in the ICU, constantly on the phone seeking solutions to these problems, in addition to the anxiety of the spouse's condition has been something I would not want to bear at my current age and state of health. In fact, I could not. At least not until I made arrangements for my own health needs. And I am not terribly old yet. I suspect there were many long distance patients whose spouse I never met in the ICU waiting area, because they were unable to accompany their patient, causing even more stress and anxiety for both.

This is something you absolutely need to think about before choosing a retirement home. The years fly by.

HIinvestor
Posts: 1833
Joined: Tue Apr 08, 2014 3:23 am

Re: Availability of health care providers - how to factor this in a move?

Post by HIinvestor » Tue Dec 19, 2017 6:56 pm

We live in Honolulu which has a population of over 1million but I and D still get care out of state because while we do have some very good specialty providers they don’t have the same volume and experience as National centers like National Jewish, STANFORD and UCSF. We are willing and able to travel for top quality care and are happy with the good care we normally get in Honolulu.

That being said I agree with others that there is nothing like living in the area where you’re planning to move for 3-6 months before you start making major changes and plans, just to sus out whether things seem to be as you’re expecting them to be, including medical care.

In Honolulu, many of our doctors are retiring or 65+ so no idea how much longer they’ll keep working. Neighbor islands have fewer options and need air ambulance to Oahu when the specialists aren’t available.

User avatar
nisiprius
Advisory Board
Posts: 39283
Joined: Thu Jul 26, 2007 9:33 am
Location: The terrestrial, globular, planetary hunk of matter, flattened at the poles, is my abode.--O. Henry

Re: Availability of health care providers - how to factor this in a move?

Post by nisiprius » Tue Dec 19, 2017 7:13 pm

Since we haven't planned to move I haven't checked things out thoroughly, but the correlation between cost of living and quality of medical care seems to be surprisingly loose. I was surprised to find out that Iowa, for example, is among the better states for medical care.
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.

User avatar
ram
Posts: 1316
Joined: Tue Jan 01, 2008 10:47 pm
Location: Midwest

Re: Availability of health care providers - how to factor this in a move?

Post by ram » Wed Dec 20, 2017 2:04 am

The availability of health care in remote rural areas is likely to get worse. Health care is under pressure to reduce costs. It simply is cheaper to treat 3650 heart attacks/yr at a large hospital than 365 heart attacks/yr at 10 small hospitals. The ability and willingness to financially support small rural hospitals is declining and many rural hospitals are going out of business or restricting the scope of services to control costs.

I work at a large rural hospital and barring very severe weather we can get a catheter in a heart attack patient within 60 minutes (door to balloon time). At a large teaching urban hospital with cardiology fellowship a cardiology fellow is sleeping in the call room when a patient with a heart attack comes at 2 am. This is not possible in a community hospital (urban or rural).

More than 90% of my patients travel at least 60 minutes to seek specialty medical care.
Ram

daveydoo
Posts: 1564
Joined: Sun May 15, 2016 1:53 am

Re: Availability of health care providers - how to factor this in a move?

Post by daveydoo » Wed Dec 20, 2017 2:26 am

obgraham wrote:
Tue Dec 19, 2017 12:29 am

Everyone's entitled to their view: if you can't see living more than half an hour from a megamedicalcenter, that's fine. But please don't pass up the place you prefer thinking there's nobody there to look after you.
I think it's important to be near an academic medical center. There are lots of those that are not in major metro areas (think Hershey, PA). Although it's true that you can get good medical care anywhere, the likelihood is a whole lot lower the further you are from an academic center. You can get a good total-knee or lasik at any money-mill (see your in-flight magazine), but for actual continuity and a network of outstanding specialists, your best bet is near an academic center, imo. Yes, we've all seen articles, etc., about a tragedy that happened at some med school somewhere but at the small centers, there's no one to even blow the whistle. And at small hospitals, it's much easier (not necessarily more common, but easier) for greed and relentless attention to the bottom line to compromise quality of care; no one reins in the rainmakers there.
"I mean, it's one banana, Michael...what could it cost? Ten dollars?"

mouses
Posts: 3905
Joined: Sat Oct 24, 2015 12:24 am

Re: Availability of health care providers - how to factor this in a move?

Post by mouses » Wed Dec 20, 2017 6:59 am

I haven't had time to read all the replies, but availability of good health care is close to my #1 priority now in retirement with several health conditions.

A number of years ago I moved to the boonies where I now live. It was very hard to find a good internist and specialists. I eventually wound up driving to Massachusetts, primarily Boston, where as I am sure you know there are excellent teaching hospitals, for most of the specialists. Even for my dentist.

It gets tiring and tiresome though to drive a couple of hours to reach a doctor.

My second priority would be property tax. I took that into account before I moved, but then the town really increased it.

Seasonal
Posts: 510
Joined: Sun May 21, 2017 1:49 pm

Re: Availability of health care providers - how to factor this in a move?

Post by Seasonal » Wed Dec 20, 2017 7:07 am

nisiprius wrote:
Tue Dec 19, 2017 7:13 pm
Since we haven't planned to move I haven't checked things out thoroughly, but the correlation between cost of living and quality of medical care seems to be surprisingly loose. I was surprised to find out that Iowa, for example, is among the better states for medical care.
What are you using to rank states for medical care?

It's not a great state for buying individual insurance https://www.healthinsurance.org/iowa-st ... -exchange/

protagonist
Posts: 6021
Joined: Sun Dec 26, 2010 12:47 pm

Re: Availability of health care providers - how to factor this in a move?

Post by protagonist » Wed Dec 20, 2017 9:12 am

nisiprius wrote:
Tue Dec 19, 2017 7:13 pm
Since we haven't planned to move I haven't checked things out thoroughly, but the correlation between cost of living and quality of medical care seems to be surprisingly loose. I was surprised to find out that Iowa, for example, is among the better states for medical care.
What matters the most is the quality of your specific physician and supporting staff dealing with your specific health issue. And having worked as a physician in many parts of the USA (and the world), in my experience that is pretty random. There are some terrible doctors in major academic centers and some great ones where you least expect to find them. The major advantage of academic centers is that there are more checks and balances....the med student's work is checked by the intern which is checked by the resident which is checked by the attending physician...plus many of those are being graded on their performance.... and if your case is interesting you get discussed in conference. So you get tested and prodded a lot more (which has its pluses and minuses), and there may be less chances for error as a result.

I wouldn't put too much faith in state rankings. In this country quality of care is largely dependent on what you can afford, no matter where you live. To some extent that is true anywhere in the world. The average life expectancy in Monaco, where one in three people are millionaires, is about 90 years.

OP, move somewhere that will make you happy. The rest will fall into place.

Rupert
Posts: 4122
Joined: Fri Aug 17, 2012 12:01 pm

Re: Availability of health care providers - how to factor this in a move?

Post by Rupert » Wed Dec 20, 2017 9:39 am

OP, you've gotten good answers, I think, but I would like to add one variable that I think has not been mentioned. I suffer from an unusual presentation of a somewhat uncommon disease, and, as a result, I have to see lots of specialists, mostly just for monitoring purposes. I live in a mid-size city with a medical school, but the medical school is just sort of okay, and I don't see doctors there. My doctors are spread in private practices all over town. The most frustrating and stressful aspect of my situation is getting my doctors to share information with each other. After each test or scan, it seems I have to make multiple phone calls or drive to multiple offices to make sure each doctor gets a copy of what they need. I don't want to deal with that when I'm old. So I want to retire near an academic medical center where all my specialists are housed under one roof and can see each other's records and notes without me having to intervene to make that happen. Depending on what condition you have, this can be an important quality of life issue.

bungalow10
Posts: 2253
Joined: Sat Apr 09, 2011 6:28 am
Location: Chicago North Shore

Re: Availability of health care providers - how to factor this in a move?

Post by bungalow10 » Wed Dec 20, 2017 9:57 am

I understand the desire to live in a small/medium town. Can I recommend university towns? Places like Iowa City, Iowa, that has the University of Iowa Hospital, or Madison, Wisconsin with their UW Hospitals, have the best of small communities (and often very vibrant) AND cutting edge facilities and talent.
An elephant for a dime is only a good deal if you need an elephant and have a dime.

User avatar
HueyLD
Posts: 7176
Joined: Mon Jan 14, 2008 10:30 am

Re: Availability of health care providers - how to factor this in a move?

Post by HueyLD » Wed Dec 20, 2017 10:00 am

bungalow10 wrote:
Wed Dec 20, 2017 9:57 am
I understand the desire to live in a small/medium town. Can I recommend university towns? Places like Iowa City, Iowa, that has the University of Iowa Hospital, or Madison, Wisconsin with their UW Hospitals, have the best of small communities (and often very vibrant) AND cutting edge facilities and talent.
Well, it depends.

My state sold its univ medical center to a for-profit outfit and the new management has caused mass exit of talents. The UMC is now the worst hospital in town. Very very sad.

User avatar
heartwood
Posts: 1418
Joined: Sat Nov 23, 2013 1:40 pm

Re: Availability of health care providers - how to factor this in a move?

Post by heartwood » Wed Dec 20, 2017 10:21 am

All good insights above; I'd like to mention a variation on what's been mentioned: how available are doctors taking Medicare or new patients?

We have homes in two HCOL areas. In the first I've had 2 PCP doctors retire in 13 years. The first was a smooth transition, except the doc taking over the practice wasn't as seemingly competent or personable as the first guy. After the 2nd guy retired I had to call something like 8 offices before I found one taking new patients. The doc I found is good, only takes Medicare but not other insurance. Not a problem since BCBS covers it through referral from Medicare but as out of network.

We spend about half the year at our 2nd location. Again HCOL, smaller metro area. But, the only docs taking new patients were only a year or two out of med school. The docs that were recommended by others ... not taking new patients. We asked two patients to speak to their doc for us. He took us into his practice, but at the time it was concierge only or for members of a local union plan. We went for it. He just retired and turned the office over to a doc that was in practice with him. She takes medicare and out of state BCBS.

My suggestion is you call a few offices to judge how available PCPs are that take Medicare or any other of your insurances. After the PCP, if you have any specialists that you see on a routine basis, check their availability and insurance accessibility. In our 1st location one specialty used on a monthly basis is almost unavailable though Medicare or any insurance plan. It's out of pocket, signing an agreement not to submit to Medicare or other insurance. This in the suburbs of a major metropolitan area. And that specialty doc keeps moving on.

jebmke
Posts: 9783
Joined: Thu Apr 05, 2007 2:44 pm

Re: Availability of health care providers - how to factor this in a move?

Post by jebmke » Wed Dec 20, 2017 10:45 am

Seasonal wrote:
Wed Dec 20, 2017 7:07 am
What are you using to rank states for medical care?
You have to take it down a level and not just look at states. I live in Maryland. Some of the top medical centers are in Baltimore-Washington corridor. But if you live on the western end of the state or the Eastern Shore, you don't have a lot of good options. Even the mediocre options are getting scarcer and scarcer. One hospital in a neighboring town closed last year and another will likely bite the dust in 2018 or '19. Our local hospital had plans to build a brand new campus. They even bought the land a couple of years ago and ran all the core utilities to the site. They will never get a certificate now.
When you discover that you are riding a dead horse, the best strategy is to dismount.

Mintee
Posts: 90
Joined: Sun Aug 12, 2012 2:23 pm

Re: Availability of health care providers - how to factor this in a move?

Post by Mintee » Wed Dec 20, 2017 10:47 am

I agree with heartwood. When we moved to Texas, we knew that quality healthcare was available. What we didn't know was that we would have so much trouble finding physicians who would take individual health insurance or Medicare. We have large physician medical groups less than a mile from us, but they wouldn't take either individual insurance or Medicare.

My husband finally found a doctor who would take Medicare--with disastrous results. She misdiagnosed his illness. I am not suggesting that this would happen to you or others, but the lack of primary care physicians who will accept your insurance and ultimately Medicare is a big, big deal.

likegarden
Posts: 2900
Joined: Mon Feb 26, 2007 5:33 pm

Re: Availability of health care providers - how to factor this in a move?

Post by likegarden » Wed Dec 20, 2017 10:52 am

We are retired and in the 70s. I would not live 3 hours away from a major hospital. We live in a small town in a medium COL area in the Northeast and are 1/2 hour away from 3 major hospitals, one is a medical school. They are expanding and have taken over smaller hospitals. Recently these hospitals have created emergency and urgent care facilities in our town, which we can reach in 10 minutes. We have an HMO plan with our medical insurance, and therefore have no billing problems. We also have no problems finding specialists, because they are also in that HMO plan. So we are happy with our medical situation.

letsgobobby
Posts: 12082
Joined: Fri Sep 18, 2009 1:10 am

Re: Availability of health care providers - how to factor this in a move?

Post by letsgobobby » Wed Dec 20, 2017 10:53 am

Deleted
Last edited by letsgobobby on Thu Jul 11, 2019 3:46 pm, edited 1 time in total.

User avatar
HueyLD
Posts: 7176
Joined: Mon Jan 14, 2008 10:30 am

Re: Availability of health care providers - how to factor this in a move?

Post by HueyLD » Wed Dec 20, 2017 11:04 am

I think it is VERY IMPORTANT to seriously consider the availability of health care providers and facilities in retirement.

It is not "if," but "when" one will need increasing amount of health care in retirement. Unless one is extremely genetically blessed, it is unavoidable.

Nowizard
Posts: 2306
Joined: Tue Oct 23, 2007 5:33 pm

Re: Availability of health care providers - how to factor this in a move?

Post by Nowizard » Wed Dec 20, 2017 1:29 pm

There are reasons, sometimes related to competency and license history for physicians to locate in a small community. That is not always the case, of course, and personality factors also play a part, as do rebates on student loans for locating in an underserved area.

Check out the providers carefully if you move to a small community. Equally important, in our opinion is the quality of the support staff, the nurses, radiological techs, lab techs, etc. Our area is large and has a substantial number of highly regarded specialists. However, having been in healthcare prior to retirement, it can also be said that in areas like ours, the physicians may be excellent while the support staff leaves something to be desired. That is particularly important when hospitalized and physician orders are only as good as carried out by others.

Tim

letsgobobby
Posts: 12082
Joined: Fri Sep 18, 2009 1:10 am

Re: Availability of health care providers - how to factor this in a move?

Post by letsgobobby » Wed Dec 20, 2017 1:42 pm

Deleted
Last edited by letsgobobby on Thu Jul 11, 2019 3:45 pm, edited 1 time in total.

hoops777
Posts: 2692
Joined: Sun Apr 10, 2011 12:23 pm

Re: Availability of health care providers - how to factor this in a move?

Post by hoops777 » Wed Dec 20, 2017 7:36 pm

letsgobobby wrote:
Wed Dec 20, 2017 1:42 pm
The issue is not routine primary care, which I don’t expect to be different in a small community. In fact in some small communities you may get a better doctor, as most doctors in small communities take most insurances, including Medicare. Urban communities will see a lot more docs peeling out of the insurance and Medicare market entirely, serving only commercial insurance or working in ‘boutique’ practices.

The issue is specialty care. Not just cancer, of course, but heart disease; psychiatry; rheumatology; complex diabetes management; specialized surgeries. For one off treatments travel is fine. For monthly or more frequent visits, long distance travel can be a real pain.

I’m a ‘small town’ doc and am not casting aspersions in any way. But there is no question we don’t offer the same breadth of services and all tend to be generalists. For example, in my town if you have a head trauma and need neurosurg, you have to be transported. In the nearby big city, you most likely would not need to be.
Just curious since you are a doc.I notice more and more on the lists of available docs that most are from overseas and have gone to medical school overseas.Any concerns about the quality of education and does it make a difference if their residency was in the US?
K.I.S.S........so easy to say so difficult to do.

daveydoo
Posts: 1564
Joined: Sun May 15, 2016 1:53 am

Re: Availability of health care providers - how to factor this in a move?

Post by daveydoo » Wed Dec 20, 2017 8:14 pm

hoops777 wrote:
Wed Dec 20, 2017 7:36 pm

Just curious since you are a doc.I notice more and more on the lists of available docs that most are from overseas and have gone to medical school overseas.Any concerns about the quality of education and does it make a difference if their residency was in the US?
Plenty of threads about this, and there can be a difference. But: doctors have to be among the most heavily vetted of all professionals, with stringent multi-level boards and licensing requirements, CME requirements, re-certification requirements, adherence to tracked quality metrics at every one of their institutions, peer review for re-credentialing on an annual or biannual basis at hospitals where they admit and work, etc., etc. Yet more and more primary care is being delivered by "mid-levels" with none of these safeguards in place, and with clinical experience that is a single-digit percent of that of a physician's. And with seemingly no medicolegal liability. And let's not forget the throw-away online PhDs in nursing (for example) so that almost anyone gets to call themselves "doctor." In some states, naturopaths can be primary care doctors. So you can not understand physiology or pharmacology and prescribe homeopathic remedies that deliver less than a single molecule of active ingredient -- and call yourself a doctor. The bigger threat to quality care (than overseas-born or -trained physicians) is this expansion of the "provider" umbrella.
"I mean, it's one banana, Michael...what could it cost? Ten dollars?"

obgraham
Posts: 1222
Joined: Mon Jan 28, 2013 7:30 pm

Re: Availability of health care providers - how to factor this in a move?

Post by obgraham » Wed Dec 20, 2017 8:15 pm

hoops777 wrote:
Wed Dec 20, 2017 7:36 pm
Just curious since you are a doc.I notice more and more on the lists of available docs that most are from overseas and have gone to medical school overseas.Any concerns about the quality of education and does it make a difference if their residency was in the US?
You've brought up a touchy subject. In my opinion these things do make a difference. You want the residency to be in North America. This is where docs are trained in our methods of specialty care. There are good residencies, and there are "less good" residencies.

Medical school is a different issue: I have concerns with Americans who went to some of the lesser schools out of the country, usually because it was the place they got into. And some who went to foreign schools are not culturally tuned in to American ways of doing things. That said, there are plenty of very excellent docs who trained abroad, and they had to pass stringent US examinations.

Added: agree with Daveydoo about the expansion of midlevel providers.

User avatar
CULater
Posts: 2285
Joined: Sun Nov 13, 2016 10:59 am

Re: Availability of health care providers - how to factor this in a move?

Post by CULater » Wed Dec 20, 2017 8:23 pm

I wonder about a couple of things. First, Medicare acceptance. I've run into the situation where a medical practice has told me that they are presently not accepting new Medicare patients. However, I'm under the impression that major medical centers, particularly university hospitals are obligated to accept patients on Medicare because they are receiving federal funding. Is this accurate? If so, this argues for being near such facilities instead of somewhere where you are dependent upon being accepted as a new patient by a private practice.

Second, I have concerns about living in a large senior retirement community. In these communities, the overwhelming majority of patients are seniors who are on Medicare. I have my doubts about quality of care since there is little heterogeneity in the type of patient or the insurance. My impression of Medicare is that the reimbursements are so measly, doctors must play a numbers game by running as many patients though the mill as possible; and that they are also likely to order more tests and do other things that provide more insurance bang for the buck. I also have some doubts about the quality of many physicians who choose to wield their art in such settings with such a patient population.

If I'm right about #1 and #2 above, I'd be somewhat inclined to try to avoid settling down in areas packed with senior citizens on Medicare, and also be more interested in towns and cities which have large public medical facilities, such as university hospitals.
On the internet, nobody knows you're a dog.

User avatar
VictoriaF
Posts: 18982
Joined: Tue Feb 27, 2007 7:27 am
Location: Black Swan Lake

Re: Availability of health care providers - how to factor this in a move?

Post by VictoriaF » Wed Dec 20, 2017 9:08 pm

Please consider several hypothetical questions:
1. What if you became ill after you had moved into a rural community?
2. What if your health becomes worse than it is now?
3. What if you became unable to drive?

When I was making a decision where to live in retirement, I prioritized access to extensive public transportation. I am an excellent driver, but an acute or a chronic condition may eventually prevent me from driving. I don't want to count minutes of driving; I want to rely on public transport and minutes of walking. It also happens that extensive public transportation is associated with metropolitan areas, and metropolitan areas have a variety of hospitals and specialists. (Metropolitan areas also have great culture and diversity, but that's a different point.)

My recommendation is to retire in a HCOL area, if you can afford it. That's what I did and I am very happy with my decision.

Best wishes for a full recovery,

Victoria
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

HIinvestor
Posts: 1833
Joined: Tue Apr 08, 2014 3:23 am

Re: Availability of health care providers - how to factor this in a move?

Post by HIinvestor » Wed Dec 20, 2017 9:45 pm

We plan to retire in our very HCOL area, which is where we’ve lived nearly all our lives and our friends and family live here too. Yes, I wish we had better transit options but Uber and Lyft and taxis are abundant here and we do have a bus system.

I agree that good access to high quality medical care is important, especially as we age and tend to have jncr axing health issues. I don’t mind flying to see a specialist a few times/year but would find more frequent or urgent visits onerous.

I still believe that trying the desired location for 396 months (or longer if you can afford it) is the best way to get a good feel for these and other issues and minimize unpleasant surprises.

User avatar
ResearchMed
Posts: 9370
Joined: Fri Dec 26, 2008 11:25 pm

Re: Availability of health care providers - how to factor this in a move?

Post by ResearchMed » Wed Dec 20, 2017 9:49 pm

HIinvestor wrote:
Wed Dec 20, 2017 9:45 pm
We plan to retire in our very HCOL area, which is where we’ve lived nearly all our lives and our friends and family live here too. Yes, I wish we had better transit options but Uber and Lyft and taxis are abundant here and we do have a bus system.

I agree that good access to high quality medical care is important, especially as we age and tend to have jncr axing health issues. I don’t mind flying to see a specialist a few times/year but would find more frequent or urgent visits onerous.

I still believe that trying the desired location for 396 months (or longer if you can afford it) is the best way to get a good feel for these and other issues and minimize unpleasant surprises.
Hmmmm. I sort of think that a trial period of 396 months should suffice for most, and "or longer if you can afford it" isn't really necessary.
Maybe for those who have an unusual degree of uncertainty...

:twisted:

RM
This signature is a placebo. You are in the control group.

mega317
Posts: 3060
Joined: Tue Apr 19, 2016 10:55 am

Re: Availability of health care providers - how to factor this in a move?

Post by mega317 » Wed Dec 20, 2017 10:29 pm

daveydoo wrote:
Wed Dec 20, 2017 8:14 pm
Yet more and more primary care is being delivered by "mid-levels" with none of these safeguards in place
Midlevels absolutely have boards, licensing, CME (or CE), re-cert, peer review, quality metrics, etc. They also have a physician supervising them.

4nwestsaylng
Posts: 509
Joined: Thu Jun 15, 2017 2:03 am

Re: Availability of health care providers - how to factor this in a move?

Post by 4nwestsaylng » Wed Dec 20, 2017 11:00 pm

HueyLD wrote:
Wed Dec 20, 2017 10:00 am
bungalow10 wrote:
Wed Dec 20, 2017 9:57 am
I understand the desire to live in a small/medium town. Can I recommend university towns? Places like Iowa City, Iowa, that has the University of Iowa Hospital, or Madison, Wisconsin with their UW Hospitals, have the best of small communities (and often very vibrant) AND cutting edge facilities and talent.
Well, it depends.

My state sold its univ medical center to a for-profit outfit and the new management has caused mass exit of talents. The UMC is now the worst hospital in town. Very very sad.
I agree, "it depends". Some university medical centers have become rather oppressive multispecialty groups,signing bottom dollar contracts, going for volume, and you have admnistrator/MBA types sitting in nice offices, bullying high level academic docs to produce more, etc.. I think in the Midwest, there are some very good academic medical centers in relatively small towns. The tradeoff is the weather of course.
In New Hampshire, you have Dartmouth/Hitchcock, an academic medical center in a rural area.

In major cities with academic medical centers, often there is one major nonacademic hospital which recruits top doctors who may have come to town originally to work in the academic center but became disenchanted, and the logical step was to stay in town and go into private practice. An example of this would be Tucson,Arizona.

When I was younger, twenty years ago, I did not like the concept of retirement communities, but the concept has improved for newer generations of retirees. Homebuilders such as Shea Homes has their Trilogy brand, locating retirement centers often in the suburbs of major urban areas. For example, in the Bay Area, Brentwood California. Phoenix of course has the massive Sun City area, with top medical care.

If you can accept hot weather, the Phoenix area offers good value in terms of COL, but with several high quality hospitals in the Banner system, with academic affiliation in some. So Prescott, north of town, a bit cooler, is a quick 30 minute drive to major medical centers.
In Colorado, Fort Collins would be a good choice.In Oregon. In Washington, I would not consider any community east of the Cascades, but from Olympia to the Canadia border there is a string of good medical care, but also HCOL.

With your history of medical problems I think you should decide on climate or region, then go and spend a few months, get a feel for where you could live
with good medical facilities nearby.

Also whatever medical plan you get, you want to be able to go to specialists of your choice without having to go through the approval of a primary care gatekeeper. This is very important.

bayview
Posts: 1845
Joined: Thu Aug 02, 2012 7:05 pm
Location: WNC

Re: Availability of health care providers - how to factor this in a move?

Post by bayview » Thu Dec 21, 2017 12:18 am

We live in Asheville NC. We chose this location because (among other reasons) it has a large retirement-aged population and good hospitals. As someone who works in health information, my inner nerd picked a primary-care practice that is owned by Mission Hospital, the biggest dog in local hospitals with a good-sized teaching component, and there is an integrated health record that allows for immediate access to all my records wherever I go in the system. Everything's good, right?

Fast forward to August or September of this year, when Mission, the largest-by-far health system, and Blue Cross Blue Shield, the largest-by-far third-party insurer, get in a ya-ya-ya battle over contract renewal, resulting in BCBS cancelling coverage for most Mission-related sites as of October 5. (I still don't know how they are allowed to do this when one's insurance runs from Jan1 through Dec 31, but there you go.) We were reduced to using Sisters of Mercy urgent care and a different hospital if we needed a higher level of care while waiting for Jan 1 and new insurance coverage, and let's don't think about having to find a specialist. (No, this didn't count as a qualifying event for changing insurance mid-stream.)

This continued until the week before the end of the federal open-season for health insurance, with the huge majority of local federal employees having BCBS and using Mission. Suddenly, the two worked it out and everything was magical again, and I didn't have to change insurance.

But it's something to consider when your primary care provider, your physical therapist, all your specialists, your emergency department, and your acute inpatient hospital are all in the same group, so that if your insurance company doesn't like them anymore, you're up the creek.
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri

daveydoo
Posts: 1564
Joined: Sun May 15, 2016 1:53 am

Re: Availability of health care providers - how to factor this in a move?

Post by daveydoo » Thu Dec 21, 2017 12:21 am

mega317 wrote:
Wed Dec 20, 2017 10:29 pm
daveydoo wrote:
Wed Dec 20, 2017 8:14 pm
Yet more and more primary care is being delivered by "mid-levels" with none of these safeguards in place
Midlevels absolutely have boards, licensing, CME (or CE), re-cert, peer review, quality metrics, etc. They also have a physician supervising them.
They may be boarded for their profession but they are not boarded for their scope of practice. Physicians are boarded for what they do, not just for being "a doctor." Also, it would be interesting to compare board questions side-by-side, or even take each other's boards.

Mid-levels may have an assigned supervising physician of record; they do not necessarily "have a physician supervising them." And in this no-one-really-knows-anything-anyway era, they have fought tooth and nail for increased autonomy, and function independently in many jurisdictions. I have seen their ad campaigns -- "as good as a doctor but with the caring of a nurse," etc. And I constantly see the ads for online short-track meaningless PhD's targeting mid-levels so they can be full-fledged "doctors." :D

The plumbing technician who comes to my home may be "supervised by a plumber" somewhere, somehow, but he/she is not a journeyman plumber. Learned that the hard way -- and that was just toilets.
"I mean, it's one banana, Michael...what could it cost? Ten dollars?"

Post Reply