The Spanish Inquisition: Why is Healthcare so Much Less Expensive Overseas?

Does healthcare IT really improve medical care?

EDITOR’S NOTE: RACmonitor investigative reporter and New York attorney Edward Roche recently found himself in a life-threatening situation while on a business trip in Barcelona, Spain. Here, Roche recounts his story, the medical conditions to which he was a beneficiary, and the good news that accompanied the bill for services provided.

Today’s article is a personal anecdote. I’m happy to be back at RACmonitor. In fact, I’m happy to be alive.

Recently, I was in Barcelona, Spain, a vibrant city full of art and wonderful architecture.

But for me, it was a nightmare. I must have had some bad food in Madrid. On a Monday morning bullet train to Barcelona, I started to feel ill. Thursday morning there was an unbelievable pain in my abdomen. Cold sweat. Moaning and screaming with each breath. It was horrible and scary.

My student called emergency services. An ambulance was dispatched. It was half a kilometer away, but took more than an hour to arrive. By that time, I was blacking out. My student put a cold towel on my forehead, and kept yelling “stay with us!”

I vaguely remember getting to the Hospital Clínic de Barcelona. The last thing I remember was being told to “breathe into this.”

I awoke. Unfamiliar surroundings, but definitely a hospital.

“Do you know what day it is?” a nurse asked in an unfamiliar but pleasing accent.


“It is Sunday afternoon.”

“Three days later,” I thought. Attempting to sit up, I became aware of being completely hooked up to a number of tubes, completely immobile.

“You mean you saved me? I’m alive! What in the hell happened?”

“You had Boerhaave syndrome. There was major surgery. Your wife is here. She came from New York. Get some rest. You were very lucky.”

What was that? Later, I was to learn that “in most cases of Boerhaave’s syndrome, the tear occurs at the left postero-lateral aspect of the distal esophagus and extends for several centimeters. The condition is associated with high morbidity and mortality, and is fatal without treatment. The occasionally nonspecific nature of the symptoms may contribute to a delay in diagnosis and a poor outcome.”

According to Wikipedia, Herman Boerhaave (1668 – 1738) was a Dutch botanist, chemist, Christian humanist, and physician of European fame. He is regarded as the founder of clinical teaching and of the modern academic hospital and is sometimes referred to as “the father of physiology,” along with Venetian physician Santorio Santorio (1561–1636).

Evidently, in 1715, the good doctor was in the vicinity when a wealthy shipping captain in Amsterdam was celebrating his return from Asia, his vessel loaded with spices. He had pocketed a fortune. There was a feast with 15 courses. As was the 18th-century custom, after eating his fill, the captain went to throw up before returning to continue feasting. The rest is history.

Boerhaave syndrome is a rare event, and it has a very high mortality rate, more than 80 percent – so yes, I was lucky.

So I spent a while at the Hospital Clínic de Barcelona: seven days in the Intensive Care Unit (ICU), four days in the step-down unit, another 10 days recovering further, and a post-operative procedure to remove the 26 stitches on my back, the entry point for laparoscopic surgery performed to patch up my esophagus.

Time to go home. I could barely walk across a room.

The Medical Bill Arrives

After a few weeks, a thick letter arrived from Spain. The medical bill. I opened it up. Several pages, but not as many as I had expected.

Major surgery. Ambulance service. Heart evaluations because of two arrhythmias. Eleven days in the hospital, and again, seven in the ICU. Several barium swallow tests. A grocery bag full of drugs. Round-the-clock care. Daily medical consultations. Post-operative surgery.

The total bill: about $13,000.

I called up my doctor here in New York. He said that $13,000 is about what a person would pay for the ICU for a single day around here, not including the costs of all of the other necessary services (surgery, diagnostics, medication, nursing care, etc.).

I did some analysis. My conclusion was that the cost of medical services in Spain is less than 10 percent of that in the United States. It isn’t 10 percent or 15 percent or even 25 percent cheaper, but more than 90 percent cheaper.

How can that be? What makes it so different?

One explanation might be quality. I went for a two-month post-operative check here in New York, another barium swallow procedure. I asked the doctor:

“Hey doc, can you tell me how that surgery on my esophagus looks?”

His answer: “I can’t even tell you had surgery.”

My recovery was rapid.

So it is not quality. The Hospital Clínic de Barcelona is a world-class institution.

The drugs were about the same, only much less expensive, but that would not account for the incredible price difference. What was it?

I kept rereading the bill. Eleven days in the hospital, and the bill was only two pages. It consisted of only 30 or so claim lines. Compared to a normal hospital bill in the United States, it was much shorter, about 10 times shorter (just like the bill was 10 times less.)

What was missing in Barcelona?

I kept going over in my mind everything I saw. Then it dawned on me. No computers!

I could not remember seeing even one computer the entire time in the Clínic. Perhaps there was a screen at the nurse’s station in the step-down unit, but it was not used much.

The treatment in Spain was very much unlike that in the United States, where a computer on wheels follows the doctor on their rounds like a stalking robot. For every three minutes spent with a patient, the doctor or their assistant spends 10 minutes or more on the computer. Much more time is spent handling data than in caring for patients.

Could it be that the technology we all believe is a great fountain of efficiency and modernity actually is a source of waste and excessive costs? Is the United States killing itself by over-informatizing medical care?

What a strange term: “over-informatization.”

Coming Articles

In the next series of articles, we will examine the “informatization” of the healthcare industry in the United States. We will explore examples of high efficiency, but also look for evidence of waste and out-of-control costs. We also will look for fraud, security issues, and hidden costs about which few are aware.

In the next installment, we will start with an example of how cyber issues drastically inflate the cost of prescription medication. We will start with the pharmacy benefit management industry.

See you then.


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Edward M. Roche, PhD, JD

Edward Roche is the director of scientific intelligence for Barraclough NY, LLC. Mr. Roche is also a member of the California Bar. Prior to his career in health law, he served as the chief research officer of the Gartner Group, a leading ICT advisory firm. He was chief scientist of the Concours Group, both leading IT consulting and research organizations. Mr. Roche is a member of the RACmonitor editorial board as an investigative reporter and is a popular panelist on Monitor Mondays.

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