感觉自己也去游了下，以后有机会一定去国外看看
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- 2010.旅美散记
很有意思，谢谢分享！
9楼：
我们真的不和钱打交道。样本到我们手里，我们做必须做的一切，从不管病人的经济情况。但我对数字感兴趣，对我们工作的报销情况约知1，2：
我们的收费分2部分：技术部分和职业部分（不是很好翻译）technical fee and professional fee. For most specimens, technical fee and professional fee is about half and half. There is a universal billing code book covering all the medical services all over the country. We change jobs but our biling codes stay the same. For pathology services, for example, most biopsies are 88305 and most insurance companies and medicare reimburse about $100/part. If a prostate case has biopsy cores in 12 containers, pathologists tell the billing people or secretary 88305 x 12. Same is true for skin, GI or cervical biopsies, one container is 88305 x 1. Then we have 88307 for large benign specimes such as hysterectomies for fibroids and placentas, which will reimburse a little more than $100. 88309 are for tumor resection cases with higher reimburse rate. Any extra studies we do, we bill additional codes. For example, 88312 if we did Giemsa stain for H.pylori in gastric biopsy or PAS for fungi. I think ThinPrep gets reimbursed much less than $100, HPV Hibrid Caption test is about $150.
Poor people get medical care too. All the facilities that have received federal funds must treat emergency patients. It means all the emergent rooms have to treat patients when they come. It is the law. Our hospital have about 20% patients who never pay us a penny for our services. But whenever they come, we have to treat them. Clinical billing is complicated too. For example, if the patient comes to the hospital without colitis but got colitis during hospital stay, i don't think we would get paid by treating colitis. For a certain diagnosis, medicare (the largest goverment payer for medical services) pays a certain amount. If we messes up the medical care and patients get complications, we treat the complications for free.
It is too much to tell. Next time.
People older than 65 years old get medicare insurance from federal goverment. Poor people younger than 65 years old especially children can get some insurance from local government. In connecticut, we have Charter Oak and Huskies (two types of insurance) for poor people. Working people pay high tax for these free services. I pay tax that can feed a few families. But i feel OK because anybody who needs these help can get it including me (God forbid i will never need to use government help).
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I worked in one of the top hopsitals in US, the largest commercial lab and now in a community hospital. I do feel that the medical care quality we provide is about the same no matter where, so called standard care. That is the essence of equal right for all the people. It is not that people in large cities deserve good care and farmers deserve barefoot doctors. Also US has very strict quality assurance and quality control for all health care facilities. We get inspected by all sort of governmental and society agents all the time. Any of them can close our facility if we don't meet their standard. The inspection is unanounced.
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本帖最后由 于 2010-10-23 11:54:00 编辑
2010.旅美散记(5) 沃基根(Waukegen)之遇
今天原计划坐Metra直接去威斯康辛州基诺沙(Kenosha)旅行.没想到这趟火车只开到沃基根(Waukegen)。于是临时变通先到沃基根去逛两个小时然后在沃基根再坐发往基诺沙的火车。沃基根是这条Metra（North Line）在伊利诺伊州最后的一个县。镇上风景还是蛮美的。有不少各式建筑风格的教堂 有现代化建筑的市政厅、公共图书馆，还有一个林肯广场，更有老兵纪念广场及那一片片延绵不断的森林公园。
在沃基根的大街上巧遇到一位步履匆匆拖着旅行箱的中国人，一问是浙江温州人，移民来美很多年了。他人很热情，自告奋勇要做我们的义务向导陪我们一直走了整整两条街，包括走到了Downtown。他一路不停地向我介绍美国的房子，房地产的行情...我怎么一句也没听进去?只顾着举着相机瞎忙活着拍风景了。他仍然谈兴不减，滔滔不绝，手里还拖着一口箱子，萍水相逢，真是很难得。
后来我问他在美国做什么工作？他说他的工作就是把中国造的烂手表、假手表弄到美国来卖给美国人，听得我目瞪口呆又忍俊不禁。一问起来他也是文革老三届的，也是文革中失学、插队下乡、回城做工、再就是结婚成家、下海做点小生意，也没上过大学。再后来投靠嫁到香港移居来美国的姐姐——申请那种姊妹团聚F4类移民，足足排等了11年时间才获准举家移民来到纽约定居。
沃基根(Waukegen)是他公司所在地，家在纽约，人在这里。问其孩子也没接受过高等教育也在做生意。他说我们温州人只学做生意赚钱，读书没什么用的。辛苦赚来的钱拿去读书，一路读到博士最后统统都读到实验室里打工去了，那就是给人当苦力，做长工、打短工一辈子，难有翻身之日...听此我愕然不已。
精明能干的温州人可谓是中国的犹太人。他们在海外经商一代又一代，尤其在欧洲那些国家他们以家族、族群、乡邻为群体经商置产渐已成气候了。也不知这位温州老兄的‘读书无用论’是否真有道理? 如是，看来我们的教育价值观念也要重新审视了，呵呵。
写到此不由联想到海内外现状大抵如此：经济低迷，毕业即失业；就业难，找一份好工作更难。在国内找份稳定的好工作更须拼‘实力爹’，拼资本、拼权力、拼关系，再不就是到处都要送钱塞钱打通各种关节...也见识过花了十几万投下去，最后竹篮打水一场空的...残念！
走笔到此也不由想起了同事好友静几年前曾对我说过的话：如其将来为儿子四处找工作、到处下跪求人、处处要给人送钱也未必有结果，还不如趁现在就将这点钱给他让他放单飞去，让他自己去外面的世界闯荡打拼去，也许还能闯出一条活路来...掖在胳膊里翅膀下最后不是坐以待毙也难免不成为啃老族，社会已如此，爹妈非强势，没有办法...
静的儿子现在英国念大三，和小苹果同一天出生。我们也是几十年的同事和老朋友了，彼此相知相交几十年如一日，很难得的。
2010-10-20 于海伍德 IL USA
在沃基根的大街上巧遇到一位步履匆匆拖着旅行箱的中国人，一问是浙江温州人，移民来美很多年了。他人很热情，自告奋勇要做我们的义务向导陪我们一直走了整整两条街，包括走到了Downtown。他一路不停地向我介绍美国的房子，房地产的行情...我怎么一句也没听进去?只顾着举着相机瞎忙活着拍风景了。他仍然谈兴不减，滔滔不绝，手里还拖着一口箱子，萍水相逢，真是很难得。
后来我问他在美国做什么工作？他说他的工作就是把中国造的烂手表、假手表弄到美国来卖给美国人，听得我目瞪口呆又忍俊不禁。一问起来他也是文革老三届的，也是文革中失学、插队下乡、回城做工、再就是结婚成家、下海做点小生意，也没上过大学。再后来投靠嫁到香港移居来美国的姐姐——申请那种姊妹团聚F4类移民，足足排等了11年时间才获准举家移民来到纽约定居。
沃基根(Waukegen)是他公司所在地，家在纽约，人在这里。问其孩子也没接受过高等教育也在做生意。他说我们温州人只学做生意赚钱，读书没什么用的。辛苦赚来的钱拿去读书，一路读到博士最后统统都读到实验室里打工去了，那就是给人当苦力，做长工、打短工一辈子，难有翻身之日...听此我愕然不已。
精明能干的温州人可谓是中国的犹太人。他们在海外经商一代又一代，尤其在欧洲那些国家他们以家族、族群、乡邻为群体经商置产渐已成气候了。也不知这位温州老兄的‘读书无用论’是否真有道理? 如是，看来我们的教育价值观念也要重新审视了，呵呵。
写到此不由联想到海内外现状大抵如此：经济低迷，毕业即失业；就业难，找一份好工作更难。在国内找份稳定的好工作更须拼‘实力爹’，拼资本、拼权力、拼关系，再不就是到处都要送钱塞钱打通各种关节...也见识过花了十几万投下去，最后竹篮打水一场空的...残念！
走笔到此也不由想起了同事好友静几年前曾对我说过的话：如其将来为儿子四处找工作、到处下跪求人、处处要给人送钱也未必有结果，还不如趁现在就将这点钱给他让他放单飞去，让他自己去外面的世界闯荡打拼去，也许还能闯出一条活路来...掖在胳膊里翅膀下最后不是坐以待毙也难免不成为啃老族，社会已如此，爹妈非强势，没有办法...
静的儿子现在英国念大三，和小苹果同一天出生。我们也是几十年的同事和老朋友了，彼此相知相交几十年如一日，很难得的。
2010-10-20 于海伍德 IL USA
- 三十功名尘与土，八千里路云与月。
