The Truth is Not Negotiable
When a looming medical procedure is staring you down, you want straight talk and cold facts. You might even turn your investigation to a world wide solution. In that case, you’ll want Shai, comparing healthcare services and crunching the numbers for you. Jet Metier talked to Shai Gold about why he chose Panama to direct the international community to its shores for a medical destination and why he deals with veracity, even if it is not pretty.
Jet Metier: Let's start with a virtual cup of coffee. I am wondering about your caffeine allegiance. Because you are from Miami, I must ask you: Cuban coffee, strong and black or Boquete coffee?
Shai Gold: The difference is in the flavor and the strength. The flavor of Panama coffee is more laid back...gentle, similar to Costa Rican coffee. Cuban coffee is more like the Cuban exile experience...bitter, strong, passionate. Also....one gets served FASTER in Miami.
Jet Metier: Shai, I can see the island, the bay and the moving traffic from your Skype screen. The view from your office is stunning.
Shai Gold: Panama City (PTY) is a large metropolitan area. It is a very fast paced city with slow pace people. It sounds like an oxymoron but that is how I feel.
If one is lucky to live on the waterfront, the sunrise and sunsets are a bonus. The urban landscape is rather impressive on the waterfront and the business districts. However, it gets progressively disappointing as one ventures to the other parts. It is typical Third World; no zoning, bars on every other porch and window.
I focus on the healthcare side, where things are vastly different than in the other aspects of Panama. I feel that it is a different planet and is populated by people who are very different than the day-to-day folks.
Indeed. Keep in mind that I am an "internationalist,” been to and worked at various countries. As such, my view is rather utilitarian and the esthetics is secondary.
Jet, with me you will get balanced response. I am jaded. I don't believe in paradises or in free lunches. Nothing is perfect; people have the right to know.
Jet Metier: The way you describe Cuban coffee, could you also in a way be describing yourself. In terms of healthcare, your clients need someone who is strong, passionate, and as you have intimated through your responses on Best Places, someone who sees with clear eyes. You must have really felt that Panama was a place where you could roll up your sleeves and get to work.
Shai Gold: Yes. Panama was a calculated move. I decided to base the network here following extensive due diligence and a short stint in Colombia. Due diligence is an investigative process a business plan goes through to ensure that we have the facts right and the business will have a better chance of success.
Panama is very open in terms of its ability to rapidly establish a new business. Like in all small countries, one MUST be careful to select a segment of the economy that is NOT dominated by any of the "strong" families of the economy. In my business, we are the FIRST mover so I was welcomed by all parties involved.
Also, Panama has an excellent quality medical system with plenty of specialists. Specialists and hospital infrastructure are essential for a medical network to function in a cost effective manner.
The cost of medicine in Costa Rica is high due to the fact that it has a limited availability of specialists.
Jet Metier: How did you begin to see the world as a possible open territory in which to conduct your business? I will pose as an "every woman" and I, until recently, was not able to think that my healthcare could be taken care of at a transnational level.
Shai Gold: To begin with, I did not arrive to Panama for retirement. I arrived to set up a regional medical network and leverage the strengths I found here to clients from neighboring islands of the Caribbean. While Panama offers strong value to the North American patient, the later demographic is motivated by reasons other than those that the Caribbean client is motivated. Americans have everything at their fingertips; the only barrier may be financing their choices. With Obamacare making access to insurance more universal, we are seeing less pressure on the end user patient/consumer.
Jet Metier: And as the first lover of Panama in your field, how did Panama take to your first embrace. Was Panama "Shai" [shy] and retiring, or was it embracing and eager? How did you break into the market there?
Shai Gold: To round up the response, Panama and Shai was not love at first sight. It is more like a "functional partnership and marriage of convenience whereby complimentary skills collaborate to offer the best value model of service for international patients."
Jet Metier: Were the efficiencies of your system rooted in something you learned in a Business Econ class, and you have been expanding on ever since, or did a proposal come to you as you were working with clients in the Caribbean? I saw the video you did of the young man who had cancer, and no access to care on the small island where he lived. I can't help feel there is an altruistic value that you bring to your work.
Shai Gold: I am a 25-year veteran of American healthcare. I have been in international health services since 2004, as VP of International Medical Services of a top 20 academic medical center in Miami. I was responsible for developing the fastest growing international patient program in the USA.
I borrowed the SAME principles and re-located them here. I also co-wrote one of the best books about planning your treatment abroad. Look up on Amazon "How to Plan a Successful Medical Tourism Trip." I did it with my partner in crime, Eilene Little of Travelling for Health and Retierment.com.
Bottom line: Panama can offer a retired person the safety, security and quality of living that is associated with HIGH QUALITY medical care during the golden years. The trick is not to be taken to the cleaners while you go to the hospital.
Anyone can call me for advice and guidance. I have helped many people out of tough spots.
Jet Metier: Can you give the Best Places visitors an example of someone you helped from the US recently who measured their options and compared them to what they could get in Panama? How did the cost compare and the level of care?
Shai Gold: The key to help is to ask for it BEFORE the problem / crisis occurs. I am not a magician and cannot reverse bad outcomes or invoices. I can, however, be instrumental in helping people make the right decision, take the right path and pay the correct amount, if they have the foresight to call me in advance.
I offer a special service to expats here whereby we will settle their account vis-a-vis the hospital / provider of care using the local fee schedule. In other words, people will not be taken advantage of because they are gringos.
We just had a case where a young man ruptured a disc. He knew of me from the expat community and called me from home to advise me about his medical crisis and request help with a referral to a specialist.. We recommended two doctors for him to choose, sent a case manager to his home to take him to the medical appointment, the case manager stayed with him during the appointment to ensure he was comfortable with the subject matter. Afterwards, the patient elected to go with the neurosurgeon we suggested. We negotiated the lowest cost for hospital and professional fees and settled the case vis-a-vis the providers.
The patient is VERY grateful. He probably saved $10,000 $15,000 over what he would have been otherwise charged...as compared to a local person. Total bill was $20,000. In Miami, insurance would have been charged $45,000 - $60,000 for the same.
Jet Metier: He and his family must have been very thankful to have you in his corner.
Shai Gold: Yes they are. I saw him today for breakfast. It was nice to see that his health has been restored and he can get back to work now.
Jet, the main driver in my work is passion for people. I impart this to all my staff and I am very proud of their personal commitment to people's health and non-medical needs. Our work has three aspects: medical network of excellent professional and hospitals, case management of the medical care and the financial consequences and customer service.
Jet Metier: I knew it, Shai! I did want to ask about that. Where did this empathy come from? Did someone do a good deed for you or was there a role model who you wished to emulate? Your level of caring must be rooted in some kind of impactful event or philosophy.
Shai Gold: It came from my parents who were refugee kids whose respective families fled Europe in 1933 and 1944, respectively. They arrived to a barren land of Palestine had to make chicken salad out of chicken shit. They were determined to make life easier for others, to the best of their ability. They were humble people with a BIG heart. My father passed away 4 years ago and mom is still alive.
I grew up in Israel during idealistic times, where many people held the same selfless values of GROUP, COMMUNITY, SOCIETY, so from a young age I learned to proactively solve issues and be helpful. My experience in the USA in the public and academic medical sector was a direct continuum of my personal values from Israel.
Passion alone is not sufficient; one needs the tools of the trade. I ventured into healthcare in 1989 without prior knowledge. I saw a highly inefficient business environment and knew right away that this was my "space." Wherever I found myself in healthcare, I approached the business of medicine very differently than most other administrators. I also took a keen interest in the patient, something most administrators do not.
In "my” hospital, the doctors referred to me as the "administrative doctor." I was informally appointed to be an "honorary member of the organ translatation team.” There is value in viewing medicine from all aspects. The end result is better a environment for the medical provider and patients.
Jet Metier: I always look forward to reading your answers on Best Places, because I sense that you are committed to telling the truth, even if it hurts or is not pretty. I think that if someone wants reliable advice, they come to you. How does your candidness affect your clients? In Panama, can they handle your bluntness?
Shai Gold: jajaja.....Candid is not always good for business, but it is good for my ethics. I think that people value my integrity because TRUTH is better than FICTION. In my business, fiction can be very harmful to the end user. The medical oath states very plainly "DO NO HARM."
I have turned away patients who wanted treatment that was not efficacious. I have also just sent back to Miami a patient who needed a procedure that I thought would be better done in Miami. My goal is to go to sleep and wake up with a clear conscious.
Jet Metier: Tell us more about this idealistic time in Israel.
Shai Gold: Israel was an amazing experience; as challenging as life must have been for my parents.
Jet Metier: Did you live in a kibbutz?
Shai Gold: I lived in the city of Tel-Aviv. I elected to attend a military school and it really shaped my formative years, way of thinking and habits to this day. It was a very positive experience.
Jet Metier: And how is your perspective as an "administrative doctor" changing the way healthcare is delivered in Panama? Is it influencing the way the expat and foreign community is seeking help in Panamanian hospitals? I mean, is there a "Shai effect?"
Shai Gold: As for changing local realities, that is a trap that I try to avoid stepping in. One must be very careful about trying to effect changes in a host environment. It is actually good advice to people who are considering living overseas. GO WITH THE FLOW, make minor adjustments.
I did not create a revolution, but I have definitely demonstrated the value of evolving in a more progressive direction.
Jet, my sincere advise to folks who contemplate relocation is to conduct a personal due diligence. Do not buy into what certain web sites have to sell. These web sites have business agendas and their role is to demonstrate GLOSSY images of real estate and "low cost" retirement. Folks should know that cost of living is not categorically low here, there, or anywhere. It is lower in countries that are under-developed and higher in countries that are more developed.
Panama is the most developed Central American country with a tradition of open doors. There is a cost attached to this issue. Nicaragua, Ecuador are not developed, therefore cheaper, therefore the struggle is greater. No free lunches… (cool).
It may be cheaper for some people to live in central Florida where they have access to all the essentials than to move themselves to Central America. I meet lots of disillusioned people here.
Living abroad requires a huge mental adjustment. I am here to help people deal with effective access of the healthcare system. I have been thinking of launching a "VIP Card."
Jet Metier: Such good advice, Shai, regarding being a transplant. And as for, your incremental steps, I still suspect you have created seismic tremors around you. I think that your VIP card would be an opportunity many would leap to, because they value your astute assessments. What would it entail?
Let us say someone bought your book "How to Plan a Successful Medical Tourism Trip," and they were reading it on the plane over to Panama because they wanted to be pro-active with their healthcare. How do you recommend they tour hospitals between touring the Canal, side trips to El Valle with side trips to talk to potential doctors?
Shai Gold: Interesting take on the issue. I have never envisioned people coming for hospital tours.
The book highlights the importance of decision making factors that are not common knowledge for the "average" person. It is the insiders view on matters such as planning your medical safety, not being hood winked into a financial nightmare, the importance of independent medical case management, the difference between a medical tourism facilitator/ broker and a REAL medical network with case management and financial responsibilities. In other words, shopping for medical care is far more serious than buying anything else that is offered online.
Our typical patient from the USA is interested in one of two key services: A) saving money over cost of the same services in the USA; and, B) having procedures that are not offered in the USA due to regulatory or legal reasons.
Example for A), ortho or neurosurgery where the co-payment is high or the whole procedure would be funded out of pocket.
Example for B), removal of a tumor that does not meet size criteria, and therefore will not be performed in the USA due to malpractice concerns.
Stem cell treatment is another type of procedure. I recently opened a stem cell institute that specializes in bone marrow stem cell. This is a fairly unique procedure that American providers do not like to perform.
Jet Metier: I am grateful that you are working on stem cell research; the miracles that can follow.
How about this as a last question: what kind of business or service does Panama need that would make you and your life partner so happy if it finally came there?
Shai Gold: Panama needs service businesses that run professionally. The main challenge is that the locals do not share the Anglo-Germanic work habits. Poor workmanship is common, no commitment to excellence, no respect for timelines, or to money paid.
It is very problematic to people who come from First World countries. I could share hair raising stories about workers. Three weeks to install a new air-conditioning unit, connecting the air and water pipes wrongly. Sealing the window frame with silicon that does not withstand water. A garage that asks for $1,000 for a job that should cost $120.
But then again, it is about going with the flow. One cannot expect to move from a First World lifestyle and quality of life and get an upgrade in the Third World.
Jet Metier: As you said in one of your responses on the site, you hope I do not need your emergency services, but I am so glad you are there. Thank-you for your good work ethic, the acumen that you have honed over years of diligence at administrating healthcare, and how you have made that available to the world. And it has been my pleasure to see you and talk with you.
Thank-you again, Shai. Bye-bye. My best to your partner, Ivonne.