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The World’s Cheapest Hospital Has to Get Even Cheaper

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Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#81

Post by rb808 »

Jorge1o1 wrote: post #53
rb808 wrote: post #35

Earlier quoted context omitted.

Actually it wasn't a critically urgent problem but needed doctors attention. If someone wants an idea for an app or website - a way to lookup local ERs by price would be great.

My fear is that if hospitals start to make their prices publicly available, it will drive prices upward not downward. Why? Because hospitals have no incentive to compete on price. The majority of people get ambulance'd to the nearest hospital, not necessarily the cheapest one. So any hospital that notices it's charging less than its competitors will raise its price, because, why not? It's a very inelastic demand.

Also people compare quality on price. If you want important live-saving treatment would you choose the cheapest or most expensive?

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#82

Post by notyourday »

anigbrowl wrote: post #38
notyourday wrote: post #9

Earlier quoted context omitted.

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got see…

That's very interesting information, but I could have done without your snide allegations of laziness towards everyone not in your fortunate position - being both educated and confident enough to research and negotiate pricing, and having a relatively non-urgent problem. The last time I was in the ER I woke up there with no clue as to how I had arrived.

Most of the problems in the health care are non-urgent.

Most of people at the ER are not there "waking up and not knowing why they are in the ER". They walk into ER with something not working for them. That's exactly why it takes 3-4 hours to be seen by the ER doctor.

People like you, who wake up in the ER, are rarities. Those people are either brought to the ER in ambulances or are triaged and seen immediately. It is for those cases one could justify the costs of an ambulance ride and 500% markup of an bandage.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#83

Post by riahi »

laurencerowe wrote: post #70

The US healthcare system is absurdly inefficient but the nominal cost comparison given in the article is meaningless since wages make up a huge proportion of costs in healthcare (either directly or embedded in supplies and services.) Nominal per capita income in India is ~$2000 while in the US it is ~$60,000. Simplistically one would expect costs to be approximately 30x higher in the US so a 20x difference in cost of…

Agree. I have seen estimates place purchasing power parity of USD in India as 0.3, implying that $100 spent in India purchases as much value as $300 in the USA. This would imply a $10,000 surgery in India is somewhere in the realm of $33,000 in the USA.

I have no idea on the DRG associated with pulmonary thrombectomy to even estimate what Medicare allows for reimbursement, but it’s not going to be $200,000. If I find it, I will reply to this comment with an estimate.

Purchasing power parity compared to USA: https://data.worldbank.org/indicator/PA.NUS.PPPC.RF

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#84

Post by notyourday »

Frondo wrote: post #34
notyourday wrote: post #9

Earlier quoted context omitted.

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got see…

I had my gallbladder removed in a emergency surgery over a decade ago. It happened on a Wednesday night. I had excruciating pain, enough to nearly black out -- and a friend took me to an emergency room, where they did an ekg, ultrasound, put me on a morphine drip and operated the next day. Once the pain set in, I was in no position to do research for a variety of reasons. I'm not sure what kind of shopping around cou…

It will not work for emergencies however that's not where most of the money is burned.

Most of the money is spent on non emergency medical care that can be priced using a phone or an email. That's exactly why medical tourism is possible.

It is a case of vertical capture: should you walk into a Mount Sinai hospital, the $600 MRI of Lennox Hill will cost you between $1800 and $2800. It will be done using the exact same MRI machine. The result will be sent to India probably to the exact same company that Lennox Hill sends the MRI for a radio tech readout, except that Mount Sinai MRI won't be available for 5-7 days vs. in an hour at Lennox Hill.

So why is Mount Sinai is able to charge that amount of money for an MRI? Because it is a vertical capture. Should you walk into a Mount Sinai it is extremely unlikely that you would go out of the hospital to get an MRI. They could probably charge $7,000 and still get 90% of the patients doing it.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#85

Post by notyourday »

digitaltrees wrote: post #59
notyourday wrote: post #9

Earlier quoted context omitted.

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got see…

Were these amounts after insurance? just your share out of pocket? Or actual total?

These were the actual costs that I have to pay out of pocket until I reach the deductible of my insurance ( yearly ). I was at zero since it is a new year. In my case it is coming out of my HSA. Basically, cash price.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#86

Post by notyourday »

superhuzza wrote: post #21
notyourday wrote: post #9

Earlier quoted context omitted.

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got see…

What happens when someone has an emergency like a stroke or heart attack? Not a lot of time to email all the local hospitals. What happens when the patient is unconscious? What happens if their condition can only be treated by a certain facility or medication? But yes, surely people are only getting screwed over the healthcare system because they are lazy . /s

That's the only time when one cannot get quotes. Depending on a location ( ave/st in NYC and a time of day ) the ambulance would take one to a specific emergency room in a specific hospital chain.

But again, that's not where most of medical services "waste" is occurring.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#87

Post by iguy »

omegaworks wrote: post #77
jrochkind1 wrote: post #75

Earlier quoted context omitted.

True, but it's the distribution of wealth _between_ the U.S. and India that I'm thinking of. They can't afford to give most of their population needed heart surgery even when they've made it 100x cheaper than it is here. Here health care is destroying us too, but _most_ (not all) people who need heart surgery still get it. Sometimes it destroys them financially (not saying health care works here either), but they get…

>India literally can't afford to give them the surgery. This is what's hard to conceptually grasp about nationalized healthcare. The concept of "a nation can't afford" does not make sense because a nation-state with control of its own currency can simply create and allocate the currency to serve this purpose. I'm not sure why this is not on the table.

No, I disagree. The money represents the real output of the economy. This can be moved around to some degree (switch a bicycle factory to making surgical tools, etc) but fundamentally only so much stuff is produced. Printing more money doesn't change this.

Economic growth does, but not overnight. And figuring out how to do equivalent things with less input (whether it's model-Ts, or surgery) is an important part of that.

To take an extreme example, every space-X launch costs $50 million. If I say that America could not afford to give everyone an orbital holiday, this is not a statement about fiat dollars. It's a statement about the enormous resources, and chiefly the labor of an enormous team of people (including all the suppliers, and their suppliers) required for each such trip.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#88

Post by rushabh »

steve19 wrote: post #74
awaaz wrote: post #61

This article is really informative, and makes me feel proud to be an Indian. Medical care really is one of those things that no person should have to beg or borrow for, in a civil society. We're still not there yet as a country, but the signs are positive. FWIW, I'm relatively well off and have medical insurance, but the cost is absolutely negligible compared to what I hear is prevalent in the US - about $10 / month.…

I am not saying you should not be proud of Indian progress, but I suspect the experiences of a businessman in a big city in India are vastly different to a low caste woman with TB in rural India. A friend of mine is a nurse who did social work in rural India. What she told me about the local hospitals was horrifying, not just the condition of the hospital and how patients with infectious diseases were sleeping on the…

Experiences in India will vary dramatically based on which state you live in. If you are rural Kerla, a state with 50M people in South India, you are likely to get some of the best quality healthcare are very affordable rates.

It’s hard to generalise anything about India which is incredibly huge and diverse.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#89

Post by tomp »

omegaworks wrote: post #77
jrochkind1 wrote: post #75

Earlier quoted context omitted.

True, but it's the distribution of wealth _between_ the U.S. and India that I'm thinking of. They can't afford to give most of their population needed heart surgery even when they've made it 100x cheaper than it is here. Here health care is destroying us too, but _most_ (not all) people who need heart surgery still get it. Sometimes it destroys them financially (not saying health care works here either), but they get…

>India literally can't afford to give them the surgery. This is what's hard to conceptually grasp about nationalized healthcare. The concept of "a nation can't afford" does not make sense because a nation-state with control of its own currency can simply create and allocate the currency to serve this purpose. I'm not sure why this is not on the table.

> The concept of "a nation can't afford" does not make sense

Of course it makes sense. In any healthcare system (yeah, even pricate insurance) there are tradeoffs to be made, because the reality is that resources (hospitals, doctors, time, not necessarily just money) will always be finite. For example, having a breast scan every year might save more people than having it every 5 years, but at some point the marginal returns will be so small that it makes more sense to focus resources on other things.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#90

Post by joshuabosco »

udba wrote: post #52
rb808 wrote: post #35

Earlier quoted context omitted.

Actually it wasn't a critically urgent problem but needed doctors attention. If someone wants an idea for an app or website - a way to lookup local ERs by price would be great.

> If someone wants an idea for an app or website - a way to lookup local ERs by price would be great. > lookup local ERs by price Incredible. It's absurd that an idea like this is a reasonable suggestion.

It's beyond absurd.

Last year my system cut her finger quite deeply while dealing with a can opener, at ~9.30pm. It wasn't an ambulance-worthy emergency but still, it didn't look good. So we called our emergency number and they sent out an "ambulance lite", basically a paramedic and a doctor who's just finished university.

The cut wasn't serious despite the great loss of blood, but it was in a tricky spot and the young doctor didn't want to deal with it without a second opinion. So they took her to the ER, and we followed by car.

At the ER, within 45 minutes, she had seen the doctor on call that night and got the stitches put on from the cosmetic surgeon on duty that night.

Not only it didn't cost us 1 cent but we even got a free cup of coffee out of it, offered by one the ambulance drivers who was on call that night.

I envy a lot of things about the US, but not their medical care.

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