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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

#91

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…

The average case where people go to the ER they don't have a week to Google and research their options. More likely minutes to hours. You can definitely find some value in the US medical system if you have the time, like coupons for prescription drugs that aren't covered. But yes, don't go to the ER for non-emergencies and you'll save money and everyones resources. Hopefully that's basic logic to most people.

It took me three hours ( and I waited patiently for more responses ) before receiving the information and picking what seemed like an reasonable course of action. I obviously googled before to prepare myself of having my HSA wiped out. The horror stories told me it would be.[0]

In fact when the walk in center referred me to an ortho and said "It will be expensive. Here's a list of good ones" I asked if it was going to be "$800 dollar expensive?" at which point I was looked at by both the front-desk person and the Emergency medicine doctor as if I had grew two heads in front of them. They said "About 250 to see a specialist and about $800 for an MRI."

One of the two surgeons that I have selected based on their responses who could see me the next day were on the list of good ones ( ~30 ) that I was provided by the walk in center. No referral code was needed.

The surgeon offices, the walk in center and the physical therapists were having near orgasmic reactions hearing that it was going to be paid as a part of high deductible plan because it means that it is paid from a regular Mastercard as if I was a cash patient, immediately, the same day.

[0] I have taken friends to ER. They were never seen faster than 3-4 hours.

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

#92
post #74
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…

Reminds me of Amartya Sen's quote "...whatever you can rightly say about India, the opposite is also true". A lot of systemic issues will only be resolved as the society progresses, and there is a long way ahead for India.

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

#93

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.

Because money is just a proxy for resources. Printing more money does not create more of everything else, so it drives inflation and effectively acts as a tax on all other economic activity. You can print more, but you need to be aware that what you are doing has that effect, and if you overdo it you'll cripple your economy just the same as if you increase tax rates too much.

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

#94
I've read about this "assembly line surgery" being tried in the US as well. But the purpose was to experiment with replacing some of the more junior doctors with technicians. For example, there would be a technician who is only trained in opening the chest for heart surgery. That would be all they do, going from room to room opening chest cavities. Another technician would only do suturing at the end. These technicians would not be doctors, they would be folks who would get about as much training as an EMT (about 150 hours).

The next step after that is replacing the technicians with robots.

The only downside to this system (robots or technicians) is how will you ever get experienced doctors to do the hard stuff if they never get to practice doing the routine stuff first?

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

#95
post #83

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…

I looked into the data. This would probably be under DRG 252, 253, or 254 (DRG 252 OTHER VASCULAR PROCEDURES WITH MAJOR COMPLICATION OR COMORBIDITY, 253 OTHER VASCULAR PROCEDURES WITH COMPLICATION OR COMORBIDITY, 254 OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION OR COMORBIDITY)

The medicare DRG data is available here https://www.cms.gov/research-statistics-data-and-systems/sta...

Covered charges for 2016 ranged from ~$64,000 to ~$110,000, with ACTUAL average total payments ranging $13,000 to $26,000.

This article is using differences in purchasing power parity AND the difference in charges / actual payments to generate an eye-popping headline. At the actual data level, India is more expensive compared to the US.

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

#96

Earlier quoted context omitted.

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 i…

I do not agree that most visitors to the ER do so for non-urgent reasons, although few complaints are so severe. I don't think you've fully grasped the point people are trying to communicate to you here.

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

#97
post #94

I've read about this "assembly line surgery" being tried in the US as well. But the purpose was to experiment with replacing some of the more junior doctors with technicians. For example, there would be a technician who is only trained in opening the chest for heart surgery. That would be all they do, going from room to room opening chest cavities. Another technician would only do suturing at the end. These technicia…

Not to mention I'd bet a smaller job like that results in less context and thus higher rates of mistakes.

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

#98
post #94

I've read about this "assembly line surgery" being tried in the US as well. But the purpose was to experiment with replacing some of the more junior doctors with technicians. For example, there would be a technician who is only trained in opening the chest for heart surgery. That would be all they do, going from room to room opening chest cavities. Another technician would only do suturing at the end. These technicia…

> The only downside to this system (robots or technicians) is how will you ever get experienced doctors to do the hard stuff if they never get to practice doing the routine stuff first?

I think this argument applies to any kind of progress. As technology evolves, society loses skills, but the net benefit is hugely positive. Eventually, we don't even remember that the skills we lost were skills we once had. We get by.

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

#99

He succesfully performed a complicated surgery for $10K that would cost $200K in the US. And India still can't afford to pay those prices. The problem is obviously not that THIS guy is not working efficiently. It's that the distribution of wealth under our planetary economic system is deeply unfair.

Idk if I'd agree that it's "unfair" because that implies there's some natural balance we've disrupted, when in reality wealth is largely the result of labor and ingenuity. If a group of people gets together and creates wealth for themselves and their offspring, is it unfair that they are wealthier than the rest of the population? That kind of thinking at some level is fundamentally unfair itself - if you go collect and store nuts for winter you're less likely to starve. If we say that it's unfair now that you have all these nuts and winter is coming, then how does one provide for one's self fairly?

Wealth isn't distributed, it's created. I mean you can distribute after that but it would be theft.

Nonetheless I hate that some people are just born into economic situations where they are severely less able to actuakize their potential, so I share your sentiment. I just don't like the word unfair as it seems to disregard accomplishment and to me it demonizes people who have succeeded.

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

#100

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.

I originally thought this comment deserved downvoting, because "we'll just print money" shows a lack of understanding about the role fiat currency plays in an economy. However, I realized that this comment is a valuable addition to the discussion, because it expresses an increasingly common misconception.

So thanks for posting it.

Yes, the nation can just print money, but will anyone accept it?

When the supply of money increases, but economic output and resources are held constant, prices increase.

Imagine if the resources available in the economy are worth M currency. If the government just creates 10M currency, that doesn't mean more things are available to buy, just that each unit of currency is now only worth 1/10 of what it was before, so prices rise. But because people expect that, they try to get rid of the currency even faster, so prices rise even more than the increase in the money supply.

This results in "hyperinflation" - prices rising more than 50% per _month_ - see https://en.wikipedia.org/wiki/Hyperinflation for accounts of governments who have tried the "create and allocate currency" approach.

There's a great "Planet Money" episode on the hyperinflation of Brazil, which started when the country decided they could just print money to build a beautiful new capital city, and how it persisted for decades because it destroyed people's faith in the currency as a store of value, until Brazil created a new stable currency and convinced people they would no longer just print money to spend. https://www.npr.org/sections/money/2010/10/01/130267274/the-...

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