The World’s Cheapest Hospital Has to Get Even Cheaper • Hacker News Board

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

#101

Post by screye » Thu, Mar 28, 2019, 10:30 PM UTC

maxxxxx wrote: post #78

screye wrote: post #73

Earlier quoted context omitted.

I think I am uniquely positioned to refute your claims. I was a mechanical engineer at an automobile company before moving to software. The two are actually quite similar. It is common to run into implementation issues when going from concept to production. The big difference is, being a mature branch in an area where safety is vital, the rigor, scrutiny and time alloted to each step are significantly greater than so…

"I was a mechanical engineer at an automobile company before moving to software. The two are actually quite similar" Me too :-) Yes, things happen when you get something in production but at some time you reach a fairly stable state and things are predictable and easy to measure and quantify. With medical procedures you often encounter surprises. I agree there is something to learned but it would be terribly arrogant…

> Me too :-)

I am pleasantly surprised. Always nice to see people who have made such a transition.

I agree with you on all points here. Once in production, stability is achieved and car companies certainly do not hold all the secrets to resource allocation and administrative approaches to healthcare.

The degree of unpredictability is higher in software and medical procedures. The supply chain - production approach can only get so far.

That being said, the production approach can work splendidly well for low risk diagnoses. The production approach has already been adopted by some software companies. Especially contract based companies that involve a well defined repetitive grind and set of tools. Think developing a Cash-of-clans like mobile game or making websites for certain organizations. Both industries are quite mature. The software problem isn't interesting, but it also rarely throws curve balls.

_______

I am going on a slight tangent, but here goes.

I think there are some medical low hanging fruits. This is especially true in the US, where the escalation of service is extreme. Either you get no service or a $200/hr medical expert. If the disease is going to be a low risk common illness 95% of the time, then maybe the patient could go through a $40/hr medical practitioner whose job would be to attends to 'easy' cases and only escalates it to the $200/hr doctor if the case is serious enough. A similar case applies to the ER and ambulances too. There is, "I am about to die" emergency and then there is the "I am hurt, but 20 more minutes to the hospital in car won't change much" type of emergency.

Off topic: But, This approach is quite similar to a popular ML approach called Cascade Classifiers used for resource efficient applications. It is apt, that it would come up in a discussion about how to make Healthcare more resource efficient.

Lastly, I find the requirement of 4 year college to enter medical school to be preposterous. It is a waste of money and time for applicants and serves only to line pockets of academic institutions.

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

#102

Post by pascalxus » Thu, Mar 28, 2019, 10:35 PM UTC

jermaustin1 wrote: post #50

rb808 wrote: post #30

$2k for major surgery, nice! Last time I went to ER it was $2k for the doctor's assistant to ask a few questions and put a band aid on.

My wife fainted at a Shake Shack in NYC on the UWS. The 5 hour hospital stay with medicine, a regular check in from a nurse, and fluids cost less than $500. The The ambulance game is the real racket.

Yup, they're real basterd. I'd give them a middle finger every time I see one, but it's not the driver/nurses who deserves the blame.

This is where regulation can play a good role. We really need to stop these predatory Hospitals.

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

#103

Post by pascalxus » Thu, Mar 28, 2019, 10:36 PM UTC

rb808 wrote: post #35

rb808 wrote: post #30

$2k for major surgery, nice! Last time I went to ER it was $2k for the doctor's assistant to ask a few questions and put a band aid on.

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.

And an app to verify that all doctors, nurses and equipment used in a procedure are all part of your in-network. Going out of network is so devastating, you could loose your entire life savings.

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

#104

Post by noelsusman » Thu, Mar 28, 2019, 10:41 PM UTC

dragonwriter wrote: post #54

Jorge1o1 wrote: post #53

Earlier quoted context omitted.

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.

> The majority of people get ambulance'd to the nearest hospital, not necessarily the cheapest one. But is ambulanced-in patients the majority of hospital business?

No, not remotely. Scheduled surgeries are the lion's share of revenue at any hospital.

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

#105

Post by pascalxus » Thu, Mar 28, 2019, 10:43 PM UTC

sneakernets wrote: post #72

hourislate wrote: post #63

Earlier quoted context omitted.

Should have taken Uber/Lyft. A lot of folks are now using them to go to Emergency. https://www.buzzfeednews.com/article/carolineodonovan/taking...

Did you even read what you linked? This is terrible!

Well, you need to just appear to not be sick and they'll accept you as a ride: don't barf allover the place as you get in, wait until the trip has started. After that, they have every incentive to deliver you to the hospital.

Sure, ideally we'd have reasonable ambulance pricing, but since that's not going to happen, taxis and ubers/lyft are the best thing.

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

#106

Post by mohankumar246 » Thu, Mar 28, 2019, 10:48 PM UTC

jedberg wrote: 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 only that - not all hospitals follow this assembly line, if this chain of hospitals goes under what about the opportunities for someone doing the routinely 1 part of the surgery.

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

#107

Post by noelsusman » Thu, Mar 28, 2019, 10:49 PM UTC

DesiLurker wrote: post #58

sovnade wrote: post #40

Earlier quoted context omitted.

Every single ER will charge every insurance company/plan differently, so that list would be pretty unreliable.

that is the whole point of publishing prices. with it implicitly you have to adjust your billing to be able to charge predictably for a service such as MRI etc. and if you dont you dont survive in long run as people gravitate towards the providers that give them clarity. why should be hospitals be the only ones allowed to do this highly anticompetitive practice?

The vast majority of patients don't care about price because their insurance is covering it.

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

#108

Post by bluedino » Thu, Mar 28, 2019, 10:52 PM UTC

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…

What does a doctor make in the USA vs India?

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

#109

Post by noelsusman » Thu, Mar 28, 2019, 10:58 PM UTC

>Narayana has been able to get the retail cost of a heart bypass, its most common operation, down to $2,000, about 98 percent less than the U.S. average.

I'd like to see where they got these numbers. The average Medicare payment for DRG 236 (Coronary Bypass without Cardiac Catheter and without MCC) is $23,500. Something doesn't add up here. After adjusting for wage differences I'd imagine the numbers are much closer than this article implies.

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

#110

Post by lemoncucumber » Thu, Mar 28, 2019, 11:02 PM UTC

thatoneuser wrote: post #99

jrochkind1 wrote: post #47

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 a…

The aspect of capitalism that's problematic to me is not that people can generate wealth through labor, it's that they can generate wealth through wealth.

You can make far more money just by being rich and owning capital than you ever can by your own labor. You can own physical property that makes money like farmland, apartment buildings, natural resources, factories, etc. or you can be a shareholder in companies which make money.

Either way, it's not really your labor that's making you richer, and that's the part that feels unfair about the whole system.

A piece of anecdata to support my point: the richest families in Florence today are the same familes that were rich 700 years ago, too: https://www.vox.com/2016/5/18/11691818/barone-mocetti-floren...