Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The World’s Cheapest Hospital Has to Get Even Cheaper

bloomberg.com

Post reply on HN
Print view View original

151–160 of 202 posts

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

#151

Post by barry-cotter »

kevhito wrote: post #135
npmn wrote: post #126

Earlier quoted context omitted.

It is not out of taste. Caste System(Jati System) though weakened still alive and kicking in India. (Dalits) Lowest caste layer in India is still subjugated to things like Cow vigilantism, Honour killing, Social boycott, Caste clashes and discrimination in various/all forms of life. It is interesting to note that Dalits are almost always on the receiving end of these issues. Giving example of the Prime Minister/Presi…

> I became an Software Engineer and now live in a major city, thanks to the affirmative actions adopted by India... You mean from reservations in school / university admissions? Or does that even extend to private employment? Is there widespread resentment? I'm really curious about the parallels (or not) between racism in the US and caste in India, esp. affirmative action. The US never really went all-in on AA like I…

If you’re interested there’s an interview on the Brown Pundits Podcast, “The Life and Views of a Middle Class Indian Dalit”,

> In this episode, I had a conversation with a middle-class Dalit who lives in Gujarat. For me, Dalits are people who are reported on, written on, people who I hear about spoken of (usually sympathetically). But I wanted to talk to a Dalit who was a university educated middle-class person, to zero in on the essential aspect of being SC in India today. At least urban India.

> One interesting observation is that his own experience in India is filled with slights, but not day to day oppression. It doesn’t seem the lot of Dalits in urban India is anything like that of black Americans during Jim Crow. He seemed to assume that America had solved much of its race problem and that that’s what Dalits should aspire to. Curiously, Americans at this point, at least on the Left, perceive our racial problems as dire.

https://www.brownpundits.com/2019/03/06/browncast-podcast-ep...

Podcast links https://itunes.apple.com/us/podcast/brown-pundits/id14390070...

http://brownpundits.libsyn.com/the-life-and-views-of-a-middl...

https://www.stitcher.com/podcast/razib-khan/brown-pundits-po...

https://player.fm/series/brown-pundits/the-life-and-views-of...

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

#152

Post by jrochkind1 »

thatoneuser wrote: post #144
BucketSort wrote: post #138

Earlier quoted context omitted.

Does it appeal to your sense of justice that within the same society some live opulently, yet others live in constant fear of not having the basic necessities of life? Not only would I say this is unjust, but that it is also unsound and a danger to society itself. The worst qualities of humans emerge when they are fighting for survival. I'm fine with a system that has wealth inequality, I don't see any way around tha…

I'll be honest - I don't know many people who are of sound mind and body and who consistently make level headed choices living in constant fear of having basic necessities. I know a LOT of people in this situation because they don't improve their skills, don't work many hours, had kids young, had numerous kids, want to live in a high demand area despite low income or because they prioritize luxury items over quality…

“For we each of us deserve everything, every luxury that was ever piled in the tombs of the dead kings, and we each of us deserve nothing, not a mouthful of bread in hunger. Have we not eaten while another starved? Will you punish us for that? Will you reward us for the virtue of starving while others ate? No man earns punishment, no man earns reward. Free your mind of the idea of deserving, the idea of earning, and you will begin to be able to think.”

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

#153

Post by kbutler »

omegaworks wrote: post #115
kbutler wrote: post #100

Earlier quoted context omitted.

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 mon…

I knew I'd get this kneejerk reaction to "simply create and allocate the currency," I was holding out hope that responders would finish reading the sentence. What I said was: >a nation-state... can create and allocate the currency to serve this purpose. I totally agree with you in a general sense. Creating and allocating currency and distributing it to the general population equally will cause the scenario you descri…

The point is that inflating the money supply is a tax, just a hidden one spread across all holders of assets denominated in that currency (cash, loans, salaries, ...)

Smaller amounts of "print and spend" inflate less than large amounts, but they do cause inflation, and the wish list is never just healthcare.

Controlling a fiat currency lets you hide some taxation as inflation, but it is no free lunch.

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

#154

Post by conductr »

npmn wrote: post #126
naruvimama wrote: post #114

Earlier quoted context omitted.

The use of the word "low caste" is in quite mean considering "poor" would be more appropriate. Just as Black or Native American would be a poor substitute for poor american. Or Roma/Eskimo/Greenlander/Sami for Europe Especially considering that the current prime minister and president of India are from so called backward communities. India has come a long way in social development and using the "caste card" is quite…

It is not out of taste. Caste System(Jati System) though weakened still alive and kicking in India. (Dalits) Lowest caste layer in India is still subjugated to things like Cow vigilantism, Honour killing, Social boycott, Caste clashes and discrimination in various/all forms of life. It is interesting to note that Dalits are almost always on the receiving end of these issues. Giving example of the Prime Minister/Presi…

Ignorant question: in India, how can a stranger know your caste? These days I assume there is some mobility, so is it possible to say move to Mumbai, dress the part, and rebrand yourself as a higher caste?

I’m in US, race is the thing here and it’s fairly identifiable.

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

#155

Post by conductr »

riahi wrote: post #95
riahi wrote: post #83

Earlier quoted context omitted.

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…

Hospitals usually lose money on Medicare and that’s part of the reason other payors have to pay subsidy rates. Not saying they pay sticker price they are billed but I doubt 13-26k is the average reimbursement for any procedure that ties up an OR for a full day (according to the article).

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

#156

Post by victor106 »

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 lived in India for about 5 years and worked in the healthcare space with all the hospitals you mention. So here's my take:-

India has amazing "private" hospitals if you compare the doctors and the equipment they use.

India also has the worst "private" hospitals if you compare the hospital support staff specially nurses. Most of them (not all) nurses have no passion and the profession itself is not given the kind of importance that it is given in the US.

Also, the public hospitals in India are a joke. They are terrible. Although some of the best doctors in India come from there. I guess, after seeing more patients than you can handle and having a free hand to do pretty much whatever the heck you want with zero liability (unfortunately and sadly at the cost of the poorest of the poor) they become good.

In most cities in India the private hospitals have turned into a profit making operation with zero oversight and in most cases governments supporting them in manufacturing patients. I would get a second and third opinion on any expensive procedure that would a doctor would recommend in India.

I made lot of friends who are doctors in India and all of them tell me they get direct cash kickbacks from hospitals and labs for referring patients. This is be highly illegal in the US.

Cleanliness is another major issue in Indian hospitals. Even in the best ones most staff don't follow basic sterilization procedures that are common in the western world.

So all in all its great that the hospitals in India are affordable to a cross section of Indians but they can be better with better government oversight and having well trained and passionate nursing staff which might increase costs.

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

#157

Post by PorterDuff »

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…

This is a bonafide question as I really don't know.

Could you train a surgeon without them ever being a doctor? Basically extract out the knowledge they need and train simply for that? It seems to me that the natural skills needed might be very different than those you need to make it through a typical medical school + a career as a family doctor.

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

#158

Post by PorterDuff »

screye wrote: post #101
maxxxxx wrote: post #78

Earlier quoted context omitted.

"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 ca…

You could surely make a case for parking the local urgent care center (and make it 24/7) right next to the ER.

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

#159

Post by conductr »

rtkwe wrote: post #55
jrochkind1 wrote: post #51

Earlier quoted context omitted.

Sterilizing and re-using IV lines definitely carries some risk. The alternative to that "risk" in India seems to be letting most not-rich people die because they can not afford to do those things differently. And the Indian health service is telling him he's _still_ costing too much. The result will be taking more risks, with some people paying the price for them. Because that is what India can afford. Meanwhile, in…

For certain values of 'can afford' given the prevalence of medical debt driven bankruptcies.

The hospital afforded to write off that bad debt; after all, the procedure was done, doctors and nurses got paid, supplies bought

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

#160

Post by wickrom »

conductr wrote: post #154
npmn wrote: post #126

Earlier quoted context omitted.

It is not out of taste. Caste System(Jati System) though weakened still alive and kicking in India. (Dalits) Lowest caste layer in India is still subjugated to things like Cow vigilantism, Honour killing, Social boycott, Caste clashes and discrimination in various/all forms of life. It is interesting to note that Dalits are almost always on the receiving end of these issues. Giving example of the Prime Minister/Presi…

Ignorant question: in India, how can a stranger know your caste? These days I assume there is some mobility, so is it possible to say move to Mumbai, dress the part, and rebrand yourself as a higher caste? I’m in US, race is the thing here and it’s fairly identifiable.

In many cases your surname/family name can give away your caste. There have been social movements in the country where groups have shunned the practice of using their family names that are used to identify caste.
Post reply on HN