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

181–190 of 202 posts

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

#181

Post by roenxi »

modi15 wrote: post #171
victor106 wrote: post #156

Earlier quoted context omitted.

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…

> Also, the public hospitals in India are a joke. They are terrible. Although some of the best doctors in India come from there. How can they be terrible and have the best doctors at the same time ? > 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. You mentioned before that some private hospitals…

Without ever having been to a hospital in India, presumably the doctors go in not-very-good, then when they become excellent they move to a private hospital.

When I look at what surgeons actually do, it seems clear to me that more than anything else they need lots of practice. Life isn't very fair, so I'm guessing most of the practice happens to poor patients and most of the competence happens to rich patients.

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

#182

Post by pvaldes »

modi15 wrote: post #171
victor106 wrote: post #156

Earlier quoted context omitted.

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…

> Also, the public hospitals in India are a joke. They are terrible. Although some of the best doctors in India come from there. How can they be terrible and have the best doctors at the same time ? > 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. You mentioned before that some private hospitals…

>How can they be terrible and have the best doctors at the same time ?

If I'm understanding correctly, public doctors are in a good position to get experience in dificult cases and learn from worst cases before to jump to private hospitals

I have a problem with the idea of "passionate nurses".

Nurses shouldn't be "passionate", they have to be professional. Passionate people, unable to emotionally detach, will burn quickly in such place like an hospital (where the supply of suffering people is endless, and they can't decide and bassically obey orders from the upper staff). This has lead in the past to compassionate serial killers. Death angels have always the best intentions drawn in their head. Trying to be the mother and best friend of each one of your patients is a terrible strategy at long term.

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

#183

Post by feistypharit »

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.…

My wife is a physician. Four weeks ago she was in severe pain and could hardly walk. She drove herself to the ER at the hospital system that is also her employer. After getting admitted at the ER, the first person she saw was a lady to collect her $150 copay... While in severe pain and before seeing a care provider. That's the current US healthcare system.

She ended up having emergency spine surgery. Fused L5-S1 vertebrae and replaced disk in between.

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

#184

Post by notyourday »

mikekchar wrote: post #180
notyourday wrote: post #132

Earlier quoted context omitted.

I believe I understood it quite well. It just does not match either my experience or what I read. There are lot of articles on the topic. Here's a random one: https://www.wmpllc.org/ojs-2.4.2/index.php/ajdm/article/view... Green triage means that there were no reason for the patient to be in the ER. With the over-triage, green is still over 70%. So lets presume that between red and yellows it is actually 30% and none…

Not to be argumentative, but the stats may not be as descriptive as it might seem. I've seen kids in ER because they put popcorn in their ear and you can definitely say that they should be at the doctor's office. On the other hand, one day in the middle of the night my blood pressure spiked to 230. My heart was racing. I had no idea what was going on. I phoned the hospital and they suggested going to the ER. I did. T…

I appreciate your point but I do not think it contradicts the numbers - going to ER and getting a green triage means that the triage personnel determined that it is not an emergency.

According to 2013 National Institute of Health study put the median cost of ER visit at $1,233. In 2015 there was over 130M ER visits. Lets arbitrary assign the cost of interacting with the Triage nurse at the ER to $233 ( which is insane lets do it anyway), then the pool of cost overtriage 130M * $1000 which is $130B. Of those even triaged up 70% is a green triage, which makes it $91B.

If we are to make an assumption that for non-emergencies addressed by ER cost only twice as much non ER then simply by sending people to a regular doctor after people are getting a green triage one realizes savings of $91B/2 = $45.5B

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

#185

Post by notyourday »

dredmorbius wrote: post #174
notyourday wrote: post #131

Earlier quoted context omitted.

So if it is chronic there's even more reason to ensure that one does not overpay for what one would be consuming all the time?

It's both the duration and increasing severity that account for much of the cost, along with the systematic cost-inflating aspects of the US healthcare system. Individual actions play little role.

That's just hand waving. If the duration increases it makes absolutely no sense not to attempt to get the cheapest way to manage the condition.

People do it all the time if they are on a hook for payments -- that's why we have drugs being grey important from Canada, Europe and India, especially if those drugs are not covered by the US insurance. Suddenly saving $200/mo per type of a pill becomes important. As soon as it is covered by insurance it becomes "Whatever, insurance pays"

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

#186

Post by notyourday »

geofft wrote: post #48
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…

> Personal responsibility is "hard" so no wonder those who tend to outsource it get fleeced. What is the effect on the market when everyone engages in "personal responsibility"? If everyone finds out about Lenox Hill Radiology and goes there instead of to hospitals for MRI, won't the effect be that demand goes up without supply obviously going up, causing increased prices and wait times? What will be the effect on ho…

> What is the effect on the market when everyone engages in "personal responsibility"? If everyone finds out about Lenox Hill Radiology and goes there instead of to hospitals for MRI, won't the effect be that demand goes up without supply obviously going up, causing increased prices and wait times?

The current situation for the same MRI is:

Mount Sinai - cost $2800, wait to schedule 5 days, wait for read out 5 more days.

Lennox Hill - cost $600, wait to schedule ~1.5 hours, wait for read out, next business day.

Distance between two locations: opposite side of an avenue and half a block. Realized savings by crossing a road: $2,200.

Where else is it possible for two identical products to be offered in that close proximity at that kind of a price difference and have people defend the pricing of the more expensive one while complaining that the services that include this product cost too much?

But here's what I think should happen: Lennox Hill would slowly increase its prices and Mount Sinai would drop its prices until it would not be possible to save $2,200 by crossing an Ave and walking for five minutes. Of course if we are to look around this is not current more likely outcome - rather Mount Sinai would buy Lennox Hill Radiology which is an independent radiology center, make it a part of the Mount Sinai hospital chain and increase Lennox Hill' price to whatever level that it currently charges ( hospital chains have been buying up independent centers hurting their cash cows for years ). Unfortunately for hospital chains radiology centers now are a proven way to make money so new ones are popping up more and more.

> What will be the effect on hospitals that were subsidizing their other business by pricing their MRIs higher?

I have never heard of this argument being used by any of the hospital chains to justify high prices for the services that can be done out of hospital and it is definitely the kind of argument that should get traction had it been possible for any hospital to bend some numbers to make it remotely plausible so I would say it is unlikely to be the case.

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

#187

Post by riahi »

conductr wrote: post #155
riahi wrote: post #95

Earlier quoted context omitted.

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).

Inpatient care for many major procedures are bundled under Medicare. This is actually the reimbursement for the entire hospitalization.

Yes many places lose money in Medicare as it probably reimburses at around 80% of cost but it’s the only data we have, so it provides the closest thing to a national comparison.

My point is that what this article ultimately shows is that the cross border comparison can generate striking numbers but almost all articles like this never place the Indian “cheap” numbers in context.

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

#188

Post by dredmorbius »

notyourday wrote: post #185
dredmorbius wrote: post #174

Earlier quoted context omitted.

It's both the duration and increasing severity that account for much of the cost, along with the systematic cost-inflating aspects of the US healthcare system. Individual actions play little role.

That's just hand waving. If the duration increases it makes absolutely no sense not to attempt to get the cheapest way to manage the condition. People do it all the time if they are on a hook for payments -- that's why we have drugs being grey important from Canada, Europe and India, especially if those drugs are not covered by the US insurance. Suddenly saving $200/mo per type of a pill becomes important. As soon as…

No, it is not.

It's an argument for structural rather than individual change.

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

#189

Post by kbutler »

omegaworks wrote: post #173
kbutler wrote: post #153

Earlier quoted context omitted.

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.

It is no free lunch, but I never claimed it was. It is an option on the table, not one without consequences. It’s never just healthcare, sure: move the goalposts and set up your slippery slope. But consider this: what if the tax produced value over the cost of its implementation? What if it prevented harder, more expensive downline complications or made the population more productive —more likely to gain, retain and…

Proposing that it is a justifiable tax for investment is very different from saying "the concept of 'a nation can't afford' does not make sense [for] a nation-state with control of its own currency".

It looks like you understand why even a nation that controls it's own currency may not be able to afford nationalized healthcare:

1) because creating and allocating currency inflates prices, it just hides the cost rather than eliminating it

2) because we cannot eliminate the cost by creating currency, cost and benefit of healthcare spending must still be evaluated in comparison to other spending priorities

Good discussion.

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

#190

Post by notyourday »

dredmorbius wrote: post #188
notyourday wrote: post #185

Earlier quoted context omitted.

That's just hand waving. If the duration increases it makes absolutely no sense not to attempt to get the cheapest way to manage the condition. People do it all the time if they are on a hook for payments -- that's why we have drugs being grey important from Canada, Europe and India, especially if those drugs are not covered by the US insurance. Suddenly saving $200/mo per type of a pill becomes important. As soon as…

No, it is not. It's an argument for structural rather than individual change.

Yes, the structural change is "make individuals be on a hook for overpayments"
Post reply on HN