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Heart Surgery in India for $1,583 Costs $106,385 in U.S.

bloomberg.com

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Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#91

Post by Gatsky »

DanBC wrote: post #83
Gatsky wrote: post #81

Earlier quoted context omitted.

It's completely meaningless to compare mortality rates. It's also not clear that if a patient had a CABG in India, went home and dropped dead within 30 days, that this data would actually be captured rigorously. Anyway, you're drawing the wrong conclusion - it's astounding how close the US mortality rate is to the Indian, which attests to how good the US system is at operating successfully on more complex, elderly pa…

> Anyway, you're drawing the wrong conclusion - it's astounding how close the US mortality rate is to the Indian, which attests to how good the US system is at operating successfully on more complex, elderly patients. Of course, you could argue that the US has optimised the wrong thing, at great expense... Is that connected to the extra funding that older people get? What happens if we compare mortality in people und…

It's still going to be problematic. There is a hidden selection bias that you can't get around. Eg in India there are still a lot of people that can't afford the CABG no matter how much it costs. Are those people less or more likely to die after surgery than the people that do get operated on? The answer invariably would be yes.

Do centres that do more surgery have better outcomes? The answer to this is already a resounding yes. There isn't any doubt about that, it's been shown over and over again for multiple different surgeries within developed countries. Surgeons knows this, and so do health insurance companies. But of course this has to be asymptotic. Doing 1000000 CABGs doesn't make you 1000 times better than the surgeon that does 1000. So I doubt there is any real difference between the surgical skill in Shetty's centre and top institutions in the US. It's an untestable question in any case. The important point is that the care overall seems grossly non-inferior to the US, not that the US is inferior.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#92

Post by gnufied »

seanmcdirmid wrote: post #13
DigitalSea wrote: post #9

The first supposed fact thrown around in the medical costs argument like this is, "Well in India their cost of living is lower, so they charge considerably less, yadda yadda..." but it's obvious the price difference goes way beyond any cost of living gap. That's over $100,000 in price difference, while it is true the cost of living (salary, prices of every day items) in India is considerably less than that of the US,…

> A doctor trained in India is no less qualified than a doctor trained in the US. In general? http://blogs.worldbank.org/developmenttalk/shocking-facts-ab... > It’s also pretty staggering that hiring qualified staff doesn’t appear to increase this probability. Das and colleagues suggest that part of the issue might be the variation in the quality of instruction in Indian medical training institutions. So there may be…

While the results of the studies are true in that study (that those fake patients were misdiagnosed), the assessment that why they were misdiagnosed is (may be?) not directly related to their competency.

As a Indian (who comes from relatively simple background), I don't need a study to tell me that general/govt. hospitals that provide PHC are overcrowded, lack necessary support staff, lack necessary equipment.

What the bloomberg article is talking about is, another class of hospitals and medical staff. Narayan Hridayala, Fortis etc employ pretty good doctors.

I doubt that, any general statement can be made about - "doctors trained in India are less qualified than US", because it depends on lot of factors.

EDIT: Added "may be?"

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#93

Post by aioprisan »

pisarzp wrote: post #75
mtgx wrote: post #40

Earlier quoted context omitted.

It's not India-specific. This is definitely happening in Eastern European countries, too, and probably even some of the western ones (although a bit more) - just like with college tuitions. There's something seriously wrong with both the healthcare system and the education system in US if the prices are 20x+ more than in any other country.

This is definitely happening in Eastern European countries, too, and probably even some of the western ones Careful here. I live in London for several years now, and from my experience Eastern European doctors are much better qualified then Western European. I'm originally from Poland, and medical studies are really hard, and people spend whole 6 years cramming just to become an apprentice to the doctor (it's Bachelo…

If you do your bachelors in non-science field, you cannot get admitted without doing a post-baccalaureate, which can take 1-2 years additional. There are a lot of science requirements to even apply to medical school, that someone with a computer science degree, for instance, would not meet and would have to take those courses (i.e. biology, chemistry, biochemistry, organic chemistry etc.)

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#94

Post by GFischer »

I've posted about this a LOT here on HN, because I live in a country (Uruguay) that has a good level of medicine and prices are way cheaper (heart surgery as described would be at least an order of magnitude cheaper than in the U.S.).

One possible explanation I came up with was:

U.S. hospitals have legions of well-paid administrators doing paperwork for insurance companies, which will have legions of people doing paperwork on their side, and government doing its bit, and lawyers doing their thing. All that money is obviously not going directly into healthcare, it's basically monstruous bureaucracy friction. I suspect "real" healthcare costs, even factoring expensive U.S. doctors, would be shockingly cheap.

There are also other "hidden" legal costs, such as the cost of malpractice insurance, and overcosts due to doctors being extremely worried about being sued over malpractice and ordering unnecessary tests.

Is there a "transparent" U.S. medical institution whose expense records could be examined to come up with where all the money is going?

That said, the article compares with Ohio's Cleveland Clinic, which is the most famous heart surgery clinic. Supply and demand alone will make heart surgery there an order of magnitude more expensive, regardless of actual costs. But I've heard most U.S. clinics arent that much cheaper.

https://news.ycombinator.com/item?id=6077593

https://news.ycombinator.com/item?id=6019464

https://news.ycombinator.com/item?id=5763001

(I was really surprised by that one, why ARE ambulances so expensive in the U.S.?)

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#95

Post by Shivetya »

danboarder wrote: post #15
DigitalSea wrote: post #9

The first supposed fact thrown around in the medical costs argument like this is, "Well in India their cost of living is lower, so they charge considerably less, yadda yadda..." but it's obvious the price difference goes way beyond any cost of living gap. That's over $100,000 in price difference, while it is true the cost of living (salary, prices of every day items) in India is considerably less than that of the US,…

At face value this appears to be a huge opportunity for innovators to take on the whole existing healthcare industry here in the USA. In reality I think many healthcare entrepreneurs either get caught in the existing framework (and dependent on it), or find the regulatory and other hurdles too hard here. That said, I still think there is a LOT of room to improve cost efficiency here, and the right entrepreneur could…

regulations forced my doctor of thirty years into selling his business. Talking to him it pushed a lot of single and dual doctor offices into selling. Electronic records keeping was the bogeyman that pushed a few over the edge, between the software costs and the manpower to get all the documents into that now required form they just didn't have the money.

Top it off with his worst payers were not the insurance companies but government based.

Government regulation, from deciding what insurance must cover for all people to not being able to shop across state lines was very much responsible for the rapid increase in healthcare. It didn't help much when we got sold out by Washington under the guise of Affordable Care to the drug, insurance, and hospital, companies. ACA was payoff for campaign contributions, that is why no one read the damn bill.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#96

Post by aioprisan »

stephencanon wrote: post #62
seanmcdirmid wrote: post #36

Earlier quoted context omitted.

That makes sense: experience increases performance, which is why we have intensive residencies; there is a reason why until recently residents were working 80+ hours a week. Perhaps we should ship all our resident-ready medical students off to third world countries where the needs are great so they can become proficient very quickly. Perhaps our system has become too soft.

Our residents do work 80+ hour weeks. Until recently, it was 100+ hours.

It's still ~100 hours a week: 6 days at up to 16 hours = 96 hours/week.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#97

Post by pessimizer »

andrewparker wrote: post #85
DigitalSea wrote: post #9

The first supposed fact thrown around in the medical costs argument like this is, "Well in India their cost of living is lower, so they charge considerably less, yadda yadda..." but it's obvious the price difference goes way beyond any cost of living gap. That's over $100,000 in price difference, while it is true the cost of living (salary, prices of every day items) in India is considerably less than that of the US,…

>> A doctor trained in India is no less qualified than a doctor trained in the US. This might be objectively true (which you could reasonably determine through some combination of standardize testing and surgery complications/outcomes), but if you ask 100 people on the street in US whether they would prefer to see a US MD or an Indian MD for their heart surgery, I bet 97 or higher would prefer the US MD. The tiny rem…

I think it's probably just racism. I bet you'd see similar outcomes if you let people choose between white doctors and Indian-American doctors, even if the white doctor was the foreign one.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#98

Post by replicatorblog »

pravda wrote: post #14

It's not greed, it's a consequence of health insurance. Get rid of health insurance and prices would drop 10x.

Another way to say this: Decouple catastrophic health insurance, what we use to cover actual medical emergencies, and routine health care costs. This is roughly the model in use in Singapore and similar to what people in the US with high deductible plans live with.

I work in the medical products field and it's amazing how much distortion is introduced into the system when "insurance" is used to pay for everyday consumables. Products that go from RX to OTC drop 80-90% overnight.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#99

Post by GFischer »

patio11 wrote: post #50

Somewhere there is a forum of doctors saying "Pfft, the US firm wants $100k for the patient records system and the Indian firm wants $1,000. Those greedy bastards! They live in a toxic industry which acts as parasites on us noble public servants saving lives every day. It serves them right to deal with international competition finally. Let's go with the Indian bidder. What could possibly go wrong."

Some times, things really are that way. It does help to know the supplier, of course.

But back to the article, there are some U.S. healthcare costs that don't make any sense, I've seen procedures with firsthand accounts of an equivalent service here in Uruguay vs the cost in the U.S., and the cost in the U.S. is an order of magnitude more (and service sometimes much worse, this is the hospital I go to, try to argue it's worse than an average U.S. hospital ! http://www.hospitalbritanico.org.uy/ ).

Similarly, the company I work for regularly gets better software for one-tenth the price of U.S. bidders, we've bought local (Uruguayan), Colombian, Ecuadorean... it does help a lot that we know the language and how to do business there. It's not a hundred-to-one comparison as you mention, but there are huge market inefficiencies (in this case, they should be arbitraged away by someone selling services in the U.S., with a focus on quality and not devolving into Infosys or something).

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#100

Post by cscurmudgeon »

patio11 wrote: post #50

Somewhere there is a forum of doctors saying "Pfft, the US firm wants $100k for the patient records system and the Indian firm wants $1,000. Those greedy bastards! They live in a toxic industry which acts as parasites on us noble public servants saving lives every day. It serves them right to deal with international competition finally. Let's go with the Indian bidder. What could possibly go wrong."

Hi patio11,

Thanks to femto, we have some data. It seems that the 30 day mortality rate is lower than that in the US. Care to answer this other than with thinly veiled casual racism?

Dr Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4 per cent mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9 per cent in the US in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons.

Dr Lewin believes Dr Shetty's success rates would look even better if he adjusted for risk, because his patients often lack access to even basic health care and suffer from more advanced cardiac disease when they finally come in for surgery.

http://www.theaustralian.com.au/archive/business-old/the-hen...

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