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

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

#111

Post by endeavour »

kokey wrote: post #86
acchow wrote: post #56

Earlier quoted context omitted.

> You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day. I find the vast majority of people are tripped up by currency conversion, but I'm surprised to find this on HN. In Japan $1 = 100 yen, but certainly I don't feel I have 100x in buying power. A bowl of ramen will cost me $8 in SF; an equivalent bowl will cost me 800 JPY in tokyo. L…

I'm surprised that how many otherwise smart people gets tripped up by this. The only time you can deduce something from the exchange rate is if you compare the difference between the two rates over a longer period of time. Then it can roughly tell you things about difference in direction of inflation between the two countries, and the effect on wages and imports/exports. If the difference between the exchange rate be…

"If the difference between the exchange rate between two countries doesn't change for a long time the prices of goods in both countries end up being roughly the same."

Simply not true. Compare the cost of a beer in, say, Thailand and Norway. Are you suggesting if the exchange rate were fixed they would reach parity over time?

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

#112

Post by rayiner »

First, adjusted for PPP that is more like $3,000. Second, nearly all personal and professional services cost way more in the U.S. Try hiring a nanny in India versus the U.S. and compare the prices.

In any case, whenever you talk about prices, it's important to try and think about it in terms of supply and demand. Why might prices for similar services be lower in India? In both countries, the price for that heart surgery is roughly the same order of magnitude as the per-capita income. But the median Indian is living far closer to subsistence than the median American. India's population is 70%+ rural and slightly over 50% are dependent on agriculture. Heart surgery isn't really an option for the median Indian.[1] While it may be financially catastrophic for the median American, between insurance, Medicare, Medicaid, etc, it is an option for the median American. The net result is that demand for heart surgeries, relative to the population, is far lower in India.

At the same time, the supply of doctors is higher. Being a doctor is considered socially desirable in India, and as a result there is a good educational infrastructure in place and plenty of candidates.

Higher supply and lower relative demand = lower prices.

I bet you can explain a lot about the U.S. healthcare industry in terms of regulatory issues, etc, but the magnitude of the impact of that is probably the difference between the U.S. and the UK, not the U.S. and India.

[1] It should be noted that when people give anecdotal reports about what things are like in India, there is tremendous perspective distortion. People will often pretend like relatively well-off people living in the cities are the "typical Indian" when in reality they're probably in the top 10%. It's as if the vast majority of India, poor and rural, doesn't exist.

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

#113

Post by stephencanon »

aioprisan wrote: post #96
stephencanon wrote: post #62

Earlier quoted context omitted.

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.

There’s a cumulative “in-hospital” time cap of 80 hours/week (88 for neurosurgical residents). In practice, however, this means that (a) the cap is regularly broken or (b) residents end up doing preparatory study, reading papers, doing research, etc outside of the hospital to remain under the cap. They are still working more or less the same hours.

Also, the 16 hour/day rule is only for interns, IIRC. Resident shifts can go up to 30(?) hours.

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

#114

Post by w1ntermute »

anu_gupta wrote: post #88
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."

Not sure what you're trying to say here. You seem to be trying to defend the cost of a $100,000 operation by making a snarky comparison with outsourcing an IT project. Is that actually what you meant?

patio11 has a long history of making snarky comments about how outsourcing to India should not be a concern to Western IT workers because the quality of Indian IT workers is much lower than that of Western IT workers and clients will ultimately recognize this and hire a Westerner instead. This is presumably something that is quite near and dear to him, as he is an American expat who lives in Gifu, a tiny, rural Japanese town. Since his primary income source (outside of Bingo Card Creator and Appointment Reminder) is doing consulting work for Western customers, it's very important to him that they pick him over Indian consultants based on how good he is, since hiring him presents all the same issues with respect to time zone, distance, etc. that hiring an Indian would.

He probably experienced a lot of difficulty initially in acquiring customers (who opted to go with the much cheaper, Indian consultants), which is why he has such an oversized Internet presence, including on Hacker News - it has helped build a brand for himself that isn't location-specific.

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

#115

Post by vbuterin »

endeavour wrote: post #111
kokey wrote: post #86

Earlier quoted context omitted.

I'm surprised that how many otherwise smart people gets tripped up by this. The only time you can deduce something from the exchange rate is if you compare the difference between the two rates over a longer period of time. Then it can roughly tell you things about difference in direction of inflation between the two countries, and the effect on wages and imports/exports. If the difference between the exchange rate be…

"If the difference between the exchange rate between two countries doesn't change for a long time the prices of goods in both countries end up being roughly the same." Simply not true. Compare the cost of a beer in, say, Thailand and Norway. Are you suggesting if the exchange rate were fixed they would reach parity over time?

Assuming no new disruptions, then yes, economic conditions in the two countries would eventually equalize and prices would differ by at most the shipping cost if one of the two countries happens to have much better natural conditions for producing beer than the other. It's because disruptions are now becoming (have become?) the norm that equilibrium never has time to come close to manifesting itself.

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

#116

Post by vbuterin »

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,…

Another question: why don't Indian doctors just import themselves to the US and earn much higher wages and profits by offering American customers something like the average of the Indian and American price?

That's what we should be asking IMO.

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

#117

Post by vbuterin »

amerika_blog wrote: post #107
dantheman wrote: post #30

Earlier quoted context omitted.

A huge problem in the US is all sorts of really really bad laws. For instance to open a new hospital you have to get permission from other hospitals in the area.

> For instance to open a new hospital you have to get permission from other hospitals in the area. This sounds like a terrible law. Where can I look for more information on this?

http://en.wikipedia.org/wiki/Certificate_of_need

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

#119

Post by losvedir »

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,…

> 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, the gap certainly isn't 100k+

Well, the article says 2/3 of people live on $2/day, implying this surgery is $1600/$2/day = 800 days worth of work.

Taking the US median income of $45k (since I don't know the 2/3 number off the top of my head), that implies the equivalent price in the US would be ($45k/365) * 800 = $98,630. So, right about the same as at the Cleveland Clinic.

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

#120

Post by vasilipupkin »

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"

Perhaps you are correct, but I doubt this assertion. U.S. graduate schools are generally the best in the world, I am not sure why that should be any different for medical schools

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