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

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

bloomberg.com

Post reply on HN
Print view View original

151–160 of 276 posts

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

#151

Post by refurb »

riahi wrote: post #133

Probably not going to get seen in this morass of comments, but I went back and reviewed the CMS data that the article cites. The article used the Diagnosis Related Group (DRG) 238 - Major Cardiovascular Procedures without Major Complications. This is the best guess at capturing the costs of "Open Heart Surgery". (CMS only releases data for the top 100 DRG codes). "Open Heart Surgery" is a term for a variety of surgic…

Nice catch! You are correct, it's the reimbursement that counts, not what the hospital claims are its expenses!

The differences in payment between the hospitals is due to the DRG payment adjustments for local cost of living, disproportionate share, etc.

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

#152

Post by deepGem »

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,…

"I think when your medical system becomes so expensive it's cheaper for people to fly out of the country, pay for accommodation and even some spending money to get the same level of care" - I wonder why this not happened on a large scale yet. It seems so simple - fly out stay for 10 days and get the surgery done, visit some exotic places such as the Taj Mahal and come back. Almost heart surgeries are planned, so planning is also not a concern. These days booking a flight in and out is a non-issue as is the issue of staying in a hotel. What's stopping people from adopting this on a large scale ?

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

#153

Post by lewstherin »

larrywright wrote: post #147

This is over 94,000 Rupees. That is a huge amount of money in India. I'm not sure most people realize the cost of living difference between the two countries. Case in point: I was in India (Chennai) for a week on business a couple of months ago. During that time (M-F), I had a driver who was dedicated to me. He took me to the office and back, and took me anywhere else I wanted to go. This wasn't a taxi service, he ha…

That seems absurdly low. I stay in Chennai and typical taxi rates run upwards of 18Rs per KM (approx 0.48US$ per mile). I agree there is a considerable difference in the cost of living, but what you likely paid the guy was a tip for the entire week. Even assuming the car, gas etc. was paid by your company, the amount still seems low for a driver's fee for a week. My dad's driver makes 11,000INR a month.

94,000 Rupees is a lot of money in India but it is not so huge either. A small local doctor in a city will make around that money in a month.

(ps: If you actually had a guy driving you for 25$ in Chennai, do pass me his number. I will happily use him.)

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

#154

Post by refurb »

pravda wrote: post #39
sdoering wrote: post #21

Earlier quoted context omitted.

Would they? Or would the poor middle class people not being able to afford cancer-treatment/heard surgery just have a considerably lower life-expectancy? I am not sure, so I really would love to see the numbers/facts supporting your statement. Would love to learn of this magic fact. [cynicism end] [Edit]: Typo [Edit 2:] In Germany, with full health-insurance the cost for a Cardiopulmonary bypass are round about 30k €…

First of all, I am sure the 106K figure is a phony 'list price' figure and not reflective of how much is actually paid. Second of all, you ignore the incredible sums of money taken from the 'poor middle class' and handed over to the health industrial complex. For most of this country's history [the USA], there was no such thing as health insurance. The poor got charity care and the middle class were able to pay. Why…

You are correct, look at the post by riahi.

The hospital may charge $106K, but Medicare only reimburses them for $15-25K.

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

#155

Post by stonemetal »

seanmcdirmid wrote: post #36
bayesianhorse wrote: post #28

Earlier quoted context omitted.

I read about this clinic somewhere else, and there it was said this clinic actually outperforms western clinics in terms of complications, which seems to be achieved through staggering case numbers per doctor.

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.

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.

The problem is they would become proficient at treating the wrong things. Medical conditions vary greatly by geography. Polio is still alive in the third world, Russia is fighting drug resistant TB, and up thread there is a mention of a surgery performed at a 1000x rate in India compared to the US(Once a decade vs once a day). All the while what affects Americans would be glossed over because it doesn't infect the rest of the world at the same rates.

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

#156

Post by harichinnan »

acchow wrote: post #56
kamaal wrote: post #42

Earlier quoted context omitted.

>>You don't see this kind of innovation in the American health system because it has been engineered with greed in mind right from the start. As an Indian, I can tell you people here think the same about our health care system. The Doctor in discussion here, Dr Devi Shetty is a sort of a local hero here in Bangalore. And who knows in some years he might as well be a national hero. Its basically because he seems to br…

> 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…

if the same logic were true, cars would cost 1/60 of labor + reduced price on parts locally made + same price and import duty on imported parts. However cars typically cost twice in India.

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

#157

Post by harichinnan »

kamaal wrote: post #106
realrocker wrote: post #72

Earlier quoted context omitted.

I am in Bangalore and don't have medical insurance. Paid Rs 300 fee to General Physician for a consultation another 1500 Rs. for a bunch of tests. In my hometown in Bihar the same thing costs Rs 150+500 with excellent doctors. It's not all rosy but it's not that bad.

The only thing I can tell you is to go and get health insurance ASAP. Both for yourself and your dependents. Get one and be safe, one serious illness can bankrupt you these days(actually it always has). But my point is even a week of hospitalization can be pretty expensive. And don't be under an impression you will be able to travel to Bihar or wherever when the need arises. During cases of emergency those are not pr…

Agree. The last time I bought health insurance in India, it cost me Rs 2600 ~ $50 for a year for $10000 worth of coverage.

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

#158

Post by lewstherin »

sfall wrote: post #126
cscurmudgeon wrote: post #100

Earlier quoted context omitted.

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, compa…

I will say that you are comparing one doctor to the national average. This only shows he is better than average, but what is the Indian average mortality rate. Another issue that your article mentions is that he specializes on a select procedure and another doctor mentions that this option of specialization is not available to all surgeons. Don't take this as part of any sides argument. All I want to point out is tha…

It looks like the mortality rates mentioned are for the entire chain of hospitals, not just Dr. Shetty.

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

#159

Post by ctdonath »

danso wrote: post #129

Can't resist posting this anecdote from Atul Gawande's (best known for his New Yorker medical pieces, such as the one about checklists) book, Better: A Surgeon's Notes on Performance...at the end, he describes spending some time in India as a visiting surgeon to see how innovation was possible in comparatively squalid circumstances. The Nanded hospital he describes below serves 1,400 villages, about 2.3 million peopl…

The key:

His department was able to obtain some older laparoscopic equipment inexpensively.

Thanks to high-cost health care systems elsewhere spending enormous sums on the latest & best equipment on a regular basis, older equipment capable of facilitating very good (albeit not best possible) results becomes inexpensive.

In all the sneering at the high cost of healthcare in some areas, the consequential benefits to others gets overlooked. If you want the very best, yes it will cost a lot; if you're willing to settle for good instead of best, you can leverage what those buying the best paid for. If you cut the high cost options, the good low cost options may very well become infeasible.

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

#160

Post by jdmichal »

stephencanon wrote: post #127
DougWebb wrote: post #123

Earlier quoted context omitted.

When it comes to medical care, you have to be really careful about how you define "outcome" if you want to use that as an incentive. You can't just use patient recovery/survival, because then you'd have doctors avoiding patients that need their care the most. You'd also continue to get extraordinary measures taken to extend the life of patients that can't survive, even when letting them go is the more humane thing to…

For rare conditions and the very sick, there are a lot of thorny issues, and fee-for-outcome may be hard to implement well. However, those don’t represent the bulk of medical procedures; the vast majority of what’s done in a hospital is utterly routine and predictable, and the outcomes are most definitely quantifiable.

But, in those routine cases, fee-per-service-rendered is pretty much exactly the same as fee-per-outcome, no? I mean, barring malpractice, which already has its own (litigious) path of remediation.
Post reply on HN