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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.

#161

Post by ctdonath »

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've had heart surgery, costing very close to that six-figure the article gives. Every dollar was well spent. Tearing my chest open with a car jack, rendering me dead for most practical purposes, replacing body parts with cyborg components meant to last for decades, bringing me back to life, repairing the extensive damage caused, continuous monitoring for anything that could go wrong for a week, and sending me home in perfect condition save for a narrow scar, a daily pill and ticking like Captain Hook's crocodile - that's a heckuva process to go thru, it went spectacularly well, and I'm alive in great shape, heck yeah it was worth half the price of my house. They brought me back from the dead, how much is that worth?

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

#162

Post by jdmichal »

aioprisan wrote: post #93
pisarzp wrote: post #75

Earlier quoted context omitted.

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.)

Well, to be fair, OP only said apply to medical school, not get in...

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

#164

Post by stephencanon »

jdmichal wrote: post #160
stephencanon wrote: post #127

Earlier quoted context omitted.

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.

It brings the financial incentives inline with what everyone says the goal is. Fee-for-service incentivizes volume, even if it comes with the consequence of worse outcomes; we simply depend on doctor’s morals to not push it too far, with malpractice and licensing handling truly outrageous abuses. Fee-for-outcome explicitly incentivizes better quality control in a much more fine-grained manner.

More on point, fee-for-service incentivizes unnecessary and expensive diagnostic tests. Let’s say a patient presents with an uncomplicated broken arm. If there’s a set payment for an outcome (successful treatment of the break, with fully restored function), and diagnostic and treatments costs come out of that fee, the incentive is to order as many x-rays as are necessary to successfully treat the injury and no more. In fee-for-service, the orthopedist has no incentive not to order superfluous imaging because it doesn’t cost her anything, and may have incentive to order extra imaging (if, say, she also owns the imaging center that bills for it).

Medicine is littered with examples where there are two tests whose diagnostic power is statistically equivalent, and yet doctors common write for the more expensive test. Fee-for-service is either a neutral or perverse incentive in these cases. Fee-for-outcome aligns the incentive with what society seems to want (lower-cost healthcare with good outcomes).

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

#165

Post by jjoonathan »

deepGem wrote: post #152
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 plan…

Either it's illegal (the government's fault) or hospitals deal with insurers on a bundle basis and they aren't willing to cut out their most profitable procedures (the market's fault). Depends on who you ask, I'm sure :)

Liability might be a problem, but it only accounts for 2% of medical expenditures in the US, so I wouldn't expect it to be insurmountably difficult to insure the procedures to "US standards."

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

#166

Post by scarmig »

ctdonath wrote: post #159
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 ot…

Is your claim that the existence of excellent high-cost treatment options drive down the price of moderate good ones in the present, or that the moderate-cost good ones were at one point paid for by being the excellent high-cost ones? The two claims have very different policy implications.

Overall, though, we should be skeptical of device manufacturers' claims that dumping more money into expensive equipment leads to better health. Most money sloshing around in the healthcare system is wasted (see, for instance, the recent counterintuitive Medicaid study results: increased health care spending doesn't necessarily equate to improved outcomes). If we could spend 50% of the money for 80% of the results, that'd be an amazing improvement. And that money could be spent on other quality-of-life improvers, which very well might improve overall population health more than that last 20% coming from complicated medical treatments.

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

#167

Post by manojlds »

lewstherin wrote: post #153
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…

Yes, $25 per week is too low. Heck, I recently paid that amount for a 60km trip in Chennai ( 2 hours of travel )

94,000 Rs. - for comparison sake, my motor bike costed me Rs.99,000.

It is definitely a high amount for many Indians, but the average middle class person might be able to pay it in India.

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

#168

Post by larrywright »

lewstherin wrote: post #153
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…

All I know is what was on the hotel bill (Westin). It's possible that they had negotiated a rate with the service. I did tip, based on the guideline I was told, about 50 rupees per day.

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

#169

Post by cabalamat »

kapad wrote: post #24

Medical tourism has hurt most Indians. 1583 USD is almost 100k INR. The average per capita income in India is 1219 USD (72k INR). This figure too is very misleading, since poverty is a huge problem. A very simple plotting with data from wikipedia and rudimentary extrapolation, shows that more than 1.1 billion Indian's annual income is less than the current cost of heart surgery. India's total population is 1.2 billio…

> Medical tourism, though very fine for a lot of folks who want a cheaper alternative, is driving up the cost of medical treatments in India by leaps and bounds.

In the short term, maybe. In the long term surely it will reduce costs or at least stabilise them.

Millions of CPUs and RAM chips are sold every year, but the price of them doesn't keep going up, does it?

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

#170

Post by ams6110 »

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 would observe, that all of the "low cost" equipment and techniques that are being described here were developed by "greedy" corporations and hospitals in the USA (or possibly Europe). It's easier to be cheap when you don't have to fund any original R&D.
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