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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.

#201

Post by refurb »

phaemon wrote: post #193
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…

Why does the clinic charge that much to Medicare, if Medicare doesn't pay that much (legally, I presume)? Is it an accounting trick or something?

The amount charged to Medicare does have an impact on how much they are reimbursed (to an extent).

For example, if the charges exceed the DRG payment by a specific amount, the hospital can get an "outlier" payment to help with the excess costs.

As for how the charges are calculated, hospitals have a lot flexibility in how costs are accounted for.

Also, keep in mind that hospitals that specialize in a specific procedure often have high volumes that drive down cost. If you're getting heart surgery at a hospital that specializes in it, it's often much cheaper than a hospital that rarely does heart surgery.

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

#202

Post by kamaal »

sliverstorm wrote: post #191
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…

I'm curious what the innovation was here. Laproscopy is not new, and people are already pretty aware of its benefits. He applied it to a new operation, but is that innovation? The only step that might have been innovative is, did he skip the washing out of the abdomen step without consequence? I'm inferring here, because it seems like that would be very difficult to do.

Its like saying there was no innovation in the iPhone. I mean email, messaging, games, apps etc they were all there before right?

The innovation here is to invent practical methods of treatment(even if its a process), when you are severely strapped for resources, money, equipment and helping hands. And then do it reliably for all the patients you see over and over with a high success rate for a very affordable price.

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

#203

Post by kamaal »

harichinnan wrote: post #156
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…

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.

Cars cost twice in India for a totally different reason. Its basically because of high import duty and not because they are expensive to make in India.

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

#204

Post by kamaal »

patio11 wrote: post #125
anu_gupta wrote: post #88

Earlier quoted context omitted.

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?

No, I'm suggesting that HN commenters here are likely far less competent to speculate about the cost structure of heart operations than believe themselves to be. In an analogous situation which they actually understand, the tenor of this comment thread would reverse in a hurry. (Which we could ascribe partly to self interest but in major degree to "Deliver X for the US market in America" and "Deliver X for the Indian…

Sorry Patrick. Normally I would agree with you, but there is a difference here.

The biggest difference here is if the cost of a heart operation in India would be too high, unlike the US- poor people will have absolutely no option but to die here. That is what it really comes down to. In US it leads to a person getting bankrupt, but in India poor people don't have the luxury of getting bankrupt. In my city(Bangalore) we have government hospitals- though they never acknowledge it officially, but they often administer euthanasia to poor patients. It happens with the poor in nearly all critical illness cases- Heart ailments, cancer, fire accident victims, mental illness. Often the relatives themselves request a euthanasia because the pain, price and duration of treatment is beyond their emotional and financial means.

So you can either make the treatment a little affordable so that people can benefit, while you make some profit out of it. Or they die anyway and you lose some profit.

Innovation in a situation like this is born out of necessity. Its a do or die situation.

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

#205

Post by spartango »

DanBC wrote: post #82

People have mentioned the cost of MRI scans in the US. How much would it cost to buy a bunch of scanners (full body, and bucket-type for arms and legs) and employ technicians to do the scanning and offer this as a service to hospitals? You could have technicians working on shifts to have out-of-hours scanning. The scans are provided in electronic format to the patient and to the doctors specified by the patient. The…

Just a heads up, MRI machines cost 10s of millions of dollars and come with $1M+/yr service contracts. They have pretty substantial power costs as well. They are sufficiently expensive that some big institutions lease them from the manufacturer.

I won't delve into the other parts of your idea, which likely have merit, but just realize that the costs of running such an operation would not be small.

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

#206

Post by sliverstorm »

kamaal wrote: post #202
sliverstorm wrote: post #191

Earlier quoted context omitted.

I'm curious what the innovation was here. Laproscopy is not new, and people are already pretty aware of its benefits. He applied it to a new operation, but is that innovation? The only step that might have been innovative is, did he skip the washing out of the abdomen step without consequence? I'm inferring here, because it seems like that would be very difficult to do.

Its like saying there was no innovation in the iPhone. I mean email, messaging, games, apps etc they were all there before right? The innovation here is to invent practical methods of treatment(even if its a process), when you are severely strapped for resources, money, equipment and helping hands. And then do it reliably for all the patients you see over and over with a high success rate for a very affordable price.

Its like saying there was no innovation in the iPhone.

The iPhone was not innovative for including email and messaging. The iPhone was (to my recollection) primarily innovative in the use of the touchscreen and some innovative UX design.

The innovation here is to invent practical methods of treatment

But was anything actually invented?

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

#207

Post by apalmer »

petilon wrote: post #132
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,…

"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." Actually, it is not just the healthcare industry. All industries in capitalist societies are engineered with greed in mind, and that's OK. It works very well. The problem in the healthcare industry is not greed, but insurance. When someone else is paying for the care you don't…

I kinda get your point, but your analysis as far as capitalism/greed etc seems more ideological than logically rational. The problem as you state it isn't insurance, its the inelasticity of health insurance. Simply put a significant amount of people will pay as much as they can get their hands on for even a marginally improved outcome if their life is on the line. Conversely very few people will refuse life saving treatment based on price, IF they can somehow get their hands on the necessary money, even if they feel it is a 'rip off'.

Your stated areas where american healthcare is efficient are optional, cosmetic surgey, lasik etc...

Not to say insurance doesnt play a part, just saying you havent presented a solid logical arguement.

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

#208

Post by apalmer »

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…

This is being done on a large scale, health tourism is a real thing. I think probably you dont realize how widespread this phenomenon is, and conversely I think more than a 'large scale' you are really asking, why isn't virtually everyone doing this?

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

#209

Post by apalmer »

pessimizer wrote: post #97
andrewparker wrote: post #85

Earlier quoted context omitted.

>> 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.

Naw, not true, at least on the east coast indian doctors (with american MDs) are common and are not generally viewed as 'inferior' in any way to caucasian doctors.

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

#210

Post by dougk16 »

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…

"but certainly I don't feel I have 100x in buying power"

Sometimes the economics do conveniently work out this way, which is why some people might get confused. For example I lived in Poland for a few years, and at the time a dollar got you about three zloty, and for the majority of day-to-day stuff you did indeed have about 3x the buying power. Of course for things like computers you ironically had about 1/3 the buying power.

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