The World’s Cheapest Hospital Has to Get Even Cheaper
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Re: The World’s Cheapest Hospital Has to Get Even Cheaper
#2Compared to high margin low volume surgeries in the US, this is low margin high volume. Its ingenious how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses.
Some things make sense like having medical machines maintained in house. Other things, like sterilizing and reusing IV lines seem pretty risky. But perhaps the risk is approachable in this case since a patient is less likely to sue if complications arise from something that could somehow be twisted into a jackpot lawsuit?
Re: The World’s Cheapest Hospital Has to Get Even Cheaper
#3Compared to high margin low volume surgeries in the US, this is low margin high volume. Its ingenious how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses. Some things make sense like having medical machines maintained in house. Other things, like sterilizing and reusing IV lines seem pretty risk…
> Its ingenious how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses.
Having observed a few major surgeries in the US, this appears to not be a unique practice and doesn't explain the pricing difference.
Re: The World’s Cheapest Hospital Has to Get Even Cheaper
#4Compared to high margin low volume surgeries in the US, this is low margin high volume. Its ingenious how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses. Some things make sense like having medical machines maintained in house. Other things, like sterilizing and reusing IV lines seem pretty risk…
Assembly line approaches to surgery are not unique to India. The Russian ophthalmologist Svyatoslav Fyodorov who pioneered the radial keratotomy (correction of myopia by reshaping the cornea) in the 1970's founded an institute - the Fyodorov Eye Microsurgery Complex - that performed radial keratotomies in an assembly line manner [0][1]. Operating tables would literally be rotated from one surgeon to another. At the time, surgical correction of myopia in the West was fairly unknown, as opposed to today where ads for Lasik are blasted everywhere.
[0] https://en.wikipedia.org/wiki/Svyatoslav_Fyodorov
[1] https://en.wikipedia.org/wiki/Fyodorov_Eye_Microsurgery_Comp...
Re: The World’s Cheapest Hospital Has to Get Even Cheaper
#5Compared to high margin low volume surgeries in the US, this is low margin high volume. Its ingenious how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses. Some things make sense like having medical machines maintained in house. Other things, like sterilizing and reusing IV lines seem pretty risk…
> how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses.
This is most certainly the case in the US. Most of teaching hospitals have residents do most of the "easy work" such as getting there, have the attending specialist perform the critical part and again have the residents do the rest.
Re: The World’s Cheapest Hospital Has to Get Even Cheaper
#6Really interesting article. As always, the truth is probably somewhere in the middle.
I wonder what would happen if a company known for affordable quality, like Toyota, could make an efficient assembly-line for health care.
Re: The World’s Cheapest Hospital Has to Get Even Cheaper
#7Really interesting article. As always, the truth is probably somewhere in the middle. I wonder what would happen if a company known for affordable quality, like Toyota, could make an efficient assembly-line for health care.
I think applying methods that for manufacturing to healthcare is not a good idea. Manufacturing is generally very predictable whereas health care often isn't. We already have tried to manage software development like an assembly line. That didn't work for software and I don't think it will work for health care.
Re: The World’s Cheapest Hospital Has to Get Even Cheaper
#8Compared to high margin low volume surgeries in the US, this is low margin high volume. Its ingenious how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses. Some things make sense like having medical machines maintained in house. Other things, like sterilizing and reusing IV lines seem pretty risk…
> Its ingenious how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses. Having observed a few major surgeries in the US, this appears to not be a unique practice and doesn't explain the pricing difference.
The difference here is not that we don't do surgeries efficiently, but that we are subject to the effects of regulatory capture, which stops any kind of price competition in its tracks and leads to $300 bags of saline.
Re: The World’s Cheapest Hospital Has to Get Even Cheaper
#9Earlier quoted context omitted.
> Its ingenious how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses. Having observed a few major surgeries in the US, this appears to not be a unique practice and doesn't explain the pricing difference.
The difference here is not that we don't do surgeries efficiently, but that we are subject to the effects of regulatory capture, which stops any kind of price competition in its tracks and leads to $300 bags of saline.
I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business.
Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got seen by an emergency medicine doc. I got a $120 (ER) brace for free in that clinic -- it is probably one of 100 in NYC, open 7 days a week from 8 am to midnight -- i did not go to their other one which is 24x7
Instead of spending $800 on X-ray at the ER, I spent $40 and got results on a CD within 10 minutes at the same walk in clinic.
My MRI was not $2800 but $600 because instead of doing it in a hospital I did it at the radiology center. Both the doc at the walk in clinic and the surgeons said "You can do it in the hospital but it would cost a lot more and take a lot longer. Go to Lenox Hill Radiology -- they have about fifty locations in the city and you would be able to get it done today oh and your results will be emailed to us".
My two visits to orthopedic surgeons ( there were two different doctors working at the same office ) specializing in sports medicine ( fixing athletes ) cost me $260 ( first visit ) and $120 ( follow up ) -- same two surgeons looked at me and the second visit included a second set of X-rays ( not extra cost ).
My one on one PT specializing in sports rehab is costing me $100/h rather than unknown amount.
I have a hunch simply because I let my fingers do the Googling my ACL surgery wont cost me $50k even though I won't be leaving NYC to do it.
What is that magic thing that I did? Googled "Sports medicine surgeons" and sent emails to the email addresses. I also googled "Physical therapy near me" and emailed all of them, getting the prices and asking if they had any experience with rehabbing athletes -- I read reviews of the ones that did not respond after -- none of them had good reviews. The ones that did respond had very decent prices, used tech and were on the ball oh and they had stellar reviews.
But I guess that is hard.
Edit: Cute. Bring on the downvotes. That's the crux of the problem. Personal responsibility is "hard" so no wonder those who tend to outsource it get fleeced. When HN re-enables my posting ability I will respond to the individual questions/positions.
Re: The World’s Cheapest Hospital Has to Get Even Cheaper
#10Really interesting article. As always, the truth is probably somewhere in the middle. I wonder what would happen if a company known for affordable quality, like Toyota, could make an efficient assembly-line for health care.
I think applying methods that for manufacturing to healthcare is not a good idea. Manufacturing is generally very predictable whereas health care often isn't. We already have tried to manage software development like an assembly line. That didn't work for software and I don't think it will work for health care.
> We already have tried to manage software development like an assembly line. That didn't work for software
What makes you say that? Assemblies like:
- product owner writes detailed user stories from communications with client
- developers pick them, implement them, and put them up for review
- CI server runs automated tests
- reviewers check the code for maintainability issues
- QA folks check the feature from the perspective of a user, ensuring that the acceptance criteria are met
- product owner accepts and merges to shared branch
What problems do you see or have you experienced in something like this?