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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.

#171

Post by muzz »

From the article it's not clear what the major drivers are in bringing down the costs. What I've gathered from the piece and another link posted in the comments:

* No air conditioning

* Buying used scrubs

* Buying in bulk, directly from manufacturers [1]

* Surgeons that work "typically work 60 to 70 hours a week" [1]

The additional link [1] seems to indicate that the innovation is simply volume. The highly-trained surgeons perform more surgeries, the expensive equipment is utilized more hours of the day, etc.

[1] http://m.theaustralian.com.au/archive/business-old/the-henry...

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

#172

Post by enraged_camel »

ctdonath wrote: post #161
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…

You are succumbing to the common fallacy of associating cost with quality.

Last week, my dad (who is a doctor in Turkey) was telling me about a new study that compared the cost of healthcare services in various countries around the world and the satisfaction of patients. He said that the USA ranks close to the bottom of the index, meaning that considering how much American patients pay for healthcare, their level of satisfaction is incredibly low.

This is why "healthcare tourism" exists and is dominated by American patients.

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

#173

Post by 007emma007 »

India is the second in health care tourism all across the world and if you want to see what are the comparison for each surgery in India with respect US for the same surgery http://www.techcrump.com/need-a-surgery-then-fly-to-india/ and here you can also see what is the state of healthcare in India for the peoples in India

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

#174

Post by tsax »

- The hospital industry is a monopolized cartel - you usually need the approval of existing hospitals in an area before you can open your own. - The insurance industry is a cartel - there are extreme compliance costs that only a few big players can take care of. - Employer provided insurance is subsidized. - Most 'reform' of health care in the US has punished individual insurance holders while strengthening the employment-based insurance system further strengthening third-party payment systems including increasing lists of 'must-cover' mandates for health insurance. - McCarran-Ferguson act exempted health insurance from a competitive national market. - The culture and institutional incentives in US healthcare push towards extreme capital-intensive expenditures and cut down on labor-intensive expenditures even when its not cost effective for the procedures that the patients require. Hospital beds get more expensive per day while extremely unlikely to succeed procedures like proton therapy expand further.

This paper is very illuminating and comprehensive: http://c4ss.org/content/2088. Please have a look even if you disagree with the solutions and the ideology of the author. I assure you it will be worth your time.

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

#175

Post by tsax »

tsax wrote: post #174

- The hospital industry is a monopolized cartel - you usually need the approval of existing hospitals in an area before you can open your own. - The insurance industry is a cartel - there are extreme compliance costs that only a few big players can take care of. - Employer provided insurance is subsidized. - Most 'reform' of health care in the US has punished individual insurance holders while strengthening the emplo…

Let me also add licensing regulations that require MDs for routine procedures. Though nurse practitioners are becoming more involved and this is a good development. Another issue which HN commenters are aware of is the AMA's cartel monopoly on medical school seats to control the supply of doctors.

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

#176

Post by skue »

Gatsky wrote: post #146
mistermann wrote: post #135

Earlier quoted context omitted.

The same innovation would result in a massive lawsuit in the US would it not (if the first few attempts failed)?

No. There is a process that occurs when piloting a new surgical technique. This often involves animal models initially, eg inducing duodenal perforation in pigs and trying the surgery there. Then it might be practiced on human cadavers to work out more of the technical aspects. Then a feasibility study is performed on a small number of patients using a trial protocol ie. patients have to opt in after giving informed…

The next phase, going from validated new procedure/approach to broader adoption, has its own ethical issues. During my medical training I scrubbed into three surgeries that should have been routine, but where an experienced surgeon decided to try a new approach that he had heard about. All three cases went wrong, and one was near-fatal. Fortunately, there were no long term consequences.

Learning new techniques in a field that requires hands on training with real patients who are entrusting their lives to the experience of the surgeon is a constant balancing act. It's the same with training new surgical residents -- which Atul Gawande also discusses in one of his earlier books, Complications.

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

#177

Post by hingisundhorsa »

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 this the magical trickle-down healthcare plan? :-)

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

#178

Post by rehack »

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…

>The only thing I can tell you is to go and get health insurance ASAP. Both for yourself and your dependents.

I am not too sure about that. I think medical insurance hasn't yet become all pervasive in India, and thankfully so.

Insurance companies are there to make profit, and so will tend to exploit fear to maximize their profits. Leading to inflated costs, as it has happened in US.

So I am against insurance in this form, unless it works like a non-profit cooperative. In fact Dr. Devi Shetty has also innovated here, with a scheme which costs as little as Re. 5 per month (1/60 USD per month) and provides heart coverage to rural Indians. It works as a cooperative scheme of course.

I am surprised, Insurance companies, even exist. As they should be the first thing to be replaced by Software (as in 'Software eating the world' by Marc Andressen)... It should happen, will just take some time, I guess.

So, I think, India can still save itself from corporate medical insurance. As seen in some countries like Canada, a fully public health care system, works as good, if not better.

On a personal note, after having, earlier, taken medical insurance for me and family by paying some 9000/- Rs per annum and getting a cover of 300000/- Rs. I decided this year to not renew it.

But of course, I won't dare to prescribe it generally, each person must take his own decision.

Appendix: 1) http://arachnoid.com/wrong/index.html (ctrl-f 'Insurance is a wise investment')

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

#179

Post by hingisundhorsa »

ams6110 wrote: post #170
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.

Strong statements need to be backed up with strong data. You said "all of the equipment and techniques". Did you not read the Gawande section? Seems like the techniques are new and weren't invented by us.
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