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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.

#191

Post by sliverstorm »

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.

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

#192

Post by enraged_camel »

ctdonath wrote: post #181
enraged_camel wrote: post #172

Earlier quoted context omitted.

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…

You are succumbing to the common fallacy of disassociating cost from quality. Yes, a good successful job can be done much cheaper - but, on the whole, the odds of success & quality degrade fast when less is spent. When it is YOUR life on the line, you may very well be willing to pay significantly more for those diminishing returns; they may be diminishing, but they are in fact greater returns. "Healthcare tourism" by…

>>When it is YOUR life on the line, you may very well be willing to pay significantly more for those diminishing returns; they may be diminishing, but they are in fact greater returns.

There is no evidence that this is the case. Note that the vast majority of the cost is due to the massive complexity of the system: every party involved - and there are many - wants their cut, and they don't necessarily contribute to the well-being of the patient or the efficiency of the process.

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

#193

Post by phaemon »

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?

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

#195

Post by snowwrestler »

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…

This careful, protective process is one reason that health care innovation costs so much more in the U.S. than it does in developing nations.

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

#196

Post by muzz »

hingisundhorsa wrote: post #177
ctdonath wrote: post #159

Earlier quoted context omitted.

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? :-)

Sounds like the opposite of trickle-down. It's rich health care systems basically subsidizing equipment for poor ones.

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

#197

Post by Patrick_Devine »

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 think this is one of those cases where the proverb "necessity is the mother of invention" seems prescient.

It reminds me of physicians joining the military to work in battlefield condition because war creates the most interesting cases in terms of quantity and difficulty. Because you're in a triage situation, you can try out things where you normally wouldn't have a chance.

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

#198

Post by sfall »

lewstherin wrote: post #158
sfall wrote: post #126

Earlier quoted context omitted.

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.

the principal still stands don't compare one hospital or hospital chain, to another country.

If the US average is 1.9 then their is probability that a US hospital chain that is at 1.4 or less.

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

#199

Post by chetanahuja »

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…

$25 (approx. 1500 Rs by today's exchange rates) for car and driver for a week is implausibly low in a major Indian city. Depending on the particulars of the car etc, you could get this deal for a day or two, definitely not five.

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

#200

Post by gvb »

GhotiFish wrote: post #182
ctdonath wrote: post #161

Earlier quoted context omitted.

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…

This is exactly what is wrong with health care in a free market. if you had an operation with a 10% chance of failure for $5000, would you take it? What if you could spend twice the money and cut your risk down to 5% if you quadrupled the expense? $20000, even I'd take that option for you, as an objective observer. what if you could cut it down to 4% for $50000? Ok now it's getting a little silly, but it's still your…

The problem is that people want 0% risk and have someone else pay the infinite price tag.
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