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In India, 'no frills' hospitals offer $800 heart surgery

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Re: In India, 'no frills' hospitals offer $800 heart surgery

#71

Post by theatrus2 »

geon wrote: post #42
toomuchtodo wrote: post #34

Earlier quoted context omitted.

Why is there no business in the US yet that matches healthcare consumers with these Indian operations? A healthcare travel agent if you will.

I don't know about businesses, but a lot of people go to Thailand for dental care or boob implants.

I was about the mention Thailand and Taiwan as two popular medical tourism places.

You're out $1-2k on the ticket, but paying a tiny fraction for great healthcare.

You just can't sue anyone later (but that is maybe a good thing).

Re: In India, 'no frills' hospitals offer $800 heart surgery

#72

Post by [deleted] »

jcnnghm wrote: post #70
nbouscal wrote: post #52

Earlier quoted context omitted.

> Once the old substances patent expires, any drug company can produce generics. Except for when the company makes a tiny modification to the drug that doesn't change its effectiveness and files for a renewed patent, like in the Novartis suit that India's Supreme Court recently (and rightfully) rejected.

That's not the way patents work. There is not a renewal, but a new patent on the modified substance. The patent on the original substance would still expire. This, of course, raises an interesting question. If the claim is that the tiny modification doesn't change the drugs effectiveness, why not produce the original substance with the expired patent (or purchase a generic from a pharmaceutical that is already doing…

[deleted]

Re: In India, 'no frills' hospitals offer $800 heart surgery

#74

Post by microarchitect »

jcnnghm wrote: post #69
microarchitect wrote: post #60

Earlier quoted context omitted.

If every country adopts that policy, which is the direction things are headed because it's the dominant strategy, the rate of medical advancement will be much lower. What's the use of medical advancement that can't help more than 10% of humanity? It's far more important that we move to a world in which all human beings have access to basic sanitation and healthcare than it is to spend billions of dollars attacking st…

What's the use of medical advancement that can't help more than 10% of humanity? When the patent expires everybody benefits. Until then, it's available to everyone, but they must help pay for the drugs development. If nobody pays, the drug isn't developed, and nobody gets any benefit. It's far more important that we move to a world in which all human beings have access to basic sanitation and healthcare than it is to…

A general remark first. Your statements are full of hyperbole and it's hard to take you seriously.

All I said was that your hypothesis of a slower rate of medical advancement in the short term might be acceptable if it ensures that (a) more people have access to critical drugs and (b) more human beings have access to basic necessities of life that are taken for granted in most of the western world. Might be good if you respond to this claim instead of setting up a whole bunch of poorly thought out strawmen.

When the patent expires everybody benefits.

You do realize that drug patents are full legal in India, don't you? And the only thing that isn't allowed anymore is evergreening, which is of dubious benefit to society anyway. Further, India has issued exactly ONE compulsory licence (for an expensive cancer drug) ever. There is no evidence for your initial claim that India ignores patents.

I'm now going to ignore the strawman you've put about totalitarianism but I will make one remark about this statement.

Do the "few rich people" that are helped not end up paying for the R&D of the treatment for everyone else in perpetuity?

What is wrong with this? Don't we all benefit from inventions and ideas of many other humans, most of whom aren't rewarded financially from our successes?

If the US stops paying, the drug never gets produced, or gets produced much later because there is no private incentive to produce.

I would like to see citations on your claim that private capital (i.e., not money from the NIH, HHMI etc.) is responsible for the high rate of drug discovery in the US.

Re: In India, 'no frills' hospitals offer $800 heart surgery

#75

Post by Scaevolus »

yummyfajitas wrote: post #37
mschuster91 wrote: post #2

Couple this with a medical insurance system and you'll have a copy-paste model for pretty much every development country (and the United States cough )

India has a medical insurance system. It's pretty simple, really - you pay actuarial cost + profit margin and it covers low probability high cost events. Cost sharing induces patients to be price conscious, inducing downward pressure on prices. Most common procedures have prices listed on a sign, for less common stuff you need to ask the doctor for the price. It doesn't usually cover birth control, psychologists, etc…

Can you elaborate? Do you pay the average monthly cost of the entire pool, and then any extra charges the hospital bills?

Re: In India, 'no frills' hospitals offer $800 heart surgery

#76

Post by SapphireSun »

yummyfajitas wrote: post #37
mschuster91 wrote: post #2

Couple this with a medical insurance system and you'll have a copy-paste model for pretty much every development country (and the United States cough )

India has a medical insurance system. It's pretty simple, really - you pay actuarial cost + profit margin and it covers low probability high cost events. Cost sharing induces patients to be price conscious, inducing downward pressure on prices. Most common procedures have prices listed on a sign, for less common stuff you need to ask the doctor for the price. It doesn't usually cover birth control, psychologists, etc…

Correct. The problem is that a simple system like that is similar to car insurance, it only helps you pay for catastrophe. The reason US health insurance is so expensive is because we tried to institute a health plan via insurance that tries to do things like address chronic conditions and preventative care. There are many problems with that, but the point is that India has only solved the easy problem. We are in the midst of solving the hard problem: How do we equitably manage the healthcare of the entire nation that gives the rich and poor alike quality health care.

That said, we aren't doing it right at the moment since it's taking us about 16% GDP to do it when other countries have managed to do much better financially with better overall outcomes.

Price consciousness is a marginally good thing in health care. If people are going to get treated for the sniffles, they can easily price discriminate. The real problem is that price transparency, for all the expensive things in health care, doesn't actually help. You can only price discriminate when you understand what you're buying. When you don't understand, price becomes a signal of quality, and people don't compromise with their health like they would with cars. They also are paying with other people's money. In fact, some case studies have found that price transparency causes the lower price guys to simply raise their prices to compete with the higher price guys regardless of quality because patients don't care about price except to the degree it signals quality.

Re: In India, 'no frills' hospitals offer $800 heart surgery

#77

Post by yummyfajitas »

Scaevolus wrote: post #75
yummyfajitas wrote: post #37

Earlier quoted context omitted.

India has a medical insurance system. It's pretty simple, really - you pay actuarial cost + profit margin and it covers low probability high cost events. Cost sharing induces patients to be price conscious, inducing downward pressure on prices. Most common procedures have prices listed on a sign, for less common stuff you need to ask the doctor for the price. It doesn't usually cover birth control, psychologists, etc…

Can you elaborate? Do you pay the average monthly cost of the entire pool, and then any extra charges the hospital bills?

Typically you pay the average monthly cost of people with similar risk profile to yourself. Suppose the average monthly cost for nonsmoking men aged 30-35, BMI 25-27, not currently sick, is 2000 rs. Then I'll pay maybe 2100 rs (so insurance company makes a profit).

I.e., I pay my average cost, not the average over the whole pool.

If you are a smoking man aged 50-55, BMI 32-35, with diabetes, you'll pay more. You'll pay the insurance companies best estimate of your average cost, not our average cost.

Re: In India, 'no frills' hospitals offer $800 heart surgery

#78

Post by yummyfajitas »

SapphireSun wrote: post #76
yummyfajitas wrote: post #37

Earlier quoted context omitted.

India has a medical insurance system. It's pretty simple, really - you pay actuarial cost + profit margin and it covers low probability high cost events. Cost sharing induces patients to be price conscious, inducing downward pressure on prices. Most common procedures have prices listed on a sign, for less common stuff you need to ask the doctor for the price. It doesn't usually cover birth control, psychologists, etc…

Correct. The problem is that a simple system like that is similar to car insurance, it only helps you pay for catastrophe. The reason US health insurance is so expensive is because we tried to institute a health plan via insurance that tries to do things like address chronic conditions and preventative care. There are many problems with that, but the point is that India has only solved the easy problem. We are in the…

How do we equitably manage the healthcare of the entire nation that gives the rich and poor alike quality health care.

(Assuming "we" means India, though I don't live there anymore.) Fix corruption, the licensing system, the protectionism, etc, so that they become wealthier. Make the rest of the economy as capitalistic as the medical system. It's hard to fix anything with a GDP/capita The real problem is that price transparency, for all the expensive things in health care, doesn't actually help. You can only price discriminate when you understand what you're buying.

(I think now you are talking about the US.) Strangely, when Indians pay out of their own pocket (in whole or in part), they routinely price shop. Is price shopping a weird skill that Indians have but Americans don't? I suspect not, given that my uninsured mother routinely does it.

Re: In India, 'no frills' hospitals offer $800 heart surgery

#79

Post by mjfern »

atdrummond wrote: post #58
FraaJad wrote: post #56

Earlier quoted context omitted.

Narayana Hrudayalaya has some of the best post-operation recovery numbers comparable or better than your first world hospitals. > The hospital enjoys a high success rate - an average 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, compared to 1.9% in the U.S. http://healthmarketinnovations.org/program/narayana-hrudayal...

Who audits the numbers for the hospital? Is it all self-reported?

Who audits the numbers at U.S. hospitals?

Re: In India, 'no frills' hospitals offer $800 heart surgery

#80

Post by skylan_q »

noonespecial wrote: post #66

"Essentially we realised that as you do more numbers, your results get better and your cost goes down," Tis tempting to just think of this as a "low rent" version of the "real" procedures that are offered at much higher costs in the west, but there really is something to just doing enormous numbers of procedures when it comes to the brutal learning of human medicine. I would not be surprised to start seeing innovatio…

Necessity is the mother of innovation. This sort of thing might invite competition in that price range. Spending millions of dollars at a hospital that's in no danger of going out of business is a lot less likely to lead to innovation than a hospital that's got to beat another one's price point that's directly sensitive to the consumer/patient.
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