7 ms·
Compared 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 t
by smush 8y ago
Compared 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?
- ebg13 8y ago> 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.
- rhombocombus 8y agoThe 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.
- notyourday 8y agoI 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.
- 8ytecoder 8y agoWhat's the incentive for me to save all that money when my insurance pays for it anyway and my company pays for my insurance? Insurance is supposed to do this job - negotiate prices ...etc., but, people are so attached to their doctors that insurance usually caves giving hospitals a much higher bargaining power.
- notyourday 8y agoHigh Deductible Plan. Takes care of big ass expenses, steep cost in the beginning.
- ams6110 8y agoIt's a start, but imperfect because most people with a high deductible plan will also have a health savings account (HSA). The HSA may even be required, not sure. The problem with HSAs is that although it's "your" money, it can only be spent on qualified health expenses. So there's a reduced incentive to spend carefully, because you can't use the money for anything else.
- leetcrew 8y agoif you end up with "too much" money in your HSA, can't you just reduce the amount of money that goes into it? obviously you can't just go buy a car with the money, but to me it seems like there is a strong incentive not to overspend from your HSA if you control how much of your paycheck goes into it.
- atonse 8y agoYup and organizations like the AMA that artificially keep the numbers of graduating doctors down to create a shortage and drive up prices.
- pseudolus 8y agoAssembly 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 https://en.wikipedia.org/wiki/Svyatoslav_Fyodorov [1] https://en.wikipedia.org/wiki/Fyodorov_Eye_Microsurgery_Complex https://en.wikipedia.org/wiki/Fyodorov_Eye_Microsurgery_Comp...
- notyourday 8y ago> 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.
- eitally 8y agoThis happens in the US, too. (my daughter just had open heart surgery at a top tier research hospital.) It's very common for a resident surgeon to open the patient and prep the detailed surgical site as part of their practical work (residency, fellowship). This usually happens under direct supervision of the attending, but not always. But, in the case of cardiac surgery, "getting to the heart" is a very quick process -- a couple of incisions, some clamps & drainage, and there's a heart right in front of you. The time-consuming early part is getting the anesthesia work done (not just sedation, but installing all the necessary ports, tubes and catheters) and hooking them up on a heart/lung bypass. I can't comment on your second point.
- redisman 8y agoWe had a birth recently and the residents (who get paid very little) did 80% of the work while the attending surgeon came and went and probably spent a total of 15 minutes with us. The insurance company was still billed almost 10k for a epidural.
- jrochkind1 8y agoSterilizing and re-using IV lines definitely carries some risk. The alternative to that "risk" in India seems to be letting most not-rich people die because they can not afford to do those things differently. And the Indian health service is telling him he's _still_ costing too much. The result will be taking more risks, with some people paying the price for them. Because that is what India can afford. Meanwhile, in the U.S. we can afford spending two orders of magnitude more. Something is not right.