6 ms·

The US healthcare system is absurdly inefficient but the nominal cost comparison given in the article is meaningless since wages make up a huge proportion of co

The US healthcare system is absurdly inefficient but the nominal cost comparison given in the article is meaningless since wages make up a huge proportion of costs in healthcare (either directly or embedded in supplies and services.) Nominal per capita income in India is ~$2000 while in the US it is ~$60,000. Simplistically one would expect costs to be approximately 30x higher in the US so a 20x difference in cost of $200,000 to $10,00 doesn't seem absurd.

riahi 8y ago
Agree. I have seen estimates place purchasing power parity of USD in India as 0.3, implying that $100 spent in India purchases as much value as $300 in the USA. This would imply a $10,000 surgery in India is somewhere in the realm of $33,000 in the USA. I have no idea on the DRG associated with pulmonary thrombectomy to even estimate what Medicare allows for reimbursement, but it’s not going to be $200,000. If I find it, I will reply to this comment with an estimate. Purchasing power parity compared to USA: https://data.worldbank.org/indicator/PA.NUS.PPPC.RF https://data.worldbank.org/indicator/PA.NUS.PPPC.RF
- riahi 8y ago
  I looked into the data. This would probably be under DRG 252, 253, or 254 (DRG 252 OTHER VASCULAR PROCEDURES WITH MAJOR COMPLICATION OR COMORBIDITY, 253 OTHER VASCULAR PROCEDURES WITH COMPLICATION OR COMORBIDITY, 254 OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION OR COMORBIDITY) The medicare DRG data is available here https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/medicare-provider-charge-data/inpatient.html https://www.cms.gov/research-statistics-data-and-systems/sta... Covered charges for 2016 ranged from ~$64,000 to ~$110,000, with ACTUAL average total payments ranging $13,000 to $26,000. This article is using differences in purchasing power parity AND the difference in charges / actual payments to generate an eye-popping headline. At the actual data level, India is more expensive compared to the US.
  - conductr 8y ago
    Hospitals usually lose money on Medicare and that’s part of the reason other payors have to pay subsidy rates. Not saying they pay sticker price they are billed but I doubt 13-26k is the average reimbursement for any procedure that ties up an OR for a full day (according to the article).
    - riahi 8y ago
      Inpatient care for many major procedures are bundled under Medicare. This is actually the reimbursement for the entire hospitalization. Yes many places lose money in Medicare as it probably reimburses at around 80% of cost but it’s the only data we have, so it provides the closest thing to a national comparison. My point is that what this article ultimately shows is that the cross border comparison can generate striking numbers but almost all articles like this never place the Indian “cheap” numbers in context.
bluedino 8y ago
What does a doctor make in the USA vs India?
- noir_lord 8y ago
  Lawsuits I think.
robertAngst 8y ago
https://www.opensecrets.org/lobby/top.php?indexType=s https://www.opensecrets.org/lobby/top.php?indexType=s Can we start blaming Physicians and Pharmacists yet? Physicians are 300k+/yr earners because they artificially limit admissions of medical school. Not to mention its dangerous to use Pharmacists in 2019. Everything should be done by computers. Expensive Dangerous rubber stamp. But yes, Hospitals, insurance companies, and pharmacies are to blame. To no surprise, all top 20 lobbyists, hundreds of millions of dollars.
- pas 8y ago
  > they artificially limit admissions of medical school Do they? I thought it was about number of residency spots available that was the real bottleneck. Anyway, sources please!
  - scarejunba 8y ago
    They did when I was younger. Fortunately, I work in a field without massive administrative fiat and my skill is sufficient. See https://usatoday30.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm https://usatoday30.usatoday.com/news/health/2005-03-02-docto... There's other news, but based on the amount of time it takes to make a doctor and the hysteresis in the market, this should do.

riahi 8y ago

Agree. I have seen estimates place purchasing power parity of USD in India as 0.3, implying that $100 spent in India purchases as much value as $300 in the USA. This would imply a $10,000 surgery in India is somewhere in the realm of $33,000 in the USA. I have no idea on the DRG associated with pulmonary thrombectomy to even estimate what Medicare allows for reimbursement, but it’s not going to be $200,000. If I find it, I will reply to this comment with an estimate. Purchasing power parity compared to USA: https://data.worldbank.org/indicator/PA.NUS.PPPC.RF https://data.worldbank.org/indicator/PA.NUS.PPPC.RF

riahi 8y ago
I looked into the data. This would probably be under DRG 252, 253, or 254 (DRG 252 OTHER VASCULAR PROCEDURES WITH MAJOR COMPLICATION OR COMORBIDITY, 253 OTHER VASCULAR PROCEDURES WITH COMPLICATION OR COMORBIDITY, 254 OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION OR COMORBIDITY) The medicare DRG data is available here https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/medicare-provider-charge-data/inpatient.html https://www.cms.gov/research-statistics-data-and-systems/sta... Covered charges for 2016 ranged from ~$64,000 to ~$110,000, with ACTUAL average total payments ranging $13,000 to $26,000. This article is using differences in purchasing power parity AND the difference in charges / actual payments to generate an eye-popping headline. At the actual data level, India is more expensive compared to the US.
- conductr 8y ago
  Hospitals usually lose money on Medicare and that’s part of the reason other payors have to pay subsidy rates. Not saying they pay sticker price they are billed but I doubt 13-26k is the average reimbursement for any procedure that ties up an OR for a full day (according to the article).
  - riahi 8y ago
    Inpatient care for many major procedures are bundled under Medicare. This is actually the reimbursement for the entire hospitalization. Yes many places lose money in Medicare as it probably reimburses at around 80% of cost but it’s the only data we have, so it provides the closest thing to a national comparison. My point is that what this article ultimately shows is that the cross border comparison can generate striking numbers but almost all articles like this never place the Indian “cheap” numbers in context.

bluedino 8y ago

What does a doctor make in the USA vs India?

noir_lord 8y ago
Lawsuits I think.

robertAngst 8y ago

https://www.opensecrets.org/lobby/top.php?indexType=s https://www.opensecrets.org/lobby/top.php?indexType=s Can we start blaming Physicians and Pharmacists yet? Physicians are 300k+/yr earners because they artificially limit admissions of medical school. Not to mention its dangerous to use Pharmacists in 2019. Everything should be done by computers. Expensive Dangerous rubber stamp. But yes, Hospitals, insurance companies, and pharmacies are to blame. To no surprise, all top 20 lobbyists, hundreds of millions of dollars.

pas 8y ago
> they artificially limit admissions of medical school Do they? I thought it was about number of residency spots available that was the real bottleneck. Anyway, sources please!
- scarejunba 8y ago
  They did when I was younger. Fortunately, I work in a field without massive administrative fiat and my skill is sufficient. See https://usatoday30.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm https://usatoday30.usatoday.com/news/health/2005-03-02-docto... There's other news, but based on the amount of time it takes to make a doctor and the hysteresis in the market, this should do.