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In India, 'no frills' hospitals offer $800 heart surgery
- mschuster91 14y agoCouple 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)
- vaadu 14y agoGood luck with the ambulance chasing lawyers in the US. Also, India's drugs are cheaper.
- mschuster91 14y agoAmbulance chasing lawyers? You mean, there exist lawyers who race behind ambulances just to get a mandate from the injured for suing the hospital for any and all possible malpractice? Edit: No need for downvoting. This behaviour even has a Wikipedia article. I am ashamed living on a planet where such things occur.
- philwelch 14y agoIt's just an expression. Lawyers don't literally chase ambulances. It's illegal for lawyers to accost people in the emergency room offering their services, and it's probably illegal to literally chase an ambulance as well due to traffic laws. The story has more to do with suing someone for the personal injury that landed the patient in the hospital in the first place, but it's meant to refer to lawyers going out of their way to recruit clients who might not have even wanted to file suit in the first place, or to unethical, enterprising lawyers in general.
- nairteashop 13y agoOne of my buddies in LA got involved a multi-car accident. Within minutes he had a lawyer stop by his car and drop off his business card in case he could be "of assistance". So yeah, "ambulance chaser" an expression, but sadly very close to reality in some cases...
- toomuchtodo 14y agoWhy are India's drugs cheaper? Is their patent system different than in the US? Or does the government dictate the price drugs can be sold at?
- mschuster91 14y agoBasically, the Indian government doesn't give a sh#t about the methods that US pharma companies are using to generate more revenue in the US (slightly alter the compound so it's basically the same stuff, and then patent the new stuff).
- greesil 14y agowhat patents?
- fakeer 14y agoIf you are referring to now-a-days somewhat popular belief that India doesn't respect patents or has no patent system then I am humbly requesting you to do a little bit of research and you'll find out that it's very very far from the truth. It's just that it doesn't grant a patent on A because the patent of C expired and the company decided to call it A or if rejected then applied again by calling it B. jm2c.
- nairteashop 14y agoIt's both. The Indian supreme court recently rejected Novartis' patent on Glivec, because the formulation wasn't different enough to merit a new patent (I don't know enough to know whether that was the right decision; just pointing out that the patent situation is different). The Indian government also has pricing restrictions on ~350 drugs deemed "essential". On top of this, compared to the US, there's little to no drug marketing in India (yet). Plus lower labor/capital costs, etc.
- ankitml 13y agoNot true, there are huge marketing overheads in India. Drug Marketing in India is much more hidden, companies shower huge gifts and money to doctors to prescribe their drug. SO essentially companies cannot publicly declare this as marketing budget.
- jcnnghm 14y agoOf course their drugs are cheaper, if drugs companies won't sell to them at huge discounts, India ignores the patents and produces the drugs themselves. Consequently, the US subsidizes their drugs, insofar as they do not contribute to the costs of R&D, including research and clinical trials for working and failed drugs. 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. To quantify, about 58% of US medical funding is provided by private industry. Pharmaceuticals alone spend more than the NIH. NIH in the US spends 29 times more than NHS in the UK on health research, despite having only 6 times more people. The US spends 4 times more per capita than Australia on medical research. This is one of the two gigantic elephants in the healthcare debate auditorium, the other being patient outcomes for comparable patients. Of course US aggregate data is skewed because of the general health of the population (fatness), and those without insurance, but what happens when comparing patient outcomes between people with insurance in the US, with people that are comparably healthy (i.e. fatness and related issues) in other countries. The whole thing is basically a health-and-wealth transfer scheme from the insured to the uninsured. We see basically the same thing whenever space research is discussed. Pompous Europeans bash US progress and "meager space funding", while the US outspends the entire world combined over 3 to 1 on space research. In the end, the "solution" to both is to cut spending to both medical and space research to global per-capita levels, and let the advanced research go undone, unless other countries choose to start contributing. Of course, that would be a true tragedy of the commons.
- mschuster91 14y agoWell, but the majority of new US medicine is just modified versions of old substances.
- jcnnghm 14y agoOnce the old substances patent expires, any drug company can produce generics. There is no incentive to ignore patents and produce generics if the patent is expired because other companies will likely be producing generics, assuming there is actually a market for the drug.
- swatkat 14y agoSomewhat related info: Government of Karnataka (an Indian state) has an healthcare insurance for economically poor called 'Yeshasvini'[0]. It covers treatment, surgery and other healthcare expenses for a nominal yearly premium. In fact this was conceptualized by Devi Shetty[1], founder of Narayana Hrudayalaya featured in linked article. [0]http://www.yeshasvini.kar.nic.in/about.htm#about http://www.yeshasvini.kar.nic.in/about.htm#about [1]http://www.narayanahospitals.com/services/corporate-social-responsibility/ngo-support-work/yeshasvini-a-co-operative-farmers-healthcare-scheme/ http://www.narayanahospitals.com/services/corporate-social-r...
- yummyfajitas 14y agoIndia 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, nor is it a redistribution scheme in disguise. The system works quite well. The rest of the world should learn from India.
- Scaevolus 13y agoCan you elaborate? Do you pay the average monthly cost of the entire pool, and then any extra charges the hospital bills?
- yummyfajitas 13y agoTypically 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.
- SapphireSun 13y agoCorrect. 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.
- sgt 14y agoSo cheap it almost makes me feel like having heart surgery just to know I didn't miss out on a great offer.
- kansface 14y agoNo no, you should hold off for their Groupon!
- fakeer 14y agoI live near Manipal Hospital in Bangalore and had to stay with a friend in there, thrice in last 6-7 months. Maybe he likes it there too and I often go to their cafeteria(outside) which is cheap and good. I meet so many foreigners here. I've talked to them; they simply say it's very good - service, expertise - and it's a f*ing loot! And no, this is no such no-frills hospital. So, if you are from a western country and earning even decent money then you are welcome to India and any hospital/hotel/place might make you feel like royalty - mostly without compromising in quality.
- toomuchtodo 14y agoWhy is there no business in the US yet that matches healthcare consumers with these Indian operations? A healthcare travel agent if you will.
- kitcar 14y agoThere are; google "medical tourism" - that being said there is some potential liabilities in that business...
- nairteashop 14y agoOh, there is! Here's a list of such businesses (on the right side of the page): http://www.patientsbeyondborders.com/facilitator http://www.patientsbeyondborders.com/facilitator
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- quentusrex 14y agoAre they releasing any patient follow up statistics? It'd be interesting to compare their post-op complication stats to some of the 'overpriced' facilities.
- Breakthrough 14y agoYes, but to save money, the patients will have to evaluate themselves and send the results back to the doctor instead. [/sarcasm]
- healthenclave 14y agoLooks like you have edited your comment since you first made it. The success rates are high and on par with western counter parts. Also this is a private hospital , I think you haven't visited a good private hospital in a developing country. Many have US/Uk trained docs and quality of service and care on par with that of developed countries.
- rorrr2 13y agoSource?
- raverbashing 14y agoWell, they haven't heard any complaints so far!! Edit: Makes me guess, but what if their success rate is higher than the high priced facilities... Oh and I would absolutely go for medical tourism. Beyond not being overcharged by the procedure, I wouldn't be pushed the "latest drugs" with debatable results or in a case where the latest drug is needed, it would be avaiable at a lower cost.
- logn 14y agoWell you can hire a software engineer in India for $10/hr. I think cost of living should have been at least mentioned in this article.
- healthenclave 14y agoInflation is increasing the cost of living in India and China. A decent apartment (not luxury) will cost you min. $100K in any Indian city (even C and D tier cities) While not as expensive as Manhattan or London, relative to Indian salaries everything is getting expensive.
- fakeer 14y agoAgree. I'm looking for a flat to invest in and I am finding them out of reach, even after taking housing loan and they are running away from me a lot faster than I can catch up, besides, I've already started to pant :( (meaning the salary going to other holes in significant portions)
- areddy 14y agoI visited China for a week. I felt China's inflation is horrible. Everything costs 1.5 to 3x more when compared to India.
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- arbuge 14y agoSome frills might be useful when you're having heart surgery...
- kiba 14y agoJust because their healthcare system is low cost doesn't mean it is of poor quality. Incidently, if you read the article, you will see such claim: "Essentially we realised that as you do more numbers, your results get better and your cost goes down," he said. However, the details on how good their care is very lacking.
- healthenclave 14y agoThis is for people who are earning 2-4$ / day and for majority of Indians and I guess the same model would work for majority of the world , who would not be able to otherwise afford even a $10k medical bill.
- kirubakaran 14y agoNot when the frills mean that you can't afford the surgery at all.
- dclowd9901 13y agoI'd gladly give up $200 aspirin, personally...
- swatkat 14y agoAnother worthy mention is state-run Jayadeva Institute of Cardiovascular Sciences and Research[0]; a Bangalore based hospital that provides state-of-the-art and affordable heart related healthcare services[1]. [0]http://www.jayadevacardiology.com/achievements.html http://www.jayadevacardiology.com/achievements.html [1]http://www.jayadevacardiology.com/procedure_charges.html http://www.jayadevacardiology.com/procedure_charges.html
- TheMagicHorsey 14y agoAn eye hospital operator in India pioneered this model of efficient health care -- not this guy. Check it out the TED talk for Aravind Eye Hospital: https://www.youtube.com/watch?v=b5QCM1_gVGA https://www.youtube.com/watch?v=b5QCM1_gVGA
- brador 14y agoIsn't India one of the top countries for surprise kidney removal? General link: http://en.wikipedia.org/wiki/Organ_trade#Illegal_organ_trade http://en.wikipedia.org/wiki/Organ_trade#Illegal_organ_trade
- harichinnan 14y agoThat's a factual statement. Just like you could've gone to the dentist in Oklahome and got H1V or Hepatitis. http://abcnews.go.com/Health/60-oklahoma-dental-patients-test-positive-hepatitis-hiv/story?id=18991527#.UXQ1Q78Tvu0 http://abcnews.go.com/Health/60-oklahoma-dental-patients-tes...
- brador 14y agoIt's the likelihood that's important, not the binary.
- ajays 14y agoThat's irrelevant to the topic at hand.
- spartango 14y agoThe insinuation is that this hospital is scammy in some way, perhaps covering its costs by harvesting organs. I somewhat understand where that skepticism comes from, as scam operations in developing countries are not unheard of. That said, this would seem to be a big enough operation to not be going down that route, and to be fair, these organ stealing operations are far less common than we fear them to be. Just a bit of paranoia floating around. I'd be far more worried that this operation is taking risks with patient care (in-op and post-op) in its cost cutting. I'd think it much more likely that you walk away from a low-cost hospital with an infection than missing an organ.
- pavanky 14y ago> Payment for…organs is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation and leads to profiteering and human trafficking. That is probably the reason India is ranked high. No "surprise kidney removals". It is usually the rich (and sometimes people from the west) that can not get a transplant legally in their countries opt to buy their way out of it in more lax countries.
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- ams6110 13y agoA modern pre-fab hospital could conceivably be less prone to harbor infectious bacteria than the decades-old facilities that are common in the "1st world." And air-handling systems, particularly air-conditioners, have been known to host veritable breeding colonies of pathogens.
- Dn_Ab 13y agoWhy do you so handily dismiss the article without addressing its content? He is bringing 'expensive' care to people who would otherwise be ignored and making more money to boot. He is doing this by being more efficient, distributed, modular, small and optimizing details right down to architecture and construction. In a world where a large chunk still die from trivial diseases, it is clear current methods do not scale. If this model can safely serve more people, more cheaply and is more profitable then it surely is worth trying. Our current approach to healthcare certainly could do with more efficiency. He states in the article that charity does not scale, even if that is the case, a more efficient healthcare system also improves the efficiency of charity by multiplying how far each unit of currency goes. Is that not what HN is about? There is probably an Amdahl's Law style limit to this approach where certain expensive specialty care does not benefit from this type of parallelization. But much of the world is not healthy enough to have those as major concerns. Separation may be useful there too, perhaps prices for many treatments are inflated from too much coupling of services? We won't know without experimenting. As for your link, I believe this is exacerbated by combining highly sterilized environments with sloppy practices. If people are in and out as quick as possible, and only key areas are kept highly sterile this may actually be a bonus. More practice from high throughput aslo drills checklists. A quick google suggests 2% mortality rate and 3% H-aI. Even if padded, looking at his stats - 15,000 surgeries performed and operating since 2001; if it were really so bad I suspect complaints would be much more forceful and he would not be so profitable. Being profit motivated and no frills gives incentives to pay attention to waste, errors and quicker reaction time in dealing with those.
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- newyankee 14y agoRelevant Al-jazeera documentary http://www.aljazeera.com/programmes/indianhospital/2012/05/20125292412865958.html http://www.aljazeera.com/programmes/indianhospital/2012/05/2...
- hashkanna 13y agothe article mentions Al Jazeera's 6 part coverage on Narayana Hrudalaya. here is the video link. http://www.youtube.com/watch?v=-MqC6ga034U http://www.youtube.com/watch?v=-MqC6ga034U
- curiousfiddler 13y agoI'd like to take a shot at answering this: why is a low cost medical treatment effective in India? 1. For the most part, medical education is good in India. In the better hospitals you will find that doctors are generally very smart and knowledgeable. They also happen to be very practical when suggesting treatments and do consider the treatment cost as a factor when suggesting options. 2. The cost of living in India is lower when compared to the developed world. 3. The equipment cost and medicine cost is also lower compared to the developed world. Also, please understand, India "is not a developed nation". Everyone there "cannot" afford expensive medical treatment. Yet, people who cannot afford expensive treatment "can" suffer from ailments like cancer, heart problems etc. I find it commendable that such people do have a fairly reliable option to save their life, however imperfect it may appear, compared to the system in the developed world. Standards will improve as the country develops, but for now, they offer a good solution.
- skylan_q 13y agoI'm going to guess it's because people in India are allowed to practice medicine and produce equipment. If I were to start practicing medicine and producing equipment up here in Canada I'd be arrested in a heartbeat. (Unless I went through all the hoops, and I again have a hunch there's many more here than in India)
- curiousfiddler 13y agoWell yes they are, but it is regulated (in terms of educational qualification etc). What I was trying to get at, is developing and underdeveloped countries face a lot of problems. To produce worthy result in such circumstances is something definitely worth cheering IMO. There are so many deprived/underdeveloped/developing societies in the world which are similar to India in terms of the resources that they have access to, yet somehow the aspirations of people are not channelized and they end up doing things which are awful (e.g. terrorism). I feel India could be used as a positive example in such cases. There are a lot of inspiring stories of people who perform amazingly well, despite access to very little resources, just because they have a direction in life and an aspiration that is meaningful. I have been inspired by several such stories in my life, which will find absolutely no mention in any western or even local media.
- noonespecial 13y ago"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 innovations coming out of these facilites that would be impossible in the west.
- skylan_q 13y agoNecessity 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.
- Egregore 13y agoWith 4 operations/day they will be the masters of heart surgery, but will they have the time to write scientific papers?
- jmduke 13y ago"Minimum Viable Heart Surgery."
- rubikscube 13y agoThere's some low cost alternatives in the USA too for other types of surgery. http://www.surgerycenterok.com/ http://www.surgerycenterok.com/ They even have the integrity to list prices publicly. It's because they are brave doctors working outside of the government healthcare racket. http://www.surgerycenterok.com/pricing.php http://www.surgerycenterok.com/pricing.php
- eli 13y agoBad headline. From the article: "...the group believes it can cut the cost of heart surgery to an astonishing 800 dollars." It hasn't actually done it yet.
- jbrowning 13y agoHere's a better version of this article with photos of the hospital: http://www.news.com.au/lifestyle/health-fitness/no-frills-hospital-indian-chain-narayana-hrudayalaya-does-surgery-at-fraction-of-the-cost/story-fneuz9ev-1226625469519 http://www.news.com.au/lifestyle/health-fitness/no-frills-ho...
- tn13 13y agoI know some people who were operated at "Narayana Hrudayalaya". One of my relative had received treatment there. Like any other news reports the $800 figure is a bit of exaggeration. The total cost of the surgery including travel, additional stay at hospital, pre and post-surgery treatment etc. costs around <$2500. More power to NH.
- Attocs 13y agoDespite my cynicism, I too have had a positive experience with at least one Indian medical institute. Instead of using general anesthetic and an operating theater to work on my friend (which would have required several nights recovery in a hospital) they operated on him under local anesthetic in the dentist's chair. It wasn't pretty but it was a complete success. Other doctors had quoted me 60,000 rupees for the procedure ($1100 USD) but the whole thing was done for 10,000 rupees ($184 USD). Working with people who live on the street, I cross paths with the medical profession here regularly. Some doctors have proven to be pretty apathetic, but the odd one, through the necessity of giving affordable health care to India's thronging poor, has proven to be truly innovative. An account of discount surgery here: http://lostinmumbai.org/2013/03/11/9/ http://lostinmumbai.org/2013/03/11/9/ Some of the discount was good will but a lot was innovation and the ability to take risks through the absence of repercussions.