21 ms·

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

• asitkumar 13y ago
  India is just cheap and best :> I wonder it would be great if the medical facilities in india be improved considering the huge mass of population.
• ctrl_freak 13y ago
  You would think more Americans would fly to India to get expensive medical procedures done. Or are there other issues that need to be overcome to do this?
  • hartror 13y ago
    http://en.wikipedia.org/wiki/Medical_tourism#India http://en.wikipedia.org/wiki/Medical_tourism#India
  • acchow 13y ago
    Some insurance companies even throw in a cash incentive. "Need a heart bypass? We'll give you $10k and waive the co-pay if you do it in India"
  • venomsnake 13y ago
    A few things: 1. People don't know about it. 2. Are the outcomes comparable? 3. Legal protection - you will have hard time suing Indian specialist in India and there won't be much damages to extract anyway. 4. Age? A good chunk of people that need that types of surgeries are well covered by Medicare. 5. You also need plane tickets, recovery time and at least one companion - so you may look at a lot higher total cost. 6. Plain old fear/ racism. And the moment it becomes common there will be the full media smear campaign, scaremongering etc
    • seanmcdirmid 13y ago
      Besides, Cuba is closer. Canada is also a bargain compared to the US and you don't even have to violate state department rules. However, ironically enough, the USA has a booming medical tourism industry also. At about 60-80k, it is only half as small as India (150,000), though nowhere near Thailand (1.42 million).
• joshmn 13y ago
  As an American. this makes me sad. Just sick to my stomach. It's just greed.
  • noonespecial 13y ago
    But its not just greed. Greed is also whats driving the Indian entrepreneurs to try to offer the surgeries cheaply and en-mass. Its more than that. Its unfair exploitation, regulatory capture, raw corruption and senseless parasitism. Its greed mutated and run amok. Its what happens when you get greed wet and then feed it after midnight.
    • eru 13y ago
      Actually, in this case it is not greed in India. The guy running the show is a `real hero'. But the US has plenty of self-less people, too.
• danboarder 13y ago
  I found it fascinating how this goes way beyond wage differences -- it's a serious focus on fiscal efficiency. The entrepreneur behind this has opened 21 new hospitals in India focused on bringing more affordable care: "...he has cut the price of artery-clearing coronary bypass surgery to 95,000 rupees ($1,583), half of what it was 20 years ago, and wants to get the price down to $800 within a decade." This leaves me wondering: Where is the innovation toward affordable care here in the USA?
  • bobdvb 13y ago
    What incentive is there in the USA to reduce healthcare costs? The system is totally corrupt.
    • pliny 13y ago
      I don't know much about the American healthcare system, but wouldn't it be the same incentive when selling any product? If you sell the same quality product for cheaper, you will get more business than your competitors. That's what competition in a free market is, no?
      • arjie 13y ago
        The high barriers to entry in the field make it conducive to collusion. I'm not saying there is collusion, just saying that given that the supply isn't going away and that new upstarts cannot disrupt the market, you may make more money by not competing on price.
      • anonymoushn 13y ago
        There are some people doing this, like this surgery center in Oklahoma http://kfor.com/2013/07/08/okc-hospital-posting-surgery-prices-online/ http://kfor.com/2013/07/08/okc-hospital-posting-surgery-pric... For most of the market, price competition does not occur because providers will not disclose the price of a service before selling it.
      • IbJacked 13y ago
        That's how it should work. Unfortunately, the U.S. healthcare system isn't really a free market. There are many laws and regulations (and insurance company imposed rules) that prevent healthy competition in the marketplace.
• DigitalSea 13y ago
  The first supposed fact thrown around in the medical costs argument like this is, "Well in India their cost of living is lower, so they charge considerably less, yadda yadda..." but it's obvious the price difference goes way beyond any cost of living gap. That's over $100,000 in price difference, while it is true the cost of living (salary, prices of every day items) in India is considerably less than that of the US, the gap certainly isn't 100k+ It's comparisons like these that really make you sick to your stomach. You don't see this kind of innovation in the American health system because it has been engineered with greed in mind right from the start. The lobbyist super groups, hospitals being paid kickbacks for using an exclusive medical equipment provider, the money hungry mentality of US medical corporations is more than obvious. I think when your medical system becomes so expensive it's cheaper for people to fly out of the country, pay for accommodation and even some spending money to get the same level of care, if not higher than that of your own country, regardless of cost of living differences and other nation specific costs that's absolutely ridiculous. By the sounds of it, India is going to be the new global superpower if more and more people fly there to pay for medical treatment it benefits their economy in the end (given how a substantial chunk of the population is below the poverty line, this might not be such a bad thing). A doctor trained in India is no less qualified than a doctor trained in the US. So expertise or training is no excuse either. In-fact I've found Indian trained specialists to be more thorough, careful, understanding and compassionate in comparison to that of Australian trained medical professionals (I'm from Australia). When was the last time you saw or heard of a poor American medical specialist or surgeon? The question is: Will America ever change their ways? Or will quality medical care only be reserved for those who can afford decent medical insurance or have jobs that provide fair medical benefits? One thing is for certain, this is submission is going to garner a lot of responses from both sides of the fence if past submissions along these lines are anything to go by.
  • seanmcdirmid 13y ago
    > A doctor trained in India is no less qualified than a doctor trained in the US. In general? http://blogs.worldbank.org/developmenttalk/shocking-facts-about-primary-health-care-in-india-and-their-implications http://blogs.worldbank.org/developmenttalk/shocking-facts-ab... > It’s also pretty staggering that hiring qualified staff doesn’t appear to increase this probability. Das and colleagues suggest that part of the issue might be the variation in the quality of instruction in Indian medical training institutions. So there may be some institutions from which a qualification does make a difference. But given the paper’s results, the effect of such institutions must be rather small. The fact that providers working in better equipped facilities don’t have a higher probability of prescribing the right treatment is also alarming. Obviously, heart surgery isn't rocket science, and our medical training is a bit overpriced, but is it so easy to compare two disjoint systems?
• randomtree 13y ago
  What is the survival rate in India after that procedure, comparing to the US? My colleague _visited_ India and returned with a stomach flu, spent a week in a hospital.
  • mataug 13y ago
    The reason for your colleague's stomach flu might be because of some unsafe food. Most hospitals and clinics are infact quite clean and well maintained.
  • femto 13y ago
    30 day mortality rate is 1.4% vs. 1.9% in the US in 2008 [1]. The claim is that due to the high volume and single service, the surgeons get an awful lot of practice at the procedure and become very good at it. [1] http://www.theaustralian.com.au/archive/business-old/the-henry-ford-of-heart-surgery-devi-shettys-business-model-delivers-cheap-medical-care/story-e6frg90x-1225801548287 http://www.theaustralian.com.au/archive/business-old/the-hen...
  • Andrenid 13y ago
    So because your friend ate some bad food, that country's hospitals must be unhygenic? Yup, I totally see the correlation there. I'm Australian, visited the US and got severe Salmonella poisoning in Vegas... the US must have really shocking road safety laws.
    • pacomerh 13y ago
      Same here, got salmonella in Los Angeles eating at a subway. Point being, you can get sick anywhere, other factors include your body getting used to new organisms.
    • randomtree 13y ago
      My Indian friend who spent ten years in US went to visit his parents, he said he was going to buy bottled water while there and boil it before drinking. He was genuinely anxious about catching something. So yes, the low mortality rate after surgeries is actually a surprise for me.
• pravda 13y ago
  It's not greed, it's a consequence of health insurance. Get rid of health insurance and prices would drop 10x.
  • sdoering 13y ago
    Would they? Or would the poor middle class people not being able to afford cancer-treatment/heard surgery just have a considerably lower life-expectancy? I am not sure, so I really would love to see the numbers/facts supporting your statement. Would love to learn of this magic fact. [cynicism end] [Edit]: Typo [Edit 2:] In Germany, with full health-insurance the cost for a Cardiopulmonary bypass are round about 30k €. So a lot cheaper, than in the US, despite health insurance. Just wanted to present a fact, not let my comment stand as cynicism only.
    • deleted 13y ago
      [deleted]
    • pravda 13y ago
      First of all, I am sure the 106K figure is a phony 'list price' figure and not reflective of how much is actually paid. Second of all, you ignore the incredible sums of money taken from the 'poor middle class' and handed over to the health industrial complex. For most of this country's history [the USA], there was no such thing as health insurance. The poor got charity care and the middle class were able to pay. Why do you think cancer treatment has to be expensive?
      • sdoering 13y ago
        I am not stating, that it might drive prices down. As I would not be stating, that it might drive prices up. I wouldn't do this, because I do not have the necessary facts to make such a claim. If a health-insurance system would work right, the health insurance agency might have a lot of more leverage in this highly regulated market, then any individual paying for its own. But that is just an assumption. Well your next statement regarding my ironic "poor middle class" is just that: a statement, without any facts to support it. I was asking for facts to support your statements. I even did some preliminary research into the costs of comparable healthcare in Germany (where I am from). I just wanted to learn, if a "no health care" system might work better and be cheaper, but I will not just believe your statements, as that would just go against everything, I value. So I really beg you, to show me verifiable facts substantiating your statements. Please?
• teyc 13y ago
  This is classic disruption at work. There are many procedures e.g. cataract surgery costs have come down but they are such cash cows that the prices were held high. India is doing this because skills can scale if there is a system of training. It wasn't too long ago when I read the Russians invented a factory-line method of doing eye-surgery.
  • jimgardener 13y ago
    Five years back,my father got both his eyes operated upon for cataract removal at Coimbatore,India as part of some free Eye camp program.This year, my mom had cataract in both eyes surgically corrected in a private hospital in North Kerala.They charged only Rs.9500/- per eye,and the treatment was quite good.Now my Mom has 6/6 vision in both eyes.
• chiachun 13y ago
  The situation in other Asian countries like India, Taiwan, or South Korea is nearly the same. There are still some obstables. A different environment and unknown results may be the major ones. People should try to calculate the overall outcome and costs and maybe come up with some good international insurance packages.
• kapad 13y ago
  Medical tourism has hurt most Indians. 1583 USD is almost 100k INR. The average per capita income in India is 1219 USD (72k INR). This figure too is very misleading, since poverty is a huge problem. A very simple plotting with data from wikipedia and rudimentary extrapolation, shows that more than 1.1 billion Indian's annual income is less than the current cost of heart surgery. India's total population is 1.2 billion. Medical tourism, though very fine for a lot of folks who want a cheaper alternative, is driving up the cost of medical treatments in India by leaps and bounds. This makes surgeries, that were already very expensive and out of the reach of most Indian's even more expensive and out of the reach of even more people. Sources: http://en.wikipedia.org/wiki/Income_in_India http://en.wikipedia.org/wiki/Income_in_India http://en.wikipedia.org/wiki/Poverty_in_India http://en.wikipedia.org/wiki/Poverty_in_India Simpel graph of the poverty data : http://imgur.com/JngiK8W http://imgur.com/JngiK8W (I used this to find the number of people with an annual income less than 1583 USD)
  • sheri 13y ago
    > Medical tourism, though very fine for a lot of folks who want a cheaper alternative, is driving up the cost of medical treatments in India by leaps and bounds. Any evidence to back this up? Your links and statistics are about how this specific cost is still out of reach of a lot of people. I don't think anyone is debating that. > This makes surgeries, that were already very expensive and out of the reach of most Indian's even more expensive and out of the reach of even more people. The article shows how the cost of surgery has dropped over time, and their goal being to drop it further.
  • g8oz 13y ago
    Ah, the medical version of the "fixed lump of labor" fallacy.
  • cabalamat 13y ago
    > Medical tourism, though very fine for a lot of folks who want a cheaper alternative, is driving up the cost of medical treatments in India by leaps and bounds. In the short term, maybe. In the long term surely it will reduce costs or at least stabilise them. Millions of CPUs and RAM chips are sold every year, but the price of them doesn't keep going up, does it?
• barking 13y ago
  In my country I know of a hepatologist who claims to have seen higher than normal rates of hepatitis B amongst people who have travelled to lower cost countries for dental treatment. One country was mentioned in particular (not India as it happens).
  • koralatov 13y ago
    Your comment left out the single most important piece of information: the country in which the treatment took place. I have no plans, and thankfully no need, to go abroad for low-cost treatment of any sort, but someone reading your comment might, and the key fact you omitted might stop them making a horrible mistake.
    • barking 13y ago
      I was tempted to mention it. But what I am writing is hearsay until such time as this doctor goes public with it, if he ever does that. If it's true it would cause a major controversy in the EU.
• shameerc 13y ago
  I'm just curious to know the situation in countries like Russia and China, because many of my friends took their medical degree from those Countries. Is is just the education is cheaper or entire industry?
  • pipirupirupi 13y ago
    >Is is just the education is cheaper In Russia medical and other uni education free if you can pass entrance tests.
  • piyushpr134 13y ago
    I am from India. I think one major cost factor is price of medicine. In India, you can get medicine at very low cost compared to the west. Salary and dollar conversion/PPP are also major cost factors. For instance, a urine test costs $1-$1.5 in India, urine culture is about $6, a USG scan is about $14. In USA, urine routine is $30, culture is $70 and USG is $750
• patio11 13y ago
  Somewhere there is a forum of doctors saying "Pfft, the US firm wants $100k for the patient records system and the Indian firm wants $1,000. Those greedy bastards! They live in a toxic industry which acts as parasites on us noble public servants saving lives every day. It serves them right to deal with international competition finally. Let's go with the Indian bidder. What could possibly go wrong."
  • noonespecial 13y ago
    Lots of stuff. But the question isn't about which of those two systems will be better in the end. The question is what to do when you've only got $75k.
  • anu_gupta 13y ago
    Not sure what you're trying to say here. You seem to be trying to defend the cost of a $100,000 operation by making a snarky comparison with outsourcing an IT project. Is that actually what you meant?
    • w1ntermute 13y ago
      patio11 has a long history of making snarky comments about how outsourcing to India should not be a concern to Western IT workers because the quality of Indian IT workers is much lower than that of Western IT workers and clients will ultimately recognize this and hire a Westerner instead. This is presumably something that is quite near and dear to him, as he is an American expat who lives in Gifu, a tiny, rural Japanese town. Since his primary income source (outside of Bingo Card Creator and Appointment Reminder) is doing consulting work for Western customers, it's very important to him that they pick him over Indian consultants based on how good he is, since hiring him presents all the same issues with respect to time zone, distance, etc. that hiring an Indian would. He probably experienced a lot of difficulty initially in acquiring customers (who opted to go with the much cheaper, Indian consultants), which is why he has such an oversized Internet presence, including on Hacker News - it has helped build a brand for himself that isn't location-specific.
      • 13y ago
• swatkat 13y ago
  Jayadeva Institute of Cardiovascular Sciences and Research, a popular hospital in Bangalore, publish procedure charges (in Rupees) on their website. Might be interesting for comparison. http://www.jayadevacardiology.com/procedure_charges.html http://www.jayadevacardiology.com/procedure_charges.html
• carbocation 13y ago
  I can assure you that the doctors doing 1-2 CABGs per day are not making $30M-$70M/year. Alas I don't know how much the hospital takes, but I know that there are ~500,000 CABGs per year. I suspect that we as a nation are not spending $50 billion annually on CABGs, but I could be off.
• nazgulnarsil 13y ago
  "greed" is generally a code word for "incentives are too complex for me to bother to try to understand."
• tenfingers 13y ago
  I'd like to point out that the price difference is most likely to do with the marked conditions of the health care in general, and has nothing to do with the quality of the operation itself. There is a big problem with health care in most countries that I've been living into for extended periods of time (France, Italy and to a lesser extent Germany). Anything sorrounding "medical" and/or "health care" has a 10x-100x price blowup, for absolutely no reason. I'm not even speaking about surgery, I can start by phisiotherapy consumables, such as elastic bands. Elastic bands are used in phisical rehab. They are dirt cheap, usually, if you buy them inside a child play store. But behold, if you buy the same stuff from "Thera Band", which is officially sold to hospitals and clinics, a couple of meters of the stuff will cost you 20-30 times more. I worked as an assistant in a phisical rehab clinic for several years, and this kind of bullshit is amazing, because it goes for everything (air balls, plastic rods for balancing excercises, and so on). The price inflation goes even higher with actual machines. There is a machine which is called "Rehab 3xxxx" (produced by a clinic around here which I helped develop, so I won't disclose the details), which is just a linear actuator which moves back and forth. Literally, nothing more. There is an embedded controller which allows to tune the extension limits, and a couple of ABS plastic accessories that hold to the knee, wrist, etc. The idea is just to move the articulation, and/or rotate it, over and over. You would think that there is something "fancy" about it, to name a few details which I wished this machine had: * force feedback to stop the motion (right now the machine will just twist your arm as configured, no matter the force) * speed regulation (who needs it? just one speed is good enough) * some sort of patient-id so that you don't need to reconfigure it each time But not really. Like I said, this is just a dumb linear actuator, with incredibly cheap ABS plastic accessories and a fancy name. Price? 30k euros in the basic kit. The funny part: for anything medical, you have to demonstrate that this machine is effective somehow. So we had a trial in an hospital, wrote an article about the effectiveness (or lack thereof) and did some paperwork. The idea is that you just have to demonstrate that it doesn't hurt. Of course, a physiotherapist will be twice as effective, but it's more expensive on an hourly basis, so that's why clinics love to buy the machine and just let patients sit on it. I'm literally disgusted, but I can see everything around "medical" equipment having the same issues. All the economy surrounding hospitals, doctors and equipment is essentially broken, because there's essentially no competition, assured money (by the state in this case) and a lot of corruption going on within the clinics and medical companies (unfortunately). edit: english.
• bluecalm 13y ago
  Another case: I live in Poland and needed a knee surgery (arthroscopy). Costs: -visit to a doctor and diagnosis (30$ per visit) -MRI of a knee (135$) -surgery + one day stay in private clinic (1k$) So now I wanted to pay for everything without help of our health care system because that would mean waiting. When I tell people in US MRI costs 135$ in Poland they just can't believe it and this is in commercial clinic so they make money here, it has nothing to do with national health care system as I didn't use any refunds.
  • skyjumpr 13y ago
    Do you mind if I ask where you went for such a cheap arthroscopy? I'm possibly in the market for this procedure myself, trying to weigh all the options.
• DanBC 13y ago
  People have mentioned the cost of MRI scans in the US. How much would it cost to buy a bunch of scanners (full body, and bucket-type for arms and legs) and employ technicians to do the scanning and offer this as a service to hospitals? You could have technicians working on shifts to have out-of-hours scanning. The scans are provided in electronic format to the patient and to the doctors specified by the patient. The centre encrypts all the scans and stores them for X years to cover regulation and litigation. There's a big capital investment cost, but you're not doing any actual medicine there (no interpretation of scans, for example) and so litigation risk is reduced. You can concentrate on churning people through the machines, you don't have to give way to emergency cases that need immediate scans. And the price of a scan can be listed up front. Is this a stupid idea? (Or is it already being done?)
  • Steko 13y ago
    You've framed it as consumer friendly but basically your hypothetical shop, on top of being another middleman, has gained a weak local monopoly on MRI's. That sounds like it's going to be bad for both consumers and hospitals which is why it would never happen. As a sidenote the problem with MRI's isn't a lack of supply. A popular factoid a few years ago was that Pittsburgh had more MRI machines than Canada. Even if that was only half accurate it tells part of the story about high MRI costs.
  • IvyMike 13y ago
    That's not too far from the way things worked when I got my MRI. Type "medical imaging" and your town's name to find local storefront MRI shops. The interpretation of the scan is still the cost bottleneck. It's a specialized skill, and is not something your doctor wants to do own their own.
  • spartango 13y ago
    Just a heads up, MRI machines cost 10s of millions of dollars and come with $1M+/yr service contracts. They have pretty substantial power costs as well. They are sufficiently expensive that some big institutions lease them from the manufacturer. I won't delve into the other parts of your idea, which likely have merit, but just realize that the costs of running such an operation would not be small.
• GFischer 13y ago
  I've posted about this a LOT here on HN, because I live in a country (Uruguay) that has a good level of medicine and prices are way cheaper (heart surgery as described would be at least an order of magnitude cheaper than in the U.S.). One possible explanation I came up with was: U.S. hospitals have legions of well-paid administrators doing paperwork for insurance companies, which will have legions of people doing paperwork on their side, and government doing its bit, and lawyers doing their thing. All that money is obviously not going directly into healthcare, it's basically monstruous bureaucracy friction. I suspect "real" healthcare costs, even factoring expensive U.S. doctors, would be shockingly cheap. There are also other "hidden" legal costs, such as the cost of malpractice insurance, and overcosts due to doctors being extremely worried about being sued over malpractice and ordering unnecessary tests. Is there a "transparent" U.S. medical institution whose expense records could be examined to come up with where all the money is going? That said, the article compares with Ohio's Cleveland Clinic, which is the most famous heart surgery clinic. Supply and demand alone will make heart surgery there an order of magnitude more expensive, regardless of actual costs. But I've heard most U.S. clinics arent that much cheaper. https://news.ycombinator.com/item?id=6077593 https://news.ycombinator.com/item?id=6077593 https://news.ycombinator.com/item?id=6019464 https://news.ycombinator.com/item?id=6019464 https://news.ycombinator.com/item?id=5763001 https://news.ycombinator.com/item?id=5763001 (I was really surprised by that one, why ARE ambulances so expensive in the U.S.?)
• yaix 13y ago
  Maybe it would make more sense to compare it to prices in Europe or other places with similar medical standards. My guess would be $100k in the US is about $50k in other places. At least my travel health insurence charges twice the rate if I travel to the US compared to "rest of the world".
• rayiner 13y ago
  First, adjusted for PPP that is more like $3,000. Second, nearly all personal and professional services cost way more in the U.S. Try hiring a nanny in India versus the U.S. and compare the prices. In any case, whenever you talk about prices, it's important to try and think about it in terms of supply and demand. Why might prices for similar services be lower in India? In both countries, the price for that heart surgery is roughly the same order of magnitude as the per-capita income. But the median Indian is living far closer to subsistence than the median American. India's population is 70%+ rural and slightly over 50% are dependent on agriculture. Heart surgery isn't really an option for the median Indian.[1] While it may be financially catastrophic for the median American, between insurance, Medicare, Medicaid, etc, it is an option for the median American. The net result is that demand for heart surgeries, relative to the population, is far lower in India. At the same time, the supply of doctors is higher. Being a doctor is considered socially desirable in India, and as a result there is a good educational infrastructure in place and plenty of candidates. Higher supply and lower relative demand = lower prices. I bet you can explain a lot about the U.S. healthcare industry in terms of regulatory issues, etc, but the magnitude of the impact of that is probably the difference between the U.S. and the UK, not the U.S. and India. [1] It should be noted that when people give anecdotal reports about what things are like in India, there is tremendous perspective distortion. People will often pretend like relatively well-off people living in the cities are the "typical Indian" when in reality they're probably in the top 10%. It's as if the vast majority of India, poor and rural, doesn't exist.
  • wslh 13y ago
    Another thing to analyze is what's called "diseconomies of scale" where costs and/or prices rise with scale. Also many countries subsidize the health sector.
  • eru 13y ago
    > Higher supply and lower relative demand = lower prices. For manufactured goods and services that's not true in the _long run_. Higher demand will eventually bring down prices, and goods in low general demand will not see the innovation that brings down costs.
• deleted 13y ago
  [deleted]
• danso 13y ago
  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 people, with just 9 surgeons (Gawande says that'd be comparable to the state of Kansas having 9 surgeons): http://www.amazon.com/dp/0312427654 http://www.amazon.com/dp/0312427654 note: It's a little OT, but I guess it's an interesting anecdote because it talks about how absolutely significant surgical innovation (not just, "good for the India masses") can occur in desperate situations. I have no idea if that applies to the state of the art of heart surgery in India. ------------ Among the many distressing things I saw in Nanded, one was the incredible numbers of patients with perforated ulcers. In my eight years of surgical training, I had seen only one patient with an ulcer so severe that the stomach’s acid had eroded a hole in the intestine. But Nanded is in a part of the country where people eat intensely hot chili peppers, and patients arrived almost nightly with the condition, usually in severe pain and going into shock after the hours of delay involved in traveling from their villages. The only treatment at that point is surgical. A surgeon must take the patient to the operating room urgently, make a slash down the middle of the abdomen, wash out all the bilious and infected fluid, find the hole in the duodenum, and repair it. This is a big and traumatic operation, and often these patients were in no condition to survive it. So Motewar did a remarkable thing. He invented a new operation: a laparoscopic repair of the ulcerous perforation, using quarter-inch incisions and taking an average of forty-five minutes. When I later told colleagues at home about the operation, they were incredulous. It did not seem possible. Motewar, however, had mulled over the ulcer problem off and on for years and became convinced he could devise a better treatment. His department was able to obtain some older laparoscopic equipment inexpensively. An assistant was made personally responsible for keeping it clean and in working order. And over time, Motewar carefully worked out his technique. I saw him do the operation, and it was elegant and swift. He even did a randomized trial, which he presented at a conference and which revealed the operation to have fewer complications and a far more rapid recovery than the standard procedure. In that remote, dust-covered town in Maharashtra, Motewar and his colleagues had become among the most proficient ulcer surgeons in the world.
  • 13y ago
• riahi 13y ago
  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 surgical procedures done on the heart, including valve replacement, vascular repairs of the aorta/vena cava/pulmonary vessels, and coronary bypass. These span a wide variety of DRG codes, including 216-221 for valve replacement, 228 (other cardiothoracic procedures with major complications), and 231-236 for cardiac bypass. Assuming we are comparing the operation known as coronary bypass grafting, then 238 is a decent enough code to use, with the proviso that it's not the best source for data. Looking at the numbers claimed: If you download the Excel file from CMS [1], you can sort by DRG and Provider Name. Yes, if you search by DRG 238 and filter by Cleveland Clinic you will get $106,385 charged to Medicare. However, what the article completely leaves out (and anyone in medical practice will assume) is that Medicare simply does not pay the amount covered. Average Total Payments by Medicare: $26,898. That's how much Cleveland Clinic gets reimbursed, on average, by Medicare for any procedure included in DRG 238. It gets more interesting when you include all providers and sort by average total payments. The highest average Medicare reimbursement to anyone for DRG 238 is $54,682; the lowest $13,233. Another interesting example: In Alabama, at Brookwood Medical Center, DRG 238 covers $111,008 and only reimburses $15,552. These comparisons of the US system to outside countries really need to compare average US reimbursement to their stated cost, because they sure aren't funding an army of administrators to get the insurance companies to pay up. In summary, you can get "open heart surgery" in the US (Alabama) for "$15,552". I wonder what the Alabama price is if you walk in and offer to pay cash. If you can get it at the Medicare reimbursement rate, that compares decently to the Indian price. [1] http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html http://www.cms.gov/Research-Statistics-Data-and-Systems/Stat...
  • refurb 13y ago
    Nice catch! You are correct, it's the reimbursement that counts, not what the hospital claims are its expenses! The differences in payment between the hospitals is due to the DRG payment adjustments for local cost of living, disproportionate share, etc.
• larrywright 13y ago
  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 had nobody else to shuttle around. When I was working, he just waited around for me to call. The cost for all of this? US $25, for the entire week. That's what I paid the car service, so he's getting some amount less than that. All this to say: These sorts of comparisons are not as dramatic as they seem.
  • lewstherin 13y ago
    That seems absurdly low. I stay in Chennai and typical taxi rates run upwards of 18Rs per KM (approx 0.48US$ per mile). I agree there is a considerable difference in the cost of living, but what you likely paid the guy was a tip for the entire week. Even assuming the car, gas etc. was paid by your company, the amount still seems low for a driver's fee for a week. My dad's driver makes 11,000INR a month. 94,000 Rupees is a lot of money in India but it is not so huge either. A small local doctor in a city will make around that money in a month. (ps: If you actually had a guy driving you for 25$ in Chennai, do pass me his number. I will happily use him.)
    • manojlds 13y ago
      Yes, $25 per week is too low. Heck, I recently paid that amount for a 60km trip in Chennai ( 2 hours of travel ) 94,000 Rs. - for comparison sake, my motor bike costed me Rs.99,000. It is definitely a high amount for many Indians, but the average middle class person might be able to pay it in India.
    • larrywright 13y ago
      All I know is what was on the hotel bill (Westin). It's possible that they had negotiated a rate with the service. I did tip, based on the guideline I was told, about 50 rupees per day.
  • chetanahuja 13y ago
• joseflavio 13y ago
  I believe that the high medical costs are exactly the result of Free market in the long run. Entities will always unite to get stronger, control the market and to do so they will support little by little laws that allow this. Just my 2c, but if you don't keep your laws and democratic institutions distant from the big money... the free market will transform in a legal monopoly.
• socialmediaisbs 13y ago
  Just had heart surgery. It's closer to $170,000 here in the states. :-/
  • firefoxNX11 13y ago
    Just curious - How much was it covered by health insurance?
• grandalf 13y ago
  For anyone interested, I'll perform heart surgery for you in India for only $1200.
• muzz 13y ago
  From the article it's not clear what the major drivers are in bringing down the costs. What I've gathered from the piece and another link posted in the comments: * No air conditioning * Buying used scrubs * Buying in bulk, directly from manufacturers [1] * Surgeons that work "typically work 60 to 70 hours a week" [1] The additional link [1] seems to indicate that the innovation is simply volume. The highly-trained surgeons perform more surgeries, the expensive equipment is utilized more hours of the day, etc. [1] http://m.theaustralian.com.au/archive/business-old/the-henry-ford-of-heart-surgery-devi-shettys-business-model-delivers-cheap-medical-care/story-e6frg90x-1225801548287 http://m.theaustralian.com.au/archive/business-old/the-henry...
• 007emma007 13y ago
  India is the second in health care tourism all across the world and if you want to see what are the comparison for each surgery in India with respect US for the same surgery http://www.techcrump.com/need-a-surgery-then-fly-to-india/ http://www.techcrump.com/need-a-surgery-then-fly-to-india/ and here you can also see what is the state of healthcare in India for the peoples in India
• tsax 13y ago
  - The hospital industry is a monopolized cartel - you usually need the approval of existing hospitals in an area before you can open your own. - The insurance industry is a cartel - there are extreme compliance costs that only a few big players can take care of. - Employer provided insurance is subsidized. - Most 'reform' of health care in the US has punished individual insurance holders while strengthening the employment-based insurance system further strengthening third-party payment systems including increasing lists of 'must-cover' mandates for health insurance. - McCarran-Ferguson act exempted health insurance from a competitive national market. - The culture and institutional incentives in US healthcare push towards extreme capital-intensive expenditures and cut down on labor-intensive expenditures even when its not cost effective for the procedures that the patients require. Hospital beds get more expensive per day while extremely unlikely to succeed procedures like proton therapy expand further. This paper is very illuminating and comprehensive: http://c4ss.org/content/2088 http://c4ss.org/content/2088. Please have a look even if you disagree with the solutions and the ideology of the author. I assure you it will be worth your time.
  • tsax 13y ago
    Let me also add licensing regulations that require MDs for routine procedures. Though nurse practitioners are becoming more involved and this is a good development. Another issue which HN commenters are aware of is the AMA's cartel monopoly on medical school seats to control the supply of doctors.
• codex 13y ago
  Given that surgery costs are dominated by labor costs (surgeon plus support staff) and labor costs 20x more in the US than in India (see: http://www.economicpopulist.org/content/china-and-india-really-are-cheap-labor-manufacturing http://www.economicpopulist.org/content/china-and-india-real...) is it any wonder that surgery is 10x more expensive in the US? If the only cost were labor it would be 20x!
• keithjia 13y ago
  heart surgery in China: $237.95 heart surgery in Mexico: $199 on Saturdays WTF is the point of talking about is, such BS. Who here is willing to have their baby girl's heart surgery done in India vs best of the US here?
• Cardeck1 13y ago
  I'm not gonna go on the conspiracy road but the world is functioning on the wrong parameters. Instead of being a united civilization and help each other in order to advance to a higher level, we are fighting each other like lions for supremacy in every domain possible. Our whole system is based on superficial needs and wants rather than focusing on what we really need as species/civilization. How can we expect innovation and progress when we can't even cross the damn ocean without selling our souls...we can't even cross our own borders without special rules. Not to mention that racism is high in many countries. We are divided as hell. If an advanced race would watch us right now they would probably laugh hard and leave.
• pawrvx 13y ago
  Anything you can do, we can do cheaper, and better.
• tn13 13y ago
  When government enters any equation and starts over-regulating in the name of "poor" the poor must be actually worried. Indian healthcare system is no less greedy than that of United states, I know several examples where Doctors would perform needless surgeries, will recommend expensive surgeries for terminally ill patients (which makes death more painful) and so on. Indian government is a big believer in state interference into everything but when it comes to healthcare Indian government's approach is different. Instead of telling private hospitals who they should be run, Indian government builds its own hospitals. Thus private hospitals are left on their own with very little government interference. Thus those doctors can experiment while being very open about their experiments.
• tn13 13y ago
  One of the prerequisites for markets to work is that, both the parties should get into a transaction willingly. That premise somehow gets violated when it comes to healthcare. That is why there are too many market inefficiencies which are skewed towards hospitals and insurance companies.
• deleted 13y ago
  [deleted]
• zaroth 13y ago
  Bloomberg is comparing apples and oranges, to the point of caricaturization. They are also link baiting with false statements. First, the link bait: "The same procedure costs $106,385 at Ohio’s Cleveland Clinic, according to data from the U.S. Centers for Medicare & Medicaid Services." Funny thing is they actually cite their data source, so I downloaded the Excel sheet and looked for myself. The $106,385 is the "Average Covered Charges" for "238 - MAJOR CARDIOVASC PROCEDURES W/O MCC" at Cleveland Clinic. If you read the definition of "Average Covered Charges", it is not the cost of the procedure. The cost, aka "Average Total Payments" was actually $26,898. That's what medicare pays, including co-pays, deductibles. I spent a few minutes browsing http://my.clevelandclinic.org/ http://my.clevelandclinic.org/ - the Ohio Cleveland Clinic has over 3,000 physicians and scientists, 1,700 residents and fellows in training, with 47 buildings on 167 acres. They helped develop coronary bypass surgery in 1967. Shetty (the "Henry Ford of heart surgery") is standing on the shoulders of giants, and as well he should. The Cleveland Clinic and Narayana Hrudayalaya coexist symbiotically, and I'm happy we have both in the world. Coronary bypass surgery has to be invented first at Cleveland Clinic before Shetty can put it on the assembly line. If you have the time, read the Cleveland Clinic's 2012 Annual Report (http://viewer.zmags.com/publication/71bd62a6#/71bd62a6/1 http://viewer.zmags.com/publication/71bd62a6#/71bd62a6/1) and you can see what they think they are doing differently to provide the best service, continue driving innovative research, support their local community, and reduce costs. Take a minute to appreciate the breadth of research that goes on in their facilities, in areas including high-performance computing, robotics, 3D printing... Cleveland Clinic had $228m in Operating Income on $6.2b in Revenue in 2012. Their $6b in expenses are dominated by $3.5 billion in "salaries, wages, and benefits" which unfortunately is not broken down much further that I could find in the report. "Functionally" their expenses are $4.7b healthcare services, $450m on education and research, and $663m on G&A. I was disappointed to see their education and research expenses are less than their G&A, but it's hard to draw conclusions from such high-level data. It was interesting to note they have $1.6b of accumulated pension benefits, which are 68% funded. Unfortunately there doesn't appear to be anything resembling a financial statement on http://www.narayanahospitals.com/ http://www.narayanahospitals.com/.