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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

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?
- arjie 13y ago
  For what it's worth, there's a huge range of private care in India. From expensive hospitals that cater primarily to the upper class to charlatans without a degree holed away in a slum. The difference between these two ends is incredible. While I can imagine these results at the latter, I find them hard to believe at the former. I'm paywalled away from this for the next two weeks, so if you want the facts, that's where I'd look: what sort of private healthcare. Edit: To illustrate, another commenter has a link to an news story that says mortality is lower after the Indian procedure - 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...
- crntaylor 13y ago
  That article doesn't actually compare India to the US. In fact, it says that "It’s also likely the results aren’t India-specific." It would be interesting to see the results of a similar study carried out in the US or UK, for example. In any case, there is a difference between the general level of competency of doctors in a given country, and the level of competency available to wealthy foreigners travelling to the country for medical tourism.
  - mtgx 13y ago
    It's not India-specific. This is definitely happening in Eastern European countries, too, and probably even some of the western ones (although a bit more) - just like with college tuitions. There's something seriously wrong with both the healthcare system and the education system in US if the prices are 20x+ more than in any other country.
    - pisarzp 13y ago
      This is definitely happening in Eastern European countries, too, and probably even some of the western ones Careful here. I live in London for several years now, and from my experience Eastern European doctors are much better qualified then Western European. I'm originally from Poland, and medical studies are really hard, and people spend whole 6 years cramming just to become an apprentice to the doctor (it's Bachelors and Masters degree combined). On the other hand in western countries you can do undergrad degree in anything and only then apply to med school.
danboarder 13y ago
At face value this appears to be a huge opportunity for innovators to take on the whole existing healthcare industry here in the USA. In reality I think many healthcare entrepreneurs either get caught in the existing framework (and dependent on it), or find the regulatory and other hurdles too hard here. That said, I still think there is a LOT of room to improve cost efficiency here, and the right entrepreneur could do it. It's been done in other stagnant segments of the economy... I would like to see an Elon Musk-type entrepreneur open efficient hospitals here like this guy is doing in India.
- dantheman 13y ago
  A huge problem in the US is all sorts of really really bad laws. For instance to open a new hospital you have to get permission from other hospitals in the area.
  - noonespecial 13y ago
    That's the opportunity. Eventually regulatory capture and corruption will become so great in the US that it really does become impossible to actually provide the care. Nothing will make it through the wall of parasites. The opportunity is in helping Americans get real healthcare outside their borders. Take a glance Uber's way. You'll know you've got it right when there's serious talk about making it illegal to travel abroad to obtain medical care. For the safety of the people and the necessary good of the lowly American doctors, of course.
    - yuhong 13y ago
      impossible?
    - dome82 13y ago
      I think that it is already forbidden in some countries to get specific medical treatments abroad. It is so wrong, and I would not be surprise if it is going to happen in U.S.A. too.
  - amerika_blog 13y ago
kamaal 13y ago
>>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. As an Indian, I can tell you people here think the same about our health care system. The Doctor in discussion here, Dr Devi Shetty is a sort of a local hero here in Bangalore. And who knows in some years he might as well be a national hero. Its basically because he seems to bring in advantages of doing things in volume + some health insurance based innovations into the whole equation. And I do agree that he is pragmatically altruistic. But such people are exceedingly rare. We are simply fortunate to have him. I've never been to US, but I can tell you the Indian health care system is if not less is equally greedy compared to their US counterparts. Its just the same. These days if you don't have health insurance you are more or less screwed. Its just like the US. I mean from whatever I've read about US so far its the very same. Nothing changes. You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day. Coming to our system. Forget greed, fraud in the system is so massively high nothing that I write here will explain it. It is extremely common for doctors to order lab tests wholesale even if they are dead sure the patient has no problems at all. Doctors get commissions from testing labs/pharmacies etc for ordering lab tests, medicines. Treatment is purposefully prolonged, patients made to eat all kinds of antibiotics, undergo all sorts of non sense tests because doctors get commissions for it. The fees for completing your medical course is astronomically high. Capitation fee often runs in crores, the net fee by the time you finish your MD is so high no doubt most doctors have to practically turn into crooks to get something out of it. Add to this nearly more than a decade of studies sets a perfect stage for these sort of activities to happen. Its just the same old game, as you see in US. Just served differently.
- acchow 13y ago
  > You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day. I find the vast majority of people are tripped up by currency conversion, but I'm surprised to find this on HN. In Japan $1 = 100 yen, but certainly I don't feel I have 100x in buying power. A bowl of ramen will cost me $8 in SF; an equivalent bowl will cost me 800 JPY in tokyo. Let's not even get started on the Korean Won...
msonawane 13y ago
"Well in India their cost of living is lower" I am not sure it is true anymore. If you compare cost of living in a good infrastructure or similar lifestyle you will find India is expensive. I am sure many will disagree but just go ahead and look at cost of decent housing in any Indian metro. We too have crap doctors in India like anywhere else, may be they don't sound too expensive when you go by USD conversion.
smky80 13y ago
> so expensive it's cheaper for people to fly out of the country, pay for accommodation and even some spending money ... and even a few years of college tuition or a small mortgage ...
andrewparker 13y ago
>> A doctor trained in India is no less qualified than a doctor trained in the US. This might be objectively true (which you could reasonably determine through some combination of standardize testing and surgery complications/outcomes), but if you ask 100 people on the street in US whether they would prefer to see a US MD or an Indian MD for their heart surgery, I bet 97 or higher would prefer the US MD. The tiny remainder would probably show no preference. Their is a brand power of a US medical education, which is especially strong for US patients.
- pessimizer 13y ago
  I think it's probably just racism. I bet you'd see similar outcomes if you let people choose between white doctors and Indian-American doctors, even if the white doctor was the foreign one.
  - tripzilch 13y ago
    I agree but not sure if it's quite racism, more like prejudice. If it were a relatively poor or say (ex-) communist country with white doctors they'd be wary too.
  - apalmer 13y ago
    Naw, not true, at least on the east coast indian doctors (with american MDs) are common and are not generally viewed as 'inferior' in any way to caucasian doctors.
    - rdouble 13y ago
      In rural america often times the only doctors are Indian or Pakistani.
    - pessimizer 13y ago
      There are so many Indian doctors that it's almost become a stereotype of Indians. I'm just saying that given a choice, the white doctor gets chosen, rather than the US-educated one.
jfoster 13y ago
I can't defend the US cost entirely. It certainly seems exorbitant. That said, I think there are some things baked into the US cost that most patients probably want. A certain degree of post-operative care that maximizes comfort under the circumstances, for example. Possibly also factors that affect the success of the surgery. Heart surgery isn't necessarily over once they close you up. It's great that surgery is being made so much more accessible, of course, but these procedures are probably not comparable.
vbuterin 13y ago
Another question: why don't Indian doctors just import themselves to the US and earn much higher wages and profits by offering American customers something like the average of the Indian and American price? That's what we should be asking IMO.
- jacalata 13y ago
  Because they would have to get student status and undertake a two year residency, and then take the US medical board exams, and then come over on a H1B and work in a regular hospital (once they'd found one to sponsor them) and then get a greencard so they could work on their own and by then, maybe 10 years after they left India, they would probably be perfectly happy to continue living at the same wages instead of massively cutting their prices.
losvedir 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+ Well, the article says 2/3 of people live on $2/day, implying this surgery is $1600/$2/day = 800 days worth of work. Taking the US median income of $45k (since I don't know the 2/3 number off the top of my head), that implies the equivalent price in the US would be ($45k/365) * 800 = $98,630. So, right about the same as at the Cleveland Clinic.
- srinivasanv 13y ago
  The $2 figure quoted for Indian is not the middle 2/3, but the lowest 2/3, so it would have very little to do with the median. Let's go by the figures we actually have (mean): Per-capita income in India is $1492 Per-capita income in the USA is $49,922 So, it's around 1583/1492 = 1.06 years of work in India. And, 106385/49922 = 2.13 years of work in the USA. And since the hospital price is actually 95k Indian rupees, exchange-rate fluctuations do not matter.
  - goggles99 13y ago
    Here is what makes up the difference. In America, law mandates that hospitals treat anyone regardless of income, insurance possession or immigration status. Go to the hospital in India as an illegal alien and not only will you not get treatment, you will be jailed, then deported. Covering illegals and the uninsured is a HUGE cost that health care systems have to bear. Of course there are other things in America which drive up health costs, but treating illegals and chronically ill patients who have no insurance is the biggest. There are other major factors as well, but these laws alone bridge the gap in your calculations.
    - devdas 13y ago
      Umm, no one ever asks you about insurance unless you claim to have it? There are no checks for illegal immigrants. Chronically ill patients can still seek treatment, they may or may not be able to afford it though.
vasilipupkin 13y ago
"A doctor trained in India is no less qualified than a doctor trained in the US" Perhaps you are correct, but I doubt this assertion. U.S. graduate schools are generally the best in the world, I am not sure why that should be any different for medical schools
petilon 13y ago
"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." Actually, it is not just the healthcare industry. All industries in capitalist societies are engineered with greed in mind, and that's OK. It works very well. The problem in the healthcare industry is not greed, but insurance. When someone else is paying for the care you don't care how much it costs. You don't shop around. This enables doctors and hospitals to charge more. American healthcare is very cost efficient where the care is not covered by insurance, for example plastic surgery, lasik etc.
- skylan_q 13y ago
  It's true, but none of this matters. People prefer equally terrible health care for all as opposed to great health care for some and excellent health care for others. Soon enough, plastic surgery will be socialized to combat bullying because kids shouldn't have to suffer for being ugly. Then we'll see that efficiency disappear in the name of egalitarianism.
- apalmer 13y ago
  I kinda get your point, but your analysis as far as capitalism/greed etc seems more ideological than logically rational. The problem as you state it isn't insurance, its the inelasticity of health insurance. Simply put a significant amount of people will pay as much as they can get their hands on for even a marginally improved outcome if their life is on the line. Conversely very few people will refuse life saving treatment based on price, IF they can somehow get their hands on the necessary money, even if they feel it is a 'rip off'. Your stated areas where american healthcare is efficient are optional, cosmetic surgey, lasik etc... Not to say insurance doesnt play a part, just saying you havent presented a solid logical arguement.
  - blktiger 13y ago
    I think that the insurance companies are the real problem in the US. I pay the insurance company, who pays the doctor, who pays the insurance company. The costs go up in the opposite direction. Seems like a vicious cycle.
deepGem 13y ago
"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" - I wonder why this not happened on a large scale yet. It seems so simple - fly out stay for 10 days and get the surgery done, visit some exotic places such as the Taj Mahal and come back. Almost heart surgeries are planned, so planning is also not a concern. These days booking a flight in and out is a non-issue as is the issue of staying in a hotel. What's stopping people from adopting this on a large scale ?
- jjoonathan 13y ago
  Either it's illegal (the government's fault) or hospitals deal with insurers on a bundle basis and they aren't willing to cut out their most profitable procedures (the market's fault). Depends on who you ask, I'm sure :) Liability might be a problem, but it only accounts for 2% of medical expenditures in the US, so I wouldn't expect it to be insurmountably difficult to insure the procedures to "US standards."
- apalmer 13y ago
  This is being done on a large scale, health tourism is a real thing. I think probably you dont realize how widespread this phenomenon is, and conversely I think more than a 'large scale' you are really asking, why isn't virtually everyone doing this?
ctdonath 13y ago
I've had heart surgery, costing very close to that six-figure the article gives. Every dollar was well spent. Tearing my chest open with a car jack, rendering me dead for most practical purposes, replacing body parts with cyborg components meant to last for decades, bringing me back to life, repairing the extensive damage caused, continuous monitoring for anything that could go wrong for a week, and sending me home in perfect condition save for a narrow scar, a daily pill and ticking like Captain Hook's crocodile - that's a heckuva process to go thru, it went spectacularly well, and I'm alive in great shape, heck yeah it was worth half the price of my house. They brought me back from the dead, how much is that worth?
- enraged_camel 13y ago
  You are succumbing to the common fallacy of associating cost with quality. Last week, my dad (who is a doctor in Turkey) was telling me about a new study that compared the cost of healthcare services in various countries around the world and the satisfaction of patients. He said that the USA ranks close to the bottom of the index, meaning that considering how much American patients pay for healthcare, their level of satisfaction is incredibly low. This is why "healthcare tourism" exists and is dominated by American patients.
  - ctdonath 13y ago
    You are succumbing to the common fallacy of disassociating cost from quality. Yes, a good successful job can be done much cheaper - but, on the whole, the odds of success & quality degrade fast when less is spent. When it is YOUR life on the line, you may very well be willing to pay significantly more for those diminishing returns; they may be diminishing, but they are in fact greater returns. "Healthcare tourism" by Americans includes the ability to identify & access those pockets of excellence; those areas in general may not enjoy such inexpensive quality as the norm, nor have easy access to excellent outliers. BTW: Americans (I speak as one) are a chronically dissatisfied bunch. Having remarkable access to excellence in all things, we bitch & moan about how it isn't oh so slightly better. Yeah we complain about the cost of healthcare, and at the same time demand the absolute very best, quick to sue the pants off any doctor whose work fails perfection standards by any statistically normal degree when something could have been done better regardless of extreme cost. I suggest caring little about opinion polls where objective statistics are available.
ams6110 13y ago
I would observe, that all of the "low cost" equipment and techniques that are being described here were developed by "greedy" corporations and hospitals in the USA (or possibly Europe). It's easier to be cheap when you don't have to fund any original R&D.
- hingisundhorsa 13y ago
  Strong statements need to be backed up with strong data. You said "all of the equipment and techniques". Did you not read the Gawande section? Seems like the techniques are new and weren't invented by us.
splintercell 13y ago
>> 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. This is nothing but circlejerking. Sure the poor starving people of India are less greedy minded than rich Americans who could afford to be charitable. The reason why Indian healthcare system has more innovation than American healthcare system is precisely because of the opposite. The latter is more greedy than former and it is allowed to go in the right direction. Its easy for you to think that a product which is charging $40 per bottle profit on a $10 operating cost would make more profit than competitor's product which charges $5 profit the same bottle, but what you fail to understand that the latter will have more sales and therefore will be able to make more profit. This means people have an incentive to reduce their per item/action profit in order to increase their overall profits. If American healthcare market was allowed to be more free, you'd see lower prices and WAY more profits for healthcare companies.
solistice 13y ago
Just to put it here, you can get these price differences between US hospitals as well. http://www.huffingtonpost.com/2013/05/08/hospital-prices-cost-differences_n_3232678.html http://www.huffingtonpost.com/2013/05/08/hospital-prices-cos... in that Article, there's also a link to the Database of Medical Provider Charge data. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
iterative 13y ago
Hmmm. Why do you think it is that the costs of products and services produced by certain industries, like medical care and higher education, tend to rise much faster than inflation, while costs in other industries, like say, technology, fall over time? Could it have something to do with the fact that the industries where costs are increasing are those most heavily regulated and subsidized by multiple layers of government, while those where costs are falling (and quality is rising) are those that are least regulated and subsidized? Perish the thought! Much easier to just scream "greed!!!" and feel a bit morally superior than to actually try to understand what the problem is.
bborud 13y ago
As long as the majority of americans vote against their own self interest, nothing will change.
deleted 13y ago
[deleted]
goggles99 13y ago
Let me fill in the gaps for you. First off, this article is comparing the cheapest clinic in India, with the most expensive and most revered Heart center (Cleveland Clinic) in the world. NH is basically like getting your heart surgery done at a non air conditioned WalMart. There are no patient rooms. There is a patient room. A giant room with beds lined up civil war style. The food is akin to gruel, ETC... Of course there is going to be a significant cost difference. This is like comparing staying at a Hostile and getting dinner in the soup line with Staying a night at the Hilton and ordering a New York steak dinner for room service, of course there is going to be a significant cost difference. Leave it to a reporter to compare the cheapest abroad to the most expensive here (a bit of stretching to make the store line a bit more catchy). Second, the reported cost is false. "NH maintains its costs low, savings that are then transferred to the patient. NH's cost of open heart surgery is USD $2,000. The hospital charges $2,400 to the patient, compared to $5,500 charged at an average private hospital in India." http://healthmarketinnovations.org/program/narayana-hrudayalaya-hospital-nh http://healthmarketinnovations.org/program/narayana-hrudayal... Third, the per capita income in India is $1,000 nominal dollars, in the U.S., it's $50,000. So the average adjusted open heart surgery in India is actually $275,000 when converting to USD and comparing using the average per capita income. (Narayana Hrudayalaya's "discounted hospitals" only charge $120,000) I know that the average income does not fairly reflect the true cost differential because India has a disproportionately large population of people living in abject poverty. It does make the cost difference margin quite a bit less though. If you are wondering just how places in countries like this can operate more cheaply though? I will tell you. US laws. In America the law states that hospitals have to care for anyone even non citizens. It also puts stringent regulations on hospitals. Regulations that do not exist in India. These Regulations are very expensive to comply with. Narayana Hrudayalaya's establishments are not hospitals, they are not for emergency care. They do not treat non-paying clientele. In America, our medical costs balloon out of control for many reasons, one of the larger ones being the care of non-paying patients. Emergency rooms and therefore hospitals cannot turn away patients for any reason. They must admit illegals and uninsured (even for long term care). They cannot recoup money from these individuals so the paying customers get to flip the bill so the hospital can remain in business. Just try going to an emergency room in India as an illegal alien. You will be promptly jailed and deported. Try going without insurance or means of payment... Good luck with that (same MO as all these countries where these "cheap procedures" can be had) There are some countries where these procedures are still cheaper than in the US and they cannot legally turn away illegals and uninsured. They have a slightly different formula. The government flips the bill (subsidizes the hospitals) thus allowing them to compete cheaply (which keeps the costs low).

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?

arjie 13y ago
For what it's worth, there's a huge range of private care in India. From expensive hospitals that cater primarily to the upper class to charlatans without a degree holed away in a slum. The difference between these two ends is incredible. While I can imagine these results at the latter, I find them hard to believe at the former. I'm paywalled away from this for the next two weeks, so if you want the facts, that's where I'd look: what sort of private healthcare. Edit: To illustrate, another commenter has a link to an news story that says mortality is lower after the Indian procedure - 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...
crntaylor 13y ago
That article doesn't actually compare India to the US. In fact, it says that "It’s also likely the results aren’t India-specific." It would be interesting to see the results of a similar study carried out in the US or UK, for example. In any case, there is a difference between the general level of competency of doctors in a given country, and the level of competency available to wealthy foreigners travelling to the country for medical tourism.
- mtgx 13y ago
  It's not India-specific. This is definitely happening in Eastern European countries, too, and probably even some of the western ones (although a bit more) - just like with college tuitions. There's something seriously wrong with both the healthcare system and the education system in US if the prices are 20x+ more than in any other country.
  - pisarzp 13y ago
    This is definitely happening in Eastern European countries, too, and probably even some of the western ones Careful here. I live in London for several years now, and from my experience Eastern European doctors are much better qualified then Western European. I'm originally from Poland, and medical studies are really hard, and people spend whole 6 years cramming just to become an apprentice to the doctor (it's Bachelors and Masters degree combined). On the other hand in western countries you can do undergrad degree in anything and only then apply to med school.

danboarder 13y ago

At face value this appears to be a huge opportunity for innovators to take on the whole existing healthcare industry here in the USA. In reality I think many healthcare entrepreneurs either get caught in the existing framework (and dependent on it), or find the regulatory and other hurdles too hard here. That said, I still think there is a LOT of room to improve cost efficiency here, and the right entrepreneur could do it. It's been done in other stagnant segments of the economy... I would like to see an Elon Musk-type entrepreneur open efficient hospitals here like this guy is doing in India.

dantheman 13y ago
A huge problem in the US is all sorts of really really bad laws. For instance to open a new hospital you have to get permission from other hospitals in the area.
- noonespecial 13y ago
  That's the opportunity. Eventually regulatory capture and corruption will become so great in the US that it really does become impossible to actually provide the care. Nothing will make it through the wall of parasites. The opportunity is in helping Americans get real healthcare outside their borders. Take a glance Uber's way. You'll know you've got it right when there's serious talk about making it illegal to travel abroad to obtain medical care. For the safety of the people and the necessary good of the lowly American doctors, of course.
  - yuhong 13y ago
    impossible?
  - dome82 13y ago
    I think that it is already forbidden in some countries to get specific medical treatments abroad. It is so wrong, and I would not be surprise if it is going to happen in U.S.A. too.
- amerika_blog 13y ago

kamaal 13y ago

>>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. As an Indian, I can tell you people here think the same about our health care system. The Doctor in discussion here, Dr Devi Shetty is a sort of a local hero here in Bangalore. And who knows in some years he might as well be a national hero. Its basically because he seems to bring in advantages of doing things in volume + some health insurance based innovations into the whole equation. And I do agree that he is pragmatically altruistic. But such people are exceedingly rare. We are simply fortunate to have him. I've never been to US, but I can tell you the Indian health care system is if not less is equally greedy compared to their US counterparts. Its just the same. These days if you don't have health insurance you are more or less screwed. Its just like the US. I mean from whatever I've read about US so far its the very same. Nothing changes. You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day. Coming to our system. Forget greed, fraud in the system is so massively high nothing that I write here will explain it. It is extremely common for doctors to order lab tests wholesale even if they are dead sure the patient has no problems at all. Doctors get commissions from testing labs/pharmacies etc for ordering lab tests, medicines. Treatment is purposefully prolonged, patients made to eat all kinds of antibiotics, undergo all sorts of non sense tests because doctors get commissions for it. The fees for completing your medical course is astronomically high. Capitation fee often runs in crores, the net fee by the time you finish your MD is so high no doubt most doctors have to practically turn into crooks to get something out of it. Add to this nearly more than a decade of studies sets a perfect stage for these sort of activities to happen. Its just the same old game, as you see in US. Just served differently.

acchow 13y ago
> You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day. I find the vast majority of people are tripped up by currency conversion, but I'm surprised to find this on HN. In Japan $1 = 100 yen, but certainly I don't feel I have 100x in buying power. A bowl of ramen will cost me $8 in SF; an equivalent bowl will cost me 800 JPY in tokyo. Let's not even get started on the Korean Won...

msonawane 13y ago

"Well in India their cost of living is lower" I am not sure it is true anymore. If you compare cost of living in a good infrastructure or similar lifestyle you will find India is expensive. I am sure many will disagree but just go ahead and look at cost of decent housing in any Indian metro. We too have crap doctors in India like anywhere else, may be they don't sound too expensive when you go by USD conversion.

smky80 13y ago

> so expensive it's cheaper for people to fly out of the country, pay for accommodation and even some spending money ... and even a few years of college tuition or a small mortgage ...

andrewparker 13y ago

>> A doctor trained in India is no less qualified than a doctor trained in the US. This might be objectively true (which you could reasonably determine through some combination of standardize testing and surgery complications/outcomes), but if you ask 100 people on the street in US whether they would prefer to see a US MD or an Indian MD for their heart surgery, I bet 97 or higher would prefer the US MD. The tiny remainder would probably show no preference. Their is a brand power of a US medical education, which is especially strong for US patients.

pessimizer 13y ago
I think it's probably just racism. I bet you'd see similar outcomes if you let people choose between white doctors and Indian-American doctors, even if the white doctor was the foreign one.
- tripzilch 13y ago
  I agree but not sure if it's quite racism, more like prejudice. If it were a relatively poor or say (ex-) communist country with white doctors they'd be wary too.
- apalmer 13y ago
  Naw, not true, at least on the east coast indian doctors (with american MDs) are common and are not generally viewed as 'inferior' in any way to caucasian doctors.
  - rdouble 13y ago
    In rural america often times the only doctors are Indian or Pakistani.
  - pessimizer 13y ago
    There are so many Indian doctors that it's almost become a stereotype of Indians. I'm just saying that given a choice, the white doctor gets chosen, rather than the US-educated one.

jfoster 13y ago

I can't defend the US cost entirely. It certainly seems exorbitant. That said, I think there are some things baked into the US cost that most patients probably want. A certain degree of post-operative care that maximizes comfort under the circumstances, for example. Possibly also factors that affect the success of the surgery. Heart surgery isn't necessarily over once they close you up. It's great that surgery is being made so much more accessible, of course, but these procedures are probably not comparable.

vbuterin 13y ago

Another question: why don't Indian doctors just import themselves to the US and earn much higher wages and profits by offering American customers something like the average of the Indian and American price? That's what we should be asking IMO.

jacalata 13y ago
Because they would have to get student status and undertake a two year residency, and then take the US medical board exams, and then come over on a H1B and work in a regular hospital (once they'd found one to sponsor them) and then get a greencard so they could work on their own and by then, maybe 10 years after they left India, they would probably be perfectly happy to continue living at the same wages instead of massively cutting their prices.

losvedir 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+ Well, the article says 2/3 of people live on $2/day, implying this surgery is $1600/$2/day = 800 days worth of work. Taking the US median income of $45k (since I don't know the 2/3 number off the top of my head), that implies the equivalent price in the US would be ($45k/365) * 800 = $98,630. So, right about the same as at the Cleveland Clinic.

srinivasanv 13y ago
The $2 figure quoted for Indian is not the middle 2/3, but the lowest 2/3, so it would have very little to do with the median. Let's go by the figures we actually have (mean): Per-capita income in India is $1492 Per-capita income in the USA is $49,922 So, it's around 1583/1492 = 1.06 years of work in India. And, 106385/49922 = 2.13 years of work in the USA. And since the hospital price is actually 95k Indian rupees, exchange-rate fluctuations do not matter.
- goggles99 13y ago
  Here is what makes up the difference. In America, law mandates that hospitals treat anyone regardless of income, insurance possession or immigration status. Go to the hospital in India as an illegal alien and not only will you not get treatment, you will be jailed, then deported. Covering illegals and the uninsured is a HUGE cost that health care systems have to bear. Of course there are other things in America which drive up health costs, but treating illegals and chronically ill patients who have no insurance is the biggest. There are other major factors as well, but these laws alone bridge the gap in your calculations.
  - devdas 13y ago
    Umm, no one ever asks you about insurance unless you claim to have it? There are no checks for illegal immigrants. Chronically ill patients can still seek treatment, they may or may not be able to afford it though.

vasilipupkin 13y ago

"A doctor trained in India is no less qualified than a doctor trained in the US" Perhaps you are correct, but I doubt this assertion. U.S. graduate schools are generally the best in the world, I am not sure why that should be any different for medical schools

petilon 13y ago

"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." Actually, it is not just the healthcare industry. All industries in capitalist societies are engineered with greed in mind, and that's OK. It works very well. The problem in the healthcare industry is not greed, but insurance. When someone else is paying for the care you don't care how much it costs. You don't shop around. This enables doctors and hospitals to charge more. American healthcare is very cost efficient where the care is not covered by insurance, for example plastic surgery, lasik etc.

skylan_q 13y ago
It's true, but none of this matters. People prefer equally terrible health care for all as opposed to great health care for some and excellent health care for others. Soon enough, plastic surgery will be socialized to combat bullying because kids shouldn't have to suffer for being ugly. Then we'll see that efficiency disappear in the name of egalitarianism.
apalmer 13y ago
I kinda get your point, but your analysis as far as capitalism/greed etc seems more ideological than logically rational. The problem as you state it isn't insurance, its the inelasticity of health insurance. Simply put a significant amount of people will pay as much as they can get their hands on for even a marginally improved outcome if their life is on the line. Conversely very few people will refuse life saving treatment based on price, IF they can somehow get their hands on the necessary money, even if they feel it is a 'rip off'. Your stated areas where american healthcare is efficient are optional, cosmetic surgey, lasik etc... Not to say insurance doesnt play a part, just saying you havent presented a solid logical arguement.
- blktiger 13y ago
  I think that the insurance companies are the real problem in the US. I pay the insurance company, who pays the doctor, who pays the insurance company. The costs go up in the opposite direction. Seems like a vicious cycle.

deepGem 13y ago

"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" - I wonder why this not happened on a large scale yet. It seems so simple - fly out stay for 10 days and get the surgery done, visit some exotic places such as the Taj Mahal and come back. Almost heart surgeries are planned, so planning is also not a concern. These days booking a flight in and out is a non-issue as is the issue of staying in a hotel. What's stopping people from adopting this on a large scale ?

jjoonathan 13y ago
Either it's illegal (the government's fault) or hospitals deal with insurers on a bundle basis and they aren't willing to cut out their most profitable procedures (the market's fault). Depends on who you ask, I'm sure :) Liability might be a problem, but it only accounts for 2% of medical expenditures in the US, so I wouldn't expect it to be insurmountably difficult to insure the procedures to "US standards."
apalmer 13y ago
This is being done on a large scale, health tourism is a real thing. I think probably you dont realize how widespread this phenomenon is, and conversely I think more than a 'large scale' you are really asking, why isn't virtually everyone doing this?

ctdonath 13y ago

I've had heart surgery, costing very close to that six-figure the article gives. Every dollar was well spent. Tearing my chest open with a car jack, rendering me dead for most practical purposes, replacing body parts with cyborg components meant to last for decades, bringing me back to life, repairing the extensive damage caused, continuous monitoring for anything that could go wrong for a week, and sending me home in perfect condition save for a narrow scar, a daily pill and ticking like Captain Hook's crocodile - that's a heckuva process to go thru, it went spectacularly well, and I'm alive in great shape, heck yeah it was worth half the price of my house. They brought me back from the dead, how much is that worth?

enraged_camel 13y ago
You are succumbing to the common fallacy of associating cost with quality. Last week, my dad (who is a doctor in Turkey) was telling me about a new study that compared the cost of healthcare services in various countries around the world and the satisfaction of patients. He said that the USA ranks close to the bottom of the index, meaning that considering how much American patients pay for healthcare, their level of satisfaction is incredibly low. This is why "healthcare tourism" exists and is dominated by American patients.
- ctdonath 13y ago
  You are succumbing to the common fallacy of disassociating cost from quality. Yes, a good successful job can be done much cheaper - but, on the whole, the odds of success & quality degrade fast when less is spent. When it is YOUR life on the line, you may very well be willing to pay significantly more for those diminishing returns; they may be diminishing, but they are in fact greater returns. "Healthcare tourism" by Americans includes the ability to identify & access those pockets of excellence; those areas in general may not enjoy such inexpensive quality as the norm, nor have easy access to excellent outliers. BTW: Americans (I speak as one) are a chronically dissatisfied bunch. Having remarkable access to excellence in all things, we bitch & moan about how it isn't oh so slightly better. Yeah we complain about the cost of healthcare, and at the same time demand the absolute very best, quick to sue the pants off any doctor whose work fails perfection standards by any statistically normal degree when something could have been done better regardless of extreme cost. I suggest caring little about opinion polls where objective statistics are available.

ams6110 13y ago

I would observe, that all of the "low cost" equipment and techniques that are being described here were developed by "greedy" corporations and hospitals in the USA (or possibly Europe). It's easier to be cheap when you don't have to fund any original R&D.

hingisundhorsa 13y ago
Strong statements need to be backed up with strong data. You said "all of the equipment and techniques". Did you not read the Gawande section? Seems like the techniques are new and weren't invented by us.

splintercell 13y ago

>> 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. This is nothing but circlejerking. Sure the poor starving people of India are less greedy minded than rich Americans who could afford to be charitable. The reason why Indian healthcare system has more innovation than American healthcare system is precisely because of the opposite. The latter is more greedy than former and it is allowed to go in the right direction. Its easy for you to think that a product which is charging $40 per bottle profit on a $10 operating cost would make more profit than competitor's product which charges $5 profit the same bottle, but what you fail to understand that the latter will have more sales and therefore will be able to make more profit. This means people have an incentive to reduce their per item/action profit in order to increase their overall profits. If American healthcare market was allowed to be more free, you'd see lower prices and WAY more profits for healthcare companies.

solistice 13y ago

Just to put it here, you can get these price differences between US hospitals as well. http://www.huffingtonpost.com/2013/05/08/hospital-prices-cost-differences_n_3232678.html http://www.huffingtonpost.com/2013/05/08/hospital-prices-cos... in that Article, there's also a link to the Database of Medical Provider Charge data. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

iterative 13y ago

Hmmm. Why do you think it is that the costs of products and services produced by certain industries, like medical care and higher education, tend to rise much faster than inflation, while costs in other industries, like say, technology, fall over time? Could it have something to do with the fact that the industries where costs are increasing are those most heavily regulated and subsidized by multiple layers of government, while those where costs are falling (and quality is rising) are those that are least regulated and subsidized? Perish the thought! Much easier to just scream "greed!!!" and feel a bit morally superior than to actually try to understand what the problem is.

bborud 13y ago

As long as the majority of americans vote against their own self interest, nothing will change.

deleted 13y ago

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goggles99 13y ago

Let me fill in the gaps for you. First off, this article is comparing the cheapest clinic in India, with the most expensive and most revered Heart center (Cleveland Clinic) in the world. NH is basically like getting your heart surgery done at a non air conditioned WalMart. There are no patient rooms. There is a patient room. A giant room with beds lined up civil war style. The food is akin to gruel, ETC... Of course there is going to be a significant cost difference. This is like comparing staying at a Hostile and getting dinner in the soup line with Staying a night at the Hilton and ordering a New York steak dinner for room service, of course there is going to be a significant cost difference. Leave it to a reporter to compare the cheapest abroad to the most expensive here (a bit of stretching to make the store line a bit more catchy). Second, the reported cost is false. "NH maintains its costs low, savings that are then transferred to the patient. NH's cost of open heart surgery is USD $2,000. The hospital charges $2,400 to the patient, compared to $5,500 charged at an average private hospital in India." http://healthmarketinnovations.org/program/narayana-hrudayalaya-hospital-nh http://healthmarketinnovations.org/program/narayana-hrudayal... Third, the per capita income in India is $1,000 nominal dollars, in the U.S., it's $50,000. So the average adjusted open heart surgery in India is actually $275,000 when converting to USD and comparing using the average per capita income. (Narayana Hrudayalaya's "discounted hospitals" only charge $120,000) I know that the average income does not fairly reflect the true cost differential because India has a disproportionately large population of people living in abject poverty. It does make the cost difference margin quite a bit less though. If you are wondering just how places in countries like this can operate more cheaply though? I will tell you. US laws. In America the law states that hospitals have to care for anyone even non citizens. It also puts stringent regulations on hospitals. Regulations that do not exist in India. These Regulations are very expensive to comply with. Narayana Hrudayalaya's establishments are not hospitals, they are not for emergency care. They do not treat non-paying clientele. In America, our medical costs balloon out of control for many reasons, one of the larger ones being the care of non-paying patients. Emergency rooms and therefore hospitals cannot turn away patients for any reason. They must admit illegals and uninsured (even for long term care). They cannot recoup money from these individuals so the paying customers get to flip the bill so the hospital can remain in business. Just try going to an emergency room in India as an illegal alien. You will be promptly jailed and deported. Try going without insurance or means of payment... Good luck with that (same MO as all these countries where these "cheap procedures" can be had) There are some countries where these procedures are still cheaper than in the US and they cannot legally turn away illegals and uninsured. They have a slightly different formula. The government flips the bill (subsidizes the hospitals) thus allowing them to compete cheaply (which keeps the costs low).