10 ms·

The Cost of My Mother’s Cardiac Care in the United States and India

176 points by tchalla 12y ago

jeromeparadis 12y ago
When he was born, my son had cardiac surgery. Had another one 4 months later and a catheter later on. The two surgeries were done by one of the top 10 surgeons in the world. All in all, he was 6 weeks in the hospital. He's now in very good health. Since we live in Canada, it costs us nothing except the parking at the hospital (about $120 total with a pass) and the lost work time.
- forca 12y ago
  Free as it ought to be -- payed for out of yours and everyone's taxes. Parking should have been free, to be honest. Nothing I hate more than seeing basic services turned into money-making opportunities for the shady.
  - RealGeek 12y ago
    Since Canada doesn't spend trillions in wars and bailing out banks, they can afford to provide healthcare to it's citizens.
    - forca 12y ago
      Wow. Simple, yet profoundly true.
    - mahyarm 12y ago
      Actually, Canada pays less on a per citizen basis than the US does on it's health care. America can still have it's wars, bank bailouts and health care, if they weren't politically gridlocked with the issue.
  - jeromeparadis 12y ago
    Do you know how much it would have cost in the US? More than $1.5MM is the estimate I got. If you were to pay here as a non Canadian. About $200-300K. The missing $1MM, where is it going and where is it coming from? Everything is relative when you say everyone pay because of taxes. I would from you salary and insurance. At the end of the day, who's paying more? I don't know. But I'll tell you something: in the States, our choice would have been an late and illegal abortion or a bankruptcy. Today, we have a marvellous son that our society decided we should protect at all cost.
- yitchelle 12y ago
  Sounds similar to the German medical services available for children. My son needed surgery on his ptosis that is becoming a problem for his vision. After making seeing the doctor at the UniKlinik in Cologne, he was booked in for operation in two weeks time. The operation took place and was in hospital for about 1 week. My wife stayed with him for that whole week in the hospital. Total cost for this procedure was zero. I did not have to deal the insurance at all, the UniKlinik handled all the paperwork. We were considering having the same operation in Australia prior to relocating to Germany. It would have cost at least $2500 and months of waiting.
cdnsteve 12y ago
Thank you for sharing. Not only cost is important but people seem to forget about waiting times, the silent killer.
RealGeek 12y ago
I moved to US last year, and figured the healthcare system in US is the biggest train wreck. It is not only super expensive, but also super complicated. You have to jump through many hoops likes insurance, appointment waiting list, mail order pharmacies (who always mess up your order), pre-existing conditions etc. We were denied treatment by our insurance because of pre-existing conditions. Thankfully, Obamacare fixed it and we began to receive healthcare in 2014. The prices of healthcare are artificially inflated so high so that it is not affordable for most Americans, so they can be forced into the bizarre health insurance system. This system only makes healthcare even more expensive due to administrative costs and make it complicated for everyone. There should be no place for a middleman in healthcare. I recently went to see a doctor for a non-serious problem, and here is how it worked out. Steps to get medical care in US: 1) Call a specialist's office for appointment, and you will usually get a wait list of 3 to 6 months. 2) After months of wait, you get to see the doctor who will diagnose you. 3) Doctor sends in your prescription to your mail order pharmacy. 4) Pharmacy messes up your order; it could be incorrect dosage, pre-authorization, incorrect billing etc. 5) Your medication is delivered to you after few days, sometimes it can even take weeks. 6) You get bills, which could be 10x higher than what you were expecting. Your insurance company provides no explanation of the mysterious charges. Costs: $50 co-pay, $450 for prescription. Insurance claims: $700 specialist, $2750 prescription. Here's how it works in India: 1) Call into doctor's office, you will usually get appointment for same day or next day. You can even walk in without appointment. 2) The doctor diagnoses you, and write a prescription. 3) You take that prescription to any pharmacy, and buy the medications. Costs: $10 to $20 fee for specialist, and $20 for prescription. No Insurance required Edit: I've compared prices of various medications in US and India. Most of the medications in US cost 10x to 20x more than India.
- vonmoltke 12y ago
  > 1) Call a specialist's office for appointment, and you will usually get a wait list of 3 to 6 months. In the past year I have seen both a dermatologist and an orthopedist for the first time. I never had to wait more than a week. > 3) Doctor sends in your prescription to your mail order pharmacy. Mine have always gone to the local pharmacy of my choice. Same for my wife. > 5) You get bills, which could be 10x higher than what you were expecting. Your insurance company provides no explanation of the mysterious charges. I rarely get bills after the fact, but they always itemize and explain the charges. I also get statements showing what my insurance company paid.
kr_60642 12y ago
i am an indian living in the US for more than 10 years. Costs are cheaper in India and the big hospitals usually have good quality care. The problem is what happens when you have complications or side effects. In the US, you can sue the hospital/doctor and expect to get paid. You can't do that in India (cases drag on for decades).
idonkre5 12y ago
Americans are most money hungry people I have encountered in my life. Seriously. Every single opportunity, heck ,even life and death is seen through money. I lived in Europe, South Asia and US. Europe is sort of similar but much better. I had came to US in 2004 on H1-B. People will literally say H1-Bs are reason they are out of job. Well, that's not true in many cases. Even if it was, what about hundred and thousands of lives saved by Indian Medical facilities ? Every time I go to home ( India) I see thousands of people coming to India ; many for medical tourism. Also, FUCK this author for publishing costs. Next time think about poor people back home before going fucking social over it. Because lots of people from fucking US and Europe are coming to India for medical tourism cost to treat people at home are skyrocketing. You motherfucking bastards count it in dollars and think , well fuck its just 3K , look how cool and cheap treatment it. Point is , it is 150000 for Indians at home. A well round software engineer earns between 600000 to 800000 after 3 or 4 years. Because now many hospitals know that foreigners are fucking bastards tipping and lavishing them with money they refuse to offer same level of treatment at home. So disease created by US of money hunger ( hmmm hmmm capitalistic fuckers ) is spreading in India fast , very fast. Fuck everyone taking advantage of our not-so-low-cost medical care with your fucking dollars.
tn13 12y ago
When two parties mutually agree on some deal they both feel satisfied and have incentives to make each other happy. When the government decides what is the "interest" of one party and steps in to "protect that interest", very likely it will end up pissing off one party which eventually loses interest in any kind of innovation. US has achieved the rare distinction of screwing up both the parties in case of healthcare. Indian government in reality has even more laws and nonsense but it is too incompetent to implement any of those laws. This mostly leaves the things in a Laissez-faire situation. Like it happens in any Laissez-faire situation the third parties see too many problems but the people who are actually affected are more than happy because they are a better judge of their situation. In my village in India, we have only 1 doctor. This doctor is a homeopathic doctor who even today charges Rs 10 ( $0.16) per visit. He spends less than 5 minutes per patient and his treatment is allopathic. He moved from a distant city to this village purely because homeopathic doctor giving allopathic medicine is illegal. Over last 30 odd years not only he has got rich but he is the most powerful person in the village. He is very good at his job, has saved countless lives, delivered babies, removed aching teeth and written countless death certificates. Yes, there have been cases of wrong diagnosis and side-effects too but overall he has lead to net positive benefit to the society in my village and hence is revered. Many proper doctors tried to setup their shop in my village and have failed purely because this doctor turned out to be better than them. In India, Indian Medical Council controls the total number of doctors in the country but for a bribe of around $2M you can easily get a license to start a medical school. Medical Schools make insane amount of money and thousands of poor people enter the hospital everyday where you can get away making mistakes because the choice before these poor people is "either get this treatment or die in your home".
tn13 12y ago
Another Note: Unlike best engineers in India, best doctors in India can not migrate to US. Because of the sheer population, Indian doctors see 4x more daily patients than their American counterparts perform far too many surgeries very likely to have seen more corner cases than American doctors. Indian doctors in average private hospitals are far more competent than average American doctors. It is good that American government is protecting jobs of American Doctors at the expense of public health by barring entry to Indian doctors. We Indians get cheaper and better healthcare. :P Disclaimer: I worked for a large Cancer hospital in India.
forca 12y ago
Great read. This just show how evil for-profit medicine really is. The fact that the pay is so high in the west is disturbing. I really pray we see a single-payer socialised system in our lifetime in the US. Growing up with socialised medicine has shown me the truth. No doctor, no matter how talented, needs to make what they do. All of this should be government run as a non-profit. Government should mandate and force all pharmaceutical companies into non-profit status as well for the good of mankind. I'm sick to death of not being able to go to hospital here in the US, even with insurance, because what with the co-pays and deductibles, it costs a fortune. I just don't go, and I am in need of surgery that I cannot afford. QUESTION: Would an Indian facility in India treat me for a relatively small amount of money? Even after the flights, it would still be cheaper than the $22k I've been quoted here by multiple sources.
- GFK_of_xmaspast 12y ago
  Maybe? Medical tourism is a well-established thing.
  - toomuchtodo 12y ago
    I've often thought about establishing a medial tourism non-profit. Think Watsi.org, but for first-world consumers of healthcare, taking them to near-first-world country locals where the cost of the same quality service is much lower.
- DanBC 12y ago
  > Would an Indian facility in India treat me for a relatively small amount of money? http://www.bbc.co.uk/news/health-10837726 http://www.bbc.co.uk/news/health-10837726 While there are some good ideas the ruthless efficiency is a bit scary.
  - Scoundreller 12y ago
    Why is it scary? Is there something inherent about health care that prevents an industrial philosophy towards production?
yummyfajitas 12y ago
Her experience is the same as mine. I've had most of my medical care over the last few years done in India. This includes LASIK (34k per eye), a selective nerve root blocker injection (8k) and a micro lumbar discectomy (85k). I expect to have a second discectomy done in the next month (being really tall sucks), provided my condition doesn't worsen and I'm able to fly. Overall, my experience with India's medical system has been fantastic. I've found clean hospitals (not all of them!), total price was all completely transparent (+/- 10% of quoted price), and the doctors have generally been as good as in the US. Overall, for anyone needing significant medical work done, I strongly recommend medical tourism. Also, while you are there, have a custom suit made (particularly if you are really tall, and ordinary clothes don't fit). But be warned - I spent more on my suit than on the root blocker injection. [edit: numbers in INR. Quick reference: 1 lac INR = 1600 USD. In spite of a few years worth of inflation, I don't expect to spend more than 2k USD on back surgery.] [edit 2: 1 lac = 100,000.]
- dpeck 12y ago
  Are these in USD or INR?
  - deleted 12y ago
    [deleted]
  - Scoundreller 12y ago
    I'm guessing INR. 43k INR = US$558 8k INR = US$131 85k INR = $1397 (per xe.net)
  - voxic11 12y ago
    I love how they work out to be about what it would cost in both countries using their own currency.
- McDiesel 12y ago
  I think you got your numbers backwards... 1600 IRN ~ 1 USD, right? Your way, your lasik costs about $54M.. So you can get full Lasik for ~$50USD?
jostmey 12y ago
Awhile back I was struck by the sprawling medical campus at my University (in the US). First I passed by the original hospital, a large six story structure. Then I passed the new Children's hospital, an even larger building. Finally I walked by the latest building under construction - a twelve story behemoth spread over several city blocks. It seems that every few years a new building is added, and each one is bigger than the last. Something about the pattern felt vaguely familiar. What I asked myself also exhibits unrestrained exponential growth like the pattern of construction that I saw - then I realized the answer. A tumor!
- forca 12y ago
  I voted you up. What you say is disturbing and true. American medicine treats the symptoms and intentionally strings people along rather than cure the underlying cause. There is no profit in curing cancer -- only in the treatments. I'm convinced of this after having a few people I dearly loved die in the American medical system. We need more of a system whereby our taxes are used solely for the good of the people -- to improve our lives. It's sad, really. As much money as the US has, we could have the highest standard of living on the planet, but we're nowhere near that because of greed on the parts of tax-dodging corporations, greedy capitalists, and a whole host of other reasons.
- Spooky23 12y ago
  People are voting you down, but you make a great point. It's especially apropos when you realize that many US states have massive gluts in hospital beds and more and more procedures that once required hospitalization are now outpatient, and private insurance makes it punitive in most cases to stay in a hospital for any length of time. The money for these building binges is mostly from Medicare, which still allows hospitalization in more cases. The fact hospitals have sufficient funds to constantly build massive facilities is a signal that they are making too much money on Medicare. Particularly disturbing when you consider that Medicare is effectively a price floor for medical services.
- secabeen 12y ago
  If this is in California, they are probably replacing the old hospital for earthquake safety reasons.
induscreep 12y ago
But India is 24 hrs away by flight. If there was a list of countries with the flight duration and cost of medical care, what countries would lie on the Pareto front? What if you sorted by a "$-hr" metric?
- mahyarm 12y ago
  You hear good things about Thailand and some South American countries.
it_learnses 12y ago
We should still consider the fact that the author has a husband who's a doctor, and has family from India and is herself from India. Not sure if the costs would be the same if someone who hadn't been to India in a while or had no family were to go to seek treatment. Someone could easily take advantage of you and you'd hardly have any recourse.
- yummyfajitas 12y ago
  I have no relatives in medicine (my sister trained as an EMT, but doesn't work as such), I'm not from India and have no family there. They've been pretty straightforward with me. The price they give me comes out of the same price list as the price they give to everyone else. Also, if they rob you it's still a great deal. Do you really care a lot whether you spend $1k or $2k on surgery? I haggle with autowallahs on principle, not because I care about paying 30rs extra.
deleted 12y ago
[deleted]
- parennoob 12y ago
  India also has a parallel subsidized healthcare system of Government-operated hospitals, in which you can receive treatment at much lower costs, or often, for free. (http://en.wikipedia.org/wiki/Public_hospital#India http://en.wikipedia.org/wiki/Public_hospital#India) However, the waiting lines for everything from a basic consultation to an actual procedure are much longer, and the standard of care seems to be lesser, so a lot of people from the middle and upper classes avoid them. [Edit: parent comment seems to have been deleted, it mentioned the average figure for Indian per capita income, and asked whether most Indians could afford a procedure like this.]
  - pkaye 12y ago
    The government hospital can be poorly run and unsanitary and most people who can afford it go to private ones. I guess still better than nothing.
- atonse 12y ago
  That may be so, but the skill level is the same, and the equipment is the same, if not similar. So if the fundamental quality of care is the same, what explains the insane markup? Salaries? I doubt it.
- Erwin 12y ago
  The $47,000 was the average cost for the angiography so just finding out what was wrong with the heart -- that was what cost her $254 in India. Not a pleasant sounding procedure, involving sticking a giant needle through your forearm, guiding it up to the heart and injecting some contrast fluid so you can see what's going on the heart (still better than open heart surgery though). http://en.wikipedia.org/wiki/Angiography http://en.wikipedia.org/wiki/Angiography
  - wil421 12y ago
    I take back what I said after more thought and reading other comments. If you cant even reliably get a quote on a procedure then there are much bigger issues at hand beside the patients charges.
acabal 12y ago
I recently wrote on my blog about the cost of having a benign mole removed. I got so angry when I heard the cost of that simple procedure that I went online and calculated the cost to do it in Colombia, where I have some family. Long story short, I estimated that it would be 34% cheaper to fly to Colombia, have the same procedure done, and have a full week's vacation (at hostel rates, which is how I travel). Everything, including airfare and a full week of food and lodging, for 34% less than just the procedure in America! The best part is that I guesstimated the cost of the procedure in Colombia. But even if I tripled my guesstimate, it would still be cheaper to fly! For time-insensitive or elective procedures, you can and should go abroad. The real cruelty is people who don't have a choice--emergency situations, cancers, etc. They're trapped in our hideous system and often have to choose between their life savings and a lifetime of debt, and dying. Our American approach to healthcare disgusts me. Every time I think about it I get filled with rage.
- cpwright 12y ago
  If you can shop around in the US for something like that it can matter too. To correct my son's tongue tie the first ENT would have been over $1500 out of pocket, including anesthesia. The second one did it in his office as part of another appointment we had related to his hearing, total out of pocket $50. IMO, The biggest problem is really lack of transparency for this stuff. If a hospital takes government money (and pretty much every one of them does), it should be required to publish its rates like a utility does.
  - danielweber 12y ago
    The more they deal with insured patients, the less ready they will be to give you quotes. I was trying to find a news story of someone calling around to get price quotes on procedures and many places just immediately hung up at the question.
zaptheimpaler 12y ago
Coming from India, I have really come to hate the medical system here in the US. There are countless times I have been screwed over by the lack of transparency in cost and the layer of bureaucracy and BS imposed by having to deal with an insurance company rather than __the doctor/hospital who treated me__!! It has been a few months since I have seen a doctor, but I still receive some new goddamn bill every other day. They are usually cryptic and leave me wondering what the hell they are for, and why they were not just presented to me on the day of the test. Don't even bother asking anyone what a procedure costs. Hospital staff will redirect you to someone who deals exclusively with insurance (completely unnecessary if we just had simple bills like any other transaction FFS), and the insurance people don't have enough specifics to ever really give you an answer, not to mention the time it will take waiting on hold etc. When you are getting multiple procedures, its just not worth the time. So you are practically forced to go in completely blind about potential costs. To top it all off, my insurance coverage has expired as I recently graduated. So my options are to either pay $600 for 30 days of medicine that I need, or get the exact same medicine shipped to me from India, for $10-$20. They produce it by the millions in blister packs. This should not be so difficult! If we just had realistic prices in the first place instead of inflating them and bringing them down with insurance, this crap would not happen. And don't even get me started on "pre-existing conditions". What that means for me is constantly lying to doctors and being unable to give them a complete medical history - otherwise I'll have f* "pre-existing condition" stamped on my head and never get sane rates again. I fail to see why health care is not treated more like a series of simple business transactions in an economic system instead of this colossal mess. /rant
- swamp40 12y ago
  I don't disagree with your rant, but Obamacare eliminated all the pre-existing conditions clauses.
- yodsanklai 12y ago
  > And don't even get me started on "pre-existing conditions". What that means for me is constantly lying to doctors I don't know if it's a good idea. I have a related anecdote: My mother forgot (or omitted) to mention a pre-existing condition when she contracted a mortgage insurance. She died a few years later from causes totally unrelated to the pre-existing condition. Somehow, the insurance company found out and legally canceled the insurance.
lizzard 12y ago
I hope she knows all the lyrics to The Ramones' "Teenage Lobotomy". "Then I guess I'll have to tell 'em / That I've got no cerebellum." https://www.youtube.com/watch?v=6ssoBUb2cJk https://www.youtube.com/watch?v=6ssoBUb2cJk
- lizzard 12y ago
  Oi. Wrong window. Meant for article on missing cerebellum...
- deleted 12y ago
  [deleted]
- danielweber 12y ago
  You can delete your own posts.
AndrewKemendo 12y ago
I feel like there is a lot of beating the dead horse with this issue. Is there (holding the jingoistic flag wavers aside) any real disagreement on the conclusion that the US healthcare system is terrible for the average user - such that we need continual reminder? Didn't the whole ACA debate prove that yes, we get it it's broken and there is major popular support for changes, even if the actual changes made were not themselves popular by a plurality?
- danielweber 12y ago
  Everyone agrees that it needs to change. There is little agreement on how to change it. Most proposed changes are "let's gore the other side's ox."
  - rodgerd 12y ago
    > There is little agreement on how to change it. That's because, generally speaking, the more collectivist proposals rely on evidence from the many, many countries that pay less for healthcare per-capita and get better outcomes, while the side that feels a more lassaiz-faire approach are relying on an essentialy religious position.
    - danielweber 12y ago
      The former group also ignores countries like India and Singapore, and pretend that there is just one kind of health-care system everyone else uses, sometimes calling vaguely calling it "single-payer." People like Ezra Klein desperately try to correct these people, to no avail. And after all, why should they care to learn the facts? All they need is enough buzzwords to call the other side stupid on message boards, and they are perfectly happy.
- xtracto 12y ago
  I believe that one of the reasons why discussions around the US healthcare debate do not bring any plausible alternatives is because the /real/ solutions would comprise something like socialization of medicine (like Norway, Canada, or other developed countries) which is something that the American culture is against in its deepest roots. This is comparable to the discussion we have here in Mexico about Oil, which is also a very touchy issue because culturally, in Mexico we have always been taught that Mexico´s oil is Mexicans property, and that any attempt to privatize some of its processes would mean to "sell the Fatherland/country" to evil transnational companies. Thus, given this premise, it is almost impossible to have a "grown up" discussion about how to fix the problems related to energy.
zackmorris 12y ago
Had a similar case with someone in Nicaragua. The procedure (including diagnosis, medication etc) was $3,000 there whereas it would have been at least $30,000 in the US. I think it goes well beyond cost of living comparisons, because most things there cost perhaps 2-4 times less than here. Even if we factor in that per-capita medical costs in the US are roughly double the rest of the developed world ($6,000 vs $3,000) there is still another multiplier of perhaps 2-3x for procedures. I’m becoming more convinced every day that the US has become a two-tier society. I (and many of my friends) have had some very lean years, earning perhaps $7-15,000 and surviving. During those times, saving even $3,000 was next to impossible, because we were already $5, $10, $20,000 in debt or more. Multiply that by 10 and it’s effectively out of reach for, I don’t know, 90% of the country. The standard deductible (which is looking like it’s going to be about $6,000 under Obamacare) will often mean the loss of a home, vehicle, or college savings, especially for chronic conditions. Meanwhile the people who determine these rates (doctors, hospitals, medical supply companies, insurance agencies) enjoy comfortable incomes of $50, $100, $250,000 or more. I don’t think they are capable of setting rates ethically. Throw in the fact that aging people are desperate and will basically pay anything to live longer, and it’s an unavoidable conflict of interest. I think the simplest solution to all of this (and probably the most controversial) is to decouple medical research from practice. Ban all medicine-related patents. Create low interest government matching funds for the loans provided by supply companies to dentists and other independent practitioners. Remove the regulations that prop up monopolists and rent seekers. Start reducing the administrative layer that adds so much cost but so little quality of care. Then protect doctors from frivolous lawsuits with a bond system like plumbers and electricians use for catastrophic accidents so they can perform the procedures they feel are needed instead of the ones deemed “safest” or most profitable. Go after the true medical costs, the Erin Brockovich type of coverups that cost the economy billions. And especially go after the sources of illness - radiation from burning coal, carcinogens released by fracking, a hamstrung FDA that doesn’t have the resources to test interactions between thousands of household chemicals, carcinogenic herbicides and pesticides used on genetically modified food, and so on. I’ve heard the standard arguments about how all of this might disincentivize medical research but I don’t buy them. The system we have now rewards treatments more than cures, as evidenced by big pharma ads on TV for irritable-whatever. If we really want to start over, we need to go back to pre-Nixon, before HMOs and profit-driven care. We need to spend substantially more on medical research than we do now (rather than practice), through universities and big-data approaches where biologists and chemists can run simulations and avoid human trials. Dump the current grant system and make funding far more accessible so researching don’t spend all of their time fundraising. If we do all of this, we may just have a shot at cracking the underlying mechanisms that cause illness, basically map every virus and bacteria, the mechanisms through which genes control proteins, how we age and repair damage, etc etc. We should be growing replacement organs by now. We should have cured chronic conditions like diabetes and arthritis years ago and gotten cures for allergies, asthma and autism for free since similar pathways are at work. Right now we are doing little to no prevention, charging just enough to keep people from going to the doctor at early stages of illness, and then charging an arm and a leg for the medical equivalent of disaster cleanup. It’s really quite remarkable, and sad.
discardorama 12y ago
This reminds me of the case of a friend (who is from India) who went on vacation to India. There, something went wrong and he suffered a herniated disk in his back. He immediately went to the hospital. They took an MRI, and advised surgery. He underwent the surgery, and then had a 1 month stay at home with a nurse in attendance. Total cost came to about 200,000 rupees (about $4000). He came back to the US and then told the insurance company what had happened. (He didn't know he had to inform the company when it happened). They balked at paying his expenses, and came up with all sorts of excuses. Then he told them the cost: $4000. The person he was talking to told him was shocked, saying just an MRI here would have cost them more. They asked him to get an post-surgery evaluation done by his primary physician, and paid the bill no questions asked.
primitivesuave 12y ago
I was traveling through India with my sister, and she got terrible food poisoning. I put her in a private hospital, where she was given incredible service and recovered within a four days. The hospital bill was only 8000 rupees, or ~$150. My sister told me of one nurse who gave her exceptional care, so I tried to give that nurse a 5000 rupee ($100) tip. Without a moment of hesitation, she flat-out refused. Her response brought tears to my eyes - "Sir, this is my duty. There are poor people right outside, your money would really help them." As I talked to my relatives about what I experienced, I learned that Indian medical staff see their job as their dharma (duty), a belief that stems from their medical training and originally from the Bhagavad Gita, a religious text that is central to Hinduism. If I had to state a particular reason for the quality of Indian medical treatment, that's what it would be - that they consider their jobs a sacred duty. When someone truly believes that their job is a sacred duty, they will do it with a passion that cannot be artificially reproduced by a huge salary or per-patient compensation.
- pkaye 12y ago
  It is also because being a doctor is considered high status in India. Higher than lawyers, businessmen, engineers. Also they also command a high income. So what you did of offering a tip is more of an insult.
  - habith 12y ago
    S/he tried to tip the nurse.
  - kamaal 12y ago
    >>Higher than lawyers, businessmen, engineers. This was true at one point in time. May be around 2 decades back. But engineering has gotten very lucrative due to the IT boom, overall growth in economy and general demand for engineers in a high growth environment. Also engineering has a lower barrier to entry and pays better than what many physicians make these days. To make anything decent as a doctor you have to do your MD, which is expensive both in terms of investment of time and money. And even after that, the job at the hospital won't pay you anything close to what your average engineer at a MNC would get paid. And then don't forget the fact that many engineers can make money through side projects, freelancing and take adhoc risks like doing start ups which isn't even an option to most doctors.

176 points by tchalla 12y ago

When he was born, my son had cardiac surgery. Had another one 4 months later and a catheter later on. The two surgeries were done by one of the top 10 surgeons in the world. All in all, he was 6 weeks in the hospital. He's now in very good health. Since we live in Canada, it costs us nothing except the parking at the hospital (about $120 total with a pass) and the lost work time.

forca 12y ago
Free as it ought to be -- payed for out of yours and everyone's taxes. Parking should have been free, to be honest. Nothing I hate more than seeing basic services turned into money-making opportunities for the shady.
- RealGeek 12y ago
  Since Canada doesn't spend trillions in wars and bailing out banks, they can afford to provide healthcare to it's citizens.
  - forca 12y ago
    Wow. Simple, yet profoundly true.
  - mahyarm 12y ago
    Actually, Canada pays less on a per citizen basis than the US does on it's health care. America can still have it's wars, bank bailouts and health care, if they weren't politically gridlocked with the issue.
- jeromeparadis 12y ago
  Do you know how much it would have cost in the US? More than $1.5MM is the estimate I got. If you were to pay here as a non Canadian. About $200-300K. The missing $1MM, where is it going and where is it coming from? Everything is relative when you say everyone pay because of taxes. I would from you salary and insurance. At the end of the day, who's paying more? I don't know. But I'll tell you something: in the States, our choice would have been an late and illegal abortion or a bankruptcy. Today, we have a marvellous son that our society decided we should protect at all cost.
yitchelle 12y ago
Sounds similar to the German medical services available for children. My son needed surgery on his ptosis that is becoming a problem for his vision. After making seeing the doctor at the UniKlinik in Cologne, he was booked in for operation in two weeks time. The operation took place and was in hospital for about 1 week. My wife stayed with him for that whole week in the hospital. Total cost for this procedure was zero. I did not have to deal the insurance at all, the UniKlinik handled all the paperwork. We were considering having the same operation in Australia prior to relocating to Germany. It would have cost at least $2500 and months of waiting.

cdnsteve 12y ago

Thank you for sharing. Not only cost is important but people seem to forget about waiting times, the silent killer.

RealGeek 12y ago

I moved to US last year, and figured the healthcare system in US is the biggest train wreck. It is not only super expensive, but also super complicated. You have to jump through many hoops likes insurance, appointment waiting list, mail order pharmacies (who always mess up your order), pre-existing conditions etc. We were denied treatment by our insurance because of pre-existing conditions. Thankfully, Obamacare fixed it and we began to receive healthcare in 2014. The prices of healthcare are artificially inflated so high so that it is not affordable for most Americans, so they can be forced into the bizarre health insurance system. This system only makes healthcare even more expensive due to administrative costs and make it complicated for everyone. There should be no place for a middleman in healthcare. I recently went to see a doctor for a non-serious problem, and here is how it worked out. Steps to get medical care in US: 1) Call a specialist's office for appointment, and you will usually get a wait list of 3 to 6 months. 2) After months of wait, you get to see the doctor who will diagnose you. 3) Doctor sends in your prescription to your mail order pharmacy. 4) Pharmacy messes up your order; it could be incorrect dosage, pre-authorization, incorrect billing etc. 5) Your medication is delivered to you after few days, sometimes it can even take weeks. 6) You get bills, which could be 10x higher than what you were expecting. Your insurance company provides no explanation of the mysterious charges. Costs: $50 co-pay, $450 for prescription. Insurance claims: $700 specialist, $2750 prescription. Here's how it works in India: 1) Call into doctor's office, you will usually get appointment for same day or next day. You can even walk in without appointment. 2) The doctor diagnoses you, and write a prescription. 3) You take that prescription to any pharmacy, and buy the medications. Costs: $10 to $20 fee for specialist, and $20 for prescription. No Insurance required Edit: I've compared prices of various medications in US and India. Most of the medications in US cost 10x to 20x more than India.

vonmoltke 12y ago
> 1) Call a specialist's office for appointment, and you will usually get a wait list of 3 to 6 months. In the past year I have seen both a dermatologist and an orthopedist for the first time. I never had to wait more than a week. > 3) Doctor sends in your prescription to your mail order pharmacy. Mine have always gone to the local pharmacy of my choice. Same for my wife. > 5) You get bills, which could be 10x higher than what you were expecting. Your insurance company provides no explanation of the mysterious charges. I rarely get bills after the fact, but they always itemize and explain the charges. I also get statements showing what my insurance company paid.

kr_60642 12y ago

i am an indian living in the US for more than 10 years. Costs are cheaper in India and the big hospitals usually have good quality care. The problem is what happens when you have complications or side effects. In the US, you can sue the hospital/doctor and expect to get paid. You can't do that in India (cases drag on for decades).

idonkre5 12y ago

Americans are most money hungry people I have encountered in my life. Seriously. Every single opportunity, heck ,even life and death is seen through money. I lived in Europe, South Asia and US. Europe is sort of similar but much better. I had came to US in 2004 on H1-B. People will literally say H1-Bs are reason they are out of job. Well, that's not true in many cases. Even if it was, what about hundred and thousands of lives saved by Indian Medical facilities ? Every time I go to home ( India) I see thousands of people coming to India ; many for medical tourism. Also, FUCK this author for publishing costs. Next time think about poor people back home before going fucking social over it. Because lots of people from fucking US and Europe are coming to India for medical tourism cost to treat people at home are skyrocketing. You motherfucking bastards count it in dollars and think , well fuck its just 3K , look how cool and cheap treatment it. Point is , it is 150000 for Indians at home. A well round software engineer earns between 600000 to 800000 after 3 or 4 years. Because now many hospitals know that foreigners are fucking bastards tipping and lavishing them with money they refuse to offer same level of treatment at home. So disease created by US of money hunger ( hmmm hmmm capitalistic fuckers ) is spreading in India fast , very fast. Fuck everyone taking advantage of our not-so-low-cost medical care with your fucking dollars.

tn13 12y ago

When two parties mutually agree on some deal they both feel satisfied and have incentives to make each other happy. When the government decides what is the "interest" of one party and steps in to "protect that interest", very likely it will end up pissing off one party which eventually loses interest in any kind of innovation. US has achieved the rare distinction of screwing up both the parties in case of healthcare. Indian government in reality has even more laws and nonsense but it is too incompetent to implement any of those laws. This mostly leaves the things in a Laissez-faire situation. Like it happens in any Laissez-faire situation the third parties see too many problems but the people who are actually affected are more than happy because they are a better judge of their situation. In my village in India, we have only 1 doctor. This doctor is a homeopathic doctor who even today charges Rs 10 ( $0.16) per visit. He spends less than 5 minutes per patient and his treatment is allopathic. He moved from a distant city to this village purely because homeopathic doctor giving allopathic medicine is illegal. Over last 30 odd years not only he has got rich but he is the most powerful person in the village. He is very good at his job, has saved countless lives, delivered babies, removed aching teeth and written countless death certificates. Yes, there have been cases of wrong diagnosis and side-effects too but overall he has lead to net positive benefit to the society in my village and hence is revered. Many proper doctors tried to setup their shop in my village and have failed purely because this doctor turned out to be better than them. In India, Indian Medical Council controls the total number of doctors in the country but for a bribe of around $2M you can easily get a license to start a medical school. Medical Schools make insane amount of money and thousands of poor people enter the hospital everyday where you can get away making mistakes because the choice before these poor people is "either get this treatment or die in your home".

tn13 12y ago

Another Note: Unlike best engineers in India, best doctors in India can not migrate to US. Because of the sheer population, Indian doctors see 4x more daily patients than their American counterparts perform far too many surgeries very likely to have seen more corner cases than American doctors. Indian doctors in average private hospitals are far more competent than average American doctors. It is good that American government is protecting jobs of American Doctors at the expense of public health by barring entry to Indian doctors. We Indians get cheaper and better healthcare. :P Disclaimer: I worked for a large Cancer hospital in India.

forca 12y ago

Great read. This just show how evil for-profit medicine really is. The fact that the pay is so high in the west is disturbing. I really pray we see a single-payer socialised system in our lifetime in the US. Growing up with socialised medicine has shown me the truth. No doctor, no matter how talented, needs to make what they do. All of this should be government run as a non-profit. Government should mandate and force all pharmaceutical companies into non-profit status as well for the good of mankind. I'm sick to death of not being able to go to hospital here in the US, even with insurance, because what with the co-pays and deductibles, it costs a fortune. I just don't go, and I am in need of surgery that I cannot afford. QUESTION: Would an Indian facility in India treat me for a relatively small amount of money? Even after the flights, it would still be cheaper than the $22k I've been quoted here by multiple sources.

GFK_of_xmaspast 12y ago
Maybe? Medical tourism is a well-established thing.
- toomuchtodo 12y ago
  I've often thought about establishing a medial tourism non-profit. Think Watsi.org, but for first-world consumers of healthcare, taking them to near-first-world country locals where the cost of the same quality service is much lower.
DanBC 12y ago
> Would an Indian facility in India treat me for a relatively small amount of money? http://www.bbc.co.uk/news/health-10837726 http://www.bbc.co.uk/news/health-10837726 While there are some good ideas the ruthless efficiency is a bit scary.
- Scoundreller 12y ago
  Why is it scary? Is there something inherent about health care that prevents an industrial philosophy towards production?

yummyfajitas 12y ago

Her experience is the same as mine. I've had most of my medical care over the last few years done in India. This includes LASIK (34k per eye), a selective nerve root blocker injection (8k) and a micro lumbar discectomy (85k). I expect to have a second discectomy done in the next month (being really tall sucks), provided my condition doesn't worsen and I'm able to fly. Overall, my experience with India's medical system has been fantastic. I've found clean hospitals (not all of them!), total price was all completely transparent (+/- 10% of quoted price), and the doctors have generally been as good as in the US. Overall, for anyone needing significant medical work done, I strongly recommend medical tourism. Also, while you are there, have a custom suit made (particularly if you are really tall, and ordinary clothes don't fit). But be warned - I spent more on my suit than on the root blocker injection. [edit: numbers in INR. Quick reference: 1 lac INR = 1600 USD. In spite of a few years worth of inflation, I don't expect to spend more than 2k USD on back surgery.] [edit 2: 1 lac = 100,000.]

dpeck 12y ago
Are these in USD or INR?
- deleted 12y ago
  [deleted]
- Scoundreller 12y ago
  I'm guessing INR. 43k INR = US$558 8k INR = US$131 85k INR = $1397 (per xe.net)
- voxic11 12y ago
  I love how they work out to be about what it would cost in both countries using their own currency.
McDiesel 12y ago
I think you got your numbers backwards... 1600 IRN ~ 1 USD, right? Your way, your lasik costs about $54M.. So you can get full Lasik for ~$50USD?

jostmey 12y ago

Awhile back I was struck by the sprawling medical campus at my University (in the US). First I passed by the original hospital, a large six story structure. Then I passed the new Children's hospital, an even larger building. Finally I walked by the latest building under construction - a twelve story behemoth spread over several city blocks. It seems that every few years a new building is added, and each one is bigger than the last. Something about the pattern felt vaguely familiar. What I asked myself also exhibits unrestrained exponential growth like the pattern of construction that I saw - then I realized the answer. A tumor!

forca 12y ago
I voted you up. What you say is disturbing and true. American medicine treats the symptoms and intentionally strings people along rather than cure the underlying cause. There is no profit in curing cancer -- only in the treatments. I'm convinced of this after having a few people I dearly loved die in the American medical system. We need more of a system whereby our taxes are used solely for the good of the people -- to improve our lives. It's sad, really. As much money as the US has, we could have the highest standard of living on the planet, but we're nowhere near that because of greed on the parts of tax-dodging corporations, greedy capitalists, and a whole host of other reasons.
Spooky23 12y ago
People are voting you down, but you make a great point. It's especially apropos when you realize that many US states have massive gluts in hospital beds and more and more procedures that once required hospitalization are now outpatient, and private insurance makes it punitive in most cases to stay in a hospital for any length of time. The money for these building binges is mostly from Medicare, which still allows hospitalization in more cases. The fact hospitals have sufficient funds to constantly build massive facilities is a signal that they are making too much money on Medicare. Particularly disturbing when you consider that Medicare is effectively a price floor for medical services.
secabeen 12y ago
If this is in California, they are probably replacing the old hospital for earthquake safety reasons.

induscreep 12y ago

But India is 24 hrs away by flight. If there was a list of countries with the flight duration and cost of medical care, what countries would lie on the Pareto front? What if you sorted by a "$-hr" metric?

mahyarm 12y ago
You hear good things about Thailand and some South American countries.

it_learnses 12y ago

We should still consider the fact that the author has a husband who's a doctor, and has family from India and is herself from India. Not sure if the costs would be the same if someone who hadn't been to India in a while or had no family were to go to seek treatment. Someone could easily take advantage of you and you'd hardly have any recourse.

yummyfajitas 12y ago
I have no relatives in medicine (my sister trained as an EMT, but doesn't work as such), I'm not from India and have no family there. They've been pretty straightforward with me. The price they give me comes out of the same price list as the price they give to everyone else. Also, if they rob you it's still a great deal. Do you really care a lot whether you spend $1k or $2k on surgery? I haggle with autowallahs on principle, not because I care about paying 30rs extra.

deleted 12y ago

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parennoob 12y ago
India also has a parallel subsidized healthcare system of Government-operated hospitals, in which you can receive treatment at much lower costs, or often, for free. (http://en.wikipedia.org/wiki/Public_hospital#India http://en.wikipedia.org/wiki/Public_hospital#India) However, the waiting lines for everything from a basic consultation to an actual procedure are much longer, and the standard of care seems to be lesser, so a lot of people from the middle and upper classes avoid them. [Edit: parent comment seems to have been deleted, it mentioned the average figure for Indian per capita income, and asked whether most Indians could afford a procedure like this.]
- pkaye 12y ago
  The government hospital can be poorly run and unsanitary and most people who can afford it go to private ones. I guess still better than nothing.
atonse 12y ago
That may be so, but the skill level is the same, and the equipment is the same, if not similar. So if the fundamental quality of care is the same, what explains the insane markup? Salaries? I doubt it.
Erwin 12y ago
The $47,000 was the average cost for the angiography so just finding out what was wrong with the heart -- that was what cost her $254 in India. Not a pleasant sounding procedure, involving sticking a giant needle through your forearm, guiding it up to the heart and injecting some contrast fluid so you can see what's going on the heart (still better than open heart surgery though). http://en.wikipedia.org/wiki/Angiography http://en.wikipedia.org/wiki/Angiography
- wil421 12y ago
  I take back what I said after more thought and reading other comments. If you cant even reliably get a quote on a procedure then there are much bigger issues at hand beside the patients charges.

acabal 12y ago

I recently wrote on my blog about the cost of having a benign mole removed. I got so angry when I heard the cost of that simple procedure that I went online and calculated the cost to do it in Colombia, where I have some family. Long story short, I estimated that it would be 34% cheaper to fly to Colombia, have the same procedure done, and have a full week's vacation (at hostel rates, which is how I travel). Everything, including airfare and a full week of food and lodging, for 34% less than just the procedure in America! The best part is that I guesstimated the cost of the procedure in Colombia. But even if I tripled my guesstimate, it would still be cheaper to fly! For time-insensitive or elective procedures, you can and should go abroad. The real cruelty is people who don't have a choice--emergency situations, cancers, etc. They're trapped in our hideous system and often have to choose between their life savings and a lifetime of debt, and dying. Our American approach to healthcare disgusts me. Every time I think about it I get filled with rage.

cpwright 12y ago
If you can shop around in the US for something like that it can matter too. To correct my son's tongue tie the first ENT would have been over $1500 out of pocket, including anesthesia. The second one did it in his office as part of another appointment we had related to his hearing, total out of pocket $50. IMO, The biggest problem is really lack of transparency for this stuff. If a hospital takes government money (and pretty much every one of them does), it should be required to publish its rates like a utility does.
- danielweber 12y ago
  The more they deal with insured patients, the less ready they will be to give you quotes. I was trying to find a news story of someone calling around to get price quotes on procedures and many places just immediately hung up at the question.

zaptheimpaler 12y ago

Coming from India, I have really come to hate the medical system here in the US. There are countless times I have been screwed over by the lack of transparency in cost and the layer of bureaucracy and BS imposed by having to deal with an insurance company rather than __the doctor/hospital who treated me__!! It has been a few months since I have seen a doctor, but I still receive some new goddamn bill every other day. They are usually cryptic and leave me wondering what the hell they are for, and why they were not just presented to me on the day of the test. Don't even bother asking anyone what a procedure costs. Hospital staff will redirect you to someone who deals exclusively with insurance (completely unnecessary if we just had simple bills like any other transaction FFS), and the insurance people don't have enough specifics to ever really give you an answer, not to mention the time it will take waiting on hold etc. When you are getting multiple procedures, its just not worth the time. So you are practically forced to go in completely blind about potential costs. To top it all off, my insurance coverage has expired as I recently graduated. So my options are to either pay $600 for 30 days of medicine that I need, or get the exact same medicine shipped to me from India, for $10-$20. They produce it by the millions in blister packs. This should not be so difficult! If we just had realistic prices in the first place instead of inflating them and bringing them down with insurance, this crap would not happen. And don't even get me started on "pre-existing conditions". What that means for me is constantly lying to doctors and being unable to give them a complete medical history - otherwise I'll have f* "pre-existing condition" stamped on my head and never get sane rates again. I fail to see why health care is not treated more like a series of simple business transactions in an economic system instead of this colossal mess. /rant

swamp40 12y ago
I don't disagree with your rant, but Obamacare eliminated all the pre-existing conditions clauses.
yodsanklai 12y ago
> And don't even get me started on "pre-existing conditions". What that means for me is constantly lying to doctors I don't know if it's a good idea. I have a related anecdote: My mother forgot (or omitted) to mention a pre-existing condition when she contracted a mortgage insurance. She died a few years later from causes totally unrelated to the pre-existing condition. Somehow, the insurance company found out and legally canceled the insurance.

lizzard 12y ago

I hope she knows all the lyrics to The Ramones' "Teenage Lobotomy". "Then I guess I'll have to tell 'em / That I've got no cerebellum." https://www.youtube.com/watch?v=6ssoBUb2cJk https://www.youtube.com/watch?v=6ssoBUb2cJk

lizzard 12y ago
Oi. Wrong window. Meant for article on missing cerebellum...
deleted 12y ago
[deleted]
danielweber 12y ago
You can delete your own posts.

AndrewKemendo 12y ago

I feel like there is a lot of beating the dead horse with this issue. Is there (holding the jingoistic flag wavers aside) any real disagreement on the conclusion that the US healthcare system is terrible for the average user - such that we need continual reminder? Didn't the whole ACA debate prove that yes, we get it it's broken and there is major popular support for changes, even if the actual changes made were not themselves popular by a plurality?

danielweber 12y ago
Everyone agrees that it needs to change. There is little agreement on how to change it. Most proposed changes are "let's gore the other side's ox."
- rodgerd 12y ago
  > There is little agreement on how to change it. That's because, generally speaking, the more collectivist proposals rely on evidence from the many, many countries that pay less for healthcare per-capita and get better outcomes, while the side that feels a more lassaiz-faire approach are relying on an essentialy religious position.
  - danielweber 12y ago
    The former group also ignores countries like India and Singapore, and pretend that there is just one kind of health-care system everyone else uses, sometimes calling vaguely calling it "single-payer." People like Ezra Klein desperately try to correct these people, to no avail. And after all, why should they care to learn the facts? All they need is enough buzzwords to call the other side stupid on message boards, and they are perfectly happy.
xtracto 12y ago
I believe that one of the reasons why discussions around the US healthcare debate do not bring any plausible alternatives is because the /real/ solutions would comprise something like socialization of medicine (like Norway, Canada, or other developed countries) which is something that the American culture is against in its deepest roots. This is comparable to the discussion we have here in Mexico about Oil, which is also a very touchy issue because culturally, in Mexico we have always been taught that Mexico´s oil is Mexicans property, and that any attempt to privatize some of its processes would mean to "sell the Fatherland/country" to evil transnational companies. Thus, given this premise, it is almost impossible to have a "grown up" discussion about how to fix the problems related to energy.

zackmorris 12y ago

Had a similar case with someone in Nicaragua. The procedure (including diagnosis, medication etc) was $3,000 there whereas it would have been at least $30,000 in the US. I think it goes well beyond cost of living comparisons, because most things there cost perhaps 2-4 times less than here. Even if we factor in that per-capita medical costs in the US are roughly double the rest of the developed world ($6,000 vs $3,000) there is still another multiplier of perhaps 2-3x for procedures. I’m becoming more convinced every day that the US has become a two-tier society. I (and many of my friends) have had some very lean years, earning perhaps $7-15,000 and surviving. During those times, saving even $3,000 was next to impossible, because we were already $5, $10, $20,000 in debt or more. Multiply that by 10 and it’s effectively out of reach for, I don’t know, 90% of the country. The standard deductible (which is looking like it’s going to be about $6,000 under Obamacare) will often mean the loss of a home, vehicle, or college savings, especially for chronic conditions. Meanwhile the people who determine these rates (doctors, hospitals, medical supply companies, insurance agencies) enjoy comfortable incomes of $50, $100, $250,000 or more. I don’t think they are capable of setting rates ethically. Throw in the fact that aging people are desperate and will basically pay anything to live longer, and it’s an unavoidable conflict of interest. I think the simplest solution to all of this (and probably the most controversial) is to decouple medical research from practice. Ban all medicine-related patents. Create low interest government matching funds for the loans provided by supply companies to dentists and other independent practitioners. Remove the regulations that prop up monopolists and rent seekers. Start reducing the administrative layer that adds so much cost but so little quality of care. Then protect doctors from frivolous lawsuits with a bond system like plumbers and electricians use for catastrophic accidents so they can perform the procedures they feel are needed instead of the ones deemed “safest” or most profitable. Go after the true medical costs, the Erin Brockovich type of coverups that cost the economy billions. And especially go after the sources of illness - radiation from burning coal, carcinogens released by fracking, a hamstrung FDA that doesn’t have the resources to test interactions between thousands of household chemicals, carcinogenic herbicides and pesticides used on genetically modified food, and so on. I’ve heard the standard arguments about how all of this might disincentivize medical research but I don’t buy them. The system we have now rewards treatments more than cures, as evidenced by big pharma ads on TV for irritable-whatever. If we really want to start over, we need to go back to pre-Nixon, before HMOs and profit-driven care. We need to spend substantially more on medical research than we do now (rather than practice), through universities and big-data approaches where biologists and chemists can run simulations and avoid human trials. Dump the current grant system and make funding far more accessible so researching don’t spend all of their time fundraising. If we do all of this, we may just have a shot at cracking the underlying mechanisms that cause illness, basically map every virus and bacteria, the mechanisms through which genes control proteins, how we age and repair damage, etc etc. We should be growing replacement organs by now. We should have cured chronic conditions like diabetes and arthritis years ago and gotten cures for allergies, asthma and autism for free since similar pathways are at work. Right now we are doing little to no prevention, charging just enough to keep people from going to the doctor at early stages of illness, and then charging an arm and a leg for the medical equivalent of disaster cleanup. It’s really quite remarkable, and sad.

discardorama 12y ago

This reminds me of the case of a friend (who is from India) who went on vacation to India. There, something went wrong and he suffered a herniated disk in his back. He immediately went to the hospital. They took an MRI, and advised surgery. He underwent the surgery, and then had a 1 month stay at home with a nurse in attendance. Total cost came to about 200,000 rupees (about $4000). He came back to the US and then told the insurance company what had happened. (He didn't know he had to inform the company when it happened). They balked at paying his expenses, and came up with all sorts of excuses. Then he told them the cost: $4000. The person he was talking to told him was shocked, saying just an MRI here would have cost them more. They asked him to get an post-surgery evaluation done by his primary physician, and paid the bill no questions asked.

primitivesuave 12y ago

I was traveling through India with my sister, and she got terrible food poisoning. I put her in a private hospital, where she was given incredible service and recovered within a four days. The hospital bill was only 8000 rupees, or ~$150. My sister told me of one nurse who gave her exceptional care, so I tried to give that nurse a 5000 rupee ($100) tip. Without a moment of hesitation, she flat-out refused. Her response brought tears to my eyes - "Sir, this is my duty. There are poor people right outside, your money would really help them." As I talked to my relatives about what I experienced, I learned that Indian medical staff see their job as their dharma (duty), a belief that stems from their medical training and originally from the Bhagavad Gita, a religious text that is central to Hinduism. If I had to state a particular reason for the quality of Indian medical treatment, that's what it would be - that they consider their jobs a sacred duty. When someone truly believes that their job is a sacred duty, they will do it with a passion that cannot be artificially reproduced by a huge salary or per-patient compensation.

pkaye 12y ago
It is also because being a doctor is considered high status in India. Higher than lawyers, businessmen, engineers. Also they also command a high income. So what you did of offering a tip is more of an insult.
- habith 12y ago
  S/he tried to tip the nurse.
- kamaal 12y ago
  >>Higher than lawyers, businessmen, engineers. This was true at one point in time. May be around 2 decades back. But engineering has gotten very lucrative due to the IT boom, overall growth in economy and general demand for engineers in a high growth environment. Also engineering has a lower barrier to entry and pays better than what many physicians make these days. To make anything decent as a doctor you have to do your MD, which is expensive both in terms of investment of time and money. And even after that, the job at the hospital won't pay you anything close to what your average engineer at a MNC would get paid. And then don't forget the fact that many engineers can make money through side projects, freelancing and take adhoc risks like doing start ups which isn't even an option to most doctors.