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Part of the problem with doing this in the US is that cardiac surgery and cardiac care is a major revenue center for US hospitals. US hospitals are law bound t

Part of the problem with doing this in the US is that cardiac surgery and cardiac care is a major revenue center for US hospitals. US hospitals are law bound to treat patients who come in their Emergency Rooms, regardless of ability to pay. So, they lose money on patients who are uninsured or under-insured and need expensive care, and then they make up the difference doing expensive cardiac procedures, OB, orthopedic surgery, etc... There is a growing move to go to specialized hospitals like Heart Hospitals, Surgery Centers or stand alone OB centers in the US, because they are big revenue generators for the owners of those specialty hospitals. But, while I'm sure quality goes up at dedicated heart hospitals, it causes problems on the macro scale, because those specialized hospitals drain patients with private insurance that would otherwise be subsidizing patients without insurance at a general hospital. If you read between the lines of the article, what they don't say is they are charging cash up front for many of those surgeries. Families with children needing heart surgery that don't have insurance are forced to either pay cash or their child likely dies an early death. It sounds like the are actually turning patients away that don't have the money to pay for their surgery. You can't do that in the US.

djcapelis 17y ago
You've just made an excellent argument for why universal coverage (of some sort, public or private) is essential. This is part of why some starry-eyed supporters predict cost savings. Hard to argue too much, it sounds like they do more for better and cheaper, which is a compelling combination.
- cwan 17y ago
  I don't know that it's a great argument for universal coverage. At 2,000 dollars for open heart surgery it's still a lot but at least considerably more affordable. What will be interesting/exciting to see is how well they do at their facility in the Caymans and whether US insurers will cover the cost of treatments there. Ambulatory surgical centers have a record of greater outputs but also better outcomes than their generalist competitors. This is pretty compelling - (and at $2,000!): "Dr. Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9% in the U.S. in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons [...] Dr. Lewin believes Dr. Shetty's success rates would look even better if he adjusted for risk, because his patients often lack access to even basic health care and suffer from more advanced cardiac disease when they finally come in for surgery."
- anamax 17y ago
  > You've just made an excellent argument for why universal coverage (of some sort, public or private) is essential. Not at all. The factory model produces significant savings in processes without anything like universal coverage. For example, the factory model produces those benefits for for IC manufacture, automobiles, clothing, printing, agriculture, etc.
  - djcapelis 17y ago
    Uhm. I didn't say the factory model was an argument for universal coverage. The argument however, that we couldn't take advantage of things like this in this country in part because we didn't have universal coverage, was. It appears you may have entirely misinterpreted my post.
    - anamax 17y ago
      > I didn't say the factory model was an argument for universal coverage. Whatever. > The argument however, that we couldn't take advantage of things like this in this country in part because we didn't have universal coverage, was. Except that that's not true. As other folks have pointed out, we're starting to develop "heart surgery" factories and the like. Those folks also pointed out that some mandates that approximate universal coverage (a hospital has to take all comers) actually interfere with the development of factories because factories specialize. Note that requiring that something be open to everyone is an obstacle.

djcapelis 17y ago

You've just made an excellent argument for why universal coverage (of some sort, public or private) is essential. This is part of why some starry-eyed supporters predict cost savings. Hard to argue too much, it sounds like they do more for better and cheaper, which is a compelling combination.

cwan 17y ago
I don't know that it's a great argument for universal coverage. At 2,000 dollars for open heart surgery it's still a lot but at least considerably more affordable. What will be interesting/exciting to see is how well they do at their facility in the Caymans and whether US insurers will cover the cost of treatments there. Ambulatory surgical centers have a record of greater outputs but also better outcomes than their generalist competitors. This is pretty compelling - (and at $2,000!): "Dr. Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9% in the U.S. in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons [...] Dr. Lewin believes Dr. Shetty's success rates would look even better if he adjusted for risk, because his patients often lack access to even basic health care and suffer from more advanced cardiac disease when they finally come in for surgery."
anamax 17y ago
> You've just made an excellent argument for why universal coverage (of some sort, public or private) is essential. Not at all. The factory model produces significant savings in processes without anything like universal coverage. For example, the factory model produces those benefits for for IC manufacture, automobiles, clothing, printing, agriculture, etc.
- djcapelis 17y ago
  Uhm. I didn't say the factory model was an argument for universal coverage. The argument however, that we couldn't take advantage of things like this in this country in part because we didn't have universal coverage, was. It appears you may have entirely misinterpreted my post.
  - anamax 17y ago
    > I didn't say the factory model was an argument for universal coverage. Whatever. > The argument however, that we couldn't take advantage of things like this in this country in part because we didn't have universal coverage, was. Except that that's not true. As other folks have pointed out, we're starting to develop "heart surgery" factories and the like. Those folks also pointed out that some mandates that approximate universal coverage (a hospital has to take all comers) actually interfere with the development of factories because factories specialize. Note that requiring that something be open to everyone is an obstacle.