
 In India, 'no frills' hospitals offer $800 heart surgery - OGinparadise
http://www.globalpost.com/dispatch/news/afp/130421/india-no-frills-hospitals-offer-800-heart-surgery
======
curiousfiddler
I'd like to take a shot at answering this: why is a low cost medical treatment
effective in India?

1\. For the most part, medical education is good in India. In the better
hospitals you will find that doctors are generally very smart and
knowledgeable. They also happen to be very practical when suggesting
treatments and do consider the treatment cost as a factor when suggesting
options.

2\. The cost of living in India is lower when compared to the developed world.

3\. The equipment cost and medicine cost is also lower compared to the
developed world.

Also, please understand, India "is not a developed nation". Everyone there
"cannot" afford expensive medical treatment. Yet, people who cannot afford
expensive treatment "can" suffer from ailments like cancer, heart problems
etc. I find it commendable that such people do have a fairly reliable option
to save their life, however imperfect it may appear, compared to the system in
the developed world. Standards will improve as the country develops, but for
now, they offer a good solution.

~~~
skylan_q
I'm going to guess it's because people in India are allowed to practice
medicine and produce equipment. If I were to start practicing medicine and
producing equipment up here in Canada I'd be arrested in a heartbeat. (Unless
I went through all the hoops, and I again have a hunch there's many more here
than in India)

~~~
curiousfiddler
Well yes they are, but it is regulated (in terms of educational qualification
etc). What I was trying to get at, is developing and underdeveloped countries
face a lot of problems. To produce worthy result in such circumstances is
something definitely worth cheering IMO.

There are so many deprived/underdeveloped/developing societies in the world
which are similar to India in terms of the resources that they have access to,
yet somehow the aspirations of people are not channelized and they end up
doing things which are awful (e.g. terrorism). I feel India could be used as a
positive example in such cases.

There are a lot of inspiring stories of people who perform amazingly well,
despite access to very little resources, just because they have a direction in
life and an aspiration that is meaningful. I have been inspired by several
such stories in my life, which will find absolutely no mention in any western
or even local media.

------
sgt
So cheap it almost makes me feel like having heart surgery just to know I
didn't miss out on a great offer.

~~~
fakeer
I live near Manipal Hospital in Bangalore and had to stay with a friend in
there, thrice in last 6-7 months. Maybe he likes it there too and I often go
to their cafeteria(outside) which is cheap and good.

I meet so many foreigners here. I've talked to them; they simply say it's very
good - service, expertise - and it's a f __*ing loot! And no, this is no such
no-frills hospital. So, if you are from a western country and earning even
decent money then you are welcome to India and any hospital/hotel/place might
make you feel like royalty - mostly without compromising in quality.

~~~
toomuchtodo
Why is there no business in the US yet that matches healthcare consumers with
these Indian operations? A healthcare travel agent if you will.

~~~
geon
I don't know about businesses, but a lot of people go to Thailand for dental
care or boob implants.

~~~
theatrus2
I was about the mention Thailand and Taiwan as two popular medical tourism
places.

You're out $1-2k on the ticket, but paying a tiny fraction for great
healthcare.

You just can't sue anyone later (but that is maybe a good thing).

------
noonespecial
_"Essentially we realised that as you do more numbers, your results get better
and your cost goes down,"_

Tis tempting to just think of this as a "low rent" version of the "real"
procedures that are offered at much higher costs in the west, but there really
is something to just doing enormous numbers of procedures when it comes to the
brutal learning of human medicine. I would not be surprised to start seeing
innovations coming out of these facilites that would be impossible in the
west.

~~~
skylan_q
Necessity is the mother of innovation. This sort of thing might invite
competition in that price range. Spending millions of dollars at a hospital
that's in no danger of going out of business is a lot less likely to lead to
innovation than a hospital that's got to beat another one's price point that's
directly sensitive to the consumer/patient.

------
swatkat
Another worthy mention is state-run Jayadeva Institute of Cardiovascular
Sciences and Research[0]; a Bangalore based hospital that provides state-of-
the-art and affordable heart related healthcare services[1].

[0]<http://www.jayadevacardiology.com/achievements.html>

[1]<http://www.jayadevacardiology.com/procedure_charges.html>

------
quentusrex
Are they releasing any patient follow up statistics? It'd be interesting to
compare their post-op complication stats to some of the 'overpriced'
facilities.

~~~
healthenclave
Looks like you have edited your comment since you first made it.

The success rates are high and on par with western counter parts. Also this is
a private hospital , I think you haven't visited a good private hospital in a
developing country. Many have US/Uk trained docs and quality of service and
care on par with that of developed countries.

~~~
rorrr2
Source?

------
rubikscube
There's some low cost alternatives in the USA too for other types of surgery.

<http://www.surgerycenterok.com/>

They even have the integrity to list prices publicly.

It's because they are brave doctors working outside of the government
healthcare racket.

<http://www.surgerycenterok.com/pricing.php>

------
eli
Bad headline. From the article: "...the group _believes_ it can cut the cost
of heart surgery to an astonishing 800 dollars." It hasn't actually done it
yet.

------
logn
Well you can hire a software engineer in India for $10/hr. I think cost of
living should have been at least mentioned in this article.

~~~
fakeer
Standard IT service company entry level SE salary is ~ INR 25000/month -> INR
830/day =~ $15, now divide it by 9 and it comes down to ~ $1.7/hr. Of course
this is fresher salary and at a services company like Infosys, TCS, Wipro etc.

If you start with a product development(that means just fixing bugs in almost
all the cases) company or some of the startup(such jobs are quite few) then
the monthly salary can be sth from INR 40K to 60-70K(I'm giving an average
range, it can be higher too) so that comes down to ~ $25 to $42 per day or ~
$3 to $5 per hour.

What you mention, $10/hr, is earned by either very very experienced ones at a
services company(managerial level - never bloody ever someone who writes code
or even reads code) or good lead/senior level engineers at other companies in
their last phase of coding life cycle. It is translated as ~ INR 150,000 per
month which is quite some amount here, still.

~~~
ajays
Sure, you can hire an "SE" (and I use the quotes deliberately) for $15/day
also; but you won't get much use out of her/him. Decent grads from a good
school regularly get Rs 100K/month offers, from what I've been told (which
works out to about $10/hr or so).

~~~
kamaal
>but you won't get much use out of her/him.

Wrong. Getting paid less doesn't mean the quality is always going to be bad.

In this case getting paid less means, people don't have opportunities to begin
with and are ready to do compromise with anything just to get the opportunity.

When I started out here in India, I was paid 10,000 Rs per month at a call
center. And I considered my self fortunate for even having a job. My
programming job salary started at 14,000 Rs per month. Back then 16 hours at
office used be my regular working hours, and I didn't even complain. Heck I
considered myself extremely fortunate to even get that opportunity.

>>Decent grads from a good school regularly get Rs 100K/month offers,

You are talking of an extremely minute minority, who often don't work at their
first company for more than an year. And generally go the US to their MS or
MBA. In short they are not even relevant to the grand scheme of things.

~~~
ankitml
_Getting paid less doesn't mean the quality is always going to be bad._

In most cases like this, you get what you paid for. More number of hours and
not complaining doesnt mean quality. There might be cases like you, but
frankly the chances are too less.

------
newyankee
Relevant Al-jazeera documentary

[http://www.aljazeera.com/programmes/indianhospital/2012/05/2...](http://www.aljazeera.com/programmes/indianhospital/2012/05/20125292412865958.html)

------
jbrowning
Here's a better version of this article with photos of the hospital:

[http://www.news.com.au/lifestyle/health-fitness/no-frills-
ho...](http://www.news.com.au/lifestyle/health-fitness/no-frills-hospital-
indian-chain-narayana-hrudayalaya-does-surgery-at-fraction-of-the-cost/story-
fneuz9ev-1226625469519)

------
TheMagicHorsey
An eye hospital operator in India pioneered this model of efficient health
care -- not this guy. Check it out the TED talk for Aravind Eye Hospital:

<https://www.youtube.com/watch?v=b5QCM1_gVGA>

------
Attocs
Despite my cynicism, I too have had a positive experience with at least one
Indian medical institute. Instead of using general anesthetic and an operating
theater to work on my friend (which would have required several nights
recovery in a hospital) they operated on him under local anesthetic in the
dentist's chair. It wasn't pretty but it was a complete success. Other doctors
had quoted me 60,000 rupees for the procedure ($1100 USD) but the whole thing
was done for 10,000 rupees ($184 USD).

Working with people who live on the street, I cross paths with the medical
profession here regularly. Some doctors have proven to be pretty apathetic,
but the odd one, through the necessity of giving affordable health care to
India's thronging poor, has proven to be truly innovative.

An account of discount surgery here: <http://lostinmumbai.org/2013/03/11/9/>
Some of the discount was good will but a lot was innovation and the ability to
take risks through the absence of repercussions.

------
tn13
I know some people who were operated at "Narayana Hrudayalaya".

One of my relative had received treatment there. Like any other news reports
the $800 figure is a bit of exaggeration. The total cost of the surgery
including travel, additional stay at hospital, pre and post-surgery treatment
etc. costs around <$2500.

More power to NH.

------
jmduke
"Minimum Viable Heart Surgery."

------
mschuster91
Couple this with a medical insurance system and you'll have a copy-paste model
for pretty much every development country (and the United States _cough_ )

~~~
vaadu
Good luck with the ambulance chasing lawyers in the US. Also, India's drugs
are cheaper.

~~~
jcnnghm
Of course their drugs are cheaper, if drugs companies won't sell to them at
huge discounts, India ignores the patents and produces the drugs themselves.
Consequently, the US subsidizes their drugs, insofar as they do not contribute
to the costs of R&D, including research and clinical trials for working and
failed drugs.

If every country adopts that policy, which is the direction things are headed
because it's the dominant strategy, the rate of medical advancement will be
much lower. To quantify, about 58% of US medical funding is provided by
private industry. Pharmaceuticals alone spend more than the NIH. NIH in the US
spends 29 times more than NHS in the UK on health research, despite having
only 6 times more people. The US spends 4 times more per capita than Australia
on medical research. This is one of the two gigantic elephants in the
healthcare debate auditorium, the other being patient outcomes for comparable
patients. Of course US aggregate data is skewed because of the general health
of the population (fatness), and those without insurance, but what happens
when comparing _patient outcomes_ between people with insurance in the US,
with people that are comparably healthy (i.e. fatness and related issues) in
other countries. The whole thing is basically a health-and-wealth transfer
scheme from the insured to the uninsured.

We see basically the same thing whenever space research is discussed. Pompous
Europeans bash US progress and "meager space funding", while the US outspends
the entire world combined over 3 to 1 on space research. In the end, the
"solution" to both is to cut spending to both medical and space research to
global per-capita levels, and let the advanced research go undone, unless
other countries choose to start contributing. Of course, that would be a true
tragedy of the commons.

~~~
microarchitect
_If every country adopts that policy, which is the direction things are headed
because it's the dominant strategy, the rate of medical advancement will be
much lower._

What's the use of medical advancement that can't help more than 10% of
humanity?

It's far more important that we move to a world in which all human beings have
access to basic sanitation and healthcare than it is to spend billions of
dollars attacking statistically rare diseases producing medicines that will
help only a few rich people.

In fact, I'd go one step further and argue that your statement is actually
false in the long term. A world where all humans have access to good
healthcare and education would actually be a world in which more people
contribute to research and development of new drugs and one in which knowledge
would advance faster.

~~~
jcnnghm
_What's the use of medical advancement that can't help more than 10% of
humanity?_

When the patent expires everybody benefits. Until then, it's available to
everyone, but they must help pay for the drugs development. If nobody pays,
the drug isn't developed, and nobody gets any benefit.

 _It's far more important that we move to a world in which all human beings
have access to basic sanitation and healthcare than it is to spend billions of
dollars attacking statistically rare diseases producing medicines that will
help only a few rich people._

Would you die for that? You expect others to, no? That's kind of totalitarian.
At the same time, this argument is fallacious in the sense that it assumes we
should address no problem until the lowest level problem is solved for
everyone. That's undesirable for a large number of obvious reasons I will not
bother enumerating.

Do the "few rich people" that are helped not end up paying for the R&D of the
treatment for everyone else in perpetuity?

 _In fact, I'd go one step further and argue that your statement is actually
false in the long term. A world where all humans have access to good
healthcare and education would actually be a world in which more people
contribute to research and development of new drugs and one in which knowledge
would advance faster._

That's a nice thought. Unfortunately, there is a huge advantage to not paying
development costs, in that you can externalize them to others and reap the
benefits, which is what many countries, including India and the UK, have
chosen to do. In India it's ignoring the patent, in the UK it's setting a
price ceiling, which effectively shifts the burden to the US since the profit
maximizing strategy is still to sell the drug in the UK because marginal
revenue exceeds marginal cost. If the US stops paying, the drug never gets
produced, or gets produced much later because there is no private incentive to
produce.

~~~
microarchitect
A general remark first. Your statements are full of hyperbole and it's hard to
take you seriously.

All I said was that your hypothesis of a slower rate of medical advancement in
the short term might be acceptable if it ensures that (a) more people have
access to critical drugs and (b) more human beings have access to basic
necessities of life that are taken for granted in most of the western world.
Might be good if you respond to this claim instead of setting up a whole bunch
of poorly thought out strawmen.

 _When the patent expires everybody benefits._

You do realize that drug patents are full legal in India, don't you? And the
only thing that isn't allowed anymore is evergreening, which is of dubious
benefit to society anyway. Further, India has issued exactly _ONE_ compulsory
licence (for an expensive cancer drug) _ever_. There is no evidence for your
initial claim that India ignores patents.

I'm now going to ignore the strawman you've put about totalitarianism but I
will make one remark about this statement.

 _Do the "few rich people" that are helped not end up paying for the R &D of
the treatment for everyone else in perpetuity?_

What is wrong with this? Don't we all benefit from inventions and ideas of
many other humans, most of whom aren't rewarded financially from our
successes?

 _If the US stops paying, the drug never gets produced, or gets produced much
later because there is no private incentive to produce._

I would like to see citations on your claim that _private_ capital (i.e., not
money from the NIH, HHMI etc.) is responsible for the high rate of drug
discovery in the US.

------
hashkanna
the article mentions Al Jazeera's 6 part coverage on Narayana Hrudalaya. here
is the video link. <http://www.youtube.com/watch?v=-MqC6ga034U>

------
arbuge
Some frills might be useful when you're having heart surgery...

~~~
kiba
Just because their healthcare system is low cost doesn't mean it is of poor
quality.

Incidently, if you read the article, you will see such claim:

 _"Essentially we realised that as you do more numbers, your results get
better and your cost goes down," he said._

However, the details on how good their care is very lacking.

------
brador
Isn't India one of the top countries for surprise kidney removal?

General link: <http://en.wikipedia.org/wiki/Organ_trade#Illegal_organ_trade>

~~~
harichinnan
That's a factual statement. Just like you could've gone to the dentist in
Oklahome and got H1V or Hepatitis. [http://abcnews.go.com/Health/60-oklahoma-
dental-patients-tes...](http://abcnews.go.com/Health/60-oklahoma-dental-
patients-test-positive-hepatitis-hiv/story?id=18991527#.UXQ1Q78Tvu0)

~~~
brador
It's the likelihood that's important, not the binary.

