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In India, 'no frills' hospitals offer $800 heart surgery (globalpost.com)
171 points by OGinparadise on Apr 21, 2013 | hide | past | web | favorite | 108 comments



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.


just a heads up, you can italicize on HN by wrapping word(s) with asterisks like:

    India *is not* a [..]
sorry to take away from thread; insightful comment.


Thanks, will use that in future. Looking back at my comment, I don't seem to like the double quotes either.


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)


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.


India is hugely bureaucratic and inefficient..


There is a lot of state run medical colleges in India which offers (almost) free education, so that the doctors complete their education without racking up a huge debt.


There are state run medical colleges, but by no means there are a 'lot'.

Yes the fees is less, but its not (almost)free.

And there are many doctors who move out of India, because the money is good outside.


161 out of 355 is state run. [1] When compared to the fees in the US and private colleges in India, the fees are very low (at least 1/5)

[1]http://mciindia.org/InformationDesk/MedicalCollegeHospitals/...


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


No no, you should hold off for their Groupon!


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.


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


There are; google "medical tourism" - that being said there is some potential liabilities in that business...


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


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).


Oh, there is! Here's a list of such businesses (on the right side of the page): http://www.patientsbeyondborders.com/facilitator


As others pointed out, this medical tourism niche definitely exists and so does dental tourism. Getting a root canal while taking a mexican or thai vacation.


"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.


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.


With 4 operations/day they will be the masters of heart surgery, but will they have the time to write scientific papers?


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


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.


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.


Source?


Well, they haven't heard any complaints so far!!

Edit: Makes me guess, but what if their success rate is higher than the high priced facilities...

Oh and I would absolutely go for medical tourism. Beyond not being overcharged by the procedure, I wouldn't be pushed the "latest drugs" with debatable results or in a case where the latest drug is needed, it would be avaiable at a lower cost.


Yes, but to save money, the patients will have to evaluate themselves and send the results back to the doctor instead.

[/sarcasm]


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


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.


[deleted]


Why do you so handily dismiss the article without addressing its content? He is bringing 'expensive' care to people who would otherwise be ignored and making more money to boot. He is doing this by being more efficient, distributed, modular, small and optimizing details right down to architecture and construction. In a world where a large chunk still die from trivial diseases, it is clear current methods do not scale. If this model can safely serve more people, more cheaply and is more profitable then it surely is worth trying. Our current approach to healthcare certainly could do with more efficiency. He states in the article that charity does not scale, even if that is the case, a more efficient healthcare system also improves the efficiency of charity by multiplying how far each unit of currency goes. Is that not what HN is about?

There is probably an Amdahl's Law style limit to this approach where certain expensive specialty care does not benefit from this type of parallelization. But much of the world is not healthy enough to have those as major concerns. Separation may be useful there too, perhaps prices for many treatments are inflated from too much coupling of services? We won't know without experimenting.

As for your link, I believe this is exacerbated by combining highly sterilized environments with sloppy practices. If people are in and out as quick as possible, and only key areas are kept highly sterile this may actually be a bonus. More practice from high throughput aslo drills checklists. A quick google suggests 2% mortality rate and 3% H-aI. Even if padded, looking at his stats - 15,000 surgeries performed and operating since 2001; if it were really so bad I suspect complaints would be much more forceful and he would not be so profitable. Being profit motivated and no frills gives incentives to pay attention to waste, errors and quicker reaction time in dealing with those.


[deleted]


So, I looked back at his comments, and couldn't find any others about India. Maybe I didn't go far enough, but...?


Narayana Hrudayalaya has some of the best post-operation recovery numbers comparable or better than your first world hospitals.

> The hospital enjoys a high success rate - an average 1.4% mortality rate within 30 days of coronary artery bypass graft surgery, compared to 1.9% in the U.S.

http://healthmarketinnovations.org/program/narayana-hrudayal...


Who audits the numbers for the hospital? Is it all self-reported?


Who audits the numbers at U.S. hospitals?


good question; the US Department of Health & Human Services.

you can browse their site for more information about their mission and mandate, but here are some starting points:

http://www.hhs.gov/about/

http://www.hhs.gov/about/orgchart/

http://www.hhs.gov/regulations/


A modern pre-fab hospital could conceivably be less prone to harbor infectious bacteria than the decades-old facilities that are common in the "1st world." And air-handling systems, particularly air-conditioners, have been known to host veritable breeding colonies of pathogens.


You assume that the situation was ideal before these guys came in to "give people hospital infections." Also you have to realize that in many third world countries you have to bribe doctors more than $800 for the "free care" and still have WWII style hospitals.

My point is that maybe the Mayo Clinic offers better care...if you happened to have $150,000 under your mattress, but most people don't. So we have to find the best solution, within our price range.


Well, that is highly contestable. $150k is not a big deal for an extremely small fraction of people(<0.1%?). And with almost similar success rates, I find it hard to believe why anyone would pay that much money for very little more. The returns diminish really quickly.

Also, you don't bribe people in the hospitals mentioned in the article.


>> And with almost similar success rates, I find it hard to believe why anyone would pay that much money for very little more. The returns diminish really quickly.

The diminishing returns are irrelevant when your life is on the line and you risk losing your life. You just don't want to be that one

>> Also, you don't bribe people in the hospitals mentioned in the article.

Please re-read my comment. I was talking about corruption in state hospitals.


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.


I agree with your point but those $10 engineers are probably living in a shitty shared apartment in Bangalore. He doesn't have 24/7 water. Works few times a week. When he does, he has to go down his apartment to fetch it. He doesn't go to fancy restaurants. He doesn't have a dish washer or an AC or any other fancy stuff. And whole of $10 is probably not reaching him if he works for a company (It's usually $3-4/hour that he actually gets).

India is a place where a frugal lifestyle is extremely cheap. $400/month is easy for a single person.

At the same time a luxurious quality lifestyle (probably the same as the "average" in the first world) is actually higher than usual, same cars cost twice as much, electronics are always late and usually pricier, movies and nice restaurants are about the same, broadband internet is very pricy and I can go on.

I think we should keep in mind "cost of similar quality living"


Inflation is increasing the cost of living in India and China. A decent apartment (not luxury) will cost you min. $100K in any Indian city (even C and D tier cities)

While not as expensive as Manhattan or London, relative to Indian salaries everything is getting expensive.


Agree.

I'm looking for a flat to invest in and I am finding them out of reach, even after taking housing loan and they are running away from me a lot faster than I can catch up, besides, I've already started to pant :( (meaning the salary going to other holes in significant portions)


I have myself bought a home in Hyderabad...And I am convinced that that it is useless. Only if you sell the home, you can make it a worth while investment. That too, in the order of 10% which is probably same as mutual funds...Plz do total cost of ownership before buying.


Oh, you are in a trap.

If you have taken a huge loan(>40 lacs) to for your apartment. Especially in India- Hyderabad or Bangalore doesn't matter. You are likely to spend the next 15 years worrying about EMI's.


Living in reality, People dont marry if You dont have a house. For most people it is ok to get a loan and buy a house if they wish to start a family.


I visited China for a week. I felt China's inflation is horrible. Everything costs 1.5 to 3x more when compared to India.


wtf!! Dont attribute it to inflation, it is called "Cost of living index".


>wtf!!

A bit of civility would help.


sorry, i was just overwhelmed at this. I expected a bit more intelligence on HN. I apologize for the language!


As an Indian, I can tell you $10/hr is some thing like dream pay I can imagine.

With 16 hour schedules and no weekends. I can make something like 2,40,000 per month.

That is something like the pay super-rich people get paid here in India.

Your ordinary programmer is worth around just less than a dollar per hour.


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.


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).


>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.


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.


When I started out here in India, I was paid 10,000 Rs per month at a call center.

If it makes you feel any better, I started at Rs 1500 per month in a top IT firm.


That includes medical insurance for you and your family. If you are willing to travel you can get good house for rent at INR 10K month. I pay INR 6k for 1500 sqft house and my previous office is 7 km from my house. You can do rest of the math to figure out how somebody getting $25 per day can live comfortable life. Anything above $25 is bonus.


If you are referring to me then I know all this, being a resident.

But yes, the GP commenter might find it useful. In a city like Bangalore it still is a shoe-string budget and I can say this with authority as a 26+ yr old bachelor living in a one bedroom flat.

I was just commenting on his assumption/observation that we get $10/hr in general :-)


I just added more data to yours to just give an idea to others :)



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

http://www.news.com.au/lifestyle/health-fitness/no-frills-ho...


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


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.


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.


"Minimum Viable Heart Surgery."


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)


India has a medical insurance system. It's pretty simple, really - you pay actuarial cost + profit margin and it covers low probability high cost events.

Cost sharing induces patients to be price conscious, inducing downward pressure on prices. Most common procedures have prices listed on a sign, for less common stuff you need to ask the doctor for the price.

It doesn't usually cover birth control, psychologists, etc, nor is it a redistribution scheme in disguise.

The system works quite well. The rest of the world should learn from India.


Correct. The problem is that a simple system like that is similar to car insurance, it only helps you pay for catastrophe. The reason US health insurance is so expensive is because we tried to institute a health plan via insurance that tries to do things like address chronic conditions and preventative care. There are many problems with that, but the point is that India has only solved the easy problem. We are in the midst of solving the hard problem: How do we equitably manage the healthcare of the entire nation that gives the rich and poor alike quality health care.

That said, we aren't doing it right at the moment since it's taking us about 16% GDP to do it when other countries have managed to do much better financially with better overall outcomes.

Price consciousness is a marginally good thing in health care. If people are going to get treated for the sniffles, they can easily price discriminate. The real problem is that price transparency, for all the expensive things in health care, doesn't actually help. You can only price discriminate when you understand what you're buying. When you don't understand, price becomes a signal of quality, and people don't compromise with their health like they would with cars. They also are paying with other people's money. In fact, some case studies have found that price transparency causes the lower price guys to simply raise their prices to compete with the higher price guys regardless of quality because patients don't care about price except to the degree it signals quality.


The reason US health insurance is so expensive is because we tried to institute a health plan via insurance that tries to do things like address chronic conditions and preventative care.

False. Every other developed country has solved this problem while paying less - in most cases substantially less - than the USA. This while, according to a variety of statistics, getting better health outcomes.

There are a lot of reasons why medicine costs so much in the USA, but the factor that you identified is more of a convenient excuse than "the reason".


Oh I don't disagree with you. I meant that the reason "insurance" costs so much is because we tried to shoehorn other countries' systems into an insurance scheme. Indian insurance is much closer to what actual insurance is like, so it's much cheaper.


How do we equitably manage the healthcare of the entire nation that gives the rich and poor alike quality health care.

(Assuming "we" means India, though I don't live there anymore.) Fix corruption, the licensing system, the protectionism, etc, so that they become wealthier. Make the rest of the economy as capitalistic as the medical system. It's hard to fix anything with a GDP/capita < 1 lac/year.

The real problem is that price transparency, for all the expensive things in health care, doesn't actually help. You can only price discriminate when you understand what you're buying.

(I think now you are talking about the US.) Strangely, when Indians pay out of their own pocket (in whole or in part), they routinely price shop. Is price shopping a weird skill that Indians have but Americans don't? I suspect not, given that my uninsured mother routinely does it.


(I am only addressing the US).

Price shopping happens when the payer is directly affected by the costs (note: you mentioned your mother is uninsured) and when you can evaluate the quality (or don't care). It's actually very difficult to evaluate who's good and who isn't because a) statistics aren't often released (because hospitals and doctors block them) and b) the statistics can be difficult to interpret (a good doctor with bad stats can just have a sicker overall population). A big problem was that the data capture to adjust for these factors wasn't there (records were frequently kept on paper and billing codes barely correspond to reality). A big problem has been simply that even when the data was there, it is incredibly expensive to aggregate and report it.

In the US, we are attempting to fix some of these things. Medicare has implemented Quality Metrics and the requirement that doctors implement electronic medical record systems that measure some of the easier things to measure (patient counseled about managing diabetes, summary slip issued at end of visit, et cetera). Hopefully, price transparency plus a modern statistical reporting system will result in price shopping being viable in the next decade (of course the patient must be willing to discriminate).


Sorry! I was talking about the US, which is the system I sort of kind of barely understand. Other than what the GP said, I don't know much about India. I was just addressing the sentiment that India's insurance scheme should be transplanted here and that it would fix a lot of things.


Can you elaborate? Do you pay the average monthly cost of the entire pool, and then any extra charges the hospital bills?


Typically you pay the average monthly cost of people with similar risk profile to yourself. Suppose the average monthly cost for nonsmoking men aged 30-35, BMI 25-27, not currently sick, is 2000 rs. Then I'll pay maybe 2100 rs (so insurance company makes a profit).

I.e., I pay my average cost, not the average over the whole pool.

If you are a smoking man aged 50-55, BMI 32-35, with diabetes, you'll pay more. You'll pay the insurance companies best estimate of your average cost, not our average cost.


Somewhat related info: Government of Karnataka (an Indian state) has an healthcare insurance for economically poor called 'Yeshasvini'[0]. It covers treatment, surgery and other healthcare expenses for a nominal yearly premium. In fact this was conceptualized by Devi Shetty[1], founder of Narayana Hrudayalaya featured in linked article.

[0]http://www.yeshasvini.kar.nic.in/about.htm#about

[1]http://www.narayanahospitals.com/services/corporate-social-r...


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


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.


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.


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.


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.


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

A drug under patent might be accessible to 10% of the population now, but considering the number of people who will be able to access it in the future the total percentage looks very different. 50 years from now, long after the drug has gone generic, what percentage of the population who lived over that time would have had access? It would be far more than 50%.


Well, but the majority of new US medicine is just modified versions of old substances.


Once the old substances patent expires, any drug company can produce generics. There is no incentive to ignore patents and produce generics if the patent is expired because other companies will likely be producing generics, assuming there is actually a market for the drug.


> Once the old substances patent expires, any drug company can produce generics.

Except for when the company makes a tiny modification to the drug that doesn't change its effectiveness and files for a renewed patent, like in the Novartis suit that India's Supreme Court recently (and rightfully) rejected.


That's not the way patents work. There is not a renewal, but a new patent on the modified substance. The patent on the original substance would still expire. This, of course, raises an interesting question. If the claim is that the tiny modification doesn't change the drugs effectiveness, why not produce the original substance with the expired patent (or purchase a generic from a pharmaceutical that is already doing just that)?

Their actions seem to suggest that they do believe the modification increases the drugs effectiveness, but they don't want to pay for any of the R&D behind that.


Just for note sake US companies uses Indians as Guienna Pig for R&D, so don't tell me we are not doing our part. So basically loot money from all over the world and than try to extract more with patent system. Sorry we can't let you do that.

http://www.rsc.org/chemistryworld/2013/01/india-supreme-cour... http://healthcare.blogs.ihs.com/2012/11/26/clinical-trial-co... http://www.ahrp.org/cms/content/view/898/84/


Ambulance chasing lawyers? You mean, there exist lawyers who race behind ambulances just to get a mandate from the injured for suing the hospital for any and all possible malpractice?

Edit: No need for downvoting. This behaviour even has a Wikipedia article. I am ashamed living on a planet where such things occur.


It's just an expression. Lawyers don't literally chase ambulances. It's illegal for lawyers to accost people in the emergency room offering their services, and it's probably illegal to literally chase an ambulance as well due to traffic laws.

The story has more to do with suing someone for the personal injury that landed the patient in the hospital in the first place, but it's meant to refer to lawyers going out of their way to recruit clients who might not have even wanted to file suit in the first place, or to unethical, enterprising lawyers in general.


One of my buddies in LA got involved a multi-car accident. Within minutes he had a lawyer stop by his car and drop off his business card in case he could be "of assistance". So yeah, "ambulance chaser" an expression, but sadly very close to reality in some cases...


Why are India's drugs cheaper? Is their patent system different than in the US? Or does the government dictate the price drugs can be sold at?


It's both.

The Indian supreme court recently rejected Novartis' patent on Glivec, because the formulation wasn't different enough to merit a new patent (I don't know enough to know whether that was the right decision; just pointing out that the patent situation is different). The Indian government also has pricing restrictions on ~350 drugs deemed "essential".

On top of this, compared to the US, there's little to no drug marketing in India (yet). Plus lower labor/capital costs, etc.


Not true, there are huge marketing overheads in India. Drug Marketing in India is much more hidden, companies shower huge gifts and money to doctors to prescribe their drug. SO essentially companies cannot publicly declare this as marketing budget.


Basically, the Indian government doesn't give a sh#t about the methods that US pharma companies are using to generate more revenue in the US (slightly alter the compound so it's basically the same stuff, and then patent the new stuff).


what patents?


If you are referring to now-a-days somewhat popular belief that India doesn't respect patents or has no patent system then I am humbly requesting you to do a little bit of research and you'll find out that it's very very far from the truth.

It's just that it doesn't grant a patent on A because the patent of C expired and the company decided to call it A or if rejected then applied again by calling it B.

jm2c.


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


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


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.


Not when the frills mean that you can't afford the surgery at all.


This is for people who are earning 2-4$ / day and for majority of Indians and I guess the same model would work for majority of the world , who would not be able to otherwise afford even a $10k medical bill.


I'd gladly give up $200 aspirin, personally...


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

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


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...


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


> Payment for…organs is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation and leads to profiteering and human trafficking.

That is probably the reason India is ranked high. No "surprise kidney removals". It is usually the rich (and sometimes people from the west) that can not get a transplant legally in their countries opt to buy their way out of it in more lax countries.


That's irrelevant to the topic at hand.


The insinuation is that this hospital is scammy in some way, perhaps covering its costs by harvesting organs.

I somewhat understand where that skepticism comes from, as scam operations in developing countries are not unheard of.

That said, this would seem to be a big enough operation to not be going down that route, and to be fair, these organ stealing operations are far less common than we fear them to be. Just a bit of paranoia floating around.

I'd be far more worried that this operation is taking risks with patient care (in-op and post-op) in its cost cutting. I'd think it much more likely that you walk away from a low-cost hospital with an infection than missing an organ.




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