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.
India *is not* a [..]
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.
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.
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.
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).
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.
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.
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.
They even have the integrity to list prices publicly.
It's because they are brave doctors working outside of the government healthcare racket.
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.
> 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.
you can browse their site for more information about their mission and mandate, but here are some starting points:
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.
Also, you don't bribe people in the hospitals mentioned in the article.
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.
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"
While not as expensive as Manhattan or London, relative to Indian salaries everything is getting expensive.
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)
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.
A bit of civility would help.
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.
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.
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.
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.
If it makes you feel any better, I started at Rs 1500 per month in a top IT firm.
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 :-)
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.
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.
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.
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.
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".
(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.
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).
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.
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.
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.
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.
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?
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.
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.
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%.
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.
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.
Edit: No need for downvoting. This behaviour even has a Wikipedia article. I am ashamed living on a planet where such things occur.
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.
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.
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.
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.
General link: http://en.wikipedia.org/wiki/Organ_trade#Illegal_organ_trade
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.
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.