Foreigners turn to India in search of cut-price, life-saving cures

http://www.japantimes.co.jp/news/2016/03/06/asia-pacific/science-health-asia-pacific/desperate-foreigners-turn-india-search-cut-price-life-saving-cures/#.VtvsXMtX7qB

by denzil_correa • 10 years ago

147 127 10 years ago

japantimes.co.jp

hudibras• 10 years ago

The economist Dean Baker has been vocal for years about the benefits of free trade on medicine. [0] (of many)

But while the powers-that-be are fine with free trade for cars, cheap clothing, electronics, etc. or exporting American manufacturing jobs overseas, it's a different tune all the sudden when you try to do the same thing to powerful industries, like doctors or lawyers.

[0]http://www.cato.org/publications/cato-online-forum/doctors-d...

jpatokal• 10 years ago

Are you claiming that the American car lobby is not powerful? You might need a history refresher on how (for example) "voluntary export restraints" came to be a thing:

https://en.wikipedia.org/wiki/Voluntary_export_restraints#19...

But they've been fighting that battle for close to 50 years and losing.

horsecaptin• 10 years ago

Don't have to go all the way to India if you live in the US. Mexico is close by. And soon, Cuba will be even closer for some.

puissance3• 10 years ago

People wer exporting them from Canada, but big pharma lobbied for bans (http://news.healingwell.com/index.php?p=news1&id=526618). Anywhere close to US mainland, especially Mexico, I am afraid, will meet with the same fate.

Cuba's a different story as they just tell US lawmakers to fuck off.

dineshp23• 10 years ago

I find the concept of intellectual property and patents ridiculous.

What would be the benefit of granting IP over an invention or innovation to a corporation or a group of individuals versus releasing the knowledge under the public domain? Except the corporation or inventor(s) making money off of it, I can't think of anything significant. Instead, if the knowledge is made freely available under the public domain, the limitation becomes how well the innovation is used for the benefit of humanity instead of the limitation being access to the invention itself and IP.

Maybe the existence of IP and patents was important to get to the present as a way of rewarding innovation, but it's high time to look for a better model.

I know this is a very complex issue for which there are no simple answers or solutions, but a good starting point might be to think about a society where the motivation for innovation is not financial reward.

Taking the example of patented drugs, how is it justified to keep access to life saving drugs beyond the reach of most people(including people in developed nations)?

forrestthewoods3• 10 years ago

how is it justified to keep access to life saving drugs beyond the reach of most people

Trivially. By asserting that without intellectual property protection those drugs wouldn't have been invented. I'm not arguing if that's true or not. But it's certainly how people justify it.

I'm going to copy and paste one of my favorite comments on copyright. From Judge Richard Posner. It's bit a of a wall of text; sorry. It's worth reading in it's entirety.

"A distinguishing characteristic of intellectual property is its "public good" aspect. While the cost of creating a work subject to copyright protection—for example, a book, movie, song, ballet, lithograph, map, business directory, or computer software program—is often high, the cost of reproducing the work, whether by the creator or by those to whom he has made it available, is often low. And once copies are available to others, it is often inexpensive for these users to make additional copies. If the copies made by the creator of the work are priced at or close to marginal cost, others may be discouraged from making copies, but the creator’s total revenues may not be sufficient to cover the cost of creating the work. Copyright protection—the right of the copyright’s owner to prevent others from making copies—trades off the costs of limiting access to a work against the benefits of providing incentives to create the work in the first place.

STRIKING THE CORRECT BALANCE BETWEEN ACCESS AND INCENTIVES IS THE CENTRAL PROBLEM IN COPYRIGHT LAW. [empaphsis added]

For copyright law to promote economic efficiency, its principal legal doctrines must, at least approximately, maximize the benefits from creating additional works minus both the losses from limiting access and the costs of administering copyright protection."

http://cyber.law.harvard.edu/IPCoop/89land1.html

venomsnake• 10 years ago

One may argue that balance is way off right now. I would prefer to see a system in which there are lump sums by the government for a treatment development with certain performance characteristics.

And the government owns the rights afterwards. We should make pharma companies do work for hire.

crdoconnor6• 10 years ago

Trivially. By asserting that without intellectual property protection those drugs wouldn't have been invented

That isn't trivial. It's stupid. It's a completely non-disprovable argument.

Plenty of innovations are created where creators voluntarily yields their rights and plenty of others are probably not created because the creator of it (under employment) isn't hugely keen on creating yet more property for his or her employer to exploit.

runholm• 10 years ago

The issue is that with medicine, it cost vast amounts of money to develop and test a medicine. If there was nothing making sure the investment would pay of, there would be much less money spent developing medicine.

I am not saying the system is perfect, and some companies push the prices to the ridiculous to exploit people in need, but removing medical patents altogether would require some other equally strong economic incentive to keep development rolling.

Fuxy2• 10 years ago

The prices pharma companies ask for is ridiculous and makes the drug unavailable to 90% of the people that need it.

if they priced their drug to make it more accessible they could easily make the development cost back by making money off the 90% they left to die or hunt for drugs on the Indian market.

There needs to be a balance between getting drugs to the people that need it and making a profit. Currently that balance is non existent and pharma companies charge ridiculous amounts knowing full well that us insurance companies will pay it.

You know how the rest of the planet feels when your insurance company refuses to pay for your drugs and you have to pay for it yourself.

crdoconnor6• 10 years ago

We already have publicly funded research, which is an altogether more effective way of developing new medicines anyway.

gautamdivgi• 10 years ago

I think you're missing the point on both the money and the patent laws in India. According to the article "Successive governments have taken a view that patents should be granted only for major innovations, not updates to existing compounds — allowing domestic manufacturers to make generic versions of drugs at vastly lower cost." - which basically means you get a patent for real innovation, not minor cosmetic changes to keep your cash flow going.

The second - "Pharmaceutical firms say India’s disregard for patents will stifle innovation or make drugs commercially unfeasible — Gilead paid $11 billion to buy the developer of Sovaldi in 2012."

Note that it didn't cost $11B to research the drug but what it cost to buy the company. It is disingenuous to claim that their R&D cost is that high.

ekianjo3• 10 years ago

The issue is that with medicine, it cost vast amounts of money to develop and test a medicine.

If that is the real issue, then subsidize the costs of clinical research, instead of accepting that everyone pays the price of drugs 10 times what they should cost.

deciplex2• 10 years ago

Except the corporation or inventor(s) making money off of it, I can't think of anything significant.

But, that alone is significant enough to justify most intellectual property: patents, copyright, etc. But, it's not nearly enough to justify a patent system that allows you to patent absolutely obvious bullshit then turn around and sue everyone. And, it doesn't justify our copyright system either, with insane terms which span centuries.

So I would agree that it's an open question whether the way we do intellectual property now is better than absolutely nothing i.e. everything publicly known is automatically public domain. I suspect we'd be better off with no patents and no copyright, than with what we have now. But intellectual property in theory and properly implemented, is unquestionably a fine idea, and obviously far superior both to the shit show we have now, and also to a Wild West approach.

Anyway, it's not like you need patents to gouge patients cf epipen, insulin, where patents ran out decades ago and yet, strangely, stuff that costs a few dollars to actually make, is priced in the hundreds of dollars.

zanny3• 10 years ago

But, that alone is significant enough to justify most intellectual property: patents, copyright, etc.

No, certainly not. Guaranteeing corporate profits are never a justifiable reason to restrict freedom of information so severely.

You do not need a patent on plastic forks to make money selling them. If there is demand, the floating price will be above the price of manufacture, and the economy is incentivized to meet that demand. If drug recipes were not patented, and there was demand for a drug, once the profit overcomes opportunity cost everyone in industry has incentive to start meeting the demand.

Plenty of arguments exist in this thread why you do not need private for-profit research to discover medicine - and why in many ways having such a system is counter-productive in the first place (the industry consistently refuses to consider anything as a product they cannot patent - and will actively harm people by not selling products they know work but that they cannot guarantee long-term monopoly on).

melling2• 10 years ago

This should be a HN FAQ because every time the topic comes up, someone makes your invalid argument. Well, it's not really an argument but more of the sympathy card.

It cost billions to develop a drug and pennies to make it. Can you explain the business model where companies don't go out of business and research dries up? India is creating drug resistant bacteria because antibiotics are so overused.

http://www.nytimes.com/2014/12/04/world/asia/superbugs-kill-...

Who's going to pay for the research needed to prevent a pandemic?

I'm going to write a blog so this question doesn't need to be answered every couple of months.

How about India with a million people turning 18 every month (https://news.ycombinator.com/item?id=11232383), develop a drug industry to create better and cheaper new drugs, while creating great jobs for people who need them?

Of course, if you simply give away everyone's work, no company is going to stay in business.

dineshp23• 10 years ago

My point was that innovation and financial reward need to be decoupled to ensure valuable knowledge is not locked behind IP.

Of course, if you simply give away everyone's work, no company is going to stay in business.

To think about a future without ridiculous restrictions on access to knowledge(which IP law promotes implicitly), it is important to stop accepting the status quo in which innovation and financial reward are directly linked.

You seem to accept the reality that innovation has to be linked to financial reward by gaining exclusive rights over the invention using IP laws,which,respectfully,is preposterous.

iofj• 10 years ago

Who's going to pay for the research needed to prevent a pandemic?

Actually given that this is a real threat, someone will. Even if only to save themselves.

And because they'd have extreme problems if they saved only themselves, rather than the entire civilization supporting them, they'll make it available to others too.

Yes this is hardball negotiating 101 : if doing something solves a strategic risk for someone, don't pay them a dime to do it. You may even consider making it more expensive for them to do, if that provides you with an advantage.

puissance3• 10 years ago

Might be unrelated to the topic but I don't understand how you came up with the summation "India is creating a drug resistant bacteria because antibiotics are overused" from that nytimes article. The same article also mentions that the overuse of antibiotics in US factory farms has also lead to outbreaks of drug-resistant diseases in recent years. Yes it mentions that there's been a clampdown from 2000 to 2010, but I am skeptical of accepting this fact without numbers. Can I go ahead and say that US will be responsible for creating drug resistant bacteria?

You may not know this, but one of the major outbreaks of drug-resistant superbugs is because of Indian drug manufacturers exploiting lax environmental laws to dump anti-bacterial refuse into village waterways. A large number of these manufacturers are contracted by US big pharma because it is much cheaper to produce (even patent-protected) drugs in India. If you're interested, here's the bad medicine report on it https://s3.amazonaws.com/s3.sumofus.org/images/BAD_MEDICINE_....

My point is no one country or entity can be blamed for the rise of superbugs. The problem is systemic and it needs us to step out of our reductionist paradigm to solve it.

ekianjo3• 10 years ago

I find the concept of intellectual property and patents ridiculous.

I think what's more ridiculous is that the patent system was not made, in the first place, to lock competition out of the market. It was supposed to be a starting point to create licenses for other companies to produce the same item, by providing royalty fees to the original patent owner.

But the system has quickly become a way to create rents and lock competitors out of the market. Short of fixing patents by making them shorter and all, we should find a way to market licenses at reasonable costs so that alternatives exist even during patent protection.

DanBlake• 10 years ago

Im curious what is stopping some other countries (even micro-nations) from instituting a policy that forfeits all patents on medication.

Lets say you take the country of Saint Lucia- Could they not spur the economy (among the lowest in the world by GDP) by saying any company can manufacture any existing drug and sell it? I feel like the medical tourism for that could be extreme, especially since there is still many treatments india still does respect the patent for.

If the country put it in their constitution that all drugs should be a human right, could a legal action be taken against the country itself? I imagine the only recourse would be the pharma companies trying to force legislation in other countries to bring sanctions, but I think that would be a hard sell.

benjamo• 10 years ago

Such a country wouldn't get admission to the WTO and would have a very hard time trading with the other countries in it.

It would also amount to state endorsed IP theft.

x5n17• 10 years ago

Theft is such a strong word. If you control the language, you control the world.

linuxkerneldev• 10 years ago

Such a country wouldn't get admission to the WTO

As opposed to what we do when we invade and bomb/drone other countries? As opposed to what we did when we engineer coups in resource rich countries? Come on. Let me guess, you're buying into the idea that generics hurt RnD. Let me assure you, having worked briefly in a pharma RnD lab, the bulk of big pharmas expenditures are on marketing and bribes, NOT RnD. Here's a recent headline: http://www.statnews.com/pharmalot/2016/02/22/novartis-south-...

You'll find similar bribery cases with GSK, Pfizer, etc.

forrestthewoods3• 10 years ago

Trade treaties. Saint Lucia wants to trade with bigger countries. Those countries may not want to trade back if Saint Lucia goes out of their way to reproduce intellectual property.

Could legal action be taken? If Saint Lucia signed a treaty that defined rules for such an action.

Also, selling a drug for any price smells an awful lot like capitalism. Some folks would rather the government set prices. Hey, I wonder what happens if a company sells bad drugs that hurts people? The government should impose regulations. Hrm I bet that would drive costs up. Maybe drug companies need some financial incentives to help cover those costs? .... Wait a second!

taneq• 10 years ago

I dunno about legal action but I could sure imagine individual pharma companies (and other primarily IP-related industries with heavy R&D costs) deciding not to sell products there ever again.

x5n17• 10 years ago

WTO, American sanctions, American coups, CIA, to name a few. Also India actually manufacturers these drugs, and most of them should be generic because they have been around for a long time. Small nations would not be able to manufacture them the same way India does.

FlyingSnake• 10 years ago

Seconded.

Also Saint Lucia doesn't have the clout as India when it comes to global trade.

ucaetano11• 10 years ago

This only works for countries that create no drugs, so they can benefit from companies in other countries spending the billions required to create new drugs, without any spending.

Not to mention that every single Pharma company would stop all R&D investment in about 5 seconds.

Would you invest your own money in a Pharma company if there were no drug patents?

adrianN2• 10 years ago

Maybe we shouldn't let Pharma companies do the R&D and then pay for it via expensive heathcare. Maybe we should take the money and directly fund research and make the results free for everyone.

rlpb• 10 years ago

"It [is] fallacious to assume that only the cost of R&D is reflected in the price of a drug. The hidden cost of marketing is a great contributor to figures quoted."

https://www.kent.ac.uk/law/ip/resources/ip_dissertations/200...

sangnoir2• 10 years ago

Would you invest your own money in a Pharma company if there were no drug patents?

India does not disagree with drug patents, from the article: "Successive governments have taken a view that patents should be granted only for major innovations, not updates to existing compounds."

Pharma companies are notorious for extending patents (in perpetuity) by adding small 'updates' to existing compounds when the patent nears expiry. This is rather similar to Disney's strategy: get copyright period extended right before Mickey Mouse is about to enter the public domain.

sandGorgon• 10 years ago

because you need leverage to pull it off - just like refusing to sign the Paris Climate Treaty or the Nuclear Non-Proliferation Treaty.

India has a long history of Non Alignment and trade blockades going back 50 years.... but most importantly has huge economic leverage right now, only second to China (in Asia).

In fact, my personal bet is on Iran to be able to do something like this - they have a sizeable youth and good education systems... as well as a long history of leverage against the west . If only they get rid of their religious constitution.

reitoei• 10 years ago

If only they get rid of their religious constitution

Apply that to any situation in any country in the middle east.

Htsthbjig• 10 years ago

"Im curious what is stopping some other countries (even micro-nations) from instituting a policy that forfeits all patents on medication."

Simple answer: The US will invade that country in no time, or give millions or billions of dollars to support those against the Government in the country to instability the country.

They do it with Syria(they gave hundreds of millions of dollars in weapons to "moderate rebels" to start a war against Assad, Saudi Arabia gave billions or Ukraine(they gave 6 billion dollars to opposition), that are reasonable big countries. They can wipe out any small country that dare to go against US national interest.

With India, South Africa there was death threats, and killings,lots of money under the table and blackmailing of people in Government and finally economic sanctions.

If someone puts something on a paper it does not matter unless that someone has the means to protect what is in the paper.

Native Indians had the right to own the American land because it was the land of their fathers and grandfathers but the white man had repetition rifles and railroads.

awongh• 10 years ago

Feels like there should be some kind of website or service that tracks these drug price arbitrage / differences.

abpavel• 10 years ago

The problem is not in patents or capitalism, but in perpetual extension of intellectual property in a Disney-like fashion. The point of "Cyclical" is that there is a cycle - a life-cycle of development, then intellectual monopoly and finally general availability. Sovaldi's patent should have expired in 2012, and Martin Shreli's Daraprim's patent should have expired in 1973. Perpetual extension simply abuses the system, and the stories like in the original article are just a reflection of system's abuse, not the flaw of the idea of protecting intellectual property in the first place.

adventured2• 10 years ago

Not to mention the FDA holding back generic drug approvals. They've got a backlog of generics awaiting approval that is over 4,000 now (they like to white lie and say they've "acted" on many of those, which of course isn't the same thing as an approval).

afarrell• 10 years ago

Wow. How hasn't AARP raised hell about this? Maybe they aren't the most powerful lobbying organization in America after all.

maxerickson3• 10 years ago

There's no patent keeping other companies from producing Daraprim equivalents for sale in the US, it's just that no generic maker had bothered to setup an FDA approved production process.

There's a few thousand people using it in the US, so there isn't a huge market for it.

Medicare is a big enough consumer that it should probably be running a program where it shares risk with generic makers that are willing to produce drugs that don't cost a lot, as long as the company maintains quality. Basically, make sure that line start up and regulatory costs aren't preventing $1 pills for rare conditions coming to market.

chimeracoder9• 10 years ago

Medicare is a big enough consumer that it should probably be running a program where it shares risk with generic makers

Perhaps, but Medicare has literally no incentive to do this.

It's one thing to posit that a monopsony or oligopsony could result in driving prices down. And in a closed system, that might be what happens[0].

But at the end of the day, Medicare has no mandate to ensure sustainability of reimbursement and payment rates. Since they can't raise revenues (taxes) without Congress, they balance the budget by driving reimbursements (for service providers) down below cost. Pharmaceutical companies are actually affected by this too, but because the big-ticket items are under monopoly protection (via drug patents), unlike care delivery, Medicare still has to pay sticker price for those.

The people who end up being hurt by this, by the way, are not Medicare patients, but uninsured patients and privately-insured patients.

[0] But not always - like a monopoly, a monopsony can choose price or quantity, but not both.

yummyfajitas3• 10 years ago

Patents are not perpetually extended, Disney-style. Only copyrights are. Daraprim is not under patent.

The issue with Shkreli is purely exploitation of bad FDA rules, not patents. The FDA is the problem here.

HarryHirsch3• 10 years ago

The issue with Shkreli is that he broke the gentlemen's agreement arount low-volume drugs. Derek Lowe talks about it from time to time.

The FDA insisting that drugs conform to standards of purity and activity isn't the problem here. When you talk to someone who is working in pill manufacturing you'll learn that it is a complex process. The thing must reliably disintegrate in the digestive tract, the active substance must be distributed evenly, excipients do influence bioavailability - just as with Theranos the standards exist for a reason.

The ecosystem around low-volume drugs is strange. Perhaps it would be best for the NIH to open up their own facility, just because of the bad press that Pharma Bro caused for the whole industry.

vinodkd3• 10 years ago

I know the article and the discussion is about access to drugs, but I must call out that part of the success of medical tourism in India is the lack of stranglehold control over medical care by insurance companies. In India, I can:

- Get an estimate for service before it happens, and plan for it therefore.

- Pay for the service at the time of discharge with/without insurance

- decide by myself if i want to get a specific procedure done or not - no fuss of "does the insurance cover it?". Of course, this is one area where the costs of service being inherently low helps.

- get all my medical records in my hand

These are basic patient freedoms, IMO, that the insurance industry in the US has taken away.

I dont know the history of how it came to be this way in the US, but as it stands, the situation is very geared towards getting mystery service - you dont know what you're allowed until you're refused, you dont know how much the service cost you until months later and even then in multiple bills from various hosiptals, doctors practices and specialists, and you have to ask for your records because you cannot keep them safe!

I have all my records from every treatment in India, but not one coherent,collated record of my last physical checkup in the US. There's something broken there.

bobby_9x• 10 years ago

This is why we need to completely get rid of health insurance in the US. If Hospitals could only charge the actual value for their services, and not the inflated insurance prices, the prices would be much lower.

One of my friends is a Doctor. He told me that they need to over-charge for services because of the insurance companies. If they charge $20 (the actual cost of the service), they might get $4 back from the insurance company. If they charge $100, they might get the $20 from the insurance company for the service. We need to cut out the middle man. It's basic economics.

The drug issue in the US is mostly the fault of the government. It takes hundreds of millions of dollars and 10+ years to get FDA approval. This stifles innovation and creates an environment where there are only a few players (IE: a monopoly). The result is ridiculous prices due to no competition.

ocean32• 10 years ago

If they charge $100, they might get the $20 from the insurance company - the remaining 80 goes to the insurance company?

mindslight5• 10 years ago

Mandating identical pricing for all customers [0], published price lists, and all-inclusive standardized line items based on services rendered (not costs incurred) could accomplish the similar thing. Unpaid bills for emergency (non-deniable) services would come from a general state fund, which would then recover from the debtor (or not).

Whatever the solution is, it's got to be stealthy enough to get past the "insurance" cartel. The grass roots demand for national Romneycare obviously came from legitimate problems, but the political machine twisted it into just further empowering the accounting-protection racketeers.

[0] Providers would still be free to set whatever prices they wanted, they just could not have different rates "negotiated" for different customers. And obviously accounting-skirting kickbacks would be illegal.

ksk• 10 years ago

If Hospitals could only charge the actual value for their services, and not the inflated insurance prices, the prices would be much lower.

I don't quite understand how you're arguing using the term "basic economics" that Hospitals en-mass will leave money on the table in a capitalist economy.

GFK_of_xmaspast• 10 years ago

The drug issue in the US is mostly the fault of the government. It takes hundreds of millions of dollars and 10+ years to get FDA approval

Can you point to some jurisdictions where it does not take hundreds of millions to bring a drug to market.

chimeracoder9• 10 years ago

part of the success of medical tourism in India is the lack of stranglehold control over medical care by insurance companies. In India, I can: Get an estimate for service before it happens, and plan for it therefore, Pay for the service at the time of discharge with/without insurance

There are a lot of problems with the insurance industry in the US. The first two that you call out, though, are a bit more subtle, and have to do with the way medical billing has evolved in the US. (Medical billing is related to, but distinct from, insurance).

The reason that you can't get quotes beforehand is because the providers literally do not know what it will end up costing you. As I mentioned in another comment, Medicare effectively leans on private insurers (and uninsured patients[0]) to subsidize the costs of care delivery.

A simplified version: a certain lab test costs $100 from the manufacturers. Medicare decides to pay $80, and providers have no room to negotiate this. Let's say that, for a given hospital, Medicare patients comprise 50% of the patients (not unusual in certain areas). On average, the hospital has to make $120 on each of the other 50% of the patients just to cover the per-unit costs, before paying for the overhead of actually running and staffing a hospital.

So, they bill private insurers $400. They don't expect private insurers to pay $400/test, but they use this as a starting point. In the end, the private insurer (say, Aetna) will come back and say, "okay, we'll pay 200% of what Medicare reimburses, for all Aetna patients you administer this test to for the next year, if you stop sending us these bills"[1]. So, they strike a deal to pay $160/test[2]. That leaves $160-120 = $40 of revenue on 50% of the patients to pay for all the overhead, so hopefully the overhead can be limited to $20/unit, or the practice will go under[3].

Unfortunately, most hospitals can't present patients with different bills depending on their insurance status[4]. So, they present that bill for $400 to uninsured patients, not actually expecting that they'll pay the full amount. If you know this, you can tell them, "if you reduce the bill to $40, I'll pay in cash today." Unfortunately, most people don't know this.

So, the reason you can't get a quote in advance is that the doctor literally has no idea how much it will actually cost you. Because, even if they know your insurer, they don't know the details of your plan well enough to give you a precise quote. And the actual resulting price is only very indirectly related to how much it costs the provider.

[0] this second part - uninsured patients - is more an unintended consequence rather than the intended effect

[1] In reality, it's a bit more complicated, because it's not always set at the level of the insurer (ie, it's not always "all Aetna patients", but more likely "all ____ Aetna patients", which makes it more complicated.

[2] If you're really unlucky, the provider might even enter a capitated agreement with your insurer, in which case they receive a lump sum up-front without actually knowing how many tests they'll administer.

[3] Unsurprisingly, a lot of practices have gone under and been bought out by hospital networks in recent years (and hospitals have similarly gone under and been bought out by insurance companies).

[4] this is a combination of federal and state laws, as well as the infrastructure it would require

mindslight5• 10 years ago

If you know this, you can tell them, "if you reduce the bill to $40, I'll pay in cash today." Unfortunately, most people don't know this.

I've often heard this, but have recently been asking for cash prices for some routine services, and the responses I've gotten have been either "um, we don't do that", or just simply referencing their fake inflated prices.

It's probably different if you've already got an unpaid bill in front of you, especially for a larger procedure, and you're dealing with the billing skinjob rather than the receptionist. But that's still quite far from how sane transactions work.

e40• 10 years ago

The reason that you can't get quotes beforehand is because the providers literally do not know what it will end up costing you.

Because the system was design that way. Time and materials vs. fixed price. Most of the rest of the world is on fixed price. We seem to think that's a socialist (or communist, depending on who you talk with) idea.

The problem with T&M is there is no incentive to save money, when it wouldn't affect the outcome. That extra test? Sure! Want your "friend" to stand in with you in the operating theater, even though it adds $50k to the bill, no problem! (This last thing I read about... just mind blowing.)

vinodkd3• 10 years ago

Thanks for this well thought out response. [4] is the killer clearly. My naive response as I read yours was: "Well, just have two rates, the medicare one and the regular one". But if laws prevent that...well then that's played straight into the insurance companies hand.

discardorama• 10 years ago

Anecdata, size 2, from India:

My uncle (who had a device implanted 4 years ago to regulate his heartbeat) went into the ER one of the premium hospitals in our city (Fortis). He was having some weird symptoms, and his blood sugar was off. They strongly recommended that they upgrade his device to a pacemaker! (A highly expensive procedure). When my cousins refused, the hospital pumped him full of insulin and discharged him. He came home and relapsed again. This time he was taken to another hospital, and the problem was some infection in his kidney.

Another cousin: had a severe pain in his stomach area. Went to a hospital, they injected him with a painkiller and let him go. Pain continued: he went to another, same deal. Finally he got to a third hospital, and they diagnosed the problem: kidney stone.

There's caveat emptor for Indian hospitals. Be careful.

vinodkd3• 10 years ago

This is true. The big "chain" hospitals do have pushy tactics, doctors with lab prescription quotas etc. Similarly, but at the other end of the spectrum, there are hospitals in smaller towns that mistreat you or send you off with painkillers.

Clearly, your mileage will vary, so you have to do research, ie, talk to people you trust, much like everything else in India :)

lake99• 10 years ago

I've had good experience with big "chain" hospitals, be it Apollo, Columbia Asia, Wockhardt, or whatever else. I never found them pushy. One of the docs from there quit and opened his own clinic. He doesn't even charge me for consultation. Don't know why.

Of course, doing your own research is critically important. Many doctors are dangerously ignorant of anything that doesn't come under their specialty.

kamaal• 10 years ago

>There's caveat emptor for Indian hospitals. Be careful.

Yes, as an Indian I can confirm this. Medical Malpractice is a big think in India. What makes it possible is doctors can get away from it. Any kind of criticism is not tolerated by the medical fraternity. Remember that program by Aamir Khan in Satyamev Jayate. There was a tremendous backlash from doctors as though it was their birth right to cheat.

A few things that ordinary Indians have to undergo everyday.

1. Doctors running polyclinics in areas they have no specialization in.

2. Polyclinics running mini-labs. To sustain which, doctors order pointless tests(especially blood work) which might not even be needed.

3. Commission deals with local pharmacy stores, so that they prescribe brands only available at that pharmacy in exchange for a commission.

4. Prolonging treatment to maximize net consultation fees. Prescribing drugs/tests to boost their commission.

5. Tests claimed to be done, which aren't. Also known as the 'basin test'. Collect the patients blood and throw it in the basic, cook up artificial numbers to make it look normal.

6. A while back I visited a hospital with my mom for arthritis. To my surprise they ordered an X-ray. Nurse tells us X-ray is the regular routine no matter what patient walks into the department. The Orthopedic apparently thinks its the best way for him to recover his money invested on a X-ray machine. Same goes for colonoscopy/MRI/CAT scan and other complicated tests.

7. In government hospitals nurses routinely ask for bribes from poor patients. Administering euthanasia for burn victims especially from poor families who can't afford long term health care in return for a bribe is common.

The list can go on and on...

I know a colleague who was verbally abused by a doctor for being 'a little intelligent', it was almost like he was furious the patient was resisting being cheated.

Foreign nationals may not face all this as they go to top line hospitals. But the ordinary Indian continues to suffer at these people's hand.

Foreigners turn to India in search of cut-price, life-saving cures

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