Ask HN: Xray cost – USA $200 (13000 INR), India 1000 INR – what causes 10x diff?

https://news.ycombinator.com/item?id=15349676

by user-on1 • 9 years ago

93 143 9 years ago

news.ycombinator.com

https://www.medifee.com/treatment/dental-xray-cost/

http://health.costhelper.com/dental-x-ray.html

Why would a full mouth xray cost be this different, there may be some difference in few aspects but what adds up to more than 1000% difference?

itamarst• 9 years ago

1. Labor costs.

2. USA has insane health system where everything is more expensive than it has to be because "freedom".

You can remove that 2nd factor by comparing costs with country that has a sane socialized medicine/single payer system.

narrator• 9 years ago

India doesn't have socialized medicine. It's still 10x cheaper.

vinothgopi• 9 years ago

Adam made an episode explaining medical costs and why it is so high. It will at least give you a different perspective into the system.

https://youtu.be/CeDOQpfaUc8

So adding on to the labor/fixed cost increase, prices are just inflated since insurance pays for them anyway. In India, people don’t really consider insurance for such routine work due to the hassle of processing the claims too.

TkTech• 9 years ago

To compare, in Canada where medical coverage is socialized but dentistry is [usually] not, the cost of a set of x-rays (2 or 4 shots) maxes out at $100-$200 when uninsured.

ajeet_dhaliwal• 9 years ago

I had 2 shots done last week in the UK, only £20, I think it’s partly subsidised by NHS.

kansface2• 9 years ago

The US health system is probably subject to the least "freedom" of any industry in the US - possibly the world.

chadash• 9 years ago

The xrays are probably almost identical. The difference is that dentists simply charge much more in the United States. The median dentist salary in the US is about $150,000 [1]. In India, the median dentist salary is 344,000 INR, or about $5,250.

Some of this can be attributed to general differences in labor costs between the US and India. With few exceptions, most service industries in India are going to charge less because it's not as wealthy of a country. However, the biggest difference is that Americans are simply used to paying absurd amounts for medical care of any sort. There are a variety of factors at play, including strict limits on the number of dentists graduating each year, dental insurance coverage (most dental insurance plans cover x-rays, so people with insurance tend not to consider the cost), etc.

[1] http://www1.salary.com/Dentist-Salary.html [2] https://www.payscale.com/research/IN/Job=Dentist/Salary

sp332• 9 years ago

I was thinking of this a couple of days ago when an uninsured person got an estimate of $25,000 for dental surgery. https://twitter.com/ForgetAmnesia/status/912456274532585472 https://twitter.com/ForgetAmnesia/status/912369049958584320 I wonder if the increasing specialization is driving costs up too. If you have fewer patients you might feel pressure to charge each one more instead of admitting that you picked too small a niche.

zerohm• 9 years ago

Also, all the operational overhead in that US dentist office will cost more than the Indian side. The secretary, the assistant, the building lease, etc. (I'm not saying that we can't fix the problem of overpriced healthcare, I'm just saying it's a contributing factor)

Strangely though, the US enjoys lower prices for consumer goods like fashion brands, and consumer electronics. Nike shoes and a Sony TV will be more expensive in India than the US.

jogjayr4• 9 years ago

Strangely though, the US enjoys lower prices for consumer goods like fashion brands, and consumer electronics. Nike shoes and a Sony TV will be more expensive in India than the US.

That's not strange at all. India has import duties on many goods, especially electronics.

oli89• 9 years ago

What does the iPhone cost in India? Has Apple subsidized it?

KGIII7• 9 years ago

Rs. 24,490. About $380 USD.

Prices as of September 2017, currency conversion via Google on today's date and time.

tosaket• 9 years ago

It is the opposite. iPhone costs at least 20% more in India.

nickbauman3• 9 years ago

Durable goods (especially from the same manufacturer) cost about the same across the world.

KGIII7• 9 years ago

It absolutely shouldn't account for such a large discrepancy, but is the level of expertise the same? I would also expect that the US dentist has paid much more for their education.

Did the US dentist go to school longer? As I said, I'm sure they paid more. Is the US dentist more skilled at their job? Are the requirements to practice dentistry lower in India? Are the results better or worse in India?

You also mentioned the lower wealth in India. There is also a lower standard of living cost. Costs for products and services have long-since been decoupled from expenses and people charge what they think the market will bear.

Also, is there a greater supply of dentists? My understanding is that the AMA artificially limits the supply of medical doctors, but I'm not sure about dentistry. I also have no idea what it's like in India.

Given what little I know of the situation, I suspect I'd support the idea of Indian dentists making more money, not US dentists making less money. I believe teachers and medical professionals should be well paid. $150,000/year isn't that much. We have programmers who make larger salaries, and they don't even give me a free toothbrush.

Edit: Google tells me that the average salary in India is $616, so the average Indian dentist makes about 8.5x the average income. That's about $225,000 in the US.

jimmies4• 9 years ago

Did the US dentist go to school longer? As I said, I'm sure they paid more. Is the US dentist more skilled at their job? Are the requirements to practice dentistry lower in India? Are the results better or worse in India?

I assume the phrase "no amount of safety is enough" when it comes to health care is a false statement, it's an economic problem: Am I/is the population willing to pay 1000% (10x) more for say, 2% to 1% (2x) improvement chance in the person fucking up my teeth?

With that in mind, I wonder is going to school for a long time necessary? I think we have a return-on-investment curve (or time in school vs chance that the person fucks up) that plateaus at some point here. Maybe it plateaus where the Indian requirement is, and people in the US stay in school too long for very little returns.

sorenjan3• 9 years ago

For comparison the median salary for dentists in Sweden is $51 500 [0]. The reason for the high salary in the US is not the expensive education ($100 000 extra per year buys a lot of education), it's the high income inequality [1]. The expensive health care with few incentives to lower the prices of course helps.

[0] http://www.lonestatistik.se/loner.asp/yrke/Tandlakare-1241

[1] https://en.wikipedia.org/wiki/List_of_countries_by_income_eq...

creaghpatr• 9 years ago

I'd like to add:

-malpractice insurance -administration/documentation costs

The procedure price in the US has to account for filing the claim, issuing the patient an EOB, then going through the adjudication process, then finally billing the patient for the copay/deductible payment, a percent of which will likely have to be written off.

highd• 9 years ago

I don't think "high income inequality" is much of an explanation for why someone has high income...

colanderman• 9 years ago

Can you provide any insight into the market forces keeping dentist salaries low in Sweden? High supply / low demand / salary/insurance caps / lower cost of living / non-salary benefits / etc.? (In the US we have the opposite of these… artificially low supply, private insurance hides costs, high cost of living in urban areas…)

nickbauman3• 9 years ago

I have been considering medical tourism for this reason. But moreover, I see doctors responding to the strangulation of the sector by insurance companies by offering less care for more money. I can go to Costa Rica and get a lot of things sorted for a fraction of the costs and many of the doctors are trained in the US anyway.

zaptheimpaler4• 9 years ago

It doesn't make sense to compare salaries between US & India on a US$ perspective. Indian salaries are lower in terms of USD, but the cost of living is also lower - basically the 5$ USD meal at McDonalds in US costs maybe 1$ USD in India. If you are paid "less", but everyone else is paid "less" too, then goods/services are cheaper - so the actual goods/services you can purchase will be the same for a much lower salary in India. Lookup purchasing power parity.

It might be more sensible to compare how much more dentists make than the average income. i.e Average dentists salary / average salary.

For US I get - 175350/55775 ~ 3x

For India its 8.5x

So dentists are probably pretty well paid in terms of the standard of living they can purchase.

potlee• 9 years ago

It does make sense to compare them on a USD basis if you trying to figure out what causes a 10x difference in x-ray cost between the U.S. and India (in USD)

capex• 9 years ago

A Big Mac in India costs $2.76 USD vs $5 in US. See the Big Mac Index [1]

1. http://www.economist.com/content/big-mac-index

fellellor• 9 years ago

The average proportion still doesn't make sense. Because the large population depresses the national average income greatly. On the other hand if you are comparing spending power I feel it should be more accurate to include GDP Per Capita (Purchasing Power Parity) in your calculations.

US GDP per capita nominal = 57.5K USD, US GDP per capita PPP = 46K USD. This gives a PPP-to-GDP ratio of 0.8. The average dentist salary is 175,350 USD (nominal). So the US average dentist salary (PPP) is 140,280. This finally gives you a dentistSalary-to-nationalAvg (PPP) of 3.

Now, I'll do these same calculations for India. GDP per capita (nominal) is 1.7K USD and in PPP terms it is 6.1K. This leads to a PPP-to-GDP ratio of 3.6. In India the average dentist salary is 312,797 INR according to payscale. This is equivalent to 4750 USD (nominal). In PPP terms, this is equivalent to annual salary of 17.1K USD (PPP). So finally we have a dentistSalary-to-nationalAvg ratio of 2.8 for India.

So our metric is 3.0 for the US vs 2.8 for India.

Most statistics were obtained from Tradingeconomics.com which also appeared on top of google searches. I may also have screwed up my calculations somewhere, but I don't know.

credit_guy• 9 years ago

In my case most often it’s a hygienist who takes the x-rays, not the dentist. But even assuming it’s the dentist, and the dentist is paid at 200k/y, that translates into $100 per hour or about $1.7 per minute. It never takes more than 10 min to do the x-rays, so the labor cost of a set of x-rays can be at most $20, most likely much lower.

pravula• 9 years ago

Look at how much the insurance company actually pays for that $200 xray. It may be comparable.

simonh4• 9 years ago

This summer I was in China as my wife is Chinese and everybody was complaining how expensive everything is these days. The thing is salaries in China have gone up hugely as well and that is mainly why prices have gone up. If the workers in a factory are paid 5x as much as 15 years ago, the lorry driver taking the goods to the shop is paid 5x as much, the shop assistants are paid 5x as much, etc, etc then the goods sold in the shop are pretty much going to have to cost 5x more than they used to.

Same thing here. The rent on the dentists office costs more, the dentist is paid more, the utility bills cost more, medical practitioner insurance costs more, the receptionist is paid more. You can’t have many times higher salaries in the US and not expect things to cost more than they do in somewhere like India.

wonderous• 9 years ago

Household income for the average house hold has not increased that much: https://www.advisorperspectives.com/dshort/updates/2017/09/1...

simonh4• 9 years ago

I was talking about China as an example of how average wage increases, in China, are linked to changes in the prices of goods and services. So just as these things are different in China between then and now, so we can see that these factors can affect prices in India versus the USA or other western countries (I live in the UK).

jimmies4• 9 years ago

If the workers in a factory are paid 5x as much as 15 years ago, the lorry driver taking the goods to the shop is paid 5x as much, the shop assistants are paid 5x as much, etc, etc then the goods sold in the shop are pretty much going to have to cost 5x more than they used to.

I think that is not necessarily true in all cases: Not every cost scales the same way. If the operation depends on human labor, such as in the food industry, then that would be true. The human cost in many operations going up up 5x, yet the iPhone and the xray machine cost the same pretty much everywhere in this world. It is cheaper to obtain and use an iPhone in the US than it is in, say China.

How much does the machine is factored in as part of the bill in the US?

simonh4• 9 years ago

I don’t know, but even then the machine has to be transported, installed and maintained in the US by US labour all of which cost more. Then there’s regulatory compliance and inspections.

So sure you can’t just do a streghtforward multiple and you’re done, that’s why I said ‘pretty much’. Some of the costs might be similar, others might be 20x or more. China probably doesn’t have medical practitioner insurance or regulatory compliance inspections at all, so those costs won’t even exist.

Tepix2• 9 years ago

Usually, the productivity also increases over time so the price of the product will increase slower than the wages.

exabrial• 9 years ago

Just curious, what country was the machine developed in and originally certified in? It seems a lot of medical stuff is developed American health companies, certified by the FDA, then exported... Not the other way around.

jacquesm• 9 years ago

Lots of it is made by Philips and Siemens as well as a huge number of Japanese manufacturers. GE is big in healthcare equipment too and there are many lesser known medical equipment manufacturers all over the globe.

In all it is definitely not an American affair.

athenot• 9 years ago

Europe too develops a lot of tech[1]. And uses it for a lot less than the US.

In France (Paris area), the price for a dental visit including 1-2 xrays is €42.00[2]. This is the pre-negotiated rate between dentists and the state insurer. Dentists are free to charge more but they must display prominent signage indicating they don't follow standard rates.

[1] Peruse this catalog and notice the European companies in here. http://www.medicalexpo.fr/fabricant-medical/systeme-radiogra...

[2] https://www.ameli.fr/essonne/chirurgien-dentiste/exercice-li...

spapin• 9 years ago

Do you think pharma companies that develop this are going: "we will develop an X-Ray machine, and only Americans will pay for it"?

I would assume they try to get a profit anywhere they sell it. Which means $20 x-ray is a realistic profitable cost per x-ray. But the US healthcare is so broken that they manage to extract 10x more money out of it.

mitchellst2• 9 years ago

Actually... kind of.

Imagine you're a French pharma company. You know the US is the richest country in the world and spends a quarter of its massive GDP on healthcare. When you put together R&D budgets, it makes sense that you plan to recoup most of your investment in the US, and that US FDA approval is one of your most important goals.

Of course they want a profit anywhere they sell it. But the calculation would change if the US health care system weren't so "messed up." You may not make the investment at all, because you couldn't recoup it over a reasonable timeline without the margins you get in the US.

The US rewards advanced medical tech development more than any other country. There are many things wrong with our system, and this might be related to some of them. But on its own, it belongs in the W column.

galadran• 9 years ago

More appropriate comparison would be to the UK where the cost of a private dental X-ray is between £9-£14 ($14-$22) [1], although realistically you would want a consultation as well. Most Brits use the NHS (state socialised) which provides a checkup and treatment for ~£20 for simple cases including x-rays [2]. Note that [2] is costs for an entire treatment which might be multiple visits and laboratory work.

[1] http://www.whatclinic.com/dentists/uk/x-ray [2] http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Dentalcosts.a...

tonfa• 9 years ago

I think it's similar prices in France, xray+consultation is in the order of 60 EUR.

pjc50• 9 years ago

Note to non-Brits: NHS dentistry (and opticians) are a little different from the rest of the NHS, in that not everything is free and the NHS services are oversubscribed, so people tend to go private.

shoo• 9 years ago

The nhs seems fairly impressive & well regarded internationally.

That said, anyone have some data on the quality of dental work done in UK system vs that of other countries?

Anecdotally i know a couple of people who lived in UK and moved to Australia have been pretty excited* about being able to access higher quality dental care to repair / mitigate earlier work done in the UK.

* well, as excited as one can reasonably get about expensive, painful, time consuming dental work...

dnel2• 9 years ago

The dentist doing surgery under the NHS will be the same one doing a private appointment afterwards. The only difference is the price you pay after, not the quality of the work. Each dentist typically has a limited number of NHS patients on their books so it can be pretty hard to find one available NHS spaces but private dental is not expensive.

kalleboo2• 9 years ago

The prices are also on the same order of magnitude here in Japan, which is another country typically seen as high-cost. (the number a quick Google turned up was $35 for a panorama x-ray, before insurance)

The government health-insurance scheme also covers 70% of the costs of covered dental work and within this system the costs that dentists can charge are regulated (which in some cases leads to perverse incentives where dentists split up procedures like cleanings so they can bill the insurance for two procedures instead of one)

dnel2• 9 years ago

I use a private (non-NHS) dentist in the UK, my last x-ray was wrapped up in my standard check-up price of ~£50, the cost is clearly so low they can just not bother billing for it separately.

bastijn2• 9 years ago

My (somewhat educated) guess:

1. Hospital staff bills less per hour

2. They typically run cheaper systems (not top of the line but specifically made for India/Asia or refurbished. Can be up to 1/3rd of costs of western world system.

3. They typically keep their systems longer and have more exams to earn back their system costs.

4. Service licenses are cheaper due to labor costs. (24/7 support is cheaper in India)

It not much different from why other costs of living are cheaper in India really.

By the way. A lot of people go to private clinics where the differences are much less. More like 1/4-1/5th of the price.

gorbachev2• 9 years ago

5. Greed

The healthcare industry in the US operates on the principle maximizing profits. They excel at it at the expense of patients who have limited choices to comparison shop and/or choose their healthcare providers.

Case in point. My daughter ripped up her lip pretty bad several years ago. It required immediate stitching to repair. At the recommendation of our family doctor we went to an ER known for doing good work. The stitching took 20 minutes. The bill came up at $11,000 USD. Or $30K / hr.

That's nothing but greed. There is no reasonable explanation for that bill.

bastijn2• 9 years ago

Note it might not be the greed of the hospital staff. Instead pharmaceutical companies might be charging ridiculous amounts for medication and operation supplies.

In addition, a hospital is like a company. It must try to break even. Hospital management is presured to reduce costs as we have an aging population. Predictions are medical costs for the entire population will explode. Furthermore, the cost pyramid for Healthcare is an inverse one. The 5% chronically ill take 95% of the total costs. They cannot afford to entirely pay for their care thus hospital management is forced to get these costs reimbursed elsewhere. Which might be you.

Aging population and the inverse Healthcare pyramid places hospital management in a difficult position where they would have to reduce costs to such an extent they cannot provide proper care. Their only solution is to get more money in so the debit/credit sides are in balance again.

refurb2• 9 years ago

Calling it "greed" ignore the complexities of the US healthcare system.

Let me ask, was the claim for $11K or was the amount paid $11K?

kansface2• 9 years ago

Your explanation lacks imagination.

jogjayr4• 9 years ago

I can assure you the healthcare industry in India is by-and-large for-profit. It doesn't mean everything has to be more expensive.

2close4comfort• 9 years ago

The cost is inflated to what the insurance market will bear in the US, with no market pressure like that in India and people paying for what they use you have a much more realistic price.

robocat• 9 years ago

$30* for dental x-ray in New Zealand (private system).

NZ has first world dental care. The price is from 2013, but straight conversion to USD will approximately offset inflation.

Dentist's salary guideline: https://www.careers.govt.nz/jobs-database/health-and-communi...

[*] https://www.consumer.org.nz/articles/dentists-fees

jpollock• 9 years ago

Note: NZ doesn't have malpractice insurance. [1]

[1] http://www.commonwealthfund.org/publications/in-the-literatu...

user-on15• 9 years ago

What happens behind the screen where one country is able to groom healthy medical/ insurance system and other countries get infected with so called insurance systems. Is it about the consumers being weak or is it about the service providers being strong?

sitharus• 9 years ago

I think it's due to relative power of the consumers. In most medical and dental situations the consumer does not have a lot of power compared to the providers. A government-lead system can drive down to the cost of providing, eliminating the profit consideration.

In New Zealand dental work is almost entirely private, there's no government backup for most people (there's an exception for basic work for those on low income).

On the other hand dental insurance is almost unheard of so clinics can't ask for too much. Last time I had a checkup, 2 xrays and a clean and polish it came to NZ$160 and that wasn't at a cheap practice. Also removal of two upper wisdom teeth was NZ$2500 including sedation.

It's been noted above that NZ doesn't require malpractice insurance due to the presence of ACC so this probably has a material impact on the prices.

arjunvpaul• 9 years ago

How fitting that it took the longest article that TIME has ever published to explain this. Here is a link https://goo.gl/SAqq6F (the original is behind a paywall).

If the only thing you learn is about the term "Chargemaster", then you are half way there in understanding this scam. I personally think YC should have a Call for Proposals just to disrupt the Chargemaster.

Journalist and author, Steven Brill won the Sidney award for this work https://goo.gl/StZXGA . He also later wrote a book on this called America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System . Amazon link here https://goo.gl/r2yk6A .

mitola2• 9 years ago

If i remember it correctly i did it in central european country privately (not public) for around 25 euros or something like that

mitola2• 9 years ago

Which is around 2 times more than in India.

SilasX2• 9 years ago

This just goes back to the cost disease problem we observe in health care, education, and housing in America.[1]

My takeaway from the discussion is that the big cost inflators are:

A) Litigation. Not that you can screw the customer without consequence everywhere else, but it makes the same conflict much more expensive and uncertain. In other countries, malpractice is handled by regulation, so suing over anything not covered by the regulators is virtually impossible.

B) Lack of transparency; no one knows how much something should cost, and why, and what they're getting for the more expensive option, and also have the incentive to reduce it, so cruft can persist.

You might be tempted to explain the difference by labor costs, which are higher in the US, but labor is also more productive in the US which should mostly cancel it out. Plus, in India they probably have to pay more for the equipment, which further mitigates the locality effect.

[1] HN discussion linking to SlateStarCodex article: https://news.ycombinator.com/item?id=13613687

golfstrom• 9 years ago

Medical providers in the US do not compete on price. There is in general little to no price transparency, as everything is traditionally paid for by private insurance. So as a rule, dentists will charge the maximum allowed by private insurance for x-rays.

In the US, people are complaining more and more about the cost of healthcare, but usually in terms of the cost of insurance. They never ask why providers charge what they do (p.s. - if you're in the hospital, don't ask your nurse to bring you a tissue, just buy some from the gift shop).

mitchellst2• 9 years ago

"Charging the maximum allowed by private insurance" is the same thing as competing on price. You're just competing to please insurance plans, not consumers. Admittedly, the insurance plans have every incentive to play ball: they want to brag on large provider networks in order to sell themselves to employers/consumers, and every corporation and person in the US is legally obligated to buy health insurance, so they don't lose customers by failing to deliver value for money.

alexanderstears4• 9 years ago

And health insurance companies have capped profit rates - the only way to return more money to shareholders is to cover more expenses. A $10 treatment means the insurance company gets to send about 80 cents to the shareholders, a $100 treatment means they get to send $8 to the shareholders. Is it any surprise that they don't really care about prices when they're incentivized to make prices more expensive and the law stipulates that you must buy health insurance if you can afford it?

KGIII7• 9 years ago

As I have mentioned before, you don't expect your automobile insurance, even full coverage, to pay for a tuneup. Expecting medical insurance to pay for regular care is just inserting a middleman that extracts value while increasing costs and adding no benefit.

Of course, this means people would have to pay for their regular care and visit the doctor on schedule.

The reasonable alternative is single-payer health care. Insurance is for catastrophic things, not for regular maintanence. Using it to pay for penis pills and birth control only makes it more expensive. Pushing for insurance to cover more things is only making the fees go up and their profits greater. Insurance shouldn't cover your regular checkup.

And, as stated, single-payer appears to be the only rational solution. According to the vast amounts of evidence, it is even less expensive on the whole society AND has better overall outcomes. Those of us with money will still be able to pay for extra care, there would still even be an insurance industry.

alexanderstears4• 9 years ago

The reasonable alternative is single-payer health care. Insurance is for catastrophic things, not for regular maintanence. Using it to pay for penis pills and birth control only makes it more expensive. Pushing for insurance to cover more things is only making the fees go up and their profits greater. Insurance shouldn't cover your regular checkup.

I really hope that the dissident right and progressives can team up on this. We can offer every American access to quality, cost effective, non-discretionary care for less than we currently spend on the ACA's contorted cross-subsidy and insurance profit guarantee scheme.

We could offer everyone access to no-cost healthcare and cap the expenses at something like 10% of our GDP with a fully empowered rationing feature that gives us the best QALYs for the money. We'll have to fight past the views of extremists but it would go a long way to making the U.S a better nation.

And it would permit a separate completely private, minimally regulated healthcare system for those who wanted it.

uberduber2• 9 years ago

I agree that almost all medical providers that take insurance do not compete on price.

However, even for medical services that insurance doesn't cover or cash only practices, people are terrible consumers. One of the biggest problems I see is that people have no idea on how to judge a physician and take price as a proxy for quality. For example, I found out my doctor did a medical treatment (not covered by insurance) for $150. Three other doctors quoted me $750-1150. One quoted $3500. When I told my friends about this bargain they all looked at me like I was insane. When I told my other healthcare providers, they went "Who? Oh, I know him. He does that? For $150? Really?! I'll have to go see him."

With dentistry, there's often total annual payment caps on insurance and a lot isn't covered. When I managed a call center I was astounded by how much the agents paid for dental work. They would just literally see dentist referral ad on TV, go to that dentist, and then when quoted $6k, would just go "ok" and agree. Of course, I also saw many of these people pay thousands above sticker on cars with no shortage (Nissan Altima).

Gurushek• 9 years ago

Brain less topic, everything depends upon value of the money (other bla bla things , cost of sources,workers salary etc). , example: 2 liter coca cola -78rs , in us 2.40$ (more then 220rs)

user-on15• 9 years ago

Would you buy coca cola if it costs $15 in usa?

kalleboo2• 9 years ago

Except there are many examples in this thread of other developed countries with high material and labor costs but that can still offer affordable private dental care.

2-3x the cost of India? Sure. 10x? Now it's starting to get out of wack.

nickbauman3• 9 years ago

Mostly for the same reason a Swedish bus driver gets paid 50x an equivalent Indian one does. Protectionism. Most of the "free world" relies on this practice of immigration control to keep wages high. You really don't want a free market unless you're from a poor country.

nine_k• 9 years ago

Immigration control is not only about the job market.

gumby• 9 years ago

Not to defend the appalling US system but the costs of operating a dentist's office in the US is higher. There are environmental laws concerning the chemicals used and disposal (if you drill into someone's legacy mercury filling you have to dispose of the debris carefully for example), drug handling and disposal, and of course malpractice insurance premiums.

All that being said, dentists in the US make out like bandits.

benevol• 9 years ago

Put very simply: It's a corrupt system.

And it's been know for a long time, so the only thing that's new is that some people are becoming aware of the degree of corruption.

refurb2• 9 years ago

Corruption how? Just calling it corruption isn't really that helpful.

krzyk• 9 years ago

Wow, so the cheapest panoramic x-ray is $60 in USA. I paid for mine in Poland 34 PLN (which is slightly more than $9), some time ago.

And right now my dentist gets me those (and tomography when needed) included in the treatment price (which doesn't change depending on the fact if I need the scans).

BTW. Dentists services are almost completely private in Poland - I don't know a single person that uses the dentists that are provided by the state (which are cheaper or even free).

It is quite different for other health related professions.

tryingagainbro• 9 years ago

salaries.

rent.

assistants.

employees to deal with insurance crap.

INSURANCE--say, if you get mouth cancer 12 months later you'll sue them for missing it.

most likely they paid 5-10 times more for the equipment, being USA and all.

user-on15• 9 years ago

Sounds like we are paying so much money for a for a big lie.

readhn2• 9 years ago

Simple: it can cost up to $300,000 to become a dentist in USA. It probably costs 100x less in India.

Before dentist charges for that first X-ray he or she is already potentially a few hundred thousand dollars in debt...

Folks would charge a thousand dollars for X-Ray if they could get away with it.

Welcome to capitalism.

pravda• 9 years ago

Welcome to the sunk cost fallacy!

manquer• 9 years ago

To get a good dental degree with masters in india without govt scholarship? It costs atleast 200-250 k USD . It is misconception that education is cheap here

readhn2• 9 years ago

this is news to me that in India tuition costs are more expensive than in some public colleges in USA...

appleiigs• 9 years ago

This is a classic economics 101 topic (Purchasing Power Parity). Prices should equalize, but can't due to barriers such as customs and immigration laws.

Obligatory Big Mac index link: http://www.economist.com/content/big-mac-index

arjie• 9 years ago

Americans tie consultation to scans. The opinion on the scan is often done by the same establishment that does the scan. But diagnosis is hard, and operating a machine not as hard. America doesn't allow market principles to handle operation because it's hard for an efficient market to apply in diagnosis. Tying these two things together, with the additional weight of the unwieldy insurance industry with its inefficient pricing means that everything costs more. This is not to mention the fact that insurance's regulatory capture is choking the industry.

Besides, Americans don't know how to run a market in health. It's a cultural thing. They deify classes of people and then have trouble fitting them into reality.

abhishekgarg120• 9 years ago

You should watch this. https://www.youtube.com/watch?v=CeDOQpfaUc8

jitendrac• 9 years ago

That is not true, X-ray in india costs around INR 300 ($5)to INR 120($2) based on the hospitals and trust managed orgs.

user-on15• 9 years ago

So if there is a dental patient in America and if in case he can reach both a dentist in America and a dentist in India in exactly 1 hour, would he choose to go to dentist in India or dentist in America?

Costs are as in title.

sigmaintegrale• 9 years ago

Sorry for the broad reply but Supply and Demand; Cost of living. Plus we assume that the service in India is the same as the USA. USA also has much more overhead in running a company that India, which from what I understand is still very much a cash oriented society.

starrychloe• 9 years ago

Lack of competition

https://www.youtube.com/watch?v=fFoXyFmmGBQ

Ask HN: Xray cost – USA $200 (13000 INR), India 1000 INR – what causes 10x diff?

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