In India, 'no frills' hospitals offer $800 heart surgery

http://www.globalpost.com/dispatch/news/afp/130421/india-no-frills-hospitals-offer-800-heart-surgery

by OGinparadise • 13 years ago

171 98 13 years ago

mschuster914• 13 years ago

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

vaadu• 13 years ago

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

mschuster914• 13 years ago

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

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

toomuchtodo2• 13 years ago

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

jcnnghm4• 13 years ago

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

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

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

swatkat2• 13 years ago

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

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

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

yummyfajitas3• 13 years ago

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

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

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

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

Scaevolus• 13 years ago

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

SapphireSun4• 13 years ago

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

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

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

sgt• 13 years ago

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

kansface• 13 years ago

No no, you should hold off for their Groupon!

fakeer5• 13 years ago

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

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

toomuchtodo2• 13 years ago

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

quentusrex• 13 years ago

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

Breakthrough• 13 years ago

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

[/sarcasm]

healthenclave3• 13 years ago

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

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

rorrr2• 13 years ago

Source?

raverbashing• 13 years ago

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

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

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

logn• 13 years ago

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

healthenclave3• 13 years ago

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

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

fakeer5• 13 years ago

Agree.

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

fakeer5• 13 years ago

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

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

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

areddy3• 13 years ago

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

ajays3• 13 years ago

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

suhastech• 13 years ago

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

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

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

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

kamaal4• 13 years ago

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

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

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

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

arbuge• 13 years ago

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

kiba• 13 years ago

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

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

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

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

healthenclave3• 13 years ago

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

kirubakaran• 13 years ago

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

dclowd9901• 13 years ago

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

swatkat2• 13 years ago

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

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

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

TheMagicHorsey• 13 years ago

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

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

brador2• 13 years ago

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

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

harichinnan• 13 years ago

That's a factual statement. Just like you could've gone to the dentist in Oklahome and got H1V or Hepatitis. http://abcnews.go.com/Health/60-oklahoma-dental-patients-tes...

brador2• 13 years ago

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

ajays3• 13 years ago

That's irrelevant to the topic at hand.

spartango• 13 years ago

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

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

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

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

pavanky• 13 years ago

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

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

newyankee• 13 years ago

Relevant Al-jazeera documentary

http://www.aljazeera.com/programmes/indianhospital/2012/05/2...

hashkanna• 13 years ago

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

curiousfiddler3• 13 years ago

I'd like to take a shot at answering this: why is a low cost medical treatment effective in India?

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

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

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

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

skylan_q2• 13 years ago

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

curiousfiddler3• 13 years ago

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

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

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

eru• 13 years ago

India is hugely bureaucratic and inefficient..

mh-• 13 years ago

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

    India *is not* a [..]

sorry to take away from thread; insightful comment.

curiousfiddler3• 13 years ago

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

abraham_s2• 13 years ago

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

kamaal4• 13 years ago

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

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

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

noonespecial• 13 years ago

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

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

skylan_q2• 13 years ago

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

Egregore• 13 years ago

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

jmduke• 13 years ago

"Minimum Viable Heart Surgery."

rubikscube• 13 years ago

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

http://www.surgerycenterok.com/

They even have the integrity to list prices publicly.

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

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

eli• 13 years ago

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

jbrowning• 13 years ago

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

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

tn13• 13 years ago

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

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

More power to NH.

Attocs• 13 years ago

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

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

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

In India, 'no frills' hospitals offer $800 heart surgery

Related Stories