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?
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
[0] http://www.lonestatistik.se/loner.asp/yrke/Tandlakare-1241
[1] https://en.wikipedia.org/wiki/List_of_countries_by_income_eq...
Second question: would you prefer living without well-cooked burgers, or live with bad teeth?
The difference in value is there.
Another example: brain surgeons have an average salary in the US of $450 000 [0], in Sweden it's $65 700. I would agree that there is some room for higher salaries for people with advanced degrees in Sweden, but I also think that the income inequality in the US is way too high. It's a cultural thing.
[0] https://www.payscale.com/research/US/Degree=Doctor_of_Medici...
[1] http://www.lonestatistik.se/loner.asp/yrke/Hjarnkirurg-5131
They are also overlooking the basic facts that healthcare in Sweden is significantly better than in the US despite the significantly lower pay scale, Sweden has a higher median income, and the quality of McDonalds food and service is probably better as well (it has been anywhere I have been in Europe).
In the U.S., there is no limit on this. The violence of poverty is completely overlooked as is the incredibly uneven playing field.
The healthcare industry is set to extract maximum profit with minimum service and people who cannot afford the premiums are left without care options/face bankruptcy.
This is just one of the many forces increasing income inequality.
Similarly, education is expensive not because it costs that much but because it is set to maximize profits.
I’d say that dentists making 150k is less of an issue than the fast food workers making 1/8 of that with minimum wage which has not increased in decades and a house median cost is above 600k-1m.
Human beings are not seen as having dignity or value beyond the exploitable.
This doesn't actually answer any questions or address any actual issues, unless you're willing to force dentists to work with your so-called "appropriate salary" with the full force of the law.
What virtually all advanced democracies have done is rather make a judgement about what kinds of fees are reasonable to pay for dental and medical services, and limit what the national health insurance system will pay to that.
Then see if anybody is willing to practice dentistry. They usually are.
(Also, in most, if not all, of these countries, dentists are free to charge any rate they wish for dental services, and if they can find enough people willing to pay those fees with their own money, instead of using the national health insurance system, that's fine, too. But that's typically not necessary, and hence not common.)
But a Swedish dentist definitely can even though he just earns twice as much as the guy flipping burgers, I don't see your point. The only reason to pay a worker more is to attract more talent to the profession, and Medicine is the field that is by far the most selective in Sweden meaning that they already get the best talent. The only thing you would accomplish by paying them more is making healthcare less affordable for the people.
10 CEOs can't fix your teeth.
That is incredibly arrogant and so far wrong it's not even close to the truth.
This seems like fact to me. The whole point about McDonalds is that they have perfected their processes so well that there is very little difference in quality and output between someone who has spent 20 years making hamburgers and someone who has been there a month.
If someone is capable of being a dentist, they can likely make hamburgers. The reverse is probably not true - some portion of the people making hamburgers likely don't have what it takes to make it through dental school.
Not everyone who gets through school gets high marks, and of those that get high marks not all of them are necessarily inclined to be good with the tools they use.
I've known of some pretty awful dentists who tended to do as much damage to their patients as they did repairs. I have no reason to believe they'd be any better at making burgers or anything else they attempted to do.
And it takes arrogance to believe that a degree makes you superior to those who don't have one. The truth is it takes longer to become proficient in some skilled labor trades than it does to become a dentist, and it take more actual skills to do the work.
I've never met a dentist who could tear down a small block Chevy engine and rebuild it. Not one. I've never even met one that could change the oil on one, but I've known kids who learned how before they were 12 years old.
Finally, some of the most brilliant people in history, some of the greatest engineers, designers, and inventors, are people who spent very little time in school and none at all in any kind of higher education.
If you think everyone who's making your burgers is less intelligent, less capable, less creative, than yourself you are an arrogant fool.
You sound like someone who has never had to pass advanced exams to proceed with much higher levels of education.
I have relatives who are dentists. They are extraordinary in their precision. If you think it just requires time and money you clearly will never pass med school.
Awful dentists? Yes, every field has people of bad ethics. The very word "mechanic" conjures up images of incompetent lying men who will rip you off and ruin your car. What's your point?
Arrogance - nobody said anything about better. Just better at being a dentist and that learning how to flip burgers is easy.
I know a doctor who can rebuild engines. He is also a painter and a soldier. What's your point? The intersection of dentists and people who want to mess with engines when they can easily is small. It has nothing to do with ability. Changing oil takes five seconds to learn. Have you ever diagnosed an error on a chip with an oscilloscope? I have. Does that mean you are stupid or simply haven't cared to do so?
Everyone who makes burgers is less intelligent, less capable, and less creative than me is a different statement than "making burgers doesn't require the same level of intelligence, capability, and attention to detail as dental work".
Tell me, since you're so good at rebuilding engines, how good are you at rebuilding without turning it off? Without making a mistake? Fixing engines and dentistry aren't comparable, much less flipping burgers.
"I have relatives who are dentists."
And that obviously influences your take on this issue. I didn't insult or demean your relatives, I just don't have good reason to believe they're "special" because they're dentists.
"The very word "mechanic" conjures up images of incompetent lying men who will rip you off and ruin your car."
"Changing oil takes five seconds to learn."
That is exactly the kind of arrogance I'm calling out here. The truth is, pulling a tooth takes about that long to learn too, and the tools used aren't that much different.
Don't believe me?
Come on over and I'll pop one of your teeth out in about 5 seconds without ever going to school to learn how and I'll use the same tool to change the oil on my lawn mower ten seconds later.
-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.
[0] http://www.lonestatistik.se/loner.asp/yrke/Civilingenjor-116...
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.
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.
As someone with permanent nerve damage from having my wisdom teeth removed that makes me look like a fucking stroke victim when I smile...yes, absolutely
We take a risk every time we do something. It doesn't mean that you'll absolutely be guaranteed by paying 10x more that you won't have a botched surgery, it's just less likely. Someone would say they are willing to pay 10x more for 2x less the chance, given they had an accident. The problem with that was I don't think the population will be happy adopting an 80 USD toll road and $25 per gallon for 2x less the chance of a car accident, even if that could be done. I think safety tradeoff is easier said than done.
I ask because you did pay 10x more if you had that dentistry work done here in the US and the outcome is as you've described.
I've been advised by a dental surgeon to not take off my wisdom teeth because of this.
Did you receive warnings about it before surgery?
My grandpa has cancer and is getting chemo, the chemo seems very expensive (at least 100x more expensive than the same molecules but without FDA certification in India). However, the hospital bills each intramuscular injection at $200. An intramuscular injection is the same injection as a flu shot. Now, why can I get a flu shot for $20 at walgreens but a hospital charges $200 to perform the same sort of shot with a different payload?
And why can't we trust people to do it themselves? Diabetics stick themselves with needles routinely with pretty basic training.
I wonder how much my health insurance would be if I could forego check ups, promise not to use insurance to cover on-patent medication, and DIY my healthcare as much as possible. And I'll keep wondering because apparently a lot of that would be illegal.
Plus, the bizarre system of "You can only change once per year and in specific windows or for a major life change".
Strangely though, the US enjoys lower prices for consumer goods like fashion brands, and consumer electronics. Nike shoes and a Sony TV will be more expensive in India than the US.
That's not strange at all. India has import duties on many goods, especially electronics.
It might be more sensible to compare how much more dentists make than the average income. i.e Average dentists salary / average salary.
For US I get - 175350/55775 ~ 3x
For India its 8.5x
So dentists are probably pretty well paid in terms of the standard of living they can purchase.
Its the same reason it doesn't make sense to directly compare programmers salaries in San Francisco vs. Pittsburgh. If (made up numbers) 120K$ in SF buys the same lifestyle as 90K$ in Pittsburgh, it means someone making 120K in SF is roughly as wealthy as someone making 90K in Pittsburgh. Certainly saying that the SF programmers make 1.3x more is true, but the more fundamental question is the lifestyle that the income affords you.
And of course a lot of things cost the same regardless of where you live. Manufactured goods cost pretty much the same in India as in the US and sometimes more, because of import duties. Gasoline is significantly more expensive.
The point I was making is that some things cost the same no matter where you live. The Indian dentist who wants to take a foreign vacation, buy an iPhone, or a car needs to spend more, relative to her income, than the American dentist. Purchasing power only holds for things that are labor-bound (mainly services, and goods that are labor-intensive to manufacture) rather than resource-bound.
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.
Prices as of September 2017, currency conversion via Google on today's date and time.
http://pricebaba.com/mobile/pricelist/apple-price-list
My bad.
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).
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.
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.
However, the actual prices have gone through the roof. Before the ACA, the total amount paid to Labcorp for some bloodwork was about $28 a few years ago, same bloodwork today I get a bill for $300. This year I needed some labs where my doctor normally charges $60. However, there was one test he couldn't do and I'm a hard stick, so he told me I should just get it all done at the hospital. I know hospitals are expensive, but I figured paying another $200-300 would be worth not getting stuck twice. When the bill came it was $1150 with the special test only being about $30 out of the $1150. Insurance never would've allowed this rate before but now they're incentivized to make prices higher.
It’s really a shame how the wealthiest nation on the planet can’t provide for its citizens.
Or it means that to become the wealthiest nation, you’ve got to be ruthless and screw the poor. This means America will be a wealthy country, shitty healthcare, literally shit on the streets and will do absolutely fuck all when natural disasters hit.
I don't think America became wealthy because it has crappy social services, but I think that a crappy social safety net and a big upside to personal success makes it an environment that really gets peak performance out of driven people.
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).
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.
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?
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.
That is, other than the medical bill and the education bill, if I have my own family later on.
Even in China salaries might be 5x higher now but also the exchange rate has halved, so foreign goods are effective 10x more affordable now. Hence cars are everywhere, compared to when I started going there when owning a private car was an impossible dream for most families and the streets only carried busses and taxis.
[1] http://www.whatclinic.com/dentists/uk/x-ray [2] http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Dentalcosts.a...
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)
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...
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...
[1] http://www.commonwealthfund.org/publications/in-the-literatu...
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.
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.
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.
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.
Let me ask, was the claim for $11K or was the amount paid $11K?
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.
Obligatory Big Mac index link: http://www.economist.com/content/big-mac-index
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 .
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.
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
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.
All that being said, dentists in the US make out like bandits.
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.
Costs are as in title.
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...
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.
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.
isn't most of it for wasteful reasons.
>There are many things wrong with our system
Many people are saying this often, seems like people have just surrendered and submitted themselves to organized skillful abuse by such systems. Wish we have more cumulative willpower than present.
In all it is definitely not an American affair.
2-3x the cost of India? Sure. 10x? Now it's starting to get out of wack.
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.
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.
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.