Comment by esperent | Hacker News Reader

Comment by esperent | Hacker News Reader

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> In asia you can walk into a clinic and see a doctor in 30m

... If you're rich relative to the general population, then you can go to an expensive private clinic and be seen quickly, yes.

I doubt that's the case for public hospitals and in any case, I've been inside public hospitals in Indonesia, Cambodia, and Vietnam (all for other people's needs, nothing major thankfully). Trust me, you do not want to get treated in one of those and as a westerner you'll never even see them unless you friend gets bitten by a monkey in the Cambodian jungle (for example) and there's no private clinics nearby. I always assumed the casual attitude towards hygiene that Asian people have wouldn't extend to hospitals. I was wrong. There were literally blood stains on the wall in the corridor. The toilet was a hole in the ground with a bucket of water and a scoop to wash your hands and ass with. There was no soap. This wasn't a small hospital, it was the main hospital for a city of about 200k people.

Back when I lived in Japan, my employer-sponsored yearly health screening had an optional head MRI exam. I could book it a few days before, and would take 15 minutes with a single technician.

Now it costs around $300: https://www.tokyomidtown-mc.jp/en/pdf/optional_menu.pdf

MR screening is a great way to increase unnecessary biopsy and stress etc except in a very narrow range of conditions.

Edit: https://bmjopen.bmj.com/content/12/1/e056572

This is a really weird claim to me. It can’t be about the MRI itself, it must be about the surrounding politics or legal environment.

How can it ever be bad to have more objective data? Having a test result to ignore is still strictly better than not testing at all. You still have the option to ignore or discount the test results if you want to. If you’re forced to do otherwise that’s entirely a human problem, not a technological one.

> How can it ever be bad to have more objective data? Having a test result to ignore is still strictly better than not testing at all.

That’s why you base healthcare on data. And that’s what the data shows.

I still don’t get it.

If MRIs lead to unnecessary biopsies, then don’t do the biopsy. What exactly does the data show? If doing a test leads to an unnecessary biopsy, how can it be the test’s fault? Tests aren’t moral agents. The MRI machine can’t make any healthcare decisions for anyone.

That’s a problem with the interpretation, and how results are presented to patients. The MRI scanner is working as intended but the humans are getting the probabilities wrong, as usual.

Specificity is not always high. Yes, it’s an interpretation issue, but it’s a know problem. A better radiologist might help, but the issue is that many things look the same or very very similar on MRI. Evidence based medicine is the way to go.

It’s not terribly expensive. Most scans cost under $100 at the top facility in the wealthy part of Delhi. The cost would be 20-30% lower at centers in cheaper parts of the city.

Delhi’s nominal per capita income is north of $6k. Even if you’re plain average, a $60-80 one time scan is within reach.

Spending 10-20% of you monthly income on on a single test does not seem like a good deal at all.

1. Government hospitals offer MRI scams at free or heavily subsidized prices to everyone. Going to a private clinic is optional

2. You typically don't need MRI scams all that often

Edit: replied to completely wrong comment. Below was supposed to go to one comment above.

Government rate is $120 per imaging session, with standard 1/3 deductible. Minimum wage in Tokyo at this moment is $1336, so more like 3-5% after additional diagnosis and fees.

I wonder how they do this.

Just the scanner install, service contract and chilling is 6 figures, and the staffing is a significant sum. Maybe the throughout is very high (scan quality low)?

Labor is cheap in india Doing low average 10 of day test is between 15-90 min, 30.000 p/m. Justifies the machine cost. Assuming weekends are open.

You wont pay many bills with 10 MRs a day even if your staff are cheap. They must be doing 50ish. And I have questions about the quality of the protocol and the resolution of the scans.

Rent in India is pretty cheap. Even for residential apartments, rental yield in Delhi is not more than 2%.

Not sure you are aware of low income, low rent countries dynamics.

I’m not.

It’s more that I’m aware of MR equipment costs, and I can’t see the equipment being discounted.

You can get them for 300-500k in dollars on indiamart.

Salary of medical assistent around 3 dollars per hour.

A few k per month would definitely make the purchase worthwhile.

That is very cheap. The room build is another large cost, but labour is a large part of that cost where I am.

The image quality is going to be unlike what you get from a higher spec machine, but does that matter most the time?

A crappy picture can be diagnostic.

Do you know the model or make of what they are using? I’d be interested to see what they are like.

I struggle with the idea that 10 MRs a day would support a business anywhere, so seeing numbers is really interesting.

> I always assumed the casual attitude towards hygiene that Asian people have ...

Hmmm, might be generalising a bit too much there.

As a generalisation (too, heh) people in Japan seem to be fairly careful with hygiene.

> I always assumed the casual attitude towards hygiene that Asian people have

You're totally right to call me on that generalization. I meant the parts of Asia I've personally spent time in: India, Sri Lanka, Nepal, Bangladesh, Myanmar, Cambodia, Indonesia, Vietnam, Laos, Philippines, and to a lesser extent Malaysia and Thailand.

Other Asian countries like Taiwan, Japan, Korea, and Singapore don't deserve this shade thrown at them and I apologize.

I suspect the issue is less of a general attitude and more of a combo of poor resources and poverty. Tons of hospitals in India are spanking clean - though these are often the private ones.

No, it's a cultural thing. For sure it came from poverty. But it persists in places where that's no longer an excuse. For example my neighborhood in Vietnam has kerbside trash/recycling collection four days a week. Even if you couldn't pay you could easily put your bags with someone else's. Hell I'd pay for the entire street gladly. And yet several of my neighbors still pile up their trash and burn it. I've ended up shouting at them a few times - unfortunately being polite does nothing in this culture, while getting angry, as a foreigner, is extremely effective no matter how much I dislike doing it.

I know people would say "adapt to the place you're in". But I draw the line in a few places. Burning trash and mistreatment of dogs are what push me past that line and turn me into a shouting maniac.

> Tons of hospitals in India are spanking clean

Private hospitals. Lots of commercial places are kept spanking clean. It's weird though, it rarely extends to the neighborhood. I'll never stop finding it weird to see a stylish hotel with manicured grounds next door to a literal dumping ground that they don't seem bothered by.

Yeah. And so much staff… I am from Germany where I have the fancy private health insurance and I spent 5 days in a hospital in Bangalore. I think on my fancy-pants hospital wards were 10 nurses on staff per shift for roughly 20 patients, plus support personnel. The quality was very good. I think it comes down to the availability of a skilled workforce for relatively cheap salaries, while in Germany the salaries are higher, staff is incredibly less in headcounts.

Asia is a big region and using "Asian" to describe people from different areas seems overgeneralizating to me at least (though it's the language customs that do that)

I propose Expasia as a name for the kind of Asia Westerners can usually relate to.

East or Southeast asia is often pretty accurate to describe the region that westerners think of.

Weirdly enough, that's not completely accurate as I discovered from moving to the UK.

In Australia (where I initially moved from), the term "Asian" does indeed refer to people from East or Southeast Asia.

But it turns out for people in the UK, the term "Asian" refers to people from India (and immediate area I guess).

(!) For East/Southeast Asia, they use the term "Oriental".

It sure surprised the heck out of me.

Well not sure how they would relate to North Korea or Guinea.

Well, as a "European", I feel your frustration. But in this context I think it's fair to assume that people are talking about the parts of Asia where westerners are likely to go for cheap healthcare. Which basically means SEA + India.

You can get an MRI in Japan with insurance for less than 10,000 yen (~$75).

You don’t need to be rich, and it doesn’t matter if it’s public or private. Having lived in 6 countries in Asia over 20 years it’s never been expensive, difficult, dirty, or anything like you describe.

Well the exception being Singapore. That was expensive but covered by insurance so it still cost $0.

Edit: another thing. What is with the west more or less forcing natural birth and kicking you out of the hospital the next day? I would hate to give birth in a western country. Thankfully my kids were born in Asia. Hospital took care of baby and mum for 6 days then we left the hospital. Cost was 2 weeks salary.

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