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Comment by patio11 | Hacker News Reader

Somewhere there is a forum of doctors saying "Pfft, the US firm wants $100k for the patient records system and the Indian firm wants $1,000. Those greedy bastards! They live in a toxic industry which acts as parasites on us noble public servants saving lives every day. It serves them right to deal with international competition finally.

Let's go with the Indian bidder. What could possibly go wrong."

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Hi patio11,

Thanks to femto, we have some data. It seems that the 30 day mortality rate is lower than that in the US. Care to answer this other than with thinly veiled casual racism?

Dr Shetty's success rates appear to be as good as those of many hospitals abroad. Narayana Hrudayalaya reports a 1.4 per cent mortality rate within 30 days of coronary artery bypass graft surgery, one of the most common procedures, compared with an average of 1.9 per cent in the US in 2008, according to data gathered by the Chicago-based Society of Thoracic Surgeons.

Dr Lewin believes Dr Shetty's success rates would look even better if he adjusted for risk, because his patients often lack access to even basic health care and suffer from more advanced cardiac disease when they finally come in for surgery.

http://www.theaustralian.com.au/archive/business-old/the-hen...

I will say that you are comparing one doctor to the national average. This only shows he is better than average, but what is the Indian average mortality rate. Another issue that your article mentions is that he specializes on a select procedure and another doctor mentions that this option of specialization is not available to all surgeons.

Don't take this as part of any sides argument. All I want to point out is that the numbers you provide only paint part of the picture. Yes maybe flying to India for this one doctors procedure would be worthwhile but is it true across the board.

It looks like the mortality rates mentioned are for the entire chain of hospitals, not just Dr. Shetty.

the principal still stands don't compare one hospital or hospital chain, to another country.

If the US average is 1.9 then their is probability that a US hospital chain that is at 1.4 or less.

There will also be hospitals that have a higher rate. That said, the number is relevant as medical tourists tend to go to hospitals like this doctor's not the bad hospitals.

The main point is that you can get a better chance of living at a much cheaper rate.

Not sure what you're trying to say here. You seem to be trying to defend the cost of a $100,000 operation by making a snarky comparison with outsourcing an IT project.

Is that actually what you meant?

patio11 has a long history of making snarky comments about how outsourcing to India should not be a concern to Western IT workers because the quality of Indian IT workers is much lower than that of Western IT workers and clients will ultimately recognize this and hire a Westerner instead. This is presumably something that is quite near and dear to him, as he is an American expat who lives in Gifu, a tiny, rural Japanese town. Since his primary income source (outside of Bingo Card Creator and Appointment Reminder) is doing consulting work for Western customers, it's very important to him that they pick him over Indian consultants based on how good he is, since hiring him presents all the same issues with respect to time zone, distance, etc. that hiring an Indian would.

He probably experienced a lot of difficulty initially in acquiring customers (who opted to go with the much cheaper, Indian consultants), which is why he has such an oversized Internet presence, including on Hacker News - it has helped build a brand for himself that isn't location-specific.

There's one problem with your argument: patio11 doesn't actually do consulting anymore.

http://www.kalzumeus.com/2013/07/17/kalzumeus-podcast-5-quit...

My long history of comments on the issue generally references my time at the old Japanese day job, where I was pressganged into dealing with our Indian subsidiary and asked to shepherd the five folks who came to work at our Nagoya location from it. This is what I was doing during three years of 100 hour weeks.

A more charitable read of my old comments would be "The project(s) were beset by communication issues, terribly managed by the Japanese company (which, in the fine tradition of Japanese companies, I'll take blame for since I was unable to resolve it despite trying), and additionally undermined by pervasive competence issues."

I'm not talking my book here. In the first place, I don't have a book, as I no longer consult. In the second case, Indian BPO firms are less competitive with me than Chinese take out restaurants: our target customers are different, our projects are different, our marketing methods are different, etc etc.

Once again, an attempt to attribute someone's words to simple financial interests or other superficial biases makes a whole thread dumber. Has this kind of argument ever worked on HN, even once? This attempt at psychoanalyzing Patrick is so comically ineffective that it might have been improved with a few intimations that he was also in the best pockets of the NSA.

You are way out of line here.

No, I'm suggesting that HN commenters here are likely far less competent to speculate about the cost structure of heart operations than believe themselves to be. In an analogous situation which they actually understand, the tenor of this comment thread would reverse in a hurry. (Which we could ascribe partly to self interest but in major degree to "Deliver X for the US market in America" and "Deliver X for the Indian market in India" being two very, very different propositions.)

Sorry Patrick. Normally I would agree with you, but there is a difference here.

The biggest difference here is if the cost of a heart operation in India would be too high, unlike the US- poor people will have absolutely no option but to die here. That is what it really comes down to. In US it leads to a person getting bankrupt, but in India poor people don't have the luxury of getting bankrupt. In my city(Bangalore) we have government hospitals- though they never acknowledge it officially, but they often administer euthanasia to poor patients. It happens with the poor in nearly all critical illness cases- Heart ailments, cancer, fire accident victims, mental illness. Often the relatives themselves request a euthanasia because the pain, price and duration of treatment is beyond their emotional and financial means.

So you can either make the treatment a little affordable so that people can benefit, while you make some profit out of it. Or they die anyway and you lose some profit.

Innovation in a situation like this is born out of necessity. Its a do or die situation.

"I'm suggesting that HN commenters here are likely far less competent to speculate about the cost structure of heart operations than believe themselves to be"

In my case: U.S. cost structures, sure, I don't know them, though I do speculate and guess, and asked if someone knows of a hospital with transparent enough data.

Uruguay cost structures are a different bag altogether, since they're mostly government-run and they have to make numbers somewhat public. Add to that one of my brothers working in a hospital (he's a few years from graduating as a doctor) and other sources, and I can get an estimate that I hope is correct to an order of magnitude. A relative has been a customer of the Cleveland clinic, so I know the exact number he paid. I also know the exact number another person paid for the exact same surgery here in Uruguay - it was close to one-tenth, and he chose to pay private rather to go through the public institutions (which have huge delays).

Below is a PDF in Spanish, on an investigative piece from a weekly that goes into great detail on the costs of surgery in Uruguay. I'll just quote some basic numbers:

- Fixed fee per major surgery (medical act) UY$ 27.500 / U$ 1300

- Monthly Head Heart Surgeon salary (per hospital) UY$ 263.000 / U$ 12500

- Other heart surgeons, between UY$ 162.500 and 243.000 depending on seniority and other factors - U$ 8.000 to 12.000 range, per month. Those are close to the best salaries anywhere in Uruguay, usually as well trained as any doctor in the U.S.

- Cost to the hospital per major operation (heart surgery), UY$ 206.000 / U$ 10.000

Smaller operations like angioplasty cost UY$ 60.000 / U$ 3.000

The most expensive surgery is heart transplant, which costs UY$ 684.000 / U$ 32000

All those are set by the government, so those ARE the actual costs (well, actually they were in 2008, I didn't adjust by inflation and exchange rate), no insurance or strange stuff involved. The patient is not billed a cent, but there is a huge delay (months usually), and doctors don't really schedule surgery unless it's critical for the person's health (almost no quality of life procedures through the public system).

http://www.semanario-alternativas.info/archivos/2008/5)mayo/...

PD: Surgeons and Anesthesists have tremendous power, and managed to get paid close to ten times the rate of other doctors.

Some times, things really are that way. It does help to know the supplier, of course.

But back to the article, there are some U.S. healthcare costs that don't make any sense, I've seen procedures with firsthand accounts of an equivalent service here in Uruguay vs the cost in the U.S., and the cost in the U.S. is an order of magnitude more (and service sometimes much worse, this is the hospital I go to, try to argue it's worse than an average U.S. hospital ! http://www.hospitalbritanico.org.uy/ ).

Similarly, the company I work for regularly gets better software for one-tenth the price of U.S. bidders, we've bought local (Uruguayan), Colombian, Ecuadorean... it does help a lot that we know the language and how to do business there. It's not a hundred-to-one comparison as you mention, but there are huge market inefficiencies (in this case, they should be arbitraged away by someone selling services in the U.S., with a focus on quality and not devolving into Infosys or something).

Lots of stuff. But the question isn't about which of those two systems will be better in the end. The question is what to do when you've only got $75k.

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