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.
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.