Monday, November 23, 2009

More Health-Care Lessons from India

From the Salon.com article "How I Got Well in India for $50: My cheap, fast and effective treatment in New Delhi reminded me of everything wrong with American healthcare":

I had anticipated getting sick in India. What I hadn't anticipated was that India's treatment would turn out to be so good. And cheap. Unless you happen to be one of the hundreds of millions of Indians who are poor and don't live in a major metropolitan area. The Indian healthcare system is an anarchic hodgepodge, with little insurance, little regulation and a range of services offered by hundreds of government-run, trust-run and corporate hospitals. The care it produced for me was fast, effective, courteous and cheaper than American medicine, even when adjusted for the lower cost of living.

The cost to see the doctor (a gastroenterologist, for a bacterial infection)? $6. The pharmacy bill was about $1. Total cost, $7, with no insurance company involvement whatsoever.

In some ways, the Indian system is like the U.S. system before the spread of private insurance -- that extra layer of bureaucracy is still not a major factor in Indian healthcare costs. Private insurance costs help explain why the U.S. spends a greater percentage of its GDP on healthcare than the European democracies. The Indian system of health insurance also works differently, in a way that holds down costs. Those Indians who do have private insurance pay their bills out of pocket -- to doctors who don't charge much because of all the competition -- and then get reimbursed. The insurance companies aren't the ones setting the rates or acting as the middle man.

Almost 25,000 doctors graduate from India's medical schools every year. Because there is so much competition, doctors and hospitals are forced to keep their prices low to get patients. Residents, who go to medical school straight from high school, only make the equivalent of a few hundred dollars a month. An average surgeon's salary would be around $8,000 per month.

HT: Colin Grabow

22 Comments:

At 11/23/2009 3:10 PM, Blogger Size said...

I'm delighted to read these articles on your blog, Professor.

Now I know where I'll be going to get anything that resembles actual health care after congress is through "reforming" in this country.

 
At 11/23/2009 3:41 PM, Anonymous Anonymous said...

This is why we import doctors from India.

 
At 11/23/2009 4:01 PM, Blogger Bill said...

We won't be able to afford the plane fare to India once Obama raises taxes to pay for the health care "reform."

 
At 11/23/2009 5:13 PM, Blogger juandos said...

Hmmm, good comments!

Bill I found your comment to be quite funny (and no, I don't mean ha! ha! funny either) since I work for an airline and was wondering the very samething myself...

The real question is, will AARP get into the act of running a medical tourism route to places like India or are they welded to ObamaCare?

 
At 11/23/2009 7:26 PM, Anonymous Anonymous said...

AARP supports obamacare because it will have the effect of killing medicare advantage. This will be good news for their supplemental insurance plans (where they get the majority of their revenue).

 
At 11/23/2009 7:44 PM, Blogger randian said...

A very important omission is the answer to the question "How does one vet an Indian doctor?"

 
At 11/23/2009 7:58 PM, Anonymous Dr. T said...

"Residents, who go to medical school straight from high school..."

These medical students are too young, and they learn few fundamentals of the human body. They don't know how to diagnose anything other than common diseases with "textbook" presentations. They are body mechanics, not physicians.

To answer Randian: Emigrants from India who wish to become US physicians must have the equivalent of an American bachelor's degree and a medical degree. They must complete a 3-5 year US residency training program (regardless of their experience in India). They must pass our medical school and specialty board examinations and show proficiency in English. Our states do not grant licenses to Indians who have only Indian medical licenses.

 
At 11/23/2009 8:00 PM, Blogger markdodson said...

Great article!

We should open a 12 month window and allow 100K doctors from India & around the world to immigrate to the US and give them a home... solves two problems at once...and likely much cheaper in the long run...

 
At 11/23/2009 8:03 PM, Anonymous Dr. T said...

I realized that Randian probably is asking how does one vet a physician in India. A look at the statistics I listed would help.

 
At 11/23/2009 9:01 PM, Anonymous Jim Egnor said...

As an internal medicine practitioner for about 20 years, one comment and forgive me for being perhaps too politically incorrect---I know of quite a few excellent docs from India. I find it interesting that they tend to not want to return home to practice their specialties. Now why would that be? Yeah...I do earn more than the median income here in the US and I can appreciate comments that perhaps the higher echelon of medicine are paid too damn much for what they/we do. How many people who read this blog...IF they had their own wages valued according to what their Indian counterparts make in their own world...would argue that in this case Indian business is equal to the US from a wage/cost of living standpoint?? I recognize I'll probably be pilloried with my comment but at least be honest with any ridicule, ok??

 
At 11/23/2009 10:12 PM, Blogger randian said...

These medical students are too young, and they learn few fundamentals of the human body.

What does age have to do with anything? There's no reason to get an undergrad degree if you want to be a doctor. It's just another BS requirement that lowers the supply of doctors to keep wages high.

If they do indeed learn few fundamentals of the human body, that's not a function of their age, that's a failure of their medical schools.

Let's stop treating doctors like high priests.

 
At 11/23/2009 10:53 PM, Blogger Methinks said...

Dr. T,

Quite a few members of my family are surgeons. No matter what part of the world they got their medical training (including the U.S.), they were terrified of over half their class.

 
At 11/24/2009 12:13 AM, Blogger BMWright said...

More proof that we should outsource our American government to India and China. We could still have big government but at half the cost. We'd have 2x more doctors and cheaper health care. And the communist have proven they know how to create jobs by taking advantage of capitalist.

Outsourcing all our Universities would produce 2x the output with 1/2 the cost. American Universities are more concerned with how to keep kids in school longer for more cash flow than how to get them a job in a dying economy.

Oh, and did I forget we wouldn't need to spend 20x more than China on our military because we can outsource our protection needs to china for 1/20th the cost. I'll be happy to hang a photo of Mao on my freshly painted red walls in return for an American growth economy like China and China's military replacing ours in the middle-east.

 
At 11/24/2009 12:57 AM, Anonymous Lyle said...

As this and other postings together suggest we have upskilled the medical profession in the US to the point where it is to expensive. The question about requiring an undergrad degree for med school dates back to the early part of the 20th century and the Rockefeller foundation (see Titan). It is interesting that John D liked homeopathy but his foundation killed it off. The rationale is that you need the science background (biochem, biology chemistry etc) to understand the material. Do the Indian schools teach this in their program, or is Secondary education in India a good bit better, i.e. they get enough in secondary school? Recall that it used to be you could practice after 1 year as an intern but now most have to spend four years as a resident, upskilling and increasing the cost of medicine, thus we introduce the nurse practitioner who has the training physicians got 50-60 years ago.
There is a begining of a trend with the Hospitalist to take care of those in the hospital, and separating the role of inpatient and outpatient medicine.

 
At 11/24/2009 3:24 AM, Blogger randian said...

The rationale is that you need the science background (biochem, biology chemistry etc) to understand the material

That is the rationale, but in my opinion it falls apart under scrutiny. For example, why does every doctor need to be a generalist? It makes no sense.

What need does a surgeon have for biochem? He's an anatomist. He doesn't even maintain the one thing for which you might need biochem, anesthesia, that's done by somebody else. Actually, the anesthesiologist doesn't need biochem, and neither does a pharmacist. Only researchers need it. The anesthesiologist and pharmacist needs to know what, how much, and when. He doesn't need to know how it works, why it works, or how to make more of it, only what it does and how it interacts in the body and with other drugs.

 
At 11/24/2009 8:38 AM, Anonymous Anonymous said...

It works the same way for getting your car fixed in America. Shop around and pay cash is better than just going to a dealer. The rates at a dealer are much higher because they've adjusted their price of labor and parts to the inflated price due to warranties.

 
At 11/24/2009 11:18 AM, Anonymous gettingrational said...

Prof. Perry, thanks for the interesting posts on healtcare.

I think that a possible new model of healthcare is emerging on this cite:

Walk-on triage clinics staffed generally with nurse practioneers at convenient locations.

The general practioneer becomes a more valued functionary becuase of the comprehensive education and training required.

The surgeon relies solely on the general practioneer for a work-up on a patient becuase the surgeon is a body mechanic and not an md.

The specialist retains pretty much the same functions,still an md, but deferring to the non-md for surgery on the patient.

 
At 11/24/2009 1:50 PM, Blogger juandos said...

"AARP supports obamacare because it will have the effect of killing medicare advantage"...

Very good point anon @ 11/23/2009 7:26 PM, one I completely forgot about...

Dr. T says: "These medical students are too young, and they learn few fundamentals of the human body. They don't know how to diagnose anything other than common diseases with "textbook" presentations. They are body mechanics, not physicians"...

Well this is an interesting point, a point that I found out about first hand in India...

Yet as mechanics go, my experience at least showed me that the mechanics were pretty darn good...

 
At 11/24/2009 3:49 PM, Anonymous Anonymous said...

my most recent experience of the practice of medicine in india highlighted an important difference between the system there and here. i visited an orthopedic specialist with a severe pain in my wrist. he listened to my complaint, had me demonstrate the limits of my flexibility, and prescribed a treatment. when i asked him if he needed an x-ray or an mri, he said that he didn't think he was going to learn anything that he didn't already know. he told me that my bill would increase ten-fold from less then $10 if he did. if i'd been to an american doctor, i'd probably have been screened either because the doctor wanted to close off the possibility of a law suit or because he stood to benefit from prescribing a visit to the radiologist.

if we pay twice as much as anyone else for health care without the commensurate improvement in our health, it seems reasonable to suspect that some of what we pay for is unnecessary. i understand that is not necessarily the only possible explanation but it is certainly one that is worth investigating.

 
At 11/24/2009 7:01 PM, Anonymous Lyle said...

Gettingrational has a good view IMHO of the future. Since we have upskilled the physician in the last 60 years we now use these skills to best advantage. This does mean that the Marcus Welby (or Dr Kildaire of an earlier generation) model of doctor patient relationship is dead. It will be a team effort, more cooperative, but likley less errors as more eyes see the situation

 
At 11/24/2009 7:01 PM, Anonymous Lyle said...

Gettingrational has a good view IMHO of the future. Since we have upskilled the physician in the last 60 years we now use these skills to best advantage. This does mean that the Marcus Welby (or Dr Kildaire of an earlier generation) model of doctor patient relationship is dead. It will be a team effort, more cooperative, but likley less errors as more eyes see the situation

 
At 11/25/2009 12:24 AM, Blogger sethstorm said...

Yes, he played russian roulette with his body and won. In the United States however, it's far from that.

In light of this, I will be a lot more selective in whom I allow for my medical care.

 

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