Amazing: US Doctors Starting to Get Outsourced to India

Excelsius

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This is the worst news I have heard about doctors and is the real aspect that can bring US doctor salaries way down: http://www.nytimes.com/2008/11/21/health/21abroad.html?ref=health The article discusses how one insurer allows elective surgeries to be performed in India with no out-of-pocket costs (airfare is covered too). Anyone worried about doctor reimbursements, should probably start worrying about a lot. I would like to hear some perspectives from med students, residents, and attendings. This is incredible and the future ramifications seem daunting.
 

Doctor D

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In a free market this could work but with insurance the patient only bears a very reduced part of the burden so why would they choose to go to india? Also here is a quote from the article "knee surgery that costs $70,000 to $80,000 in the United States can be performed in India for $8,000 to $10,000, including follow-up care and rehabilitation". So is the patient going to live in India for 1-3 months while recovering after the surgery? Highly unlikely. Will the outcomes of the surgery and rehab be of subpar quality: likely. Will the patient be able to hold the medical team accountable for millions like they do in the US? Probably not. I don't see this having a major impact but if the laws are changed so radiologists in India can practice in the US than that niche will plummet.
 

Excelsius

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In a free market this could work but with insurance the patient only bears a very reduced part of the burden so why would they choose to go to india? Also here is a quote from the article "knee surgery that costs $70,000 to $80,000 in the United States can be performed in India for $8,000 to $10,000, including follow-up care and rehabilitation". So is the patient going to live in India for 1-3 months while recovering after the surgery? Highly unlikely. Will the outcomes of the surgery and rehab be of subpar quality: likely. Will the patient be able to hold the medical team accountable for millions like they do in the US? Probably not. I don't see this having a major impact but if the laws are changed so radiologists in India can practice in the US than that niche will plummet.

If there is a surgery that you can either have in India or not have at all (because of the cost), then India might win. Someone can also have a surgery in India and recuperation in the US. The inability to sue is a major drawback, but as the article notes, you'd need a major mistake to make into the news and scare any future medical travels. Still, people can get desperate. I am also wondering if a patient will even be given a choice. If the employer requires an overseas treatment, I am not sure how much leverage you can have as an employee, besides quitting.
 
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student1799

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If there is a surgery that you can either have in India or not have at all (because of the cost), then India might win. Someone can also have a surgery in India and recuperation in the US. The inability to sue is a major drawback, but as the article notes, you'd need a major mistake to make into the news and scare any future medical travels. Still, people can get desperate. I am also wondering if a patient will even be given a choice. If the employer requires an overseas treatment, I am not sure how much leverage you can have as an employee, besides quitting.

There is PLENTY that can go wrong. If infection control in the hospital is subpar, the patient's wound could get infected, with potentially very serious consequences. And orthopedic surgery causes substantial blood loss, which almost always requires a transfusion. Who is going to be willing to get a blood transfusion in a foreign country which may not (probably does not) have adequate screening of its blood supply for pathogens? There's no way I would sign up for that.

As for "requiring" overseas treatment, I don't see how that would be legally possible. How can you require a US citizen to leave the country in order to get medical treatment? I'm no lawyer, but I can't imagine how that would be considered reasonable and customary medical care. Insurance companies are supposed to finance treatment, not deportation.
 

LizzyM

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No one is being forced to go abroad. The difference is that you can pay your deductable and co-pay and get surgery here in the States, or you and a companion can go abroad and get the surgery "for free".

Medical tourism has already found favor with the uninsured, and with people who want cosmetic plastic surgery not covered by insurance.

It's a global economy, people.
 

utjsm08

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We cannot stop the forces of globalized markets. Just like many other markets, the market for healthcare is becoming global. Many patients will elect to have procedures completed elsewhere for a much lower cost but with a higher risks in many aspects. Global price competition will drive down healthcare costs in the US and will most likely decrease doctor's salaries in certain fields of medicine. Plastic surgeons may be making a similar salary as primary care physicians (whose jobs cannot realistically be exported). We can't say we didn't know this was coming when physician's salaries in the US start to decline rapidly.
 

Made of Dreams

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global: :thumbup: vs. :thumbdown:

i know its a stretch and this is really "idealistic" but the world is only the way it is because people before us made it this way. think about the idea of medical tourism leading to better communication between medical communities of the world...and eventually EVERYONE gets incredible health care and location/convenience become the debate rather than subpar quality and costs. exciting times.
 

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Excelcius, if the person was choosing between not getting surgery at all or getting surgery in India, would they be taking away from money going to doctors anyway? If people start doing this, yeah I guess it would suck for doctors, but quality over quantity right?
 

student1799

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i know its a stretch and this is really "idealistic" ...

You'd better believe you're being idealistic: this is all about saving money. Wellpoint, the insurer mentioned in the article (which used to be called Blue Cross of California, and is now a for-profit company), is known for really aggressive cost-saving tactics. They were the first insurer to deny patients coverage for the antihistamine Claritin, and sued the FDA in court to FORCE them to take the product over-the-counter--and won. They boasted to investors at the time that it would save them $50 million per year. But outsourcing surgery to India makes that look like baby stuff.

Are you seriously suggesting that anyone would do this voluntarily, other than patients who have no financial alternative? If this arrangement becomes widespread, we are going to have two health care systems in this country even for insured people: gold-plated health care for those with good insurance, and Third World care, literally, for those with subpar insurance--which will quickly become most people, because employers are desperate to save money on health care any way they can.

think about the idea of medical tourism leading to better communication between medical communities of the world...

Think about medical tourism leading to better dissemination of drug-resistant bacteria all over the world ... (And I mean from us to them, as well as the other way around.)

I am not going into medicine to make money: I want to work with underserved patients. But that gives me even more reason to get upset about this, because it's just a way of forcing subpar health care on patients who can't fight back.

It's all very well to talk about the "global economy" when we're talking about widgets, but these are human lives we're dealing with--the lives of the physicians as well as the patients.
 

linguini

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I think that people who react negatively to this article are greater advocates of their paychecks instead of their patients. From the point of view of a patient, this seems like a worthy option to consider. It costs significantly less, a patient can get certain surgeries easier/sooner there, and (believe it or not!) India has many talented physicians, up-to-date technologies and procedures, and hygenic facilities.
 

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I've already mentioned to people that this as part of the changing face of healthcare along with mid-level providers and walkin-pharmacy clinics here in the states.

It's a growing business in more countries than India. It's one of the business models that allows healthcare providers in other countries to make more money than they would by servicing the locals in the area.

If it helps foreign doctors decide that it's economically a good choice to remain in-country to practice, I see that as a good thing.
 
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I think that people who react negatively to this article are greater advocates of their paychecks instead of their patients.

That is such a cop out. I'm sorry, but why is it selfish for someone who spends 7-12 years training AFTER 4 years of college and 200,000 in loans to want to be compensated? Doctors aren't asking for millions. They're just asking for enough to be able to pay off their loans and live a decent life after all their years of education.
 

student1799

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I think that people who react negatively to this article are greater advocates of their paychecks instead of their patients. From the point of view of a patient, this seems like a worthy option to consider. It costs significantly less, a patient can get certain surgeries easier/sooner there, and (believe it or not!) India has many talented physicians, up-to-date technologies and procedures, and hygenic facilities.

How about this quote from Atul Gawande's book Better (p.242):

"In the same hospital where I saw the thirty-five year old man die--where basic equipment was lacking, the emergency ward had just two nurses, and filth was everywhere you stepped--there was a brand-new spiral CT scanner and a gorgeous angiography facility that must have cost tens of thousands to build. More than one doctor told me that it was easier to get a new MRI machine than to maintain basic supplies and hygiene."

I'm not saying that India lacks doctors who are trying to do the best they can under these conditions--on the contrary, I'm in awe of their dedication and hard work. In the same book, Gawande writes very movingly about a general surgeon who must operate on a boy with severe hydrocephalus in order to save him. Not only does he lack training in neurosurgery, he doesn't have a sterile shunt to redirect the fluid away from the boy's brain (he uses a nonsterile one purchased from a street vendor), and he doesn't even have a drill to make a hole in the boy's skull. He spends 15 minutes boring a hole in the boy's skull with a hemostat--one of the few surgical instruments he has--to make the hole for the shunt.

That's an astounding performance, but let's not kid ourselves about the state of the Indian health care system. And even though "medical tourist" care is likely to be performed in better-equipped facilities, that wouldn't convince me that everything is going to be hunky-dory if something goes wrong. On top of that, I'd feel really uncomfortable as a "medical tourist" in a country where there are so many millions of people suffering.
 

linguini

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That is such a cop out. I'm sorry, but why is it selfish for someone who spends 7-12 years training AFTER 4 years of college and 200,000 in loans to want to be compensated? Doctors aren't asking for millions. They're just asking for enough to be able to pay off their loans and live a decent life after all their years of education.

I didn't say you shouldn't be concerned with pay. Is this medical tourism phenomenon going to mean doctors are all of a sudden being paid minimum wage? Absolutely not. Doctors are still going to be compensated well compared to the large majority of other professions. It just seems to me that some premeds get uber-concerned when their paycheck is going to be docked a few thousand dollars. Maybe we should be more concerned with patients in this country getting affordable, high quality care. If that means going to India or another country, so be it.
 

MedStudentWanna

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I didn't say you shouldn't be concerned with pay. Is this medical tourism phenomenon going to mean doctors are all of a sudden being paid minimum wage? Absolutely not. Doctors are still going to be compensated well compared to the large majority of other professions. It just seems to me that some premeds get uber-concerned when their paycheck is going to be docked a few thousand dollars. Maybe we should be more concerned with patients in this country getting affordable, high quality care. If that means going to India or another country, so be it.

There's a doctor shortage in America and docking paychecks "a few thousand dollars" every couple of years isn't going to send people running to med school. Application numbers were down this year and if the economy doesn't pick up, I would bet they'll be down next year too. Primary care docs -- the group suffering the most from the shortage -- aren't likely to benefit from a decrease in salaries, no matter how much that is.
 

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This isn't going to have any real impact in medicine. Read the last sentence of the article for the "why". Mistakes happen everywhere, but a patient may be hard pressed to sue for malpractice when their surgeon is a non-US resident, in a foreign country, with no medmal insurance (perhaps the biggest reason for the differential in price). And even if you could sue that surgeon here and he was covered, can you imagine the field day lawyers will have playing to the fears of a xenophobic jury? And aside from legal issues, if complications happen, it's generally important for major hospitals to have certain emergent capabilities, or be within a helicopter ride from a place that does. Unclear how many foreign places have these capabilities. For example, the number of MRI machines in almost every US state outnumbers all the machines in most other countries. Part of the reason our healthcare costs so much here is that it's technologically top notch. That may not be cost feasible for the typical run of the mill ailment, but for major surgery, it's kind of important.
 

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Application numbers were down this year and if the economy doesn't pick up, I would bet they'll be down next year too.

Actually applications for graduate and professional education always go up in times of tight economy. Folks don't want to jump out of college and into a bad job market. However with medicine there is generally a lag because folks have to pick up the prereqs. Expect the current economy to drive up the number of applicants within the next few years.
 

MedStudentWanna

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Actually applications for graduate and professional education always go up in times of tight economy. Folks don't want to jump out of college and into a bad job market. However with medicine there is generally a lag because folks have to pick up the prereqs. Expect the current economy to drive up the number of applicants within the next few years.

The AAMC contradicts you. Applications were down this year.
 

linguini

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There's a doctor shortage in America and docking paychecks "a few thousand dollars" every couple of years isn't going to send people running to med school. Application numbers were down this year and if the economy doesn't pick up, I would bet they'll be down next year too. Primary care docs -- the group suffering the most from the shortage -- aren't likely to benefit from a decrease in salaries, no matter how much that is.

There are still vastly more qualified applicants than medical school spots so the reduced # of applications is not going to add to the doctor shortage in this country.
 

Law2Doc

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There are still vastly more qualified applicants than medical school spots so the reduced # of applications is not going to add to the doctor shortage in this country.

Also a good point. Although applications were down, the number of matriculants went up.
 
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Retsage

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I think that people who react negatively to this article are greater advocates of their paychecks instead of their patients. From the point of view of a patient, this seems like a worthy option to consider. It costs significantly less, a patient can get certain surgeries easier/sooner there, and (believe it or not!) India has many talented physicians, up-to-date technologies and procedures, and hygenic facilities.


:laugh:


This sort of ridiculousness never ceases to amaze me. Why, exactly, should doctors not be worried about their paychecks? Do you think the insurance companies are sitting there trying to create higher quality healthcare, profits be damned? No. And yet, when they hurt doctors over and over again with paycuts and ridiculous schemes like these, there's at least a few people shouting that we should be martyrs. No. I'm not a martyr. I am a professional who wants to help heal people, but I damn well am not going to accept paycuts smilingly so that some parasitic insurance company can give its board of directors another five-million dollar bonus for Christmas.

Pull your head out of your ass and protect your own interests.
 

MedStudentWanna

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There are still vastly more qualified applicants than medical school spots so the reduced # of applications is not going to add to the doctor shortage in this country.

That would have been a really good point had it been at all relevant. My point was that cutting doctor pay isn't going to send people running to med school.
 

Law2Doc

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That would have been a really good point had it been at all relevant. My point was that cutting doctor pay isn't going to send people running to med school.

In a tight economy where it's cut pay in medicine or a tough time finding a job elsewhere, they will still come running.

I also note that since you have to start planning for med school so long before you start, lots of people are going to stick with it even if the terms change.
 

Excelsius

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As for "requiring" overseas treatment, I don't see how that would be legally possible. How can you require a US citizen to leave the country in order to get medical treatment? I'm no lawyer, but I can't imagine how that would be considered reasonable and customary medical care. Insurance companies are supposed to finance treatment, not deportation.

No one is required to do anything. People can be forced into a hopeless situation, even though they have the volition not to. Price and job sites will be the limiting (or forcing) factor.

...

It's a global economy, people.

US doctors will be at a disadvantage to compete globally. Given that US medical educational burden is around 200K, there is a limit as to how much a doctor can lower his/her prices to compete with someone in India or China who probably received free education. The lifestyle burden is also taxing - 16 years of education in some cases. If you look at it as purely business, I don't think many students will choose the medical path.

Excelcius, if the person was choosing between not getting surgery at all or getting surgery in India, would they be taking away from money going to doctors anyway? If people start doing this, yeah I guess it would suck for doctors, but quality over quantity right?

Not at first sight, but consider this: if the person has no choice to have the surgery, he/she will eventually have to have it. When there is an overseas alternative, then the incentive to have the surgery in the US will be far less. Furthermore, once these patients start the trend, others who can afford the surgery here will follow just to save money, especially if the economy doesn't bounce back to where it was before.

...
I am not going into medicine to make money: I want to work with underserved patients. But that gives me even more reason to get upset about this, because it's just a way of forcing subpar health care on patients who can't fight back. ...

I think that people who react negatively to this article are greater advocates of their paychecks instead of their patients. ...

Some naivete here. Most of us go into medicine because first of all we all like something about it. You may like to serve the undeserved, I may simply be interested in the human biology and exploring it. If someone only cared about money, there are other well paid alternatives in other careers - lawyers, hedge funds, Ph.D.s, etc. As people, we all work to make money and support ourselves and our families. When you stack up 300K in debt and have a wife and children to support, it would be interesting to hear your views on money then. The salary is not the number one priority, but given the path to becoming a doctor, it is a priority. You sacrifice a lot, you get paid for it - mutualism. I am not sure how much true altruism is possible - if you spend 16 years studying, get into 300K debt, and then agree to be paid the same as people with B.S. degrees, that's not mutualism, that's parasitism. A few people may be capable of that and my reverence to them, but most are not. That's why I don't like when people start saying "I am not into this for the money," as if they are taking the moral high ground. The reality is that the majority of us are NOT into this just for the money and people should stop this facetious moral elevation, especially when it has nothing to do with the topic at hand.
 

MedStudentWanna

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Doesn't contradict. Remember the lag. It takes a few years for folks not planning on med school to take the prereqs. Expect it to climb in the near term.

We'll wait and see, but last I heard, one of the reasons people aren't as excited about a career in medicine is because of the outrageous loans for a salary that's continuously declining. Why get yourself 200K-400K in debt and spend seven years training AFTER four years of college just to become a primary care doc when you can become a fully-licensed PA in two years and make almost the same money with only 50K in debt?
 

alibai3ah

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student1799, when atul gawande visited India he was in rural parts of the country where resources are scarce. But India has MANY hospitals in Mumbai, Dehli, Calcutta...(in the major cities) that have the same resources and technology as the US (including shunts)....The doctors are just as qualified as American doctors, and I do not understand why people keep implying that the healthcare there would be subpar.....Sure the idea of going to a developing nation can be intimidating, but for people who cannot pay 100,000 for a surgery, the costs of doing it 10 times as less is very appealing depsite the added risk....
 

MedStudentWanna

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In a tight economy where it's cut pay in medicine or a tough time finding a job elsewhere, they will still come running.

That might be true if there weren't other healthcare fields open and available with a lot less debt and a lot less time.
 

MedStudentWanna

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I also note that since you have to start planning for med school so long before you start, lots of people are going to stick with it even if the terms change.

Not when the same pre reqs get you into PA school.
 

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That might be true if there weren't other healthcare fields open and available with a lot less debt and a lot less time.

I basically agree with you on this, but I think if you took a poll on pre-allo, you would find that everyone there is going "med school or bust", and will ignore your logical argument for PA school regardless of what kind of facts you can present.
 
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linguini

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Some naivete here. Most of us go into medicine because first of all we all like something about it. You may like to serve the undeserved, I may simply be interested in the human biology and exploring it. If someone only cared about money, there are other well paid alternatives in other careers - lawyers, hedge funds, Ph.D.s, etc. As people, we all work to make money and support ourselves and our families. When you stack up 300K in debt and have a wife and children to support, it would be interesting to hear your views on money then. The salary is not the number one priority, but given the path to becoming a doctor, it is a priority. You sacrifice a lot, you get paid for it - mutualism. I am not sure how much true altruism is possible - if you spend 16 years studying, get into 300K debt, and then agree to be paid the same as people with B.S. degrees, that's not mutualism, that's parasitism. A few people may be capable of that and my reverence to them, but most are not. That's why I don't like when people start saying "I am not into this for the money," as if they are taking the moral high ground. The reality is that the majority of us are NOT into this just for the money and people should stop this facetious moral elevation, especially when it has nothing to do with the topic at hand.

Again, I didn't say that I don't care about the pay. Of course I do care how I am going to be compensated for spending hundreds of thousands of dollars and many years of my life to become a physician. But I also care about how many patients in this country aren't able to afford the surgeries they want or need or aren't able to obtain them because their insurance plans said no. Why are you looking at this situation as if Indian doctors are our competition and we have to beat them at this game of health care? As a doctor in America, you are still going to have patients, you are still going to be paid well. But I think it'd be pretty ridiculous for America to prohibit its citizens from seeking excellent, affordable care outside of its borders simply because we want the money.
 

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The lag thing is indeed huge with medicine and the reason why there was no app surge yet. The 2010 cycle will be a killer, mark my words.

I wouldn't want to be applying to law school or another grad program with no prereqs this year. Everyone single kid looking to hide from a terrible job market for 3 years is going to be applying.
 

student1799

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student1799, when atul gawande visited India he was in rural parts of the country where resources are scarce. But India has MANY hospitals in Mumbai, Dehli, Calcutta...(in the major cities) that have the same resources and technology as the US (including shunts)....The doctors are just as qualified as American doctors, and I do not understand why people keep implying that the healthcare there would be subpar.....Sure the idea of going to a developing nation can be intimidating, but for people who cannot pay 100,000 for a surgery, the costs of doing it 10 times as less is very appealing depsite the added risk....

I've been to India myself, both big cities and more rural areas, and I've seen plenty with my own eyes. I think India is an amazing country that is definitely going places, and I have no argument that India has many highly talented doctors, engineers, and so forth. But by any measure, the country's health care system is in miserable shape. Here are some eye-opening statistics from India Together, a website that originates in India:

"Let us look at our health crisis. First, public health expenditure in India is amongst the lowest in the world as a share of GDP, at less than 1 per cent. What is more, as a proportion of the total health expenditure, it accounts for under 20 per cent, making India a member of a small group of nations in extreme distress - like Cambodia and Afghanistan. Private health expenditure accounts for 80 per cent of the total health care costs.

Second, most of the private expenditure is out-of-pocket (nearly 97 per cent), as there is neither health insurance coverage for the bulk of the people, nor a viable risk-pooling mechanism. As a result, the economic consequences of ill health are devastating for most families. Surveys show that a single episode of hospitalisation costs a family about 60 per cent of the annual income, on average. This high average out-of-pocket expenditure applies to all cases of hospitalisation. This is because even in public hospitals, costs are incurred for transport, accommodation and board for the patient and attendants, bribes, and often diagnostic investigations at private facilities and purchase of drugs unavailable in government hospitals. As a result, 40-60 per cent of hospitalised patients borrow heavily at high interest, and up to 30 per cent end up slipping below the poverty line on account of healthcare costs." http://www.indiatogether.org/2007/jan/hlt-hltcare.htm


And how about this, from the Wharton School's [email protected] website?

"If inefficiency is the path to opportunity, the future for India's health care sector may be bright. Just how close that future is varies by market segment. In the case of life sciences, its arrival could coincide with industry participants' greater willingness to accept risk, while health insurance could seize its day amid rising treatment costs. As for health care delivery's chance to shine, that could be more in the distant future, stymied by a lack of infrastructure investment and trained professionals. Two recent conference panels, one at Wharton and the other at Harvard University, explored the state of India's health care system. Among the conclusions: Government and industry need to increase health care investment and employment and make high-quality care more affordable and available to all.


The Wharton India Economic Forum panel titled, "India's New Mandate: Addressing the Health Care Paradox," portrayed a system of contradictions. On the one hand, medical tourism is on the rise. On the other, tuberculosis seems unstoppable in certain states. "Paradox is one characterization," said Bhaven Sampat, professor of health care management at Columbia University and panel moderator. "But challenge is another. Like every rapidly developing country, India is faced with the challenge of how to manage growth with distribution, how to balance equity with efficiency, and how to ensure that as parts of the Indian health care sector enter the worldwide elite, the masses are not left behind."


An assessment of Indian health care reveals poor performance on the key dimensions of coverage, purchasing and delivery. "Despite India being the largest exporter of generics, most people have never seen a tablet," said Rajiv Gulati, director of India-China strategy at Eli Lilly. "Patients from the U.S. and the UK come to India for treatment, but approximately 70% of Indian patients have never seen a doctor." " http://knowledge.wharton.upenn.edu/india/article.cfm?articleid=4277


I rest my case.
 

student1799

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Some naivete here. Most of us go into medicine because first of all we all like something about it. You may like to serve the undeserved, I may simply be interested in the human biology and exploring it. If someone only cared about money, there are other well paid alternatives in other careers - lawyers, hedge funds, Ph.D.s, etc. As people, we all work to make money and support ourselves and our families. When you stack up 300K in debt and have a wife and children to support, it would be interesting to hear your views on money then. The salary is not the number one priority, but given the path to becoming a doctor, it is a priority. You sacrifice a lot, you get paid for it - mutualism. I am not sure how much true altruism is possible - if you spend 16 years studying, get into 300K debt, and then agree to be paid the same as people with B.S. degrees, that's not mutualism, that's parasitism. A few people may be capable of that and my reverence to them, but most are not. That's why I don't like when people start saying "I am not into this for the money," as if they are taking the moral high ground. The reality is that the majority of us are NOT into this just for the money and people should stop this facetious moral elevation, especially when it has nothing to do with the topic at hand.

No, I meant it quite literally. I spent 20 years working on Wall Street, where I made a lot of money and could have continued to do so (I was a money manager, not an investment banker). But about 3 years ago I decided to leave the business and go after my lifelong dream of being a doctor. I am making a large economic sacrifice to do so, considering not only the cost of postbacc and med school, but the income I would have been able to earn in my prior career during all those years of premed, medical education and residency. (It's in the millions.) On top of that, it's highly unlikely that the salary I make as a practicing physician will be at all close to the one I used to make.

I stated that I wasn't going into medicine for money because I was responding directly to linguini's comment, which was quoted above my post: "I think that people who react negatively to this article are greater advocates of their paychecks instead of their patients."

And if you'd bothered to read my post, you'd see that I'm vehemently OPPOSED to the outsourcing arrangement described in the article. So exactly what kind of "naivete" am I supposed to be guilty of?
 

LizzyM

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This only benefits greedy insurance companies. :thumbdown:

It benefits patients, too. A couple years ago I had some diagnostic tests and outpatient surgery and the co-pays came to over $1,500. I'd love to have that $ back in my pocket.

Comparing what is available to the average person in India to what is available to medical tourists is like comparing the living quarters of the average New Yorker to the presidential suite at the Waldorf-Astoria.

One of the major costs for hospitals is wages to ancillary staff. In places where a generous wage is <$5/hour, you can see how it is easy to keep costs down. This also relates to the cost of bonds and the like needed to fund new construction. When construction wages are low, the cost of constructing new buildings is lower than it is in the US. Where the cost of living is low, fresh, locally grown foods are also going to be inexpensive compared to costs in places with higher cost of living.

Employment of ancillary workers abroad helps those local economies. It might hurt our local economy if hospitals here close for lack of business.

They are producing "low cost surgical procedures" that we want to buy. We need to produce something that they want to buy. Higher education is one of those things, I think.

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No one owes anyone a living because they are studying and training for so many years.

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Much of the medical tourism is for procedures that wouldn't get done at all if it weren't for a low cost alternative abroad.
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We could lose 30% of our applicant pool and still turn away thousands of applicants so I have no worries about medical tourism causing people to leave medicine. Heck, many of the physicians treating Americans abroad were trained in US hospitals and then went "home".
 

MedStudentWanna

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No, no one owes anyone a living for training for so many years, but are you telling me that people would still want to go through four years of college, four years of med school, four or more years of residency, working 80 hours a week only to graduate residency with 200-400K in loans, and work 60-70 hours a week until retirement if they weren't being compensated for it?
 

chessodoc

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It benefits patients, too. A couple years ago I had some diagnostic tests and outpatient surgery and the co-pays came to over $1,500. I'd love to have that $ back in my pocket.

Comparing what is available to the average person in India to what is available to medical tourists is like comparing the living quarters of the average New Yorker to the presidential suite at the Waldorf-Astoria.

One of the major costs for hospitals is wages to ancillary staff. In places where a generous wage is <$5/hour, you can see how it is easy to keep costs down. This also relates to the cost of bonds and the like needed to fund new construction. When construction wages are low, the cost of constructing new buildings is lower than it is in the US. Where the cost of living is low, fresh, locally grown foods are also going to be inexpensive compared to costs in places with higher cost of living.

Employment of ancillary workers abroad helps those local economies. It might hurt our local economy if hospitals here close for lack of business.

They are producing "low cost surgical procedures" that we want to buy. We need to produce something that they want to buy. Higher education is one of those things, I think.

----------------
No one owes anyone a living because they are studying and training for so many years.

----------------

Much of the medical tourism is for procedures that wouldn't get done at all if it weren't for a low cost alternative abroad.
----------------------
We could lose 30% of our applicant pool and still turn away thousands of applicants so I have no worries about medical tourism causing people to leave medicine. Heck, many of the physicians treating Americans abroad were trained in US hospitals and then went "home".

1500 = ticket to India :)
 
8

8744

:laugh:


This sort of ridiculousness never ceases to amaze me. Why, exactly, should doctors not be worried about their paychecks? Do you think the insurance companies are sitting there trying to create higher quality healthcare, profits be damned? No. And yet, when they hurt doctors over and over again with paycuts and ridiculous schemes like these, there's at least a few people shouting that we should be martyrs. No. I'm not a martyr. I am a professional who wants to help heal people, but I damn well am not going to accept paycuts smilingly so that some parasitic insurance company can give its board of directors another five-million dollar bonus for Christmas.

Pull your head out of your ass and protect your own interests.

This is an excellent point and needs to be repeated and beaten into the heads of the typical idealistic pre-med, namely, that your zeal to sacrifice yourself is only helping other people either make money (in the case of hospital administrators and insurance providers) or secure political power (as in the case of our elected representatives). You are not helping the Holy Underserved by surrendering more of your salary every year and agitating for system where you will make less than a union plumber.

In other words, I don't see the Clintons, the Obamas, and Kennedys agreeing to give up any of there money or privileges to help the Holy Underseved, nor do I see anybody involved in health care at any level agitating for lower salaries except, of course, for the *****s on SDN.
 

linguini

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This is an excellent point and needs to be repeated and beaten into the heads of the typical idealistic pre-med, namely, that your zeal to sacrifice yourself is only helping other people either make money (in the case of hospital administrators and insurance providers) or secure political power (as in the case of our elected representatives). You are not helping the Holy Underserved by surrendering more of your salary every year and agitating for system where you will make less than a union plumber.

In other words, I don't see the Clintons, the Obamas, and Kennedys agreeing to give up any of there money or privileges to help the Holy Underseved, nor do I see anybody involved in health care at any level agitating for lower salaries except, of course, for the *****s on SDN.

I appreciate your opinion as you've obviously experienced more of the medical field than a "*****" such as myself. But my god, I hope I'm not this tainted when I get to your position. From my humble, SDN starry-eyed point of view, you're dangerously pessimistic.
 

badasshairday

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I appreciate your opinion as you've obviously experienced more of the medical field than a "*****" such as myself. But my god, I hope I'm not this tainted when I get to your position. From my humble, SDN starry-eyed point of view, you're dangerously pessimistic.

He's not. He is only being real.
 

badasshairday

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I've been to India myself, both big cities and more rural areas, and I've seen plenty with my own eyes. I think India is an amazing country that is definitely going places, and I have no argument that India has many highly talented doctors, engineers, and so forth. But by any measure, the country's health care system is in miserable shape. Here are some eye-opening statistics from India Together, a website that originates in India:

"Let us look at our health crisis. First, public health expenditure in India is amongst the lowest in the world as a share of GDP, at less than 1 per cent. What is more, as a proportion of the total health expenditure, it accounts for under 20 per cent, making India a member of a small group of nations in extreme distress - like Cambodia and Afghanistan. Private health expenditure accounts for 80 per cent of the total health care costs.

Second, most of the private expenditure is out-of-pocket (nearly 97 per cent), as there is neither health insurance coverage for the bulk of the people, nor a viable risk-pooling mechanism. As a result, the economic consequences of ill health are devastating for most families. Surveys show that a single episode of hospitalisation costs a family about 60 per cent of the annual income, on average. This high average out-of-pocket expenditure applies to all cases of hospitalisation. This is because even in public hospitals, costs are incurred for transport, accommodation and board for the patient and attendants, bribes, and often diagnostic investigations at private facilities and purchase of drugs unavailable in government hospitals. As a result, 40-60 per cent of hospitalised patients borrow heavily at high interest, and up to 30 per cent end up slipping below the poverty line on account of healthcare costs." http://www.indiatogether.org/2007/jan/hlt-hltcare.htm


And how about this, from the Wharton School's [email protected] website?

"If inefficiency is the path to opportunity, the future for India's health care sector may be bright. Just how close that future is varies by market segment. In the case of life sciences, its arrival could coincide with industry participants' greater willingness to accept risk, while health insurance could seize its day amid rising treatment costs. As for health care delivery's chance to shine, that could be more in the distant future, stymied by a lack of infrastructure investment and trained professionals. Two recent conference panels, one at Wharton and the other at Harvard University, explored the state of India's health care system. Among the conclusions: Government and industry need to increase health care investment and employment and make high-quality care more affordable and available to all.


The Wharton India Economic Forum panel titled, "India's New Mandate: Addressing the Health Care Paradox," portrayed a system of contradictions. On the one hand, medical tourism is on the rise. On the other, tuberculosis seems unstoppable in certain states. "Paradox is one characterization," said Bhaven Sampat, professor of health care management at Columbia University and panel moderator. "But challenge is another. Like every rapidly developing country, India is faced with the challenge of how to manage growth with distribution, how to balance equity with efficiency, and how to ensure that as parts of the Indian health care sector enter the worldwide elite, the masses are not left behind."


An assessment of Indian health care reveals poor performance on the key dimensions of coverage, purchasing and delivery. "Despite India being the largest exporter of generics, most people have never seen a tablet," said Rajiv Gulati, director of India-China strategy at Eli Lilly. "Patients from the U.S. and the UK come to India for treatment, but approximately 70% of Indian patients have never seen a doctor." " http://knowledge.wharton.upenn.edu/india/article.cfm?articleid=4277


I rest my case.

Bro, you are talking about the state of health care in India in a broad all encompassing sense. What will be available to tourists will not be your average run of the mill stuff. It will be top notch. My cousin is a radiologist in Mumbai, his wife is and Ob/Gyn. Go to there huge clinic, with an OR, and multiple rooms, the marble tiles and up to date equipment, you would be thinking you were in a plastic surgeon's suite in Beverley Hills.
 

Excelsius

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...Why are you looking at this situation as if Indian doctors are our competition and we have to beat them at this game of health care? As a doctor in America, you are still going to have patients, you are still going to be paid well. But I think it'd be pretty ridiculous for America to prohibit its citizens from seeking excellent, affordable care outside of its borders simply because we want the money.

You can't prohibit your patients anything. No one is suggesting that. As for competition, yes this will be a competition. Not caring about it would be the same as saying that we might as well export all of our computer and car manufacturing to China and India. It's not whether you think the other country is bad so it shouldn't get these services, but rather what the ramifications for the US would be.

...And if you'd bothered to read my post, you'd see that I'm vehemently OPPOSED to the outsourcing arrangement described in the article. So exactly what kind of "naivete" am I supposed to be guilty of?

I knew that you were not advocating outsourcing. I only mentioned your money comment, which is a separate issue, regardless on which side of the fence you are.

...In other words, I don't see the Clintons, the Obamas, and Kennedys agreeing to give up any of there money or privileges to help the Holy Underseved, nor do I see anybody involved in health care at any level agitating for lower salaries except, of course, for the *****s on SDN.

Even though I agree with you in the basics of what you're trying to say, I am not sure how effective you are with the choice of those exact words.:laugh:
 

student1799

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It might hurt our local economy if hospitals here close for lack of business.

You betcha it would. And our economy would be hurt even more if American workers don't have jobs, because all their jobs have been exported to lower-cost countries.

And it would hurt our entire society, if there is no way for the average American to make a living here, regardless of their education, training or skills. Haven't we read enough about the devastating impact of "brain drain" in developing countries to know that it would be suicidal to gut our country of professional as well as manufacturing jobs?

Besides, I thought medicine was a profession--not a race to the bottom to see who can work for less.

We need to produce something that they want to buy. Higher education is one of those things, I think.
Not for long, if your logic holds. It's way cheaper to operate universities in developing countries--let's outsource those too.

Or, if you look at it the other way, we can operate "education tourism" here: students from foreign countries can come here to receive a gold-plated university education that the "locals" (Americans whose jobs have been exported elsewhere) can no longer afford.



There is always going to be some country somewhere on earth where people are so desperately poor that they'll work for even less than the last cheap country. I remember in the early 90's Mexico was the favored place for outsourcing manufacturing--but wages went too high there, all the way to $1 per hour. That started the stampede to China, where the prevailing wage was only $0.25 per hour. Now some manufacturers with low-skill assembly operations are starting to move to places like Vietnam, where wages are even lower.

Not only can America never compete with those numbers, we shouldn't even try. There is such a thing as looking out for your own. If we are obsessed with just getting the cheapest price for everything, we are going to destroy our whole society.
 

mbe36

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I saw this on 20/20 about 10 years ago.
 

Excelsius

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Doesn't contradict. Remember the lag. It takes a few years for folks not planning on med school to take the prereqs. Expect it to climb in the near term.

You know, I used to think that's true, and generally people in the field agree with that, but after reading a little about it, it seems that there is no certain correlation, The slight hike in applications is small enough to be insignificant. Compare the graphs below - they show that there is no exact historical correlation.
Applications.jpg


These are the recession spikes:
HistoricalRecessions.png


And this is GDP growth rate:
GDP60-08.gif


There is simply no correlation (not that correlation is causation). We have to ignore the rise of applicants in the 60s-80s because their rise was due to the new medical school regulations - matriculation doubled between that period. So it was the result of the push, not bad economics.

If you look at the recession graph, you'll see a long recession near 1980. Look at the applications graph and you'll see that applications declined from 1980 all the way top 1990. I understand that there might be a lag, but not that much. Also, when you see number of applications rise starting 1990, we actually had our longest period of economic growth in our history between 1991 and 2001 - that's supposed to be a record. Yet you see the number of applicants increase during this time. Even if the applications are on the rise right now, we can't claim that it's because of the economy, especially since the economy worsened starting in September and the lag time theory would mean that we wouldn't see an increase in applicant numbers until the next 1-2 years. The applicant pool simply fluctuates and we can't predict anything. Since AAMC is advocating an increase in number of medical schools (about 12 to be ready by 2015), it makes sense that the applicant pool might increase too in the near future.
 
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Excelsius

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You betcha it would. And our economy would be hurt even more if American workers don't have jobs, because all their jobs have been exported to lower-cost countries.

And it would hurt our entire society, if there is no way for the average American to make a living here, regardless of their education, training or skills. Haven't we read enough about the devastating impact of "brain drain" in developing countries to know that it would be suicidal to gut our country of professional as well as manufacturing jobs?

Besides, I thought medicine was a profession--not a race to the bottom to see who can work for less.

Not for long, if your logic holds. It's way cheaper to operate universities in developing countries--let's outsource those too.

Or, if you look at it the other way, we can operate "education tourism" here: students from foreign countries can come here to receive a gold-plated university education that the "locals" (Americans whose jobs have been exported elsewhere) can no longer afford.



There is always going to be some country somewhere on earth where people are so desperately poor that they'll work for even less than the last cheap country. I remember in the early 90's Mexico was the favored place for outsourcing manufacturing--but wages went too high there, all the way to $1 per hour. That started the stampede to China, where the prevailing wage was only $0.25 per hour. Now some manufacturers with low-skill assembly operations are starting to move to places like Vietnam, where wages are even lower.

Not only can America never compete with those numbers, we shouldn't even try. There is such a thing as looking out for your own. If we are obsessed with just getting the cheapest price for everything, we are going to destroy our whole society.

To sum it up, Reaganomics doesn't work. When a company outsources, it makes extra profits by charging the American consumer, but paying cheap labor to a different country. Those significant extra profits benefit only the company owners and we get the concentration of a lot of wealth into very few people. Furthermore, when it comes time for the money to "trickle down," it may trickle down, but where? In China, India, etc. These people essentially transfer the wealth from the US to the East. Read the most recent NIC report "Global Trends." We have an unprecedented transfer for wealth from the West to the East, to the point that the new global players are going to be China, Russia, and India. There are talks of future EU insignificance. This is exactly why the Reagan motto doesn't work in today's global market. If you outsource doctors, insurance companies will start making record profits. The patients will keep paying the SAME premiums. So it is a fallacy to assume that outsourcing = good price for patients. Add to that doctors not being able to pay off their debts, declaring bankruptcies, not paying any taxes, and you get into the vicious circle. That doctor or steel worker that lives in your neighborhood and used to help share the taxes to pay for the local roads and schools can't do it anymore. Later, your child won't be able to go to a good local school. The real disaster will come when all these intelligent professionals decide to leave USA. The only thing left behind, in Panda language, would be "a country of *****s." I'd agree.

Everyone will suffer as a result of outsourcing. It is true for car manufacturing. It is truer for intelligent professional. That is a matter of national security too.
 
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