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The next trend in offshoring: health care?

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The next trend in offshoring: health care?

Old 10-22-04, 01:04 PM
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The next trend in offshoring: health care?

Very impressive!

The following appears courtesy of MSNBC.com.
=================
India draws 'medical tourists'

Cheaper health care a powerful attraction

John Lancaster / The Washington Post
Howard Staab, shown here with his partner Maggi Grace, traveled to India to undergo surgery to corret a faulty heart valve.

By John Lancaster
Updated: 1:51 a.m. ET Oct. 21, 2004

NEW DELHI - Three months ago, Howard Staab learned that he suffered from a life-threatening heart condition and would have to undergo surgery at a cost of up to $200,000 -- an impossible sum for the 53-year-old carpenter from Durham, N.C., who has no health insurance.

So he outsourced the job to India.

Taking his cue from cost-cutting U.S. businesses, Staab last month flew about 7,500 miles to the Indian capital, where doctors at the Escorts Heart Institute & Research Centre -- a sleek aluminum-colored building across the street from a bicycle-rickshaw stand -- replaced his balky heart valve with one harvested from a pig. Total bill: about $10,000, including roundtrip airfare and a planned side trip to the Taj Mahal.

"The Indian doctors, they did such a fine job here, and took care of us so well," said Staab, a gentle, pony-tailed bicycling enthusiast who was accompanied to India by his partner, Maggi Grace. "I would do it again."

Staab is one of a growing number of people known as "medical tourists" who are traveling to India in search of First World health care at Third World prices. Last year, an estimated 150,000 foreigners visited India for medical procedures, and the number is increasing at the rate of about 15 percent a year, according to Zakariah Ahmed, a health care specialist at the Confederation of Indian Industries.

Eager to cash in on the trend, posh private hospitals are beginning to offer services tailored for foreign patients, such as airport pickups, Internet-equipped private rooms and package deals that combine, for example, tummy-tuck surgery with several nights in a maharajah's palace. Some hospitals are pushing treatment regimens that augment standard medicine with yoga and other forms of traditional Indian healing.

The phenomenon is another example of how India is profiting from globalization -- the growing integration of world economies -- just as it has already done in such other service industries as insurance and banking, which are outsourcing an ever-widening assortment of office tasks to the country. A recent study by the McKinsey consulting firm estimated that India's medical tourist industry could yield up to $2.2 billion in annual revenues by 2012.

"If we do this right, we can heal the world," said Prathap C. Reddy, a physician who founded Apollo Hospitals, a 6,400-bed chain that is headquartered in the coastal city of Chennai and is one of the biggest private health-care providers in Asia.

The trend is still in its early stages. Most of the foreigners treated in India come from other developing countries in Asia, Africa or the Middle East, where top-quality hospitals and health professionals are often hard to find. Patients from the United States and Europe still are relatively rare -- not only because of the distance they must travel but also, hospital executives acknowledge, because India continues to suffer from an image of poverty and poor hygiene that discourages many patients.

Taken as a whole, India's health care system is hardly a model, with barely four doctors for every 10,000 people, compared with 27 in the United States, according to the World Bank. Health care accounts for just 5.1 percent of India's gross domestic product, against 14 percent in the United States.

'Centers of excellence'
On the other hand, India offers a growing number of private "centers of excellence" where the quality of care is as good or better than that of big-city hospitals in the United States or Europe, asserted Naresh Trehan, a self-assured cardiovascular surgeon who runs Escorts and performed the operation on Staab.

Trehan said, for example, that the death rate for coronary-bypass patients at Escorts is .8 percent. By contrast, the 1999 death rate for the same procedure at New York-Presbyterian Hospital, where former president Bill Clinton recently underwent bypass surgery, was 2.35 percent, according to a 2002 study by the New York State Health Department.

Escorts is one of only a handful of treatment facilities worldwide that specialize in robotic surgery, which is less invasive than conventional surgery because it relies on tiny, remote-controlled instruments that are inserted through a small incision.

"Our surgeons are much better," boasted Trehan, 58, a former assistant professor at New York University Medical School who said he earned nearly $2 million a year from his Manhattan practice before returning to India to found Escorts in 1988.

Although they are equipped with state-of-the art technology, hospitals such as Escorts typically are able to charge far less than their U.S. and European counterparts because pay scales are much lower and patient volumes higher, according to Trehan and other doctors. For example, a magnetic resonance imaging (MRI) scan costs $60 at Escorts, compared with roughly $700 in New York, according to Trehan.

Moreover, he added, a New York heart surgeon "has to pay $100,000 a year in malpractice insurance. Here it's $4,000."

In addition to patients from other developing countries, top Indian hospitals derive a significant share of foreign business from people of Indian origin who live in developed countries but maintain close ties to their homeland. But the same hospitals now are starting to attract non-Indian patients from industrialized countries, and especially from Britain and Canada, where patients are becoming fed up with long waits for elective surgery under overstretched government health plans.

"If you can wait for two years for a bypass surgery, then you don't need it or you're dead -- one of the two," Trehan said. "Similarly, if you're wobbling on your frozen joints for two years because of a waiting list, it's a human tragedy."

$5,000 'hip resurfacing'
One such patient is Tom Raudaschl, an Austrian who lives in Canada and earns his living as a mountain guide. Suffering from osteoarthritis in his hip, Raudaschl last year decided to undergo "hip resurfacing," a relatively new procedure that involves scraping away damaged bone and replacing it with chrome alloy. He learned he would have to wait up to three years if he wanted to have the operation under Canada's national health plan, a delay that would have cost him his job, Raudaschl said. In the United States, the procedure would have cost $21,000, he said.

So this month, Raudaschl flew from Calgary to Chennai, on India's east coast, where a surgeon at Apollo Hospital performed the operation Wednesday for $5,000, including all hospital costs, Raudaschl said by telephone from his hospital bed.

"As soon as you tell people that you're going to India, they frown," Raudaschl said. But he said he could not be more pleased with the service. "They picked me up at the airport, did all the hotel bookings, and the food is great, too," said Raudaschl, whose private room was equipped with Internet service, a microwave and a refrigerator. Most important, Raudaschl said the surgeon told him he would be "skiing again in a month."

To cope with its backlog of cases, Britain's National Health Service has begun referring patients for treatment to Spain and France, although for now, the health service limits referrals to hospitals within three hours' flying time, according to Anupam Sibal, a British-trained pediatrician and Apollo's director of medical services.

"Nobody even questions the capability of an Indian doctor, because there isn't a big hospital in the United States where there isn't an Indian doctor working," he said.

Before they would admit him for surgery, Staab, the heart patient, said hospital officials at Durham Regional Hospital asked for a $50,000 deposit and warned that the entire cost of treatment could run as high as $200,000.

Katie Galbraith, a hospital spokeswoman, confirmed in an e-mail that hospital costs in such cases typically are in the neighborhood of $100,000; the surgeon's bill, which is charged separately, would have added tens of thousands more. Patients such as Staab who do not qualify for charity care often are offered a payment plan, she said.

Staab was discharged from the Indian hospital on Monday and was recuperating at a nearby hotel. He planned to return to Durham, after visiting the Taj Mahal.

2004 The Washington Post Company

http://www.msnbc.msn.com/id/6293825/
Old 10-22-04, 01:15 PM
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$100,000 in malpractice insurance per year

and kerry says lawsuits aren't a problem
Old 10-22-04, 01:17 PM
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This isn't new. I've seen stories about Germans visiting Poland for dental care years ago.
Old 10-22-04, 01:52 PM
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Originally posted by al_bundy
and kerry says lawsuits aren't a problem
Wrong context. Friends don't let friends post kneejerk responses.

Kerry said, correctly, that lawsuits were a trivially small part in the rising cost of healthcare. He also said that lawsuits were having an impact on doctors and need to be reformed.

- David Stein
Old 10-22-04, 01:54 PM
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Originally posted by sfsdfd
Wrong context. Friends don't let friends post kneejerk responses.

Kerry said, correctly, that lawsuits were a trivially small part in the rising cost of healthcare. He also said that lawsuits were having an impact on doctors and need to be reformed.

- David Stein
but just like religion and guns, kerry doesn't really mean it.

birrman54
Old 10-22-04, 02:15 PM
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"Nobody even questions the capability of an Indian doctor, because there isn't a big hospital in the United States where there isn't an Indian doctor working," he said.
This is such an idiotic statement, I don't know where to start.
Old 10-22-04, 02:26 PM
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I'm not sure if this is offshoring is it? What would be is if a US hospital uses internet & other means to have doctors in India replace US doctors. This seems lik a smart move on the guy's part, tough to fault him for what he did.
Old 10-22-04, 02:41 PM
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It isn't just actual lawsuits and malpractice insurance premiums that cause the cost of healthcar in this country. It is the way doctors have to practice by ordering more tests on more people than probably necessary in order to preempt lawsuits by practicing defensive medicine.
He also said that lawsuits were having an impact on doctors and need to be reformed.
You forgot to say, he also didn't bother to show up to vote when it was in the Senate.
Old 10-22-04, 02:42 PM
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A lot of Indians do this already. Many of the doctors at these posh private hospitals in India have been trained in the US, UK, Australia, NZ etc..
Old 10-22-04, 02:43 PM
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on topic, Hospitals have been offshoring dictation transcriptions and radiology readings for years.

birrman54
Old 10-22-04, 03:44 PM
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We have "offshoring" in the hospital I work at. After hours CT exams are digitally transmitted to Australia, where they are reviewed by Radiologists there. It is daytime there when it is nighttime here. I pretty sure they are all US liscensed, they are just located in Australia.
Old 10-22-04, 05:09 PM
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Originally posted by griz
We have "offshoring" in the hospital I work at. After hours CT exams are digitally transmitted to Australia, where they are reviewed by Radiologists there.
I recall that this has been standard practice for years. I also think that billing (i.e., insurance bureaucracy) and dictation have been outsourced for even longer periods.

- David Stein
Old 10-22-04, 05:16 PM
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Originally posted by sfsdfd
I recall that this has been standard practice for years. I also think that billing (i.e., insurance bureaucracy) and dictation have been outsourced for even longer periods.

- David Stein
am I on ignore!?

birrman54
Old 10-22-04, 05:48 PM
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I remember David Sedaris replying when asked why he moved to France:

"Because if I broke my leg today, it would be cheaper to drag myself to a plane, fly first class to France, and see their best doctor than it would be to head two blocks down to the local clinic."
Old 10-22-04, 06:54 PM
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Originally posted by Birrman54
am I on ignore!?

birrman54
No, I just have really bad reading skills. Yeah, that's a pretty funny sequence of posts.

- David Stein
Old 10-22-04, 07:17 PM
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Originally posted by sfsdfd
Kerry said, correctly, that lawsuits were a trivially small part in the rising cost of healthcare.
I know he said this....and I only know about 3 doctors who are friends, but I can't find any that would agree with him. Again, I only know 3, but I would expect one of them to agree that lawsuits were a trivially small part of the rising cost of healthcare.
Old 10-22-04, 07:28 PM
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Heart surgery = High liklihood of need for blood transfusion.

A quick search came up with this:

India's blood supply, despite official blood screening efforts, continues to become infected. In 1991 donated blood was screened for HIV in only four major cities: New Delhi, Calcutta, Madras, and Bombay. One of the leading factors in the contamination of the blood supply is that 30 percent of the blood required comes from private, profit-making banks whose practices are difficult to regulate. Furthermore, professional donors are an integral part of the Indian blood supply network, providing about 30 percent of the annual requirement nationally. These donors are generally poor and tend to engage in high-risk sex and use intravenous drugs more than the general population. Professional donors also tend to donate frequently at different centers and, in many cases, under different names. Reuse of improperly sterilized needles in health care and blood-collection facilities also is a factor. India's minister of health and family welfare reported in 1992 that only 138 out of 608 blood banks were equipped for HIV screening. A 1992 study conducted by the Indian Health Organisation revealed that 86 percent of commercial blood donors surveyed were HIV-positive.



http://www.indianchild.com/aids_in_india.htm
Old 10-22-04, 07:32 PM
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I read an article about x-rays being sent via the internet to India to be processed by x-ray tech their for less money
Old 10-22-04, 11:37 PM
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Originally posted by jasonr114
I read an article about x-rays being sent via the internet to India to be processed by x-ray tech their for less money
its xrays being read by radiologists in India.

This whole thing is not really new. The wealthy in socialized medicine contries have been going abroad for years to have medical work done. In my own family, I have about 3 aunts and uncles who have had dentures done in Mexico for about 1/3 of the price. You can get a gastric bypass in Tijuana for about 8k which costs 15k+ here. Before long, you're gonna see travel agents popping up to recruit for these private hospitals.
Old 10-23-04, 12:10 AM
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Originally posted by kvrdave
I know he said this....and I only know about 3 doctors who are friends, but I can't find any that would agree with him.
Are doctors necessarily experts on the causative factors of their insurance costs? Highly doubtful. Not only are they probably being fed this line by their insurers, but they're also predisposed to believing it, since they view lawyers as their natural enemies anyway.

- David Stein
Old 10-23-04, 10:45 PM
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Originally posted by uli2000
its xrays being read by radiologists in India.

This whole thing is not really new. The wealthy in socialized medicine contries have been going abroad for years to have medical work done. In my own family, I have about 3 aunts and uncles who have had dentures done in Mexico for about 1/3 of the price. You can get a gastric bypass in Tijuana for about 8k which costs 15k+ here. Before long, you're gonna see travel agents popping up to recruit for these private hospitals.
There is travel agency in Seattle already booking day trips into Canada for flu shots.

Americans Flock Across Border for Flu Shots
Old 10-24-04, 01:18 AM
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Originally posted by sfsdfd
Are doctors necessarily experts on the causative factors of their insurance costs? Highly doubtful. Not only are they probably being fed this line by their insurers, but they're also predisposed to believing it, since they view lawyers as their natural enemies anyway.

- David Stein
Perhaps their view is tainted, but perhaps the view of trial lawyers like Edwards is tainted as well. When you read about the amount that malpractice rates have gone up, it is hard to believe that it is an insignificant amount of the rise in health care.
Old 10-24-04, 04:50 PM
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Originally posted by Just Lurking
There is travel agency in Seattle already booking day trips into Canada for flu shots.

Americans Flock Across Border for Flu Shots
That bothers me for one reason. Canada has about 10% of our population. If too many Americans head across the border for shots, won't their supply be overtaxed as well?
Old 10-24-04, 04:52 PM
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it's only good for the news cameras

the percentage of people that will get shots there is negligible


I think the whole issue is overblown. in the past manufacturers would throw out millions of unused doses every year. this year one blurb by john kerry and every one who had never got a flu shot is panicking.
Old 10-24-04, 05:14 PM
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Originally posted by al_bundy
it's only good for the news cameras

the percentage of people that will get shots there is negligible


I think the whole issue is overblown. in the past manufacturers would throw out millions of unused doses every year. this year one blurb by john kerry and every one who had never got a flu shot is panicking.
It's true they USED to throw away millions of doses a year. Drug companies don't like throwing away money. So many companies stopped producing the vaccine. Now it's only a couple, and they try and make only enough that they can sell. So when there is a problem, there is a problem.

There's been issues with the flu vaccine for a few years now.

And this isn't just with the flu shot. There are several critical meds that drug companies stopped producing, because they weren't making any/enough money on it. They stop making it and it causes a shortage for those who depend on those meds. Then is snowballs. People get switched to another similar med, and the demand causes that new med to become scarce. It's a pain in the arse.

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