Are we going to have an endless medical inflation?

[arj]

BTW, who's going around biting peoples' toes, and where do we find them?

toes or people ?

 

[Donivlapog]

Lets say renowned hospitals and big name doctors on one hand look in the prism of capitalism and a perpetual mindset of making profits from mega investments often funded by private equities (like shown in Dr.House MD TV series), rise in costs of supplies, drugs, operational expenditure, perishables, dispensibles, payroll, fiduciaries and vendors account payables, equiments maintanance costs, maintainance of canteens, food and beverages, electricity bills and ofcourse AMCs and depreciation of huge cost imagining equipments (PET, CT, MRI, X RAYS, labs, operation theaters), there maybe targets set on account receivables and it is understandable. While the aam aadmi has a mild problem and he goes for evaluation and management to one of these big facilities, some of these investments are used as a one size fits all diagnostic assist, as the very nature of symptoms and signs of many diseases are the same ranging from liquid motiin to fevers, rashes, throat infections, nausea, vomitting - could be bacterial or viral or malaria and maybe even some disorders or food poisoning, chronic or accute whatever in nature.

Government hospitals would just have a duty op doc checking for pulse, weight, BP, temperature and would prescribe a bacterial antibiotic treatment without referring to imaging or blood tests. A placebo could often times even work with the patient's immune doing the work but was just a thing in his/her own mind that the doctor has cured them.

We are in a day and age when home remedies (turmerics, garlics, vitamin rich food and beverage items) and self prescribed googled out medications are growing in large numbers bearing costs of medicine going north is lingering in peoples' mind.

As discussed in these threads AI bots in the future could replace all the expensive E&M equipments available but as of now it is the only choice left. On the other hand the patient wishes for an inexpensive treatment - this is clearly a faultline and an ever expanding problem that has no answers with Indian per capita income being low.

Many here pointed out this is an AV forum where we spend on guilt pleasures. I have an anecdote on that as well.

My dad incurred bills of 8 lakhs for cardeology and covid treatment in recent times and at 80 he feels the doctors robbed my entire career savings and began saying "Vinod, I dont want you to spend anymore on me". I said you are the reason for my very existance. He countered by saying I dont want the doctors to benefit because of heavy spenders like you!! I said i spent on a good cause but he feels some doctor who paid crores to pass MBBS and MD is recovering from peoole like me. I had to become the devil's advocate of trying to sym/empathise for the medicos who also must revover their costs and thats the very nature of this world, what goes around comes around and atleast it gave me an opportunity to spend on a noble cause. I added saying I am only guilty on spending recently on electronics as well.

I can easily say in a few years the same treatment cost would be 10k. It would slowly inch towards only the rich can afford to go to a private hospital or face the ramifications of receiving a placibo at a government facility.

 

[arj]

In india you must either have a medical insurance OR go to a govt hospital thats how it is on the west as well ( except US which does not have a govt hospital)l,,.,just that Govt hospitals are usually much better.

Indian doctors usually have far better clinical diagnosis that american/European Doctors..not for any other reason other than the sheer number of doctors one sees. In france it used to take a 1 week waiting before one could meet a doctor and doctors do not see more than 15 patients in a day. In switzerland its worse as you have to pay a premium on a weekend and beyond 5pm on a weekday.

In india there is a app for instant consultation booking and additionally the doctor is available 24x7 almost on whatsapp. a doctors appointment is a cost of a Pizza for 1 and people have an issue with the healthy option and are willing to pay for for the unhealthy one.

Thank god I am not a doctor I would have quit and done something else as it is not worth it. Most of kids of doctors I know of dont want to be doctors unless their parents own a hospital or they go abroad..its just not worth it to be a doctor in india especially when they see their friends who are Engineers/MBAs and these days Lawyers..all of which have a difficult entrance exam.

But yes just like programmers, entry level lawyers etc will have less demand for AI so will doctors. and with smartwatches monitoring and tests will also be cheaper.

 

[Nitin K]

There are good, bad and ugly sides to every profession. I have experienced very good and bad doctors. I am sure there are good and bad patients too. It's not right to put a blanket thought on anyone.
We have very good doctors in India too. Infact some of the relatives and friends from US and Canada will do dental treatments in India even if they are on a short visit rather than waiting weeks or a month for an appointment at a govt hospital or paying a lot to a private practioner over there.
A doctor and a patient should ideally understand each others issues which seems difficult though in today's scenario due to various factors.

 

[sdk]

You know the Rs 1500 a month job i mentioned earlier? That was in 1991-93. We used to do 100 to 140 patients a DAY in our 2 man OPD, every day from 8.30 am to 2.30 pm with 15 mins for gobbling lunch with patients poking their heads to ask why the delay.

This was followed by ward visits and finish by 4.30pm

The patients were nice, well behaved, grateful with cooperative staff and not self entitled uncouth brats that we get now. I used to look forward to get to work and my head dresser used to keep pleading, please come a little late, you don't even allow us to peacefully drink tea!!

Ah! Those happy days!!!

 

[sdk]

While the aam aadmi has a mild problem and he goes for evaluation and management to one of these big facilities,

I always used to explain to my patients, my not unique theory, anyone's ego would naturally make themselves the centre of the universe, so you end up with 4 generations accompanying the patient from the doddering great grandfather to the grandson crawling on the floor.

All want their two bits in by asking nonsensical questions to prove how much they love the patient. From the doctor's perspective he's been there done that and has the tshirt to prove it. You as a patient are not unique. There is enough experience and known outcomes which should be discussed with the juniors and nurses

Patients want value for the money they are paying by bugging the doctor with damnfool questions thinking "Paisa diya hai." The doctor wants then out of the door when they start asking "hagne toilet kab Jaa sakta hai". This was told to me by Dr Ramakanta Panda when i consulted him for my dad's surgery, "ke aise bhi log hai"

My dad incurred bills of 8 lakhs for cardeology and covid treatment in recent times and at 80 he feels the doctors robbed my entire career savings and began saying "Vinod, I dont want you to spend anymore on me". I said you are the reason for my very existance. He countered by saying I dont want the doctors to benefit because of heavy spenders like you!! I said i spent on a good cause but he feels some doctor who paid crores to pass MBBS and MD is recovering from peoole like me.

This is classic buyer's remorse often seen in surgical cases by bad decision making due to ego. Patients and their children, inspite of knowing the class and tier system in hospitals choose higher classes for surgical cases and then repent the costs later because they don't want to look cheap or poor in front of family and neighbours. The usual Indian "char log kya kahenge" syndrome

Whereas i approached the surgeon for my dad's bypass directly, asked him his fees separately from the packages that the hospital was offering. With Rs 1L mediclaim cover either way I would never be reimbursed any package fully. So i requested him to operate in the general class at lowest Rs 2.75L package and paid him separately by cheque 1.75L as his fees. The total cost is what I'm looking at. Sleeping on the floor for me for 3 days was a saving of about 2.5L in a higher class. Leave ego side and save money. Ask yourself the question that if someone is paying you a lakh a day to sleep on the floor, will you take it?

The surgeon's fee for the bypass in the package was Rs 13,500. And people want surgeons to do hanji hanji for that!!

My mom's angiography was again done in general class at Rs 14.5K , single room would have been Rs 45K

My patient and my wife's colleague's father were operated in the same week, in the same hospital, by the same spine surgeon. One paid 25L for the top floor suite and the other 3L for twin sharing. Both were happy post op, same outcome

Sadly patients confuse process with outcome. Focus on the doctor and not the class of admission. Outcome is all that matters.

Having learnt from that i now have a yearly premium of 1.35L for a total cover of 40L for my family as my age and medical complications now is not conducive to sleep on hospital floors anymore.

 

[Donivlapog]

I learnt one thing from your previous post. How to cut down on hospitalisation bills by choosing the general ward. They even would suggest to book private rooms for access to cleaner toilets and they polish that need for privacy in our minds. I havent tried arguing with them so far for a lesser costing general ward admission but for the covid treatment it was a covid ward for him - no choice there. The cardiology admission though was on a private AC room.

 

[sdk]

I learnt one thing from your previous post. How to cut down on hospitalisation bills by choosing the general ward. They even would suggest to book private rooms for access to cleaner toilets and they polish that need for privacy in our minds. I havent tried arguing with them so far for a lesser costing general ward admission but for the covid treatment it was a covid ward for him - no choice there. The cardiology admission though was on a private AC room.

You will always be offered a menu of rooms and classes, in the end your choice. There is no argument, the class for surgery is decided between you and surgeon before admission who then gives you the admit note for the CMO

But 8L in a private AC room is dirt cheap for Mumbai

What people don't seem to understand is that the OT, staff team, resources, ICU is the same regardless of class of initial admission and that's the important part

It's only the one day prior to surgery and 3 days after ICU that counts for bragging rights, showing visitors the posh room and toilet and view from the window and comfort of the attendant

The patient is in no condition to enjoy the facilities and the question asked to Dr Panda is of no use as post major surgery and ICU patients don't dump due to lack of solid food, antibiotics, IV glucose etc

The only ones using the fancy loo are relatives who have travelled from far and have come to mark attendance and don't really care for the patient

Rather than privacy relatives should worry more about infection and prevent all visitors. I spend a bomb at every admission by taking all visitors directly to the fancy canteen to stuff them and send them back by saying no visitors on doctors orders

Interestingly a Jain lady, single room patient, used to get 15 to 20 visitors daily even in ICU. Her husband used to look at me pityingly and ask why no one visits my dad while he was busy bribing the guard to let his visitors in

I explained to him what cross infection is and how it can be fatal for open heart surgery patients. My mom and BIL met my dad once after surgery, plus daily only one visit by me or sister but never both. Stand away from the bed and not touch dad or the bed

Sadly on the day of discharge i met the Jain gentleman still outside the ICU because the wife had got infected and was in those days running up a bill of Rs 25K a day. Which will be as much as 1L today. Stupidity has no limits

 

[sdk]

Lets say renowned hospitals and big name doctors on one hand look in the prism of capitalism and a perpetual mindset of making profits "Vinod, I dont want you to spend anymore on me".....He countered by saying I dont want the doctors to benefit because of heavy spenders like you!!

And this is the sad part of Indian society.

I'm yet to meet anyone who does not want increments, bonuses, awards at work, promotions, vesting of shares, buyouts by investors etc so that their social stock increases , driven of course entirely by altruism, by the apparent trappings of wealth like a house, car, foreign holidays, fancy audio equipment etc

But woe betide the family if the accumulated moolah escapes the house to some other house, especially that of a doctor who has a capitalist mind, perpetually seeking profits for the benefit of his own parents, wife and children.

Reminds me of a patient of mine who had twins studying in the USA for their masters

I would keep getting updates from the parents on how well they were doing academically and how proud they are

They were particularly happy when they became initial employees of Microsoft with nice salaries and tons of esops. In no time they became dollar millionaires.

Then one day the lady disputed my bill and was wanting a discount as a long term patient as she felt that my fees were rising over the years

To which i asked her, all these years your son's of my age have done so well for themselves and both of us have celebrated that

I too am a son of a mother, don't you think my mother too would like to celebrate the success and wealth of her son too just like you? So why would you resent her doing the same by asking me to reduce my fees and expect to pay as fees what you paid years back?

So when your dad did not want to benefit doctors by your heavy spending did he mean that my mother and others like her, should see all of us struggle for money, keep sleeping on the floors of low cost wards so that society's image of the the nobel soul of a struggling doctor is perpetuated with sepia tinted image of faded umbrella, torn shoes, sad looking wife and rageddy children surrounded by villagers fawning over their Dagdarbabu with dhanna sheth crying in the corner wanting the same doctor whom he would insult daily to miraculously save his one and only son?

She did apologise and pay up, but the old relations and bonhomie never returned. They finally migrated to the US and I've lost touch

If a patient cannot afford treatment they should look for options elsewhere but not badmouth the one who's been treating them to the best of his abilities or bargain after the work is done

.

 

[keith_correa]

And this is the sad part of Indian society.

I agree. I've heard many variations of the previous generations ruing the costs incurred for their treatment.
I've also noticed one common thread that to me is hilarious. There is no one that says the cost of treatment is too high - don't treat me, leave me to my fate.
It's always - why did you have to spend so much on me? The NEXT time leave me to my fate.

 

[sdk]

Don't treat me, leave me to my fate.
It's always - why did you have to spend so much on me? The NEXT time leave me to my fate.

Do I have a doozy of a story!!

My friend opened his clinic in a chawl. He became pally with neighbour who was his age

The guy lived with his mother. She would be absolutely fine for 9 months of the year, then suddenly fall ill, she would be carried to the hospital with her life hanging by a whisker, then spend months in the hospital near death and make a miraculous recovery and walk home!!

This happened year after year after year. The poor boy would spend all his money on his mother every year, never saved anything, no one would marry him looking at the scene at home.

In the meantime my friend got married, had two kids, invested his savings well and was pretty successful in life

The neighbour continued the same way for more than ten years like that, with the mother swinging between near death to pink of health but draining money all the time.

When she finally died the whole chawl secretly celebrated for the son but by then he was considered too old and now lives all alone

 

[Donivlapog]

You will always be offered a menu of rooms and classes, in the end your choice. <<This is where they automatically manipulate. I kearnt a lesson on being stubborn in such places>>

But 8L in a private AC room is dirt cheap for Mumbai

<<Mumbai is the root cause for medical inflatiin. Other cities are trying to follow suit. Lets assume one makes 12 lakhs per annum with 10% savings at most in this day and age and has to pay 8 lakhs hospital bill, 7 years of his savings is gone>>

What people don't seem to understand is that the OT, staff team, resources, ICU is the same regardless of class of initial admission and that's the important part

It's only the one day prior to surgery and 3 days after ICU that counts for bragging rights, showing visitors the posh room and toilet and view from the window and comfort of the attendant

The patient is in no condition to enjoy the facilities and the question asked to Dr Panda is of no use as post major surgery and ICU patients don't dump due to lack of solid food, antibiotics, IV glucose etc

The only ones using the fancy loo are relatives who have travelled from far and have come to mark attendance and don't really care for the patient

Rather than privacy relatives should worry more about infection and prevent all visitors. I spend a bomb at every admission by taking all visitors directly to the fancy canteen to stuff them and send them back by saying no visitors on doctors orders

Interestingly a Jain lady, single room patient, used to get 15 to 20 visitors daily even in ICU. Her husband used to look at me pityingly and ask why no one visits my dad while he was busy bribing the guard to let his visitors in

I explained to him what cross infection is and how it can be fatal for open heart surgery patients. My mom and BIL met my dad once after surgery, plus daily only one visit by me or sister but never both. Stand away from the bed and not touch dad or the bed

Sadly on the day of discharge i met the Jain gentleman still outside the ICU because the wife had got infected and was in those days running up a bill of Rs 25K a day. Which will be as much as 1L today. Stupidity has no limits

<<<being sarcastic and or misanthropic over other people, relatives, friends well wishers at this point in time does not help. Although i enjoy the caricature and satirical narratives, we are only widening the faultline. A doctor or hospital CMO cannot think in these lines to ever increase bills. There are people with struggling lives as much as people with dollor millionaire portfolio and 7 digit pay. The distribution should not follow the outliers in standard deviation. >>>

 

[aeroash]

Lets assume one makes 12 lakhs per annum with 10% savings at most in this day and age and has to pay 8 lakhs hospital bill, 7 years of his savings is gone

This is just silly. It is not financially wise to leave your money sitting idle. It's important to have sufficient health insurance coverage and invest your money wisely to stay ahead of inflation. Remember, whoever isn't utilising their savings to make more money will part with it sooner rather than later.

Tips on how to cut medical costs have already been outlined in this thread.

 

[keith_correa]

This is just silly. It is not financially wise to leave your money sitting idle. It's important to have sufficient health insurance coverage and invest your money wisely to stay ahead of inflation. Remember, whoever isn't utilising their savings to make more money will part with it sooner rather than later.

Tips on how to cut medical costs have already been outlined in this thread.

I agree wholeheartedly. My opinion is that if one manages to save just 10% of one's income then it warrants a serious relook at multiple things related to income and expenses. If 25% of one's income is not put aside and invested to grow, one is in for a lot of heartache later in life. Fortunately for me, I was advised this early in life and most importantly, I followed it diligently. Worked wonders for me!

 

[sdk]

This is just silly. It is not financially wise to leave your money sitting idle. It's important to have sufficient health insurance coverage and invest your money wisely to stay ahead of inflation. Remember, whoever isn't utilising their savings to make more money will part with it sooner rather than later.

Tips on how to cut medical costs have already been outlined in this thread.

What frankly this shows is bad financial management in that household. The parents never taught their children financial prudence at all.

If at 12L a year and the person has not met a CA, FM or MFA, has no knowledge or control over his earnings , savings and finances then it's a sad commentary on financial control in the house and over dependence on land and property as the only means of investment. No level of income will dig you out of a liquidity hole in an emergency

I'm just so glad that my parents taught us fiscal discipline right from school. We got pocket money of 50 paise a month, increased to Rs 5 in SSC, to Rs 50 in junior college to Rs 500 in degree where you manage all your faltu expenses in that.

Nothing like learning that daily discomfort of 2nd class local train student pass leaves enough money for movies, ice cream and other fun stuff instead of traveling in first class and no fun. The decision was left to us

The first thing my dad taught me was to open an account in a bank near college and deposit the pocket money there first, only then withdraw as needed. Over 4 years that built up to a nice 6.5K in savings which i used to buy watches for everyone at home as a graduation present as I had to close the account anyway.

Ah! Happy memories!

 

[Donivlapog]

This is just silly. It is not financially wise to leave your money sitting idle. It's important to have sufficient health insurance coverage and invest your money wisely to stay ahead of inflation. Remember, whoever isn't utilising their savings to make more money will part with it sooner rather than later.

Tips on how to cut medical costs have already been outlined in this thread.

I was saying lets "assume". Its a scenario and is possible also. He maybe paying car and home loan emi, or on rents he could have his children participate in extra curricular activities and he invests in 80c with lock in(ppf, elss etc...), emis on consumer electronics, mutual fund SIPs, health and term insurance, property maintainance, his vacations etc... Not silly at all, and happens in 90% of the households where the one 8 lakhs of medical bill will be the thorn that stings him.

And i am giving this as an example.

What frankly this shows is bad financial management in that household. The parents never taught their children financial prudence at all.

If at 12L a year and the person has not met a CA, FM or MFA, has no knowledge or control over his earnings , savings and finances then it's a sad commentary on financial control in the house and over dependence on land and property as the only means of investment. No level of income will dig you out of a liquidity hole in an emergency

I'm just so glad that my parents taught us fiscal discipline right from school. We got pocket money of 50 paise a month, increased to Rs 5 in SSC, to Rs 50 in junior college to Rs 500 in degree where you manage all your faltu expenses in that.

Nothing like learning that daily discomfort of 2nd class local train student pass leaves enough money for movies, ice cream and other fun stuff instead of traveling in first class and no fun. The decision was left to us

The first thing my dad taught me was to open an account in a bank near college and deposit the pocket money there first, only then withdraw as needed. Over 4 years that built up to a nice 6.5K in savings which i used to buy watches for everyone at home as a graduation present as I had to close the account anyway.

Ah! Happy memories!

What this frankly shows is the fictitious 12 LPA earning guy swearing at you doctors for your bills thats all. His curse will not be on his house owner or home loan emi company but on you guys in medical fraternity.

 

[arj]

What this frankly shows is the fictitious 12 LPA earning guy swearing at you doctors for your bills thats all. His curse will not be on his house owner or hole loan emi company but on you guys in mefical fraternity.

Maybe, we find people swearing at police, judges even bus conductors. But the problem is not the doctor but himself for having gone beyond his means/not having insurance as well as lack of good public medical services for those who cannot afford .

People love complaining and the internet is full of that. I guess in some roles one just needs to factor that and move on.

The bigger problem is no one is taught financial management but taught mathematics in school. My pet theory is is financial managment and Cooking are 2 things which must be taught in every school curriculum in 11th/12th

 

[Donivlapog]

Maybe, we find people swearing at police, judges even bus conductors. But the problem is not the doctor but himself for having gone beyond his means/not having insurance as well as lack of good public medical services for those who cannot afford .

People love complaining and the internet is full of that. I guess in some roles one just needs to factor that and move on.

The bigger problem is no one is taught financial management but taught mathematics in school. My pet theory is is financial managment and Cooking are 2 things which must be taught in every school curriculum in 11th/12th

Financial management includes the ELSS/PPF savings, his MF equity SIP or even a debt investment (or similar long run 8% cagr investments such as gold, bonds, real estates, debt MF, recurring deposits, NSC, SGB etc...) plus insurance he takes (which does not cover during wait period or supplies and dispensaries, co payments, deductibles and pre existing conditions and anyways leave a huge uncovered portion) etc... he cant aim to have the cake and eat it as well. Everybody cant be a Vijay Kedia.

What frankly this shows is bad financial management in that household. The parents never taught their children financial prudence at all.

If at 12L a year and the person has not met a CA, FM or MFA, has no knowledge or control over his earnings , savings and finances then it's a sad commentary on financial control in the house and over dependence on land and property as the only means of investment. No level of income will dig you out of a liquidity hole in an emergency

I'm just so glad that my parents taught us fiscal discipline right from school. We got pocket money of 50 paise a month, increased to Rs 5 in SSC, to Rs 50 in junior college to Rs 500 in degree where you manage all your faltu expenses in that.

Nothing like learning that daily discomfort of 2nd class local train student pass leaves enough money for movies, ice cream and other fun stuff instead of traveling in first class and no fun. The decision was left to us

The first thing my dad taught me was to open an account in a bank near college and deposit the pocket money there first, only then withdraw as needed. Over 4 years that built up to a nice 6.5K in savings which i used to buy watches for everyone at home as a graduation present as I had to close the account anyway.

Ah! Happy memories!

So you treating your relatives a bomb at cafe is a good lesson of financial management your parents taught you? Or carelessly saying 8lakhs is nothing in Mumbai these days? Ha ha! It boomerangs back at you right? Which side of the arguement are u in right now?

Maybe, we find people swearing at police, judges even bus conductors. But the problem is not the doctor but himself for having gone beyond his means/not having insurance as well as lack of good public medical services for those who cannot afford .

Swearing at police, judges, bus conductors are not going to be talked as much as Education and healthcare inflation as the former three are not everyday happenings to all, but the latter happens to each person. Insurance has been included in the 12lpa or else where those missing chunk of money is to be accounted. I gave this as an illustration only and to support the view point of medical inflation even scares a decently earning chap with health insurance.

 

[Nitin K]

The bigger problem is no one is taught financial management but taught mathematics in school. My pet theory is is financial managment and Cooking are 2 things which must be taught in every school curriculum in 11th/12th

This question has always been hovering over for years. Most of the subjects in the school/junior college curriculam is not of much practical use.
Along with financial management and cooking, having basic electrical, plumbing & carpentary workshops are so essential in practical life. But instead rote learning and scoring only high percentage/marks to secure higher admissions in most of the streams seem to be commonly encouraged maybe barring a miniscule few.

 

[Donivlapog]

This question has always been hovering over for years. Most of the subjects in the school/junior college curriculam is not of much practical use.
Along with financial management and cooking, having basic electrical, plumbing & carpentary workshops are so essential in practical life. But instead rote learning and scoring only high percentage/marks to secure higher admissions in most of the streams seem to be commonly encouraged maybe barring a miniscule few.

They can be taught financial management at the school, accounting for the ambiguity and paradox of having to teach the children how education becomes a hyper inflation later in their lives!