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Comment by Frondo | Hacker News Reader

I had my gallbladder removed in a emergency surgery over a decade ago.

It happened on a Wednesday night. I had excruciating pain, enough to nearly black out -- and a friend took me to an emergency room, where they did an ekg, ultrasound, put me on a morphine drip and operated the next day. Once the pain set in, I was in no position to do research for a variety of reasons.

I'm not sure what kind of shopping around could have taken place for that.

Could you explain how your technique would work for something like my situation?

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Isn’t the solution an advanced care directive? Where you make decisions in advance of something happening, just in case you end up in a situation where you can’t decide yourself?

E.g. no extraordinary measures or no CPR, or, get me into one of these nursing homes and not this one.

Even in public health care countries, there’s plenty of decisions that are a good idea to make in advance.

I don’t see why they can’t be scaled toward cash healthcare countries.

Comparison shopping arguably isn’t the intended purpose of advance care directives—which, FYI, can only go into force if the person is legally incapitated, and being in pain, however extreme, is a grey area as I’m sure you could make the case that decision-making capacity still exists. There’s also the issue of having the agent available when such an event happens, and having them be in possession of the directive.

Anyway, even then, it’s infeasible to enumerate all the possible decisions in advance—not only is it impossible to know what your costs will be ahead of time, there’s a lot of variation in cost. There isn’t going to be a single hospital in your region that’ll have the cheapest prices across the board, so it’s not as simple as “send me to the cheapest hospital”.

It will not work for emergencies however that's not where most of the money is burned.

Most of the money is spent on non emergency medical care that can be priced using a phone or an email. That's exactly why medical tourism is possible.

It is a case of vertical capture: should you walk into a Mount Sinai hospital, the $600 MRI of Lennox Hill will cost you between $1800 and $2800. It will be done using the exact same MRI machine. The result will be sent to India probably to the exact same company that Lennox Hill sends the MRI for a radio tech readout, except that Mount Sinai MRI won't be available for 5-7 days vs. in an hour at Lennox Hill.

So why is Mount Sinai is able to charge that amount of money for an MRI? Because it is a vertical capture. Should you walk into a Mount Sinai it is extremely unlikely that you would go out of the hospital to get an MRI. They could probably charge $7,000 and still get 90% of the patients doing it.

Final signed American radiology reports are not dictated in India, especially at academic medical centers.

They've tried; it's blown up in their faces.

https://www.nytimes.com/2003/11/16/business/who-s-reading-yo...

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