Nutrition

If ever there is an area of discourse more confused and confounded by research, spurious claims and fiction, it must be nutrition. Most western people live in the shade of good food, supplements, fast food and the anxiety of ... "is this the right food to eat."

Michael Pollan's article "Unhappy Meals" is bracing and densely argued investigation that is ever so lucid but leaves you with the sense that you are better off ignoring all advice except for maybe the opening phrase: "Eat food. Not too much. Mostly plants."

How Much should an overnight stay in Hospital cost?

Wonderful comment in a Anti Aging blog asking the simple question (in USA) which is,Why is a night in a hospital so expensive?

"I spent a night in a hospital for observation, with a battery of tests being conducted, and the hospital sent me a bill for $ 8,500. The insurance company talked them down to about $2,800.

That seems like a lot for one night. I wasn't in intensive care but spent maybe an hour attached to some pretty fancy machines like the x-ray and sonar imaging unit. If one of those machines cost US$1m and I had use of it for an hour, and the machine lasts a decade, then its time might be worth $35 an hour. I was charged $1,200 for one of the tests. Even if adding the tester and some extra for overhead, I only get $100 or so an hour. That seems like more than 10x markup to me.

Furthermore, "semi-private" accomodations are distinctly inferior to Motel 6 at $40 a night, and monitoring tasks are one nurse for every ten or so monitors. Maybe it's worth $100 a night for that but not the $680 I was charged.

I had less than an hour's time with doctors, whose time seems to be rationed in one-minute increments. Round that up to an hour, and bill me $200 for that and it's OK.

So we have maybe $100 for a bunch of tests, $100 a night for the room and $200 for seeing an hour's worth of doctors and we get $500. Add a few dollars (it wasn't expensive, even on the bill) for blood tests and supplies and let's say it's $600.

Where did the other $2,200 go?

I want to opt out of this system. Frankly, I'd rather die on the street than have medical bills that would leave me in misery and poverty forever. Medical insurance is just a way to pay for this over my life instead of all at once. I think it would be better if people had to pay their own medical bills instead of having insurance - we'd have costs go down to reasonable levels in nothing flat.

I don't want medical insurance. I want a system that's affordable without insurance. And I didn't see anything gold-plated about how I was treated and so I really want to know where all the money goes."

So for more and more patients are considering travelling to avoid these costs. For example the cost in private room in Chennai, India is probably about .... wait for it... $50

Medical Tourism = Medical Competition?

The focus of discussion on medical tourism tends to be on price reduction and costs saving set against unregulated risk and the emotional costs of travelling to a far away destination for a surgical procedure.

There is a second meme that is also of some interest: how medical tourism creates a different competitive field by enabling patients to elect to skirt their own local regulatory regime by locating treatments abroad that have not been sanctioned in their own home.

For US and European patients, there are two areas where this may be of interest: new drug compounds and risky surgery procedures that have unproven efficacy.

What will be interesting over the next few years is to see how this impacts on the heavily regulated framework in the USA particularly.